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Original Paper Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With Stakeholders

Authors:

Abstract

Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input. Objective: The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders' overall opinions about the robot. Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique. Results: Overall, most stakeholders across groups felt positively about the robot's ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor's office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home-related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot's mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security. Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots.
Original Paper
Improving a Mobile Telepresence Robot for People With Alzheimer
Disease and Related Dementias:Semistructured Interviews With
Stakeholders
Marlena H Shin1, JD, MPH; Jaye McLaren2, MS, OTR/L; Alvin Ramsey3, PhD; Jennifer L Sullivan4,5, PhD; Lauren
Moo2,6,7,8, MD
1Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, United States
2New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
3Pilltrax Systems LLC, Boston, MA, United States
4Center of Innovation in Long-Term Services and Supports, Veterans Affairs Providence Healthcare System, Providence, RI, United States
5School of Public Health, Brown University, Providence, RI, United States
6Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
7Harvard Medical School, Boston, MA, United States
8Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
Corresponding Author:
Marlena H Shin, JD, MPH
Center for Healthcare Organization and Implementation Research
Veterans Affairs Boston Healthcare System
150 South Huntington Avenue (152M)
Boston, MA, 02130
United States
Phone: 1 857 364 2767
Email: marlena.shin@va.gov
Abstract
Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most
of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons
with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to
identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through
key stakeholder input.
Objective: The specific aims were to assess what applications should be integrated into the robot to further support the
independence of individuals with MCI or ADRD and understand stakeholders’overall opinions about the robot.
Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD
living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population.
Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and
overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder
groups using a matrix analysis technique.
Results: Overall, most stakeholders across groups felt positively about the robot’s ability to support individuals with MCI or
ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in
emergency cases and having fewer in-person visits to the doctor’s office. Caregivers and clinicians also noted that remote video
communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help
buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included
health-related alerts; reminders; smart-home–related applications; and social, entertainment, or well-being applications. Stakeholders
across groups liked the robot’s mobility, size, interactive connection, and communication abilities. However, stakeholders raised
concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with
visual impairments; and privacy or data security.
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Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested
to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better
support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the
United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3
stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs.
Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting
telepresence robots.
(JMIR Aging 2022;5(2):e32322) doi: 10.2196/32322
KEYWORDS
mild cognitive impairment; socially assistive robot; robot technology; caregiver support; gerontology; aging in place; qualitative
research; mobile phone
Introduction
Background
More than 6 million Americans aged 65 years are currently
live with Alzheimer disease and related dementias (ADRD),
and it is projected that this number will increase to nearly 13
million Americans aged 65 by 2050 [1]. Approximately 80%
of people with ADRD and most people with mild cognitive
impairment (MCI) receive care in their homes [2]. In the United
States, 83% of care provided to older adults is from family
members, friends, or other unpaid caregivers; 48% of these
caregivers provide help to older adults with ADRD [1].
Caregivers of people with ADRD can often be burdened
emotionally and financially; they experience emotional,
financial, and physical challenges due to care responsibilities
at twice the rate of caregivers of older adults without dementia
[1]. The primary reason family members or friends act as
caregivers for people with MCI or ADRD is to allow them to
remain living in the community rather than in a long-term care
facility, but this may become challenging, especially for
caregivers supporting people with ADRD who live alone. ADRD
caregivers report worsening of their own health due to care
responsibilities and are required to take a leave of absence from
work or quit work [3].
Various types of robots can help people with MCI or ADRD.
Mobile telepresence robots, which are the focus of this study,
can be used to mediate communication and social exchange
between family members, friends, and others who may not be
colocated. Such contact can alleviate loneliness, support
medication compliance and other important daily activities, and
alert caregivers and clinicians in a timely way to address
changing patient needs. Studies have established the feasibility
of mobile telepresence robots for supporting social interactions
between caregivers and people with MCI or ADRD [4]. If
telepresence is complemented by autonomous robotics, the
potential range of benefits expands even further through
innovative approaches to care that can allow people with MCI
or ADRD to remain living independently in the community,
which may help to alleviate loneliness and enhance the quality
of life of people with ADRD, as well as ease the burden of
caregiving [5-11].
Although several types of robots have been developed to assist
people with MCI or ADRD, and the feasibility of telepresence
for supporting social interactions between caregivers and people
with dementia has been established [4], research on
dementia-specific adaptations and acceptance of these robots
that incorporate perspectives across 3 key end-user stakeholder
groups (ie, individuals with MCI or ADRD, caregivers, and
clinicians) has been limited in scope [4,5,11-14]. For example,
there is limited research on how autonomous robotics features
can assist a mobile telepresence robot in supporting at-home
care of people with MCI or mild to moderate ADRD. Robots
have often been developed in an ad hoc manner by technology
companies with limited understanding of the needs, preferences,
and feedback from key stakeholders [15-17]. The ways in which
robots can assist people with MCI or ADRD, their caregivers,
and clinicians need to be explored further.
Objectives
In this study, we engaged these 3 key stakeholder groups in the
design of dementia-specific adaptations to an existing,
commercially available mobile telepresence robot that is already
being used in several other settings, such as in schools for
homebound students and for home health care by remote
clinicians. The overall purpose of this qualitative study was to
obtain stakeholder feedback and identify how an existing,
commercially available mobile telepresence robot can be
enhanced to support at-home care of people with MCI or mild
to moderate ADRD, with the ultimate goal of developing an
autonomous mobile telepresence robot. The specific aims of
the study were to (1) assess what applications should be
integrated into the robot to support the independence of
individuals with MCI or ADRD and (2) understand stakeholders’
overall opinions about the robot.
Methods
Overview
The study consisted of qualitative interviews with 3 key
stakeholder groups (people with MCI or ADRD, caregivers,
and clinicians) to obtain feedback on how to adapt an available
mobile telepresence robot and further understand stakeholders’
opinions about the potential utility of the robot.
Ethics Approval
The study protocol was approved by the Institutional Review
Board at the Veterans Affairs (VA) Bedford Healthcare System
(approval number 110818). Participation in the study was
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voluntary, and informed consent was obtained from each
participant.
Study Population
Study inclusion criteria consisted of the following for each of
the three stakeholder groups, respectively: (1) male or female
Veteran aged 50 years with MCI or early ADRD living in the
community (ie, not a nursing home or assisted living facility):
people with MCI or ADRD were categorized as having MCI
versus early ADRD based on the most recent clinic visit note
at the time of recruitment and had to be alone at home for at
least 4 hours, and there had to be no indication of incompetence
in the Veteran’s medical record; (2) male or female family
caregivers aged 18 years who had a family member with an
established diagnosis of memory loss, MCI, or any cause of
dementia: the caregiver needed to have a family member with
MCI or early ADRD who frequently spent at least 4-hour
stretches alone at home apart from any caregiver in the last 12
months; and (3) male or female clinician with experience in
managing patients with MCI or ADRD: clinician participants
must have provided care to patients with cognitive impairment
and/or supported families of such patients for at least one year.
Recruitment
Our goal was to recruit at least six participants from each of the
3 key stakeholder groups: people with MCI or ADRD,
caregivers, and clinicians. To recruit people with dementia, we
identified patients with MCI or early ADRD from the current
VA Bedford outpatient primary care and dementia clinics using
electronic medical records. Once identified, the VA Bedford
study coordinator (JM) reviewed the electronic medical records
of the patients to determine whether they met the inclusion
criteria. Those who met the inclusion criteria were mailed an
invitation letter for participation in the study; the letter included
a phone number to call should they wish to opt out of the study.
The study coordinator made a recruitment phone call to patients
who did not call back to opt out.
Family caregivers were recruited through family relationships
with people with dementia who were recruited for this study or
through inputs from VA clinical providers. Caregivers also
received a letter of invitation, and the study coordinator followed
up with telephone calls or email.
VA Bedford providers with expertise and experience in
managing patients with MCI or ADRD were recruited by the
VA study principal investigator (LM) and/or study coordinator
via email. Using an opt-in approach, the recruitment email
instructed the invited clinician to contact the study coordinator
if they were willing to participate. Up to 3 emails were sent to
each clinician.
Interview Guide
The interview guide contained semistructured questions to elicit
open responses from participants, as well as structured questions
that asked participants to rate their responses on a Likert scale
as well as to categorize options (eg, from most useful to least
useful) and then provide a rationale for their response. Questions
related to perceived usefulness and perceived ease of use were
used to assist in understanding stakeholders’ preferences
regarding technology and identify adaptations that can be made
to the robot (ie, the mobile robot, as both concepts may affect
stakeholders’attitude toward using the mobile robot, which can
then influence their behavioral intention to use the mobile robot
and thereafter, affect actual use). We conducted a literature
review to understand the types of questions and qualitative
themes found in previous research studies relating to mobile
telepresence robots as well as other types of robots that have
been developed to assist people with ADRD [18-23]. On the
basis of this literature review, we developed interview questions
that focused on domains that we established a priori to help
guide our understanding of how stakeholders perceive the
mobile robot’s usefulness and ease of use: (1) technology use,
(2) design and functionality of the robot, (3) future applications
to be incorporated into the robot, and (4) overall opinions about
the robot. We established these as key domains because they
would allow us to elicit information from stakeholders to
accomplish this study’s overall purpose and specific aims. We
asked participants similar questions across all stakeholder
groups. Table 1 provides relevant questions for these domains.
Of note, for the question “Please let me know how you would
rank these applications that could be used or built into the robot
(from most useful to least useful),” the 6 categories of
applications were chosen by subject-matter expert team members
with extensive clinical knowledge (LM) and technical
knowledge (AR)—based on their professional experience in
working with people with MCI or ADRD, conducting research
on robots, and/or developing robots. The subject-matter experts
met to brainstorm and discuss what types of applications would
enhance the mobile telepresence robot for this population and
chose the 6 applications that would be the most feasible to add
to the robot.
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Table 1. Domains and relevant interview questions.
Interview questionDomain
Technology use How often do you use the internet?
How often do you use the internet for health-related reasons or to get answers to health-related questions?
What kinds of technology do you regularly use at home?
Thinking about the technology you just mentioned you regularly use: choose one of the following that best describes
your comfort level.
a. I am very comfortable using this technology.
b. I am somewhat comfortable using this technology.
c. I am somewhat uncomfortable using this technology.
d. I am very uncomfortable using this technology.
e. Not sure.
Do you use any applications for health purposes?
Design and functionality of
the robot What do you like about the design and functionality of the robot?
What do you not like about the design and functionality of the robot?
Do you have any suggestions for changes to be made to the design and functionality of the robot?
Future applications to be incor-
porated into the robot What kinds of new applications would be useful to build into the robot?
Please let me know how you would rank these applications that could be used/built into the robot (from most
useful to least useful).
a. Medication reminders or dispensing
b. Communication with family/caregivers
c. Reminders about the day’s schedule
d. Communication with medical staff/providers
e. Emergency help access
f. Social stimulation activities such as games or reading the news
Overall opinions about the
robot On the basis of the video/materials we showed you and what you now know about the current version of the
robot, what is your overall opinion about the robot (1=useless to 10=excellent)? Why did you give that rating?
What is the greatest value you think it would provide?
Do you foresee any challenges in using the robot?
Data Collection
From July to August 2019, a total of 3 health service researchers
(MS, JM, and JS) who are experienced in qualitative methods,
conducted the semistructured interviews. Each stakeholder
participated in 1 in-person individual or group interview, which
lasted approximately 60 minutes. Interviews were conducted
either at the VA Bedford main facility or at the participant’s
home. People with MCI or ADRD and family caregiver
participants received a US $50 gift card for their participation
in the interview and an additional US $30 gift card to
compensate for travel time if they participated in person at VA
Bedford. To thank them for their time and insight, the VA
clinician participants received a modest meal, which did not
exceed a value of US $20 per person. Before the interviews, all
participants provided informed consent and agreed to be
audio-recorded for transcription purposes.
After obtaining consent, the interviews began by asking
participants to complete a stakeholder group–specific
demographics questionnaire. As part of the interview process,
we also provided participants with information about the
existing, commercially available mobile telepresence robot,
which included a photo (Figure 1) and a brief explanation.
This robot is a wheeled, upright (approximately 122 cm tall),
self-propelled device that weighs 8.6 kilograms with a 14.5-cm
screen; it moves about under remote control and provides 2-way
video communication between a remote user who pilots the
robot through an app accessed via a computer, tablet, or
smartphone and a person who is physically present with the
robot. In addition, we presented a video (television news
segment) to visually display the robot’s current capabilities.
The video featured a student who was immunocompromised
and could not attend school in person. However, the student
was able to attend school and remain in the classroom virtually
through the mobile telepresence robot. Through this video, the
participants were able to see how the robot displayed the
student’s face on the screen and enabled her to talk to and
socialize with her classmates and teacher in the classroom and
how she could control the robot, allowing it to move through
the classroom and down the hallways. We then asked the
participants questions from the interview guide.
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Figure 1. Mobile telepresence robot used in the study.
Data Analysis
Interview transcripts were the primary data source for the
directed content analysis. Coding and data analysis focused on
four a priori domains: (1) technology use, (2) design and
functionality of the robot, (3) future applications to be
incorporated into the robot, and (4) overall opinions about the
robot. Using a code book that contained domains with
definitions, the core analytic team (MS and JS) jointly coded 1
interview transcript and examined the transcript for evidence
of the established domains. The 2 researchers discussed the
coding process, resolved any discrepancies, and reached a
consensus on definitions and coding classification. Thereafter,
the transcripts were divided and coded separately by the 2
researchers using NVivo (version 12; QSR International)
qualitative software.
Upon completion of coding, we generated coding reports for
each domain and stakeholder group. The data in the coding
reports were reviewed and then synthesized into a matrix, which
allowed us to organize the data to facilitate the final
interpretation. Next, we used a matrix analysis technique to
assess patterns within and across stakeholder groups [24,25].
Thereafter, for each of the 4 domains, we identified salient
themes while noting similarities and variations across
stakeholder groups. In addition, we compared patterns in the
Likert ratings and responses across stakeholder groups. To
ensure wider perspectives, we included study team members
(JM, LM, and AR) beyond the core analytic team to review and
comment on the study findings.
Results
Participant Characteristics
Overall, a majority of participants (20/21, 95%) were White
across all 3 stakeholder groups. The 6 people with MCI or
ADRD in our study sample were men (mean age 73 years, range
69-80 years), with 4 (67%) of these participants living with a
family caregiver and 2 (33%) were living alone. All 9 caregiver
participants in this study were women (mean age 60 years, range
42-80 years). Of the 9 participants, caregivers’ relationships
with family members with MCI or ADRD included 6 (67%)
participants who were the adult child or child-in-law of the
family member with MCI or ADRD and 3 (33%) participants
who were the spouse or partner. Of the 6 clinician participants,
4 (67%) were women and 2 (33%) were men. All had advanced
degrees ranging from master’s to doctoral, with an average of
20 years of experience in their respective fields. They estimated
that, on average, 89% of their patients were aged 60 years,
and 76% of their patients had cognitive impairment.
Person With Dementia and Family Caregiver
Technology Use
Although most individuals with MCI or ADRD reported that
they were able to use their mobile phones for basic functions
(eg, phone calls or SMS text messages), overall, they reported
lower use of technology and the internet than caregivers, who
reported higher use:
I don’t really use [the internet] that much. I’m not
interested and it’s confusing. [Person A with MCI or
ADRD]
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If I walk out the door without my phone, no I go back
in the house to get it. It’s not one of these, oh yeah I
forgot it I’ll get it when I get home. [Family caregiver
A]
Most individuals with MCI or ADRD had never used the internet
or applications for health-related reasons or to get answers to
health-related questions; similarly, caregivers also reported
lower use for health-related reasons or questions. However,
most caregivers reported using at least one app for health
purposes.
Design and Functionality of the Robot
Overall, stakeholders across all 3 groups expressed that they
liked the mobility and size of the robot (approximately 122 cm
tall), as well as the ability to connect and communicate in an
interactive way. However, they expressed concerns related to
the size of the robot for individuals living in smaller apartments
and trailers, as well as the stability of the robot, questioning
whether it could tip over easily. In addition, stakeholders queried
whether the screen size and quality (14.5 cm and 320×240-pixel
display) would provide enough support for those with visual
impairments who would need a screen with higher-quality
contrast and that could display larger text or image. Across all
stakeholder groups, voice commands and 1-touch lifesaving or
help buttons were the 2 top suggestions offered:
I would [add voice activation] especially if someone
has physical trouble, like if they’re [a person with
disability]. That would be a big help. [Person B with
MCI or ADRD]
I don’t know whether my dad would find it as easy to
use unless it is voice activated. Now [that] he has a
voice control for the television [he] loves it. [Family
caregiver B]
[I]f there’s a trigger, [a person] just falls, and
somebody is on the floor and there’s some device that
[the robot] has that alerts you whether it be the
bracelet or something. [A person] can activate an
emergency system and then as opposed to having a
false alarm, the person, the communicator or the
emergency system would be able to say, oh, Mr.
Smith, you’re on the floor. It would help with that.
And that would actually be extremely important.
[Clinician A]
As presented in Table 2, stakeholders offered several suggestions
on what features could be added to the robot and provided input
on how those features could help improve the design,
functionality, and use of the robot in the context of people with
MCI or ADRD. The features listed in Table 2 are presented
from most often suggested to least often suggested across all
stakeholder groups. Adding a voice command feature to the
robot was suggested most often, whereas adding lights to the
robot was the least often suggested feature.
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Table 2. Feature to add to the robot, number of stakeholders who requested each feature, and stakeholders’ feedback.
Stakeholders’ feedback on how this can help to improve
the robot’s design and functionality or help stakeholders
Stakeholders who requested each feature
(N=21),an (%)
Feature to add to the robot
Voice command; option to change the voice
(eg, male vs female voice) Helps with safety (eg, more easily able to call for
emergency help as well as call family members and
providers)
Person with MCIbor ADRDc: 5 (83)
Caregiver: 4 (44)
Clinician: 6 (100) Helps with feeling comfortable with robot (choice of
male voice vs female voice)
Screen adjustment capacity (eg, photograph
and touch screen zoom capability) Helps in emergency situations, during telehealth ap-
pointments
Person with MCI or ADRD: 0 (0)
Caregiver: 5 (56) Helps those who have visual impairments or when
visual adjustments are needed
Clinician: 5 (83)
Size, collapsible, or foldable options Helps those who live in smaller dwellingsPerson with MCI or ADRD: 3 (50)
• •
Caregiver: 3 (33) Helps with ease of moving the robot, if carrying it
from room to room or to another floor of the house
Clinician: 3 (50)
Buttons (eg, lifesaving or help call, or on
or off) Helps with safetyPerson with MCI or ADRD: 2 (33)
Caregiver: 2 (22)
Clinician: 4 (67)
Volume adjustments Helps those with hearing impairmentsPerson with MCI or ADRD: 0 (0)
Caregiver: 2 (22)
Clinician: 5 (83)
Alarm, bell, or beeping sound Helps to alert when someone is calling/dialing inPerson with MCI or ADRD: 0 (0)
• •
Caregiver: 3 (33) Helps to alert a person that robot is near them so the
person is not startled
Clinician: 3 (50)
Customizable color, print, or pattern options Helps with connection and comfort with the robot (eg,
select a color or pattern/print that the patients like)
Person with MCI or ADRD: 2 (0)
Caregiver: 3 (33)
Clinician: 1 (17)
Attachments (eg, arms, handles, or
cupholders) Helps patients, particularly with mobility challenges,
around the house
Person with MCI or ADRD: 0 (0)
Caregiver: 3 (33) Helps caregivers to have more control in the home
virtually (eg, use the robot to pick up and look at
medication bottles, start the microwave, or pick up
clutter)
Clinician: 3 (50)
Helps the robot go upstairs in a lift
Entertainment options (eg, music, television,
or movies) Helps people feel more engaged and comforted by
something familiar and enjoyable to them
Person with MCI or ADRD: 0 (0)
Caregiver: 2 (22) Helps to increase participation
Clinician: 3 (50)
Lights Helps those who have visual impairmentsPerson with MCI or ADRD: 0 (0)
• •
Caregiver: 1 (11) Helps with nighttime vision for the robot to be able
to gather visual information in a dimly lit house
Clinician: 1 (17) Helps with lights around the robot to see the robot
easily if the lights are off or the house is dimly lit
aPerson with mild cognitive impairment or Alzheimer disease and related dementias: n=6; caregiver: n=9; clinician: n=6.
bMCI: mild cognitive impairment.
cADRD: Alzheimer disease and related dementias.
Future Applications to Incorporate Into the Robot
Overview
When stakeholders in each of the groups were asked by the
study team to rank 6 possible robot applications (ie, medication
reminders or dispensing, communication with family or
caregivers, reminders about the day’s schedule, communication
with medical staff or providers, emergency help access, and
social stimulation activities such as games or reading the news)
from most useful to least useful, overall across stakeholder
groups, participants rated medication reminders or dispensing
and emergency help access as the 2 most useful applications.
For people with MCI or ADRD, the top 3 applications were
medication reminders or dispensing, emergency help access,
and reminders about the day’s schedule. Similarly, caregivers
and clinicians included emergency help access and medication
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reminders or dispensing in their top 3 rankings. However,
although communication with family/caregivers ranked the
highest and second highest choice among clinicians and
caregivers, respectively, among people with MCI or ADRD,
this application ranked fourth overall. Across all 3 stakeholder
groups, social stimulation activities such as games or reading
news ranked the lowest. Figure 2 presents the mean scores of
the 6 applications ranked across each stakeholder group with 1
being the lowest and 6 being the highest.
Figure 2. Mean score of the 6 applications ranked across stakeholder groups.
In addition to ranking the options of possible applications
provided by the study team, stakeholders across the 3 groups
offered their own specific suggestions on the types of
applications they perceived as useful to include in the mobile
robot to enhance the opportunity for individuals with MCI or
ADRD to live at home independently. We categorized these
suggestions across the 3 stakeholder groups into 4 types of
applications: health-related alerts, reminder prompts,
smart-home–related applications, and social, entertainment, or
well-being applications.
Health-Related Alerts
Suggested applications include health-related alerts such as
those that could inform providers of a change in patients’blood
sugar or blood pressure levels, as well as those that could be
triggered if a person falls. Similar to a bracelet or necklace alert,
activation and connection to a previously imputed emergency
response system such as family members, ambulance, police,
emergency medical technicians, and/or health care providers,
could occur.
Reminders
Suggested applications include those offering real-time,
step-by-step prompts on how to complete multistep activities
such as getting dressed, making a microwave meal, or turning
the oven on/off; those about medication, doctors’appointments,
other scheduled activities, and wake-up or bedtime prompts,
especially for those who have sleep problems; and those that
can prompt a person with MCI or ADRD to perform and help
with activities of daily living or instrumental activities of daily
living (eg, prompt for eating, bathing, or bathroom use).
Smart-Home–Related Applications
Suggested applications include smart-home technology
integration, in which the robot can detect motion, connect to a
home security alert, and recognize home hazards (eg, smoke
and carbon monoxide detection, or tripping hazards). In addition,
the robot can work similarly to or in conjunction with a
voice-activated smart-home device (eg, the robot turns on or
off appliances in the home).
Social, Entertainment, or Well-being Applications
Suggested applications that could enhance the well-being and
comfort of a person with MCI or ADRD include community or
social connection applications, such as ride share applications
that could assist transportation arrangement and allow
individuals with MCI or ADRD to go out into the community
independently (eg, attending religious groups for social
connection); those that stream music, movies, and television
shows either directly on the robot’s screen or projected onto a
wall, which could also be turned on virtually by a caregiver;
and games to help with cognitive engagement and exercises to
help with balance and mobility. In addition, an app related to
identifying family members or friends to assist with recall could
enhance social connection and well-being, such as integrating
contact numbers of specific family members or friends into the
robot, uploading photos and voice recordings of their family
members or friends, and inputting specific memories with family
members or friends and important dates (eg, birthdays and
anniversaries) into the robot.
Overall Opinions About the Robot
Of the 3 stakeholder groups, caregivers reported the highest
overall rating for the robot (mean 8.1; rated on a scale of 1 to
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10). All caregivers (9/9, 100%) positively perceived the robot
and liked that they could virtually check in and communicate
with their family members, especially if their family members
were to be left alone for an extended period. A caregiver
described how her family member may trust the robot more
than humans to help around the house:
If I can control [the robot] from afar that's helpful.
If it can do some things on its own like little reminders
and things, that's helpful. It just serves as a bridge
and the fact -- like I said for my dad where he doesn't
trust humans to come into the house maybe he would
let a machine. [Family caregiver C]
However, of the 9 caregiver stakeholders, 7 (78%) noted that
additional features and applications would have to be added to
the robot for it to be more useful; thus, the reason for not rating
the robot a 10.
Overall, ratings from the clinician and people with MCI or
ADRD stakeholder groups (mean 7.4 and 6.4, respectively)
were slightly lower than the caregiver group, noting that
additional features and applications had to be added to the robot
for it to be more useful. Similar to the caregiver group, all
clinicians (6/6, 100%) expressed positive perceptions about the
robot and its potential to increase a person’s independence and
ability to stay home alone:
What we worry about with people at that stage is that
they can continue to do as much as they can, but they
need support. And we do know more and more people
are living alone. And often the only option is bringing
in a home health aide who again might not be the
person they want to see there. Or they end up needing
to move often. I just think that this will provide them
the support that they need, if they welcome it, to be
able to keep doing what they’re doing as long as
possible. It seems like it’s enough support. But it’s
not too much. Especially if it’s like a menu of things.
If it’s like they don’t have to accept all of these things
at once. You could titrate [support]. [Clinician B]
However, one of the main reasons clinicians rated the robot
lower on the scale was that they perceived that the robot in its
current state did not offer much beyond what could be done
with other virtual connection platforms such as Skype, Facetime,
or other modalities used in video telehealth sessions:
I think that a lot of the things that it’s used for can
already be done through Facetime or Skype or what
not. I think that there’s a little bit extra better quality
to this. [Clinician C]
Although the robot was perceived to be beneficial in terms of
living independently if additional features and applications were
added, 50% (3/6) of the people with MCI or ADRD rated the
robot lower on the scale for two main reasons: (1) they perceived
that they did not need the robot as they had family members
who cared for them and (2) they did not know if they could use
the robot in their homes because of challenges with size and
mobility:
We don’t have [the robot] now. We do fine without
[the robot]. I got my wife. I call her my guidance
counselor...I wouldn’t use it...trying to figure out how
to use [the robot would be a challenge]. [Person C
with MCI or ADRD]
If [my children] lived really far away, I could see
where that might be nice to see them once in a while
and be able to talk to them instead of just on the
phone. It would be good that way, but [my] children
don’t live far away so me personally it’s not exciting
to have. [Person D with MCI or ADRD]
[F]rom what you say [the robot] can do I’d be happy
with it but it’s going to get in the way. It’s going to
have to use the other bedroom all the time...[The robot
is] too tall and too wide. [Person E with MCI or
ADRD]
In addition, 1 person with MCI or ADRD, who noted that he
did not really have any family or friends, reported that the robot
could provide companionship to someone who lives alone:
I think [the robot] would offer companionship because
like I said I don’t have any family really. I don’t have
any friends at all so I’m kind of alone all the time. It
doesn’t really bother me. I get used to it after a while.
But yeah, I think for somebody like me, [the robot]
would offer companionship. [Person F with MCI or
ADRD]
Greatest Value
All (6/6, 100%) stakeholders with MCI or ADRD reported that
the greatest value provided by the robot would be help in case
of emergency and/or fewer in-person visits to the doctor’s office
(ie, ability to conduct tele-visits):
[O]n an average I’ll be honest with you I avoid the
doctor as much as possible. I avoid them like the
plague because it’s something I don’t like—the smell
of hospitals. They make me sad and they’re a
depressing place. That’s another reason I don’t like
going...[I]f I can avoid going to the doctor and I can
just sit at home and say [to the doctor] see this, [the
robot would help]. [Person F with MCI or ADRD]
[I]f there was a button that [people] could just push
on the [robot] itself. [The robot] would have
programmed in your address and how to get into the
house for the emergency responders. And if it could
automatically open a door, if the doors are locked.
[Person B with MCI or ADRD]
Similar to people with MCI or ADRD, all the clinician
stakeholders (6/6, 100%) agreed that the greatest value of the
robot would be its ability to provide help in case of an
emergency, as well as help their patients with safety at home
and increase a person’s independence, particularly if additional
design features and applications were incorporated:
[T]he security feature. So often we hear someone falls
or something very minor escalates, like they leave a
potholder on the stove and turn and walk away and
the potholder burns and there’s a kitchen fire. And
it’s not even necessarily the gravity of the act. I think
that it’s the fear of what could happen ends up
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curtailing the person’s independence...[T]he daughter
or son being able to say [using the robot], what’s that
box doing in the middle of the floor? Move that to the
right. [This] could prevent a fall. [Clinician B]
Clinicians also highlighted that the robot offers an alternative
for in-person doctor visits and can provide clinicians with access
to the patient during an emergency. Although caregivers noted
similar opinions regarding emergency help, some discussed that
in-person doctor’s appointments helped their family members
get out of the house and increased social interactions.
All caregivers (9/9, 100%) reported that remote video
communication with their family members with MCI or ADRD
was one of the greatest values of the robot; this technology
allows caregivers to perform quick check-ins or longer calls
with their family members, as well as observe what is happening
when caregivers are unable to make an in-person visit:
Being able to look at the house to see by chance
maybe there’s something on the floor that they might
trip over that you could say [to the robot] go such
and such a place, there’s something on the floor, pick
it up. Being able to [see that] without actually
physically being there. I live close to my parents, but
some people [live] hours away. Having something
like this would probably help with a lot of people
[with ADRD] being able to stay in their own homes.
[Family Caregiver A]
Really to be able to see her all the time [is the greatest
value]. To see what she’s doing because I’ve gone to
the house and the stove is on. I’m like why is the stove
on? I don’t know. I’m like okay we need to be able to
see her all the time. [Family Caregiver D]
Concerns
Although there were many positive responses to the mobile
telepresence robot, all 3 stakeholder groups expressed concerns
about using the robot, including technology usability, privacy,
and security. In all, 50% (3/6) of people with MCI or ADRD
were concerned about the technology needed to operate the
robot because they did not own a computer/smartphone and
lacked knowledge of how to use this technology:
I think if [the robot] was voice commanded so you
could speak to it to do things that would be the biggest
help. But otherwise, whoever needs it has to make
sure they either have a phone that they know how to
use, [or] can use it [like] a laptop...I think people
who might be in need of that are probably going to
be older and not as likely to be tech savvy and be able
to use computers and phones. [Person D with MCI
or ADRD]
In all, 44% (4/9) of the caregivers and 67% (4/6) of the clinicians
also expressed similar concerns about the ability to use the robot
by people with MCI or ADRD (eg, ability to fix the robot if
presented with technological challenges, lack of Wi-Fi, or
equipment needed to operate the robot):
I think my mother would be good with [the robot]. I
think my father, it might be challenging for him only
because I don’t feel that he has the attention span. I
think that maybe if this machine was in front of him
and he saw what it could do, I think it might spark a
little interest. [Family Caregiver E]
I think [there are a lot of] unknowns. We only got to
see the interface if somebody was talking on the other
end. I think there are a lot of other things that are
sort of unclear including how it would work, how it
would sync with other devices, that sort of thing. Ease
of use. [Clinician D]
To address these concerns, people with MCI or ADRD and
caregivers suggested the development of a step-by-step tutorial
(video and written instructions) that could teach users how to
operate the robot. In contrast, a clinician perceived that people
with MCI or ADRD would not experience technological
challenges in operating the robot:
You’d be surprised that patients are starting to
become more tech savvy. Believe it—even cognitively
impaired people. I’ve got a couple on my video
conferencing, they’re doing okay, and the family
members are also [okay] because everybody [uses]
Skype so they’re starting to be more at ease with it.
[Clinician A]
Of the 6 people, although 1 (17%) with MCI or ADRD was
concerned about privacy or security, the other 5 (83%) were
not. However, caregivers and clinicians expressed more concerns
about privacy and security. They discussed the tension between
caregivers wanting to check in with their family members but
feeling as though they may be infringing on their family
members’ privacy when controlling the robot. Concerns
regarding privacy and patient dignity (eg, when a patient is
changing or going to the bathroom), especially when there are
multiple permissible remote users, were also noted:
[F]or the most part, he would appreciate it although
there are probably moments where it may feel
intrusive...[need to make the robot] so it’s not
intrusive into any person’s private moments...I think
that’s the only thing I would think about if someone’s
like, Hi, daughter, didn’t realize you were right here.
[Family Caregiver F]
I’m trying to picture a sort of dual control of the
on/off [which would help with] the privacy concern.
I mean the problem is that it helps him with the
privacy concern but it doesn’t help me with the check
on him. Cause he is liable to turn it off and forget that
he turned it off and then if I can turn it on anytime I
need to or want to—how does that give him the
privacy that he is looking for. So there’s that tension
there. [Family Caregiver B]
[T]here could be privacy issues. All of that needs to
be [thought about] to avoid abandonment, meaning
the [robot] gets driven into a corner, thrown down
the stairs...I could see, especially if someone’s losing
their cognition. How do we make sure that we embed
this in a way that’s the person’s needs are respected
and that it’s done on their terms? As much as the
family and the clinician’s terms. How do we remind
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them, for example, if they have a [tele-] appointment
with their doctor how do we make sure that we give
them plenty of reminders so that a face just doesn’t
show up in the middle of them watching [TV] in their
underwear? And all of the sudden they’re
embarrassed and they say I never want to do this
again. How do we build in enough fail safe features
for privacy? [Clinician B]
To help alleviate concerns, caregiver and clinician stakeholders
noted that privacy and security terms would need to be spelled
out clearly, such as those related to who would have main
control over the robot, if any data are recorded and the security
associated with it, and whether someone could easily access the
robot and obtain private information.
Discussion
Principal Findings
We conducted this qualitative study to obtain feedback from
the 3 groups of key stakeholders (people with MCI or ADRD,
family caregivers, and clinicians) on how to adapt an existing,
commercially available mobile telepresence robot to specifically
support individuals with MCI or early ADRD so that they can
continue to live at home independently. Through these
interviews, we received consistent feedback across groups,
which could enhance the robot’s usability. Suggestions that
differed by stakeholder group provided us with a complete
understanding of the adaptations that need to be made to
strengthen the utility of the robot for all stakeholder groups.
People with MCI or ADRD, family caregivers, and clinicians
all described multiple possible updates to the design and
functionality as well as the applications of the remotely
navigable telepresence robot. Family caregivers and clinicians
clearly perceived the need for additional support for people with
MCI or early stage ADRD to allow them to live alone or be left
alone for long periods. Both stakeholder groups felt that the
augmented version of the mobile telepresence robot in our study
could play an important role. Compared with clinicians and
family caregivers who were the most enthusiastic of the 3
stakeholder groups, people with MCI or ADRD reported lower
ratings for the robot. Despite these lower ratings from people
with MCI or ADRD, many stakeholders across all groups
perceived that the robot had the potential to increase a person’s
independence and ability to stay at home. For example,
stakeholders perceived the videoconferencing function (already
available in the robot) to be useful in facilitating communication
with friends or family members and for video telehealth visits
with providers, which helps strengthen relationships by bridging
the distance between individuals [26]. However, similar to
previous research that highlights the importance of developing
robots based on stakeholder feedback [18,19,27], incorporating
several adaptations regarding the robot’s design, functionality,
and applications would be critical to enhance use for their needs,
such as additional development of voice command and help
button functions as well as applications related to medication
reminders or dispensers and emergency response access [20].
These were perceived as critical features or applications to help
people with MCI or ADRD maintain independent living at
home; stakeholders raised concerns that these may be barriers
to adoption if not incorporated. Among the 3 stakeholder groups,
medication reminders and emergency help access ranked the
highest, with reminders regarding daily schedules, rounding out
the top 3 for those with MCI or ADRD. Although all 3 functions
were beyond what the robot could do at the time, the fact that
2 of the 3 related specifically to help with memory decline
highlights the importance of engaging disease-specific
stakeholders in such studies. Similarly, concerns about the ease
of use of the technology with strong recommendations from all
3 groups regarding the integration of voice commands also
underline the benefits of including people with MCI or ADRD
in the development of products or interventions for which they
are the primary target as well as family caregivers and clinicians.
Our findings echo previous studies that highlight the importance
of aligning and customizing technology functions and
applications to end-product users [12,18,19,28-31].
Our results underscore the importance of engaging and obtaining
end-user input from different groups of stakeholders in
technology development—the individual with MCI or ADRD,
the caregiver, and the clinician—which provides for the
opportunity to tailor according to the needs and interests of all
who are involved in the care of people with MCI or ADRD.
Although this is an important component of technology
development, to the best of our knowledge, only a few previous
studies have interviewed all 3 groups [12,18]. In addition,
engaging community-dwelling people with MCI or ADRD is
a critical and feasible component of technology development;
however, studies have usually lacked the involvement of people
with MCI or ADRD in technology development [16]. This lack
of involvement may lead to the implementation of technology
that is not tailored or suitable to the individuals who the
technology intends to serve [16]. Family caregivers are also
important stakeholders and are quite likely one of the most
critical given how this type of technology (mobile telepresence
robots) may help alleviate caregiver burden. Caregivers of
people with MCI or ADRD are their primary advocates; the
primary people with whom they communicate with; and may
usually be the primary decision-makers in the household. By
involving caregivers as a stakeholder group in our study, we
were able to obtain input on what types of features and
applications of the mobile telepresence robot can help reduce
caregiver burden.
The feedback provided on the adaptations to the mobile
telepresence robot and possible applications for the inclusion
of all 3 stakeholder groups aligned with concepts such as
perceived ease of use and usefulness as well as trust [32]. These
concepts are critical to the adaptation of mobile telepresence
robots in health care communication settings and can lead to
barriers in adoption if not resolved. Previous studies have noted
that barriers to the acceptance of mobile telepresence robots
included challenges in using technology and concerns about the
ability of older adults to operate the robots [18,33,34]. In our
study, compared with caregivers, people with MCI or ADRD
reported overall lower use of technology and the internet, which
may have affected their perceptions about the usefulness and
ease of use of mobile telepresence robots. People with MCI or
ADRD and caregivers expressed concerns regarding the
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technology use required by people with MCI or ADRD to
operate the robot. One of the most often suggested design
features that stakeholders across the 3 groups wanted
(particularly people with MCI or ADRD) to have incorporated
into the robot was voice command technology. This simple
design improvement has the potential to increase the perceived
ease of use and usefulness of robots. In addition, stakeholder
feedback can assist in understanding preferences that may
potentially enhance trust, thereby leading to a higher adoption
of technology. Similar to previous research [19], people with
MCI or ADRD in our study did not seem to be concerned with
privacy and security. However, in contrast to previous research
on caregivers who were more likely to perceive no ethical
dilemma when balancing this with the safety of people with
dementia [35], privacy and security were the main concerns
expressed by both caregivers and clinicians. Caregivers and
clinicians were unable to offer solutions that they felt would
alleviate their concerns but noted that these challenges would
need to be resolved for end users, such as themselves, to trust
the robot. Given the dearth of studies focusing on privacy and
security with robots for people with MCI or ADRD, additional
exploration is warranted and should be incorporated into future
research [13].
Although applications related to social stimulation activities
(eg, games or reading the news) ranked lowest across all 3
stakeholder groups, stakeholders offered suggestions in terms
of what types of social, entertainment, or well-being applications
they would want to see in the robot; for example, ride share
applications that could assist transportation arrangements and
allow individuals with MCI or ADRD to go out into the
community independently and applications that could assist
with recall to help identify family members or friends as well
as specific memories and important dates (eg, birthdays and
anniversaries). These suggested applications to enhance the
robot are important because they may enable people with MCI
or ADRD to be even more socially engaged and connected to
their family and friends—a key component of what a
telepresence robot is supposed to be doing. In particular, as
highlighted during the COVID-19 pandemic, social interactions
and connections are critical. The pandemic heightened feelings
of loneliness as the number of older adults who were socially
isolated grew and they were unable to participate in social
activities, thus significantly affecting their mental health [36].
Before the COVID-19 pandemic, about one-fourth of the older
adults living in the community in the United States were thought
to be socially isolated, with approximately 40% of these older
adults reporting feeling lonely [37]. Compared with
well-established risk factors such as smoking, high blood
pressure, and obesity [37-39], social isolation and loneliness
can increase the risk of depression, poorer cognitive function,
and dementia leading to an increased risk of mortality and
morbidity [39]. In the United States, deaths caused by Alzheimer
disease and dementia have increased by 16% during the
COVID-19 pandemic [1]. The pandemic has shown the
importance of developing innovative technology that can
improve social connections and support for older adults [36,40].
Our study results echo findings from another study of
community-dwelling older adults, highlighting that one of the
roles of a mobile robot was to provide friendship or
companionship or to provide help [27]. In addition, our study
also underscores stakeholders’ perceptions that one of the
greatest values of a mobile telepresence robot is the connection
that it can offer to people with MCI or ADRD through remote
video communication with family members and friends.
Although the robot, as is, provides access and social
connections, integrating stakeholders’ suggestions on
applications into the robot would only further enhance
engagement and social connections.
Through this qualitative study, we were able to obtain feedback
from key stakeholders and identify the types of features and
adaptations they prefer on an existing, commercially available
mobile telepresence robot to enhance the support of at-home
care for people with MCI or mild to moderate ADRD. As
discussed earlier, stakeholders offer several suggestions
regarding their desires. Some of these features and adaptations
may be more feasible than others. For example, participants
noted voice command as a highly desired feature, which is
becoming more common in robots (eg, Alexa and Siri). A
technology company that focuses on designing and engineering
robots may find this feature more feasible to include in a mobile
telepresence robot because of the advancements in this
technology compared with other desired features such as
attachments (eg, arms, handles, or cupholders), which may be
challenging because of the robot’s center of gravity, or a robot
that cleans the house, which is a function that is beyond current
capabilities. Moving forward, an important next step for
companies that design and engineer robots is to assess the
feasibility of the desires from an engineering perspective and
balance the challenges in fulfilling the desired features and
functions of the stakeholders while also ensuring the robot’s
usability for the target population.
Limitations
There are a few limitations to our study that should be
acknowledged. Similar to the challenges faced by most
qualitative studies, participants volunteered to be a part of the
study, and interviews elicited those particular perspectives; thus,
interviews may have been subject to selection bias. In addition,
stakeholders only viewed the robot through a video and did not
see the robot in person; this may have limited their ability to
visualize and understand the robot’s full capacity of what it
could offer. Our study participants were all from the Greater
Boston area; thus, we only had a sample of participants from 1
geographic area. In addition, because of the small sample size,
particularly within each stakeholder group, we were unable to
compare similarities and differences in feedback within each
stakeholder group, such as whether caregivers of varying
education levels made similar or different suggestions on
features and applications to incorporate into a mobile
telepresence robot. Because this was a qualitative research study,
we did not collect large quantitative data sets that would allow
comparisons with the general or larger Veteran patient
population. These comparisons are interesting areas for future
research. However, a major strength of our work is that, to our
knowledge, this is one of the few studies to elicit stakeholder
feedback about adaptations that can be made to a telepresence
robot from all 3 user groups: people with MCI or ADRD, family
caregivers, and clinicians. In addition, our findings are
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generalizable to other assisted technologies for individuals with
MCI or ADRD, caregivers, and clinicians.
Conclusions
Recognizing the central role of each of these 3 end-user groups
(people with MCI or ADRD, caregivers, and clinicians) is
crucial for the development and adoption of technology for
people with MCI or ADRD to help them remain living in the
community. We learned from these 3 stakeholder groups what
a mobile telepresence robot can and cannot do for people with
MCI or ADRD; a robot may help to increase social connection
and reduce feelings of loneliness, increase medication
compliance and adherence to health routines, increase the
independence of people with MCI or ADRD, and increase
caregiver well-being [41]. Our results provide insights into the
ways in which a mobile telepresence robot can be adapted to
enhance utility from the perspective of all 3 stakeholder groups,
which can ultimately be used to develop autonomous robotics
features. Future research should continue to incorporate the
perspectives of all 3 stakeholder groups in studies to further
investigate what adaptations are needed for different types of
robots to ensure optimal use by all end users.
Acknowledgments
The authors thank all key stakeholders for taking the time to participate in the interviews and for supporting this study. The authors
also thank Rachael Scali for assisting with the preparation of this manuscript. The views expressed in this paper are those of the
authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government. The
work reported in this paper was funded by the National Institute on Aging Phase I Small Business Innovation Research number
1 R43 AG060781-01 (principal investigator: AR).
Authors' Contributions
AR and LM contributed substantially to the conception and design of the study. MHS, JM, and JLS contributed substantially to
the collection and analysis of qualitative interview data. All authors contributed to the interpretation of the data and preparation
of the manuscript. All the authors have read and approved the final version of the manuscript.
Conflicts of Interest
None declared.
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Abbreviations
ADRD: Alzheimer disease and related dementias
MCI: mild cognitive impairment
VA: Veterans Affairs
Edited by J Wang; submitted 22.07.21; peer-reviewed by C Sutherland; comments to author 09.11.21; revised version received
30.12.21; accepted 25.03.22; published 03.05.22
Please cite as:
Shin MH, McLaren J, Ramsey A, Sullivan JL, Moo L
Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With
Stakeholders
JMIR Aging 2022;5(2):e32322
URL: https://aging.jmir.org/2022/2/e32322
doi: 10.2196/32322
PMID:
©Marlena H Shin, Jaye McLaren, Alvin Ramsey, Jennifer L Sullivan, Lauren Moo. Originally published in JMIR Aging
(https://aging.jmir.org), 03.05.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information,
a link to the original publication on https://aging.jmir.org, as well as this copyright and license information must be included.
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