Elsevier

Geriatric Nursing

Volume 38, Issue 6, November–December 2017, Pages 542-547
Geriatric Nursing

Feature Article
Pilot testing a digital pet avatar for older adults

https://doi.org/10.1016/j.gerinurse.2017.04.002Get rights and content

Abstract

Social isolation in older adults is a major public health concern. An embodied conversational agent (ECA) has the potential to enhance older adults' social interaction. However, little is known about older adults' experience with an ECA. In this paper, we conducted a pilot study to examine the perceived acceptance and utility of a tablet-based conversational agent in the form of an avatar (termed “digital pet”) for older adults. We performed secondary analysis of data collected from a study that employed the use of a digital pet in ten older adults' homes for three months. Most of the participants enjoyed the companionship, entertainment, reminders, and instant assistance from the digital pet. However, participants identified limited conversational ability and technical issues as system challenges. Privacy, dependence, and cost were major concerns. Future applications should maximize the agent's conversational ability and the system's overall usability. Our results can inform future designs of conversational agents for older adults, which need to include older adults as system co-designers to maximize usability and acceptance.

Introduction

The population of aging adults is rising globally, as are the numbers of older adults who live alone. In 2015, the United States Census Bureau reported that 28% of older adults live alone.1 Some will experience social isolation, which is a major health threat because it often affects mental well-being and is associated with increased morbidity and mortality.2, 3 Thus, interventions that address social isolation in older adults are vital to support healthy aging.

Information and communication technologies (ICTs) allow users to handle information and aid communication and have become a promising tool to support healthy aging.4 Several review papers examined the effectiveness of smart technologies such as robotics, virtual reality, and gaming systems and found that these technologies can effectively enhance older adults' social connectivity and support them to live at home.5, 6, 7, 8, 9

An embodied conversational agent (ECA) is a form of ICT. ECAs have a computer-generated character that can facilitate real-time verbal and nonverbal communication between a computer and user.10 The ECA system can be controlled either by an automated computer or a human to interact with users. ECAs have been used as a health coach to provide health information for consumers and improve health behaviors. Bickmore and colleagues designed a software-based automated health counselor agent to promote health behaviors.11 The users who interacted with the automated health counselor daily via computer for two months had better outcomes in the amount of walking or fruit and vegetable consumption compared to controls.11

As population of older adults grows, social support needs also increase. ECAs have the potential to provide such social support for older adults. However, there are limited studies that examined the usability of ECAs for older adults. Most of the studies that have tested ECAs have either done so in a laboratory setting or failed to include older adults as users in the evaluation. Vardoulakis and colleagues examined a human-controlled conversational agent that could interact with and provide social support for older adults for one week. A computer with audio and video was installed in older adults' home and a research assistant controlled the conversational agent, interacting with participants remotely by choosing pre-programed speech or animation commands from the control-station software. The study found older adults had a positive attitude toward the agent.12 In the present study, we aimed to extend the time of interaction and assess the overall utility of a human-operated, tabled-based ECA system with a pet avatar for older adults. The purpose of this study was to examine perceived acceptance and utility of a tablet-based human-controlled ECA system with a pet avatar used by older adults during daily interactions over three months.

Section snippets

Design

We conducted a secondary analysis of data that were collected for a parent study that deployed a tabled-based ECA system with a pet avatar (termed “digital pet”) in 10 older adults' home for three months. In the original study, 10 participants' cognition (baseline and exit), health (baseline and exit), social support (baseline and exit), comfort level with technology (baseline), and use of technology (baseline) were assessed by filling out written questionnaires. Participants were interviewed

Descriptive data

Ten female older adults between 68 and 89 years participated in this study. Nine were Caucasian and one was Native American. Seven felt somewhat comfortable using technology (see Table 2).

Interview data

We interviewed participants at baseline (recruitment), midpoint (one and a half months), and exit (three months) asking them about their experience with, perceived benefits, challenges, and concerns about the system. All participants completed the baseline interviews. Two participants withdrew before the

Discussion

Our study design presented longitudinal changes of participants' experience with and utility of the digital pet over time. The results showed that most of the participants had a positive experience and built a companionship with the digital pet. They received most of the benefits as they expected at baseline. However, participants experienced more and more usability challenges over time.

Bickmore's study showed that a computer-animated virtual health coach can effectively improve users' health

Conclusions

Our study demonstrated that a digital pet can provide older adults with companionship and enhance social interaction. However, the agent's conversational ability, technical issues, privacy, and dependence are some issues that need to be addressed. Our results can inform future designs of conversational agents for older adults, which need to include older adults as system co-designers to maximize usability and acceptance.

Acknowledgments

This study was supported in part by the National Institutes of Health/National Institute for Nursing Research Aging and Informatics Training Program (Grant Nr. T32NR014833) at the University of Washington; National Science Foundation Graduate Research Fellowship (Grant Nr. DGE-1256082); and the Taiwan Ministry of Education Technologies Incubation Scholarship.

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