Improving the practical use of social robots for people with dementiatackling methodological challenges in development, evaluation, and implementation

Abstract

Background: Positioned within the realm of digital health technologies, social robots emerge as a prospective avenue for enhancing the quality of life and social health of elderly adults and people with dementia (PwD). These robots offer companionship and social engagement, cognitive stimulation, learning and entertainment, monitoring and safety, assistance with daily activities and communication aid. Based on the existing literature, they are proven to improve social interactions, activity participation and engagement, and emotions in these target groups. It is crucial to adopt proper evaluation methodologies to study social robots and their effectiveness and implementation in this target group. Moreover, careful consideration of design and interaction methods, as well as ongoing customization, is essential to address these challenges and ensure that social robots effectively support and engage individuals with dementia in a meaningful and respectful manner. Lately, a robotic platform called MINI has been designed and developed in the robotic lab of the University of Carlos III in Madrid with an aim to support seniors and provide cognitive and social stimulation for older adults, especially for those with cognitive impairment. Aim: In this project, firstly, we aimed to review the methodologies used thus far in studies evaluating the feasibility, usability, efficacy, and effectiveness of social robots in clinical and social settings for elderly people, including persons with dementia. Secondly, we assessed the viewpoints of stakeholders and external contextual factors that could either facilitate or impede the introduction of the MINI social robot in Meeting Centres (MC) located in communities, aimed at providing support for PwD and their caregivers in the Netherlands and Spain. Thirdly, we investigated the acceptability and attitudes of the PwD and Mild Cognitive Impairments (MCI) towards the MINI robot. Lastly, we evaluated the usability and user experience of the MINI robot in the laboratory setting. Methods: For the scoping review, dedicated search strings were developed. Searches in MEDLINE (PubMed), Web of Science, PsycInfo, and CINAHL were performed on August 13, 2020. To trace facilitators and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot 11 stakeholders were interviewed in three MCs in the Netherlands and one in Spain, as well as stakeholders in health and welfare organizations in both countries. In total 12 adults with dementia participated in focus groups. The data were thematically analysed and narratively described. To evaluate the usability and acceptability of the MINI robot, mixed-method studies were conducted (acceptability; 22 | usability: 10 PwD and MCI, aged 65 and over). Individual interaction sessions lasted one month for acceptability and one day for usability. Results: In the scoping review, forms of randomized controlled trials were the most applied designs. Feasibility and usability were often studied together in mixed methods or experimental designs and were most often studied in individual interventions. Feasibility was often assessed with the Unified Theory of the Acceptance and Use of Technology model. Efficacy and effectiveness studies used a range of psychosocial and cognitive outcome measures. However, the included studies failed to find significant improvements in quality of life, depression, and cognition. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations, whereas (expected) barriers mentioned concerned the physical context and the functionalities of the MINI robot, user context, and MCs activity policies. The results of the Almere questionnaire showed that there was generally support for the MINI robot, with somewhat higher post-test ratings for its acceptability. The MINI robot was regarded as a joyous companion, particularly for people living alone. While participants appreciated the robot, improvement suggestions were also offered for its features and functions. The usability study highlighted strengths in terms of quick learning, simple system and handling, and integration of functions, while also exposing areas for improvement and the need for clear guidance and expert assistance. Conclusion: Enhancing the quality of studies in this domain necessitates a refined approach. Efficacy and effectiveness studies can benefit from robust randomized controlled trial designs, employing substantial sample sizes and individualized intervention sessions, while experimental designs hold promise for feasibility and usability investigations. Employing a mixed-method approach for data collection across all three goals - efficacy/effectiveness, feasibility, and usability - is recommended. The significance of drawing insights from multiple interaction sessions spanning at least one month cannot be understated, as it offers a pathway to unveil long-term VII impacts of social robots. The outcomes of this project hold transformative potential for a range of stakeholders, from meeting centres directors and managers to care and welfare organizations to consider elements that might hinder or facilitate the implementation of MINI robots in MCs. This research further guides the design and development of the MINI robot, matching its characteristics with the preferences and demands of PwD as well as fulfilling meeting centres policies, so promoting its effective integration and deployment. This project pioneers the assessment of the MINI robot's usability and acceptance among PwD and MCI in Spain, confirming its viability within clinical contexts. The insights gained provide a fresh perspective for advancing similar social robots designs and offer crucial guidance for tailoring robotic features to meet the specific requirements of end users.