Facilitators and barriers to using telepresence robots in aged care settings: A scoping review

Integrating Digital Assistive Technologies Into Care Processes: Mixed Methods Study

BACKGROUND

Current challenges in patient care have increased research on technology use in nursing and health care. Digital assistive technologies (DATs) are one option that can be incorporated into care processes. However, how the application of DATs should be introduced to nurses and care professionals must be clarified. No structured and effective education concepts for the patient-oriented integration of DATs in the nursing sector are currently available.

OBJECTIVE

This study aims to examine how a structured and guided integration and education concept, herein termed the sensitization, evaluative introduction, qualification, and implementation (SEQI) education concept, can support the integration of DATs into nursing practices.

METHODS

This study used an explanatory, sequential study design with a mixed methods approach. The SEQI intervention was run in 26 long-term care facilities oriented toward older adults in Germany after a 5-day training course in each. The participating care professionals were asked to test 1 of 6 DATs in real-world practice over 3 days. Surveys (n=112) were then administered that recorded the intention to use DATs at 3 measurement points, and guided qualitative interviews with care professionals (n=12) were conducted to evaluate the learning concepts and effects of the intervention.

RESULTS

As this was a pilot study, no sample size calculation was carried out, and P values were not reported. The participating care professionals were generally willing to integrate DATs-as an additional resource-into nursing processes even before the 4-stage SEQI intervention was presented. However, the intervention provided additional background knowledge and sensitized care professionals to the digital transformation, enabling them to evaluate how DATs fit in the health care sector, what qualifies these technologies for correct application, and what promotes their use. The care professionals expressed specific ideas and requirements for both technology-related education concepts and nursing DATs.

CONCLUSIONS

Actively matching technical support, physical limitations, and patients' needs is crucial when selecting DATs and integrating them into nursing processes. To this end, using a structured process such as SEQI that strengthens care professionals' ability to integrate DATs can help improve the benefits of such technology in the health care setting. Practical, application-oriented learning can promote the long-term implementation of DATs.

Acceptance of a mobile telepresence robot used to teach adapted physical activity to isolated older adults: extending and testing the technology acceptance model

This study aimed to investigate the acceptance of adapted physical activity (APA) by teachers and students before the use of a mobile telepresence robot (MTR), used to remotely supervise isolated older adults' physical activity. While previous studies have shown MTR to be fairly well accepted by older adults, nothing is known about its acceptance by APA teachers themselves. However, if they did not accept it, the MTR would not be used in the end. This would be a public health issue because isolated older adults would not benefit from supervised APA, yet beneficial to their health. To this end, 334 participants answered a survey that measured different psychological variables, based on the technology acceptance model (TAM). Student's t-tests and structural equation modeling were used for data processing. Results showed that, before use, there was not any significant difference between teachers' and students' acceptance of the MTR. Then, perceived usefulness for teaching APA, perceived ease of use, perceived enjoyment, and intention to use the MTR were lower than the mean of the scale, while perceived usefulness for older adults was higher than the mean of the scale. Finally, this study has validated an extended version of the TAM (including the need for competence and MTR self-efficacy), which allowed it to explain 84.3% of the variance of the students' and APA teachers' intention to use the MTR for teaching APA to isolated older adults. Initial obstacles to the use of the MTR seem to exist on the part of APA teachers, prior to their first use, whereas this is not the case for older adults. APA teachers' acceptance should therefore be investigated in future studies to examine whether this trend is confirmed after the effective use of the MTR.

Staff's Attitudes towards the Use of Mobile Telepresence Robots in Long-Term Care Homes in Canada

This cross-sectional study investigated staff's attitudes towards the use of mobile telepresence robots in long-term care (LTC) homes in western Canada. We drew on a Health Technology Assessment Core Model 3.0 to design a survey examining attitudes towards nine domains of mobile telepresence robots. Staff, including nurses, care staff, and managers, from two LTC homes were invited to participate. Statistical analysis of survey data from 181 participants revealed that overall, participants showed positive attitudes towards features and characteristics, self-efficacy on technology use, organizational aspects, clinical effectiveness, and residents and social aspects; neutral attitudes towards residents' ability to use technology, and costs; and negative attitudes towards safety and privacy. Participants who disclosed their demographic backgrounds tended to exhibit more positive attitudes than participants who did not. Content analysis of textual data identified specific concerns and benefits of using the robots. We discuss options for implementing mobile telepresence robots in LTC.

Telepresence robots as facilitators of physical exercise during COVID-19: a feasibility and acceptance study

The COVID-19 pandemic and associated restrictions on mobility and access to green space have disrupted exercise habits worldwide. According to the World Health Organization (WHO), approximately 1.4 billion adults were insufficiently physically active in 2016, with detrimental impacts on health. The proposed study investigated the use of telepresence-robot-based personal trainers to facilitate remote exercise during the pandemic-related lockdowns. Several adults aged 18-65 were recruited for a four-week intervention and thorough research investigation. The intervention involved one-hour outdoor exercise sessions held three times per week in a local park with a human instructor connected via a telepresence robot. Surveys assessed perceptions of social presence, usability, the intention to use the robot and the psychological benefits of access to green space. System logs tracked participation and technical errors. At baseline, 30% of the participants met the WHO physical activity (PA) recommendations, compared to 80% after the intervention. The study shows significant increases in many parameters. These are perceived in social presence (p < 0.021), usability (p < 0.04), intentions for long-term use (p < 0.05), and the mental health benefits of accessing green spaces (p < 0.013). Attendance was found to be 90%, with a 7% technical failure rate. This investigation demonstrates the promise of telepresence robots for safely providing remote access to green spaces. They can be used to facilitate exercise during public health crises, overcoming the barriers to maintaining PA.

The perceptions of university students on technological and ethical risks of using robots in long-term care homes

Introduction: The COVID-19 pandemic has disproportionately impacted long-term care (LTC) residents and exacerbated residents' risks of social isolation and loneliness. The unmet emotional needs of residents in LTC have driven researchers and decision-makers to consider novel technologies to improve care and quality of life for residents. Ageist stereotypes have contributed to the underuse of technologies by the older population. Telepresence robots have been found to be easy to use and do not require older adults to learn how to operate the robot but are remotely controlled by family members. The study aimed to understand the perspectives of multidisciplinary university students, including healthcare students, on using telepresence robots in LTC homes. The study would contribute to the future planning, implementation, and design of robotics in LTC. Methods: Between December 2021 and March 2022, our team conducted interviews with 15 multidisciplinary students. We employed a qualitative descriptive (QD) approach with semi-structured interview methods. Our study aimed to understand the perspectives of university students (under the age of 40) on using telepresence robots in LTC homes. Participants were invited to spend 15 min remotely driving a telepresence robot prior to the interview. A diverse team of young researchers and older adults (patient and family partners) conducted reflexive thematic analysis. Results: Six themes were identified: Robots as supplementary interaction; privacy, confidentiality, and physical harm; increased mental well-being and opportunities for interactions; intergenerational perspectives add values; staffing capacity; environmental and cultural factors influence acceptance. Conclusion: We identified a diverse range of perspectives regarding risk and privacy among participants regarding the implementation of telepresence robots in long-term care. Participants shared the importance of the voice of the resident and their own for creating more equitable decision-making and advocating for including this type of technology within LTC. Our study would contribute to the future planning, implementation, and design of robotics in LTC.

Beyond Plan-Do-Study-Act cycle - staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care

BACKGROUND

Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents' quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects' generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams' perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR).

METHODS

We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants' perspectives.

RESULTS

Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool 'START' to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents' needs.

CONCLUSIONS

Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic

INTRODUCTION

Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care - especially during the COVID-19 pandemic and especially in assisted living (AL) homes, where resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap.

METHODS

This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the 3 months prior to and during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care.

RESULTS

Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care.

CONCLUSIONS

Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and well-being. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.

Using telepresence robots as a tool to engage patient and family partners in dementia research during COVID-19 pandemic: a qualitative participatory study

BACKGROUND

Long-term care (LTC) settings have been disproportionately affected by the COVID-19 pandemic; it is important to address unmet needs and explore practical strategies for supporting LTC residents and staff. The involvement of patient partners and family community members in research planning, implementation and evaluation is the basis of Patient and Public Involvement approach and has been challenging during the COVID-19 pandemic, as visitation restrictions have created barriers to conducting research in healthcare settings. Innovative methods and tools are needed for conducting participatory research. This study investigated the use of telepresence as innovative tools for participatory research based on three projects conducted with patient and family partners during the COVID-19 pandemic.

METHODS

The data source includes (a) team reflective discussions, (b) weekly meeting notes, (c) field notes, and (d) interviews with ten researchers. We applied purposive sampling to select ten researchers who used a telepresence robot to conduct research in British Columbia, Canada. Semi-structured one-to-one interviews were conducted via Zoom virtual meetings. Patient and family partners contributed to team analysis to identify themes.

RESULTS

Analysis of the data produced five themes: (1) Research Enabler, (2) User-Friendly Technology, (3) Increased Engagement, (4) Lack of Infrastructure and Resources, and (5) Training and Technical Obstacles. Based on the results, we propose "ROBOT"-an acronym for five actionable recommendations to support the use of telepresence robots for research. The ROBOT recommendations represent: Realign to adapt, Organize with champions, Blend strategies, Offer timely technical assistance, and Tailor training to individual needs.

CONCLUSIONS

This study offers practical insights into the use of telepresence robots as a safe and innovative tool for conducting remote research with people with dementia, even in times of restricted access, as with COVID-19. Future research should apply more creativity and flexibility in adopting technology to expand possibilities for involving people with dementia in research.

Robots in Assisted Living Facilities: Scoping Review

BACKGROUND

Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain.

OBJECTIVE

This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research.

METHODS

On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework.

RESULTS

The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26%) considered the context of care: most studies (48/69, 70%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors' disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics.

CONCLUSIONS

The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards.

Barriers and facilitators of digital interventions use to reduce loneliness among older adults: a protocol for a qualitative systematic review

INTRODUCTION

Digital interventions are considered as a potential solution to loneliness in older adults. However, this type of intervention has had limited acceptance among older adults (aged ≥60 years). To ensure the use of digital interventions in older adults, possible barriers and facilitating factors should be better understood from the user's perspective. We aim to systematically examine the barriers and facilitators to the implementation of digital interventions designed to reduce loneliness in older adults by identifying, evaluating and synthesising qualitative studies.

METHODS AND ANALYSIS

A comprehensive search of qualitative studies for barriers and facilitators for use of digital interventions will be conducted in the following databases: PubMed, MEDLINE, CINAHL, Embase, Scopus, Cochrane Library and Web of Science. Studies reported in English will be considered for this review. Grey literature will not be included. Two reviewers (HZ and XL) will independently screen the literatures, and any differences will be solved by turning to the third reviewer (JN). The Joanna Briggs Institute (JBI) Qualitative Research Critical Appraisal Checklist will be used by two reviewers to independently assess the validity of the methods used. Relevant data about the populations, context, culture, geographical location, study methods and barriers and facilitators to the implementation of digital interventions will be extracted using the JBI standardised data extraction tool. JBI meta-aggregation methods will be implemented to synthesise the data, which will generate themes and categories based on the data. The final synthesis will establish confidence levels using the JBI ConQual approach.

ETHICS AND DISSEMINATION

The protocol does not require ethical approval. The data are based on published scientific databases. The results will be disseminated through journal articles and scientific conference presentations (if feasible).

PROSPERO REGISTRATION NUMBER

CRD42022328609.

Technological risks and ethical implications of using robots in long-term care

Introduction

The pandemic provides a unique opportunity to examine new directions in innovative technological approaches in long-term care (LTC) homes. While robotics could enhance staff capacity to provide care, there are potential technology risks and ethical concerns involved in technology use among older people residing in communal aged care homes. This qualitative descriptive study explores the technological risks and ethical issues associated with the adoption of robots in the specific context of LTC homes.

Methods

The research team including patient and family partners employed purposive and snowballing methods to recruit 30 LTC participants: frontline interdisciplinary staff, operational leaders, residents and family members, and ethics experts in dementia care. Semi-structured interviews were conducted. Thematic analysis was performed to identify themes that capture empirical experiences and perspectives of a diverse group of LTC stakeholders about robotic use.

Results

Technological risks include safety, increased workload, privacy, cost and social justice, and human connection. The findings offer practical insights based on the LTC perspective to contribute to the robot ethics literature. We propose a list of pragmatic recommendations, focusing on six principles (ETHICS): Engagement of stakeholders, Technology benefit and risk assessment, Harm mitigation, Individual autonomy, Cultural safety and justice, Support of privacy.

Conclusions

There is both a growing interest as well as fear in using robotics in LTC. Practice leaders need to reflect on ethical considerations and engage relevant stakeholders in making technology decisions for everyday care.