Conference Paper

Challenges of Deploying VR in Aged Care: A Two-Phase Exploration Study

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Abstract

While VR has shown benefits such as improving alertness, recalling memories and cognitive training for older adults, it is challenging to deploy it in aged care settings due to the complexity of social care, physical and healthcare needs of the residents. This paper presents a two-phase study that aims to explore the challenges of deploying VR technology in aged care settings. Phase one involved a thematic analysis of video recordings of 14 VR sessions, during which five residents of an aged care facility were invited to experience and interact with VR systems. Phase two aimed to explore the challenges further by analyzing semi-structured interviews with 11 staff members who had experience in coordinating VR activities in aged care homes. The results revealed a range of issues that need to be considered when deploying VR systems in aged care settings, including: usability issues related to VR systems; barriers caused by residents’ mobility constraints; physical discomfort; and challenges in providing guidance and support for residents using VR.

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... The relatively low uptake might be because RACFs are sensitive and complex environments where people typically have high care needs [7; 8]. The adoption of VR in this setting is challenging [9][10][11]. Challenges of using VR in aged care include usability issues, residents' mobility constraints, physical discomfort, and the difficulty of providing guidance and support [10; 11]. ...
... Four types of challenges brought about by the use of VR among older adults in RACFs were identified by Zhao et al. [10] including: usability, mobility constraints, physical discomfort, and facilitator guidance. There are two types of usability issues when observing participants interacting with VR systems including the use of handheld controllers and the navigation through the system. ...
... There are two types of usability issues when observing participants interacting with VR systems including the use of handheld controllers and the navigation through the system. Zhao et al. [10] suggest considering alternative control systems or modified handheld controller options. This suggestion has been aligned with the design recommendation in the review study by Thach et al. [12]. ...
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Despite there being evident benefits of using virtual reality (VR) in aged care, it is not yet widely used in residential aged care homes. One factor that may contribute to this is the willingness of staff to use VR as part of the social program offered in aged care homes. Therefore, we need to understand staff perceptions of VR programs, especially suggestions for improvement. In an analysis of responses from 10 staff working in residential aged care (also known as nursing homes), we found that staff have concerns about the suitability of VR for older people with cognitive impairments and mobility restrictions. Many older adults living in aged care have these conditions. Our findings suggest that providing staff with training on how to facilitate various kinds of valuable VR experiences and providing a clear picture of its benefits and drawbacks will help to make it suitable for people living in aged care. Furthermore, there should be greater investment in technological infrastructure and co-design of VR in aged care.
... Despite mixed views about its perceived value, VR was the most common technology used by our respondents. This finding aligns with the growing research interest in the use of VR in aged care [13,25,[30][31][32][33]. Studies have demonstrated that VR can be valuable as a calming tool for people with dementia [21], as a tool to support reminiscence in aged care [13], and as a way for people with dementia to enjoy experiences such as attending a concert [34]. ...
... Studies have demonstrated that VR can be valuable as a calming tool for people with dementia [21], as a tool to support reminiscence in aged care [13], and as a way for people with dementia to enjoy experiences such as attending a concert [34]. Conversely, recent studies have identified usability issues for residents [13,30] and highlighted challenges for staff in implementing VR in aged care [31]. This tension between benefits and challenges was evident in our interviews. ...
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Background: Digital technologies such as virtual reality, humanoid robots and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges occur when deploying these technologies in aged care settings. Objective: This study aimed to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry. It further aimed to identify the benefits and challenges of using technology for enrichment in aged care. Methods: An online survey (N=20) was distributed to people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and the perceived value of these technologies. The survey was followed by semi-structured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analysed through summary descriptive statistics and by categorizing open-ended text responses. Interview data were analysed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as virtual reality, tablet devices and mobile phones, are being used in aged care to support social activities and to provide entertainment. Respondents had differing views about the value of emerging technologies such as virtual reality, social robots, robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed four kinds of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified five barriers: resource constraints, the need to select appropriate devices and applications, client challenges, limited staff and organisational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximise the effectiveness of technology-mediated enrichment, we argue that a person-centred care approach is crucial. While enrichment experiences can be created using available technologies, they need to be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organisations to allow caregivers to facilitate individual technology-based activities for enrichment. Clinicaltrial:
... Similar to prior findings [16,27,30] we found relatively low levels of simulator sickness and task workload among older adults engaging with VR. However, the physical discomfort caused by the weight and tightness of the VR headset was mentioned as hardware challenges, which is congruent with other studies with older adults' participants [27,30,81]. In addition to more effective controls suitable for aging hands, a universal design approach to all aspects of VR equipment would be helpful to make the experience more accessible. ...
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Virtual reality (VR) is increasingly used as a platform for social interaction, including as a means for older adults to maintain engagement. However, there has been limited research to examine the features of social VR that are most relevant to older adults experiences. The current study was conducted to qualitatively analyze the behavior of older adults in a collaborative VR environment and evaluate aspects of design that affected their engagement outcomes. We paired 36 participants over the age of 60, from three diverse geographic locations, and asked them to interact in collaborative VR modules. Video-based observation methods and thematic analyses were used to study the resulting interactions. The results indicated a strong link between perceived spatial presence in the VR and social engagement, while also highlighting the importance of individual personality and compatibility. The study provides new insights into design guidelines that could improve social VR programs for older adults.
... One example is that a wheelchair should be positioned at the center of the tracking space to minimize user overreaching [51]. In another case, older adults needed help moving the wheelchair to access particular virtual objects [98]. Since it is apparent that facilitator competency is critical, [11] advised that training be offered to both aged care personnel and family members. ...
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Objective: This study explores how older adults respond to audiovisual virtual reality (VR) and perceive its usefulness to their lives. Method: Focus groups were conducted with residents of a retirement community after they viewed two audiovisual VR simulations (n = 41). Thematic analysis was used to identify patterns in responses. Results: Older adults described positive and negative emotional reactions to aspects of the VR experience, articulated content preferences, shared ideas to improve the usability of the equipment, and identified facilitators and barriers that influenced perceived usefulness. Recommendations for improving this technology include maximizing the positive aspects of VR through increasing interactivity, facilitating socializing with friends or family, and enhancing older adults' ease of use. Desired content of simulations involved travel, continuing education, reminiscence, and self-care/therapy. Conclusion: Virtual reality was reviewed positively, yet modifications are necessary to facilitate optimal user experience and potential benefit for this population. Clinical implications: As older adults are interested in using VR, especially if poor health prevents the continuation of desirable activities or new experiences, it is important to respond to older adults' preferences and remove barriers that limit use and enjoyment.
Article
Residents in long-term care report high rates of emotional loneliness. The following pilot study examined an intervention to address these feelings. A sample of eight residents used videoconferencing (Skype) to communicate with very close family/friends one or more times each week for two months. Wilcoxon matched pairs tests suggested that the intervention was not associated with significant changes in affective well-being. However, desirable changes in various aspects of social support were evident and should be explored in future research that includes a larger sample size. The logistics of implementing this videoconferencing study were extensive and increasing the sample size would necessitate changes in research methods. Most notably, choice of the hardware as well as the availability of assistance to operate the hardware and software are aspects that need to be altered. Specific recommendations are made to facilitate future research and practice.
Article
Purpose of the study: To measure and describe the effectiveness of a Virtual Reality Forest (VRF) on engagement, apathy, and mood states of people with dementia, and explore the experiences of staff, people with dementia and their families. Design and methods: A mixed-methods study conducted between February and May 2016. Ten residents with dementia, 10 family members, and 9 care staff were recruited from 2 residential aged care facilities, operated by one care provider, located in Victoria, Australia. Residents participated in one facilitated VRF session. Residents' mood, apathy, and engagement were measured by the Observed Emotion Rating Scale, Person-Environment Apathy Rating Scale, and Types of Engagement. All participants were interviewed. Results: Overall, the VRF was perceived by residents, family members, and staff to have a positive effect. During the VRF experience, residents experienced more pleasure (p = .008) and a greater level of alertness (p < .001). They also experienced a greater level of fear/anxiety during the forest experience than the comparative normative sample (p = .016). Implications: This initial, small-scale study represents the first to introduce the VRF activity and describe the impact on people with dementia. The VRF was perceived to have a positive effect on people with dementia, although, compared to the normative sample, a greater level of fear/anxiety during the VRF was experienced. This study suggests virtual reality may have the potential to improve quality of life, and the outcomes can be used to inform the development of future Virtual Reality activities for people with dementia.
Article
Objective: To synthesize and summarize the studies examining the correlates and predictors of anxiety in older adults living in residential aged care. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to peer-reviewed literature published in English. Eligible studies examined the association between at least one correlate/factor and anxiety disorders or symptoms in aged care residents aged 50+ years. Results: A total of 3741 articles were identified, of which 34 studies (with a total of 1 543 554 participants) were included in this review. Correlates associated with anxiety included pain, use of anti-depressants/lithium, depression, and lower perceived quality of life. Less consistent and/or less studied variables included younger age, female gender, higher educational level, functional dependence, subjective health status, more prescribed medications, impaired vision, insomnia, external locus of control, fear of falling, attachment, hope, meaning in life, and the influence of social, environmental, and staff/policy correlates. Conclusions: While several variables were found to have strong associations with anxiety in aged care residents, a number of factors have been examined by only one or two studies. Further research (preferably prospective studies) is therefore needed to reliably confirm findings and to help plan and develop preventative and intervention strategies. Copyright © 2016 John Wiley & Sons, Ltd.
Conference Paper
This paper considers what we can learn from the experiences of people who choose not to participate in technology-based social interventions. We conducted ethnographically-informed field studies with socially isolated older adults, who used and evaluated a new iPad application designed to help build new social connections. In this paper we reflect on how the values and assumptions guiding the technological intervention were not always shared by those participating in the evaluation. Drawing on our field notes and interviews with the older adults who chose to discontinue participation, we use personas to illustrate the complexities and tensions involved in individual decisions to not participate. This analysis contributes to HCI research calling for a more critical perspective on technological interventions. We provide detailed examples highlighting the complex circumstances of our non-participants' lives, present a framework that outlines the socio-technical context of non-participation, and use our findings to promote reflective practice in HCI research that aims to address complex social issues.
Social interaction and connectedness is important to the mental health and wellbeing of older people. The aim of this research study was to facilitate and increase opportunities for social connectedness for older people living in regional areas through the use of technology training. Weekly technology training sessions were conducted at a Seniors Citizen's Club with a peer trainer (an experienced, retired computer teacher) and sessions were attended not only by the six study participants, but also by other club members, with up to 15 club members participating in sessions. Data analysis involved all documents generated by the project, including the individual interviews, researcher observations of training sessions, reports from the peer trainer and weekly diaries maintained by participants. Findings demonstrated that computer training at the Senior Citizens Club helped participants build group cohesion and to form tiered connections with partners, family, and friends with whom they no longer live. When the trainer is seen as a peer, and training is person-centred, older people are more receptive to learning, exploring, and experimenting with technology. Although only six people were involved in the in-depth evaluation part of the study, voluntary training with the trainer in the absence of any funding continues even to this present time The outcome of this research reinforces the potential for technology facilitated tiered connectivity to enhance the quality of life for older people living in regional and rural Australia.
Article
Conducting fieldwork for investigating technology use in healthcare is a challenging undertaking, and yet there is little in the way of community support and guidance for conducting these studies. There is a need for better knowledge sharing and resources to facilitate learning. This is the second of two volumes designed as a collective graduate guidebook for conducting fieldwork in healthcare. This volume brings together thematic chapters that draw out issues and lessons learned from practical experience. Researchers who have first-hand experience of conducting healthcare fieldwork collaborated to write these chapters. This volume contains insights, tips, and tricks from studies in clinical and non-clinical environments, from hospital to home. This volume starts with an introduction to the ethics and governance procedures a researcher might encounter when conducting fieldwork in this sensitive study area. Subsequent chapters address specific aspects of conducting situated healthcare research. Chapters on readying the researcher and relationships in the medical domain break down some of the complex social aspects of this type of research. They are followed by chapters on the practicalities of collecting data and implementing interventions, which focus on domain-specific issues that may arise. Finally, we close the volume by discussing the management of impact in healthcare fieldwork. The guidance contained in these chapters enables new researchers to form their project plans and also their contingency plans in this complex and challenging domain. For more experienced researchers, it offers advice and support through familiar stories and experiences. For supervisors and teachers, it offers a source of reference and debate. Together with the first volume, Fieldwork for Healthcare: Case Studies Investigating Human Factors in Computing systems, these books provide a substantive resource on how to conduct fieldwork in healthcare.
Access and equity are guiding principles for community care in Australia. Community care in Australia is universally provided through Australia's Medicare system, which assures all people access to needed services. The largest community care system, the Home and Community Care Program (HACC), serves frail older and disabled people. The HACC program is undergoing steady reform to provide more seamless transitions of care for people from home care to residential care whether permanent or for respite purposes. Community health services provide a wide range of center-based and outreach services that any person may access and that are provided on the basis of need. Nevertheless, pressures for greater privatization of services cause tensions, and access is jeopardized further by shortages, particularly in rural areas, of aged care nurses, allied health personnel, and medical practitioners.
Article
In this work we present a user-centered development process for a GPS-based monitoring system to be used in dementia care. Our research covers a full design process including a qualitative-empirical pre-study, the prototyping process and the investigation of long-term appropriation processes of the stable prototypes in three different practice environments. Specifically, we deal with the problem of 'wandering' by persons suffering from late-phase dementia. Although GPS tracking is not a novel technological objective, the usage of those systems in dementia care remains very low. The paper therefore takes a socio-technical stance on development and appropriation of GPS technology in dementia care and assesses the practical and ideological issues surrounding care to understand why. We additionally provide design research in two different settings, familial and institutional care, and report on the design of a GPS-based tracking system reflecting these considerations. What comes to the fore is the need for ICT to reflect complex organizational, ideological and practical issues that form part of a moral universe where sensitivity is crucial.
Article
Few leisure activities are accessible to institutionalized older adults using wheelchairs; in consequence, they experience lower levels of perceived health than able-bodied peers. Video games have been shown to be an engaging leisure activity for older adults. In our work, we address the design of wheelchair-accessible motion-based games. We present KINECTWheels, a toolkit designed to integrate wheelchair movements into motion-based games, and Cupcake Heaven, a wheelchair-based video game designed for older adults using wheelchairs. Results of two studies show that KINECTWheels can be applied to make motion-based games wheelchair-accessible, and that wheelchair-based games engage older adults. Through the application of the wheelchair as an enabling technology in play, our work has the potential of encouraging older adults to develop a positive relationship with their wheelchair.
Article
Simulator sickness (SS) in high-fidelity visual simulators is a byproduct of modem simulation technology. Although it involves symptoms similar to those of motion-induced sickness (MS), SS tends to be less severe, to be of lower incidence, and to originate from elements of visual display and visuo-vestibular interaction atypical of conditions that induce MS. Most studies of SS to date index severity with some variant of the Pensacola Motion Sickness Questionnaire (MSQ). The MSQ has several deficiencies as an instrument for measuring SS. Some symptoms included in the scoring of MS are irrelevant for SS, and several are misleading. Also, the configural approach of the MSQ is not readily adaptable to computer administration and scoring. This article describes the development of a Simulator Sickness Questiomaire (SSQ), derived from the MSQ using a series of factor analyses, and illustrates its use in monitoring simulator performance with data from a computerized SSQ survey of 3,691 simulator hops. The database used for development included more than 1,100 MSQs, representing data from 10 Navy simulators. The SSQ provides straightforward computer or manual scoring, increased power to identify "problem" simulators, and improved diagnostic capability.
Article
Motion sickness susceptibility questionnaires (MSSQ) predict individual differences in motion sickness caused by a variety of stimuli. The aim was to develop a short MSSQ. Development used repeated item analysis and various scoring methods. Retained were motion types (cars, boats, planes, trains, funfair rides, etc.); corrections for motion type exposure; sickness severity weightings; childhood versus adult experiences. Excluded were visual/optokinetic items (cinerama, virtual reality, etc.) with low sickness prevalence, they added little information but could become important in the future. Norms and percentiles were produced (n = 257). Predictive validity used controlled motions (total n = 178): cross-coupled (Coriolis); 0.2 Hz frequency translational oscillation; off vertical axis rotation (OVAR); visual-motion simulator. Predictive validity for motion was median r = 0.51. Relationship between MSSQ-Short and other non-motion sources of nausea and vomiting (e.g. headaches, food, stress, viral, etc.) in the last 12 months was r = 0.2 (p < 0.01). Reliability: Cronbach’s alpha 0.87; test–retest reliability around r = 0.9; Part A (child) with Part B (adult) r = 0.68. MSSQ-Short provides reliability with an efficient compromise between length (reduced time cost) and validity (predicted motion susceptibility). Language variants include French, Italian, Spanish, Dutch, Flemish, German, Russian and Chinese.
Conference Paper
This study developed a new procedure, a Virtual Guiding Avatar (VGA), which combined self-motion prediction cues and an independent visual background (IVB) to alleviate simulator sickness (SS). The VGA, which was embodied as an abstract airplane, was designed to lead the participant along a horizontal motion trajectory through a virtual environment. Both motion prediction cues and IVBs, which provide an earth-fixed reference frame, reduced SS in separate previous studies. Participants were exposed to complex visual motion through a cartoon-like simulated environment in a very wide field of view driving simulator. Participants' responses to avatars with varying motion properties - fixed, rotation only or rotation plus translation - were assessed using a within-subjects experimental design. Results indicated that SS was reduced by a VGA that presented rotational cues alone or rotation plus translation. The VGA also increased participants' sense of presence and enjoyment relative to conditions lacking a VGA. The VGA procedure can be used to enhance user experiences in immersive virtual environments as well as to improve motion simulator design.
Conference Paper
Usability specialists were better than non-specialists at performing heuristic evaluation, and “double experts” with specific expertise in the kind of interface being evaluated performed even better. Major usability problems have a higher probability than minor problems of being found in a heuristic evaluation, but more minor problems are found in absolute numbers. Usability heuristics relating to exits and user errors were more difficult to apply than the rest, and additional measures should be taken to find problems relating to these heuristics. Usability problems that relate to missing interface elements that ought to be introduced were more difficult to find by heuristic evaluation in interfaces implemented as paper prototypes but were as easy as other problems to find in running systems.
Article
We present a concept of a wide-angle, lightweight, optical see-through head-mounted display (HMD) using free-form optics tiling. Free-form optics tiling can potentially address several critical problems in existing tiled HMD designs that use rotationally symmetric optics. The optical design of our tiled optical see-through HMD achieves a field of view (FOV) of 56° × 45° and an angular resolution of 3.2 arcmin with two display channels. We demonstrate a proof-of-concept prototype and present some of its manufacturing details. The FOV can be further enlarged by tiling more display channels together at their bottom and side surfaces.
Article
To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke. Twenty-four adults with hemiparetic stroke were randomly assigned to either an experimental group (n = 12) or a control group. Both groups underwent conventional physical therapy, 40 mins a day, 4 days a week for 4 wks. The experimental group received an additional 30 mins of virtual reality therapy each session. Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests. Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale, and spatiotemporal parameters were obtained using GAITRite. Analysis of variance and correlation statistics were performed at P < 0.05. In the balance test, the experimental group had improved Berg Balance Scale scores, balance and dynamic balance angles (ability to control weight shifting) compared with the controls (P < 0.05). In the gait performance test, the experimental group showed significant improvements in velocity, Modified Motor Assessment Scale scores, cadence, step time, step length, and stride length (P < 0.05). Improvement in dynamic balance angles was correlated with velocity and cadence (P < 0.01). This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy.
Article
New developments in assistive technology are likely to make an important contribution to the care of elderly people in institutions and at home. Video-monitoring, remote health monitoring, electronic sensors and equipment such as fall detectors, door monitors, bed alerts, pressure mats and smoke and heat alarms can improve older people's safety, security and ability to cope at home. Care at home is often preferable to patients and is usually less expensive for care providers than institutional alternatives.
Article
The role of social support in the health of older persons is well documented. This support is particularly important for isolated nursing home residents. The purpose of this study was to test the feasibility of using low-cost videophones to enhance communication between nursing home residents and their families. Ten pairs of residents and family members received videophones and engaged in regular televisits for six months. All participants completed brief survey instruments prior to and after the study period to determine the effects of the televisits on the frequency and quality of contacts. A post-study survey assessed ease and satisfaction with using videophones. Findings include identification of technical and design problems, possible solutions, factors affecting actual use of equipment, and conditions under which benefits of use may be optimal. Categories for estimating potential actual users are suggested. Importantly, the study demonstrates that videophones can be used successfully by a wide range of frail nursing home residents and can enhance social interactions, regardless of distance. Affordable videophone technology offers the potential for reduced isolation among institutionalized elders and others with distance and mobility barriers.
Australia's Aged Care Sector: Economic Contribution and Future Directions
  • Deloitte
Deloitte. 2016. Australia's Aged Care Sector: Economic Contribution and Future Directions. Retrieved June 10th, 2020 from https: //www2.deloitte.com/au/en/pages/economics/articles/australias-aged-caresector-economic-contribution.html.
Not just a simple dressing: A practitioner inquiry exploring the complexity within residential care homes and the district nursing response City University London. Jennifer A. Dudman
  • Jennifer A Dudman
Jennifer A. Dudman. 2014. Not just a simple dressing: A practitioner inquiry exploring the complexity within residential care homes and the district nursing response City University London.
The Australian National Aged Care Classification (AN-ACC). The Resource Utilisation and Classification Study
  • Kathy Eagar
  • Jennifer P Mcnamee
  • Robert Gordon
  • Milena Snoek
  • Cathy Duncan
  • Peter D Samsa
  • Carol L Loggie
  • Eagar Kathy
Kathy Eagar, Jennifer P. McNamee, Robert Gordon, Milena Snoek, Cathy Duncan, Peter D. Samsa, and Carol L. Loggie. 2019. The Australian National Aged Care Classifcation (AN-ACC). The Resource Utilisation and Classifcation Study: Report 1.
AN-ACC: A national classification and funding model for residential aged care: Synthesis and consolidated recommendations. The Resource Utilisation and Classification Study
  • Kathy Eagar
  • Jennifer P Mcnamee
  • Robert Gordon
  • Milena Snoek
  • Conrad Kobel
  • Anita B Westera
  • Cathy Duncan
  • Peter D Samsa
  • Carol L Loggie
  • Nicole M Rankin
  • Eagar Kathy
Kathy Eagar, Jennifer P. McNamee, Robert Gordon, Milena Snoek, Conrad Kobel, Anita B. Westera, Cathy Duncan, Peter D. Samsa, Carol L. Loggie, and Nicole M. Rankin. 2019. AN-ACC: A national classifcation and funding model for residential aged care: Synthesis and consolidated recommendations. The Resource Utilisation and Classifcation Study: Report 6.
An introduction to using video for research. Carey Jewitt. 2012. An introduction to using video for research
  • Carey Jewitt
Carey Jewitt. 2012. An introduction to using video for research.