Keywords

1 Background

Informal caregivers are a major pillar of the social care system in most of the countries. Taking care of a family member or another close person can be on one hand an enriching, positive experience; but very often, especially when the caregiving task lasts over a long period of time and the person in need of care has, for example, a neurodegenerative disease, informal caregivers (IC) have a high risk of feeling continuously stressed and overburdened. A representative study [1] conducted in Austria in 2005 showed that 80 % of the people in need of care (referred as “assisted persons”) receive their care by informal caregivers (IC) at home. More than 66 % of these IC’s feel overburdened by that task sooner or later, resulting in a decreased quality of the interaction between the two parties.

One of the major problems ICs face is how to assure the well-being of the AP when the IC is alone at home. Hence personal visits and frequent phone calls are the logical consequence and the most common approach to deal with this situation.

1.1 Aim of the Project

RelaxedCare wants to increase the quality of communication by reducing the number and necessity of these short, but time-consuming status checks. RelaxedCare aims to provide a system to keep the IC updated on the overall well-being of the AP in a passive and pervasive way, so as to reduce the burden of caregiving and thereby enhance the quality of life of people in care situations and the bond between IC and AP.

1.2 State of the Art

A major aim of Active and Assisted Living (AAL) is to enable people to live longer more independently at home [2, 3].

User Involvement.

There is no doubt that users must be involved in the development of Assistive Technology, but the extent to which this is actually done varies greatly by project.

Many apply various user-involvement methods, but most of them do not follow a concrete process. Standards like ISO 9241-210 (Ergonomics of human-system interaction) [4] help by supplying a more standardized development cycle which involves users at selected development phases. The FURTUNE Guidelines [5] give advice on how to involve primary end users into the research process– but still, end-users could influence the development of technical-solutions much more if they are involved in further ways.

The Ambient Assisted Living Joint Programme provides a catalogue [6] that suggests different user involvement methods for different phases of an AAL project, but this is not necessarily combined with a concrete process of how to use them.

Technology.

At the moment there are just a few existing solutions on the market that inform one about the state of an assisted person. Some of these solutions (available only in the US) offer information about the current state of the assisted person via a user interface such as a webpage [7–10]. They have been described in more detail in [11].

2 Methodology

As user involvement is a continuous and active part of the development, the technical approach is also briefly described in this section.

2.1 Technical Approach

For RelaxedCare, two major technology fields are of primary interest – Behavior Pattern Recognition and Ubiquitous Computing.

Mark Weiser, describes ubiquitous computing in [10] as “the method of enhancing computer use by making many computers available throughout the physical environment, but making them effectively invisible to the user.” This is a major challenge for RelaxedCare – both, the user interfaces and the smart home sensor network have to integrate into the living environments of the end-users.

In the field of Ambient Assisted Living, behavior pattern recognition (BPR) is a common research topic for the last 10 years. In particular, efforts were put on the detection of “activities of daily living”. Based on smart home sensor networks, these activities of daily living are processed and changes recognized. On the other side, ubiquitous and pervasive computing methods aim to create systems that integrate into the environment. RelaxedCare tries to combine those two approaches to develop an information and communication system that connects people in care situation.

The concept of RelaxedCare.

To gain user acceptance and a high degree of usability, we aim to provide the IC a pervasive, ubiquitous, low-barrier object as user interface that becomes part of the living environment. The basic idea behind the RelaxedCare system is illustrated in Fig. 1 and described below.

Fig. 1.
figure 1

The RelaxedCare concept – the Assisted Person on the upper part, the Informal Caregiver on the lower part.

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At the AP’s home, illustrated in the upper part of the picture, a smart home system is installed. Various sensors detect when the user is active, e.g. motion sensors in the living room, pressure sensors in the bed or door sensors on the refrigerator or entrance door. This information is collected within an AAL middleware platform and behaviour pattern methods are then applied on these data, yielding a wellbeing status. This status is then relayed to the IC side, as represented in the lower part of the picture. Whether the IC is at home or at work, the well-being state will be presented in an unobtrusive way such as a colour-coded lamp or a digital picture specific to the well-being state. When the IC is mobile, the same information is available via a smart-phone app. When the well-being state changes, the information can be tracked by the IC, thus keeping the IC always informed about the current well-being of the AP.

To gain user acceptance and a high degree of usability, we aim to provide the IC a pervasive, ubiquitous, low-barrier object as user interface that becomes part of the living environment.”

2.2 User Involvement Methodology

The ISO 9241-210 standard offers information about the involvement of end-users in different phases of a product development process. Lessons learned in applying this process methodology in other projects show that the steps of the ISO 9241-210 standard are often executed by different expert groups (e.g. technology development, design and user research) within the project. This can create stumbling blocks to a smooth and efficient workflow and inter-group communication because this process model doesn’t address individuals directly.

To overcome this identified gap a process methodology was chosen which addresses not only the involvement of end-user in the product development process but also offers a guideline for the involvement of each team member to actively involve him - or herself in every step of the process.

The User Inspired Innovation Process.

The User Inspired Innovation Process UIIP [13] offers a process methodology designed from an individual’s point of view. The key question for this process methodology is: “where and how can I actively contribute to the different steps of the product development process?” The UIIP combines the guideline for involving end-users (ISO 9241-210 standard) with a guideline for the involvement of each team member in a holistic product development process.

The UIIP consists of 7 steps: (a) ignite, (b) perceive, (c) collect, (d) decode, (e) assemble, (f) experiment and (g) merge. The step ‘ignite’ aims to create an understanding and inclusion of each team member’s creative potential; to exchange experiences and information with other team members; and to build bridges to other knowledge areas. On an anthropological level, the step ‘perceive’ is used as an awareness-building phase for the target groups of the project and their life contexts. Especially human values, needs, emotions, behaviour, and used technology items are addressed. The step ‘collect’ brings a mix of design and ethnographic research methods to bear, like audio-/visual documents and materials, camera surveys with contextual interviews, perspective-sorting studies, user workshops, cultural probes and studies, etc. Subsequently, the step ‘decode’ involves the sorting, grouping and interpreting of the collected data. Findings from these qualitative inquiries are used to inspire the team to create new project approaches. An example is shown in Fig. 2. During the ‘assemble’ step the team creates ideas, prototypes them and develops use cases and scenarios. Proofs of concept with users and the incorporation of given feedback to the created concept characterizes the ‘experiment’ step of the process. Finally, the ‘merging’ of the concept with developed technology and created business cases takes place.

Fig. 2.
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The cube of Requirements: It consists of small cubes. Each cube represents key findings from one method of the first end-user requirements study.

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3 Execution

The research process for the first end-user requirements engineering study was designed as an unstandardized, qualitative research study (Flick, 2009). This was a comparative study broken down into five phases, employing eight methods in total deriving a) from the field of design research (Assumption Personas and Personas, Show and Tell Method, Cultural Probes and Design Workshop) and b) from the field of qualitative social research (Questionnaire, Focus Group Discussion and Contextual Inquiry Interview). The applied research methods focused on uncovering relevant factors for assessing user needs and wishes at an early stage of the project. The study design, with its mix of methods deriving from the aforementioned research areas, was chosen to ensure rich output as a basis for the subsequent project development process. This first research period lasted from June to September 2013. A total of 207 test persons participated, split between the two user groups – informal caregivers (average age 77 years) and assisted persons (average age 66 years) – and comprising 155 females and 52 males.

3.1 Lessons from the First Phase

We learned that caregiving in families is not unidirectional. Even though the younger generation is more seen as the “informal caregiver”, they are still the children of their parents, and hence the “assisted persons” still care about their child and their family members. A major lesson from this was that most of people in need of care do not want to put extra burden on their family members and thus avoid asking for help. Hence, a new way of communication is needed that enables them to ask for help, a phone call or a visit with a very low barrier. Furthermore we learned a lot about the attitude of people towards technology, their favorite places in their homes and which aspects of technology usage in their everyday life are preferred. After the execution of all research methods from the first user requirements study, the initial Assumption Personas which had been defined in a common team creation process were compared with the findings for each user group, and several major changes had to be made. One of the major findings revealed that the average age for caregivers and their assisted persons, originally defined to be 30 + and 75 + respectively, had to be changed to 50 + and 80 +. Concerning activities of daily living and preferred objects of everyday life, various similarities among the group of the caregivers and the group of the assisted persons could be identified (Fig. 3).

Fig. 3.
figure 3

Detailed Persona at the end of the analysis phase 1

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Based on the findings of the first user requirements engineering study and the defined use cases and scenarios, five different design concepts were elaborated. In a common team election process, three out of the five design concepts which had been developed by the design team, were chosen. In order to prepare the next step of the development process in which the developed design concepts would be tested in an informal usability test with end-users of both target groups, the three design concepts were prototyped and visualized with appropriate everyday use scenarios. The informal usability test was then conducted to gather first user impressions of the proposed concepts, in order to be able to refine the concepts in an early stage of the product development for integrating the most promising aspects into prototype I.

3.2 Lessons from the Second Phase

The second end-user research study was created as a qualitative research study applying the method of design workshops, which included several sessions deriving from the field of design research. The design workshops consisted of three different sessions: round-table discussions, model building sessions and voting sessions, within the framework of the different types of messages and the cubes appearance in terms of color, material, surface structure and size.

The second research study focuses on two end-user groups: informal caregivers and young people with an average age of 17. Those groups were chosen bearing in mind the findings of the first end-user study, which revealed that the product and the services developed within this project have to address first of all informal caregivers followed by the assisted persons – but might also beyond that affect the whole family, from younger to older people. The design workshops took place in January 2015. All in all, 9 informal caregiver and 10 youths participated, with a respective average age of 17 and 72 years.

The conclusions drawn from the second user requirements study comprised recommendations for the embodiment of prototype II.

Addressing the user-group of the informal caregiver, we had to realize that the project has to face two kinds of users within this one target group:

  • One group which is familiar with new technologies, and

  • one group which is not at all facile with – and is even skeptical towards – new technology. This group may own a mobile phone but prefer not to depend on it and often leaves it at home.

Creating a modular system with basic functions which can later be extended might help to overcome the acceptance barrier and to empower the users to not to be controlled by the system but rather to control it, as the findings clearly indicated that people hate the feeling of being surveyed. This empowerment will play an important role when going to market and enables moreover the creation of an easily understandable market message.

The translation of the chosen User-Centred Design process methodology from theory into practice generally went smoothly and without major difficulties. The iterative process enabled the addressing of user wishes and aspirations in our design proposals. The concrete feedback sessions on the developed concepts and design proposals led to continuous refinement of the overall system design. Lessons learned from other projects show that the steps of the User-Centred Design process are often executed by different expert groups, e.g. technology development, design and user research, of the project. At project’s start we defined our goal as the involvement of all experts from different fields in each step of the product development process. Since we are currently running the field trials of our developed system and the research project is near its end, some conclusions can be drawn concerning our own lessons learned from the implementation of this approach to the applied process.

During this translation process we identified some areas for improvements. As mentioned before, we were well aware that the User-Centred Design Process offers information about the involvement of end-users in different phases of a product development process and that we had to keep an eye on the involvement of team members of our different expert fields in each process phase. During the work on the project we realized that we still hadn’t managed to overcome the identified gap between the expert groups of technical development, design and user research sufficiently. One conclusion from this could be that the User-Centred Design process model doesn’t address individuals – meaning the team members of the different expert groups – directly. Following this thought, we conclude that one possibility for filling the identified gap could be raising the personal motivation for each team member to actively involve oneself in every phase of the process.

4 Results

RelaxedCare is the entirely new way of communicating and caring: allowing more communication from the assisted person’s side while unobtrusively keeping informal caregivers worry-free and informed about the assisted person’s wellbeing state. The second prototype is depicted in Fig. 4. It consists of a elegantly-designed RelaxedCare cube and a smartphone app.

Fig. 4.
figure 4

The RelaxedCare second prototype consisting of the RelaxedCare Cube with tiles and the RelaxedCare App.

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At the assisted person’s home, the cube is connected to a smart home system. Innovative behaviour pattern recognition methods detect the wellbeing state of the user, including activity level, social interaction and daily life routines.

On the informal caregiver´s side, the wellbeing status is displayed in a pervasive way via the wellbeing indicator on the in the front of the RelaxedCare cube and the app.

The cube also enables both sides to send simple messages using an innovative interaction design: placing tiles with specific icons on top of the cube. Asking for help, requesting a call or saying “I am thinking of you” has never been simpler than with RelaxedCare.

Concerning the chosen methods for the user research studies of the project, the arrangement to divide the whole study into five phases where design research and qualitative social research methods were applied alternately has proven to be a fruitful approach. Each method gave clues which led to the refinement of the successive method – in other words, the generated findings from each step enabled the team to broaden the view on the target groups and to define the successive methods in an even more target-oriented way. The research methods deriving from two research realms had been chosen for specific questions whose answers were required to inform the product development process. The findings indicate that the combination of methods of qualitative social science in combination with methods of design research in generative sessions have the potential to offer insights in the area of knowledge what people know, feel and dream of. This can ultimately lead to the possibility of extracting tacit and latent knowledge of the target groups we design for and of course will be of great importance for a holistic project development in general.

The active user involvement of more than 200 end-users shifted the primary focus of the technology development from “informing the ICs” to a new form of communication between IC and AP. The original focus would have put even a certain stigma on the assisted person. Shifting the focus towards bilateral communication and providing both parties with the same tool – the RelaxedCare cube – enables them to meet more on the same level. “Caring about each other” and increasing the bond between IC and AP makes RelaxedCare more a “lifestyle object” and moves it away from the telecare field.

Lessons learned from previous projects indicate that closing the gap between the technical, design and user research experts is a success parameter for a technology development project. In RelaxedCare we aimed at applying a holistic product development process, defining a way for a close collaboration of team members from various fields with a broad variety of knowledge areas and experiences, like technology development, system design, interaction and product design, user requirements research and usability. Therefore we applied the ISO 9241-210 standard for the User-Centred Design (UCD) process methodology in the project and decided to combine it with the systematic involvement of project team members from different expert fields to every step of the applied process.

After almost three years of working on the project’s design and technical development, we are currently evaluating our final system definition and its concrete results (prototype II) in field trials in Austria and Switzerland with the end-users of the project.