Exploring Older Adults’ Beliefs About the Use of Intelligent Assistants for Consumer Health Information Management: A Participatory Design Study

Background: Intelligent assistants (IAs), also known as intelligent agents, use artificial intelligence to help users achieve a goal or complete a task. IAs represent a potential solution for providing older adults with individualized assistance at home, for example, to reduce social isolation, serve as memory aids, or help with disease management. However, to design IAs for health that are beneficial and accepted by older adults, it is important to understand their beliefs about IAs, how they would like to interact with IAs for consumer health, and how they desire to integrate IAs into their homes. Objective: We explore older adults’ mental models and beliefs about IAs, the tasks they want IAs to support, and how they would like to interact with IAs for consumer health. For the purpose of this study, we focus on IAs in the context of consumer health information management and search. Methods: We present findings from an exploratory, qualitative study that investigated older adults’ perspectives of IAs that aid with consumer health information search and management tasks. Eighteen older adults participated in a multiphase, participatory design workshop in which we engaged them in discussion, brainstorming, and design activities that helped us identify their current challenges managing and finding health information at home. We also explored their beliefs and ideas for an IA to assist them with consumer health tasks. We used participatory design activities to identify areas in which they felt IAs might be useful, but also to uncover the reasoning behind the ideas they presented. Discussions were audio-recorded and later transcribed. We compiled design artifacts collected during the study to supplement researcher transcripts and notes. Thematic analysis was used to analyze data. Results: We found that participants saw IAs as potentially useful for providing recommendations, facilitating collaboration between themselves and other caregivers, and for alerts of serious illness. However, they also desired familiar and natural interactions with IAs (eg, using voice) that could, if need be, provide fluid and unconstrained interactions, reason about their symptoms, and provide information or advice. Other participants discussed the need for flexible IAs that could be used by those with low technical resources or skills. Conclusions: From our findings, we present a discussion of three key components of participants’ mental models, including the people, behaviors, and interactions they described that were important for IAs for consumer health information management and seeking. We then discuss the role of access, transparency, caregivers, and autonomy in design for addressing participants’ concerns about privacy and trust as well as its role in assisting others that may interact with an IA on the older adults’ behalf

Engaging Older Adults in the Participatory Design of Intelligent Health Search Tools

Engaging older adults (adults 65+) in technology design can be challenging. At the same time, it is becoming ever more important to ensure inclusion of diverse perspectives in design research. Several strategies currently exist for successfully recruiting and engaging older adults in design. However, there is still much to learn about how to effectively engage older adults in the design process. In this position paper, we reflect on our experiences engaging older adults in participatory design of "smart" tools for health information search. We share our study design, including our recruitment process and procedures. We then discuss the strategies we used in the design process and challenges we encountered when designing and implementing our research protocol. We contribute our experiences in an effort to facilitate discussion of strategies and opportunities for including older adults in design research

Older Adults’ Perceptions of Intelligent Voice Assistant Privacy, Transparency, and Online Privacy Guidelines

The significant increase in the availability of intelligent virtual assistants (IVA) such as Amazon Alexa or Google Home provides a potential array of benefits to the daily life of older adult consumers; however, this increased consumption has also given rise to fears concerning privacy and security thereby limiting use by some groups. Our investigation explores older adults’ experiences and understanding of intelligent voice assistants. In a pilot study, we conducted semi-structured interviews with seven older adults to identify their understanding of IVAs and any concerns. We found that knowledge of IVA privacy practices, data use and management are key concerns for older adults. Additionally, while online privacy guidelines exist to help mitigate user concerns and address questions, many older adults in our study were unaware that these resources exist and felt that while useful they needed improvement to help older adults better navigate privacy control. Our findings suggest that to aid adoption, it is important to address older adults' concerns about privacy, data management, and how IVAs work. Therefore, our findings have the potential to inform the design and presentation privacy guidelines in the future

Bridging Community, History, and Culture in Personal Informatics Tools: Insights from an Existing Community-Based Heart Health Intervention for Black Americans

A healthy diet and increased physical activity are essential for reducing the prevalence of cardiovascular disease and related deaths, a worldwide public health concern that disproportionately affects Black American communities. Still, Black Americans can face unique challenges meeting dietary and physical activity requirements due to inequities in access and quality of care, environmental and local factors, and difficulties in changing individual health behaviors. Personal informatics and self-tracking tools are one way of increasing awareness of health behaviors to motivate behavior change. However, there are still gaps in knowledge about what encourages different users to engage with personal informatics tools over time, particularly when used in collaborative, community-health settings. This paper contributes a nuanced understanding of fifteen participants' reasons for engaging in an existing community-based health education and behavior change program that combines collaborative self-tracking with culturally relevant content and social engagement to motivate heart-healthy behaviors. We illustrate participants' positive and negative experiences engaging in self-tracking and collaborative tasks during the program. We also discuss how participants envision that integrating technology might support or hinder participant engagement and the work of deploying community-based public health interventions. Finally, we discuss design implications for culturally informed, community-based personal informatics tools that engage Black American's in heart-healthy activities

A Case for Making Web Accessibility Guidelines Accessible: Older Adult Content Creators and Web Accessibility Planning

This paper presents our experiences supporting web accessibility planning among a group of older adult online content creators. We highlight challenges we encountered meeting the web accessibility informational needs of our partners and helping this group of creators become aware and put in place measures to address accessibility issues. Our reflections highlight opportunities for future efforts to improve web accessibility support for everyday content creators and support for helping those less familiar with web accessibility options

Designing an Adaptive Web Navigation Interface for Users with Variable Pointing Performance

Many online services and products require users to point and interact with user interface elements. For individuals who experience variable pointing ability due to physical impairments, environmental issues or age, using an input device (e.g., a computer mouse) to select elements on a website can be difficult. Adaptive user interfaces dynamically change their functionality in response to user behavior. They can support individuals with variable pointing abilities by 1) adapting dynamically to make element selection easier when a user is experiencing pointing difficulties, and 2) informing users about these pointing errors. While adaptive interfaces are increasingly prevalent on the Web, little is known about the preferences and expectations of users with variable pointing abilities and how to design systems that dynamically support them given these preferences. We conducted an investigation with 27 individuals who intermittently experience pointing problems to inform the design of an adaptive interface for web navigation. We used a functional high-fidelity prototype as a probe to gather information about user preferences and expectations. Our participants expected the system to recognize and integrate their preferences for how pointing tasks were carried out, preferred to receive information about system functionality and wanted to be in control of the interaction. We used findings from the study to inform the design of an adaptive Web navigation interface, PINATA that tracks user pointing performance over time and provides dynamic notifications and assistance tailored to their specifications. Our work contributes to a better understanding of users' preferences and expectations of the design of an adaptive pointing system

A Question of Access: Exploring the Perceived Benefits and Barriers of Intelligent Voice Assistants for Improving Access to Consumer Health Resources Among Low-Income Older Adults

Intelligent voice assistants (IVAs) such as Amazon Echo and Google Home present a promising opportunity to improve access to consumer health information and resources for older adults. However, researchers know little about older adults' opinions of using IVAs for these potentially critical tasks, particularly those with already limited access. In this paper, we explore older adults' views about IVAs for consumer health and wellness information with the goal of better understanding what they envision as benefits and barriers of using such technology in the future. We shared an IVA prototype with ten older adults (60 years of age or older). We interviewed them about how a similar system might impact their access to consumer health information. Participants saw the potential for IVAs to improve their search experiences and support them with other health tasks. However, participants were also concerned about adopting an IVA for health due to access barriers, confidentiality risks, and concerns about receiving trusted information. Based on our findings, we discuss considerations for designing IVAs for underserved, older adult populations

Comparing Older and Younger Adults Perceptions of Voice and Text-based Search for Consumer Health Information Tasks

The increased prevalence of voice search presents opportunities to address consumer challenges accessing online health information. However, it is essential to understand how users’ perceptions of voice affect their search processes for health information, concerns, and different scenarios for using voice for health information tasks. We conducted semi-structured interviews with 16 younger (18-25) and older (60-64) adult participants to understand and compare their perceptions of using voice and text-based search for non-health-related and health related tasks. While most participants preferred traditional text search, younger adults were not inclined to use voice search for health information due to concerns about privacy, credibility, and perceived efficiency in filtering results. Older adults found voice search potentially beneficial for reducing manual query generation burdens; however, some were unsure of how to use the technology effectively. We provide a set of considerations to address concerns about voice search for health information tasks in the futur

A Circle of Friends: Persuasive Tools to Improve Heart Health

Cardiovascular disease (CVD) is the leading causes of death in the United States and worldwide. While CVD risk factors are well-known and many can be changed with diet and exercise, more research is needed to understand how to design effective interventions that help patients reduce CVD risk. In this paper, we present the results of a content analysis of the Health Freedom Circle of Friends (COF) Walking Program, a community-based health program run by a public health non-profit that has been shown to reduce CVD risks. We examine the design to better understand the persuasive tools used as well as parts of the design that might benefit from a technological intervention

Taking Stock of the Present and Future of Smart Technologies for Older Adults and Caregivers

Technology has the opportunity to assist older adults as they age in place, coordinate caregiving resources, and meet unmet needs through access to resources. Currently, older adults use consumer technologies to support everyday life, however these technologies are not always accessible or as useful as they can be. Indeed, industry has attempted to create smart home technologies with older adults as a target user group, however these solutions are often more focused on the technical aspects and are short lived. In this paper, we advocate for older adults being involved in the design process - from initial ideation to product development to deployment. We encourage federally funded researchers and industry to create compensated, diverse older adult advisory boards to address stereotypes about aging while ensuring their needs are considered. We envision artificial intelligence systems that augment resources instead of replacing them - especially in under-resourced communities. Older adults rely on their caregiver networks and community organizations for social, emotional, and physical support; thus, AI should be used to coordinate resources better and lower the burden of connecting with these resources. Although sociotechnical smart systems can help identify needs of older adults, the lack of affordable research infrastructure and translation of findings into consumer technology perpetuates inequities in designing for diverse older adults. In addition, there is a disconnect between the creation of smart sensing systems and creating understandable, actionable data for older adults and caregivers to utilize. We ultimately advocate for a well-coordinated research effort across the United States that connects older adults, caregivers, community organizations, and researchers together to catalyze innovative and practical research for all stakeholders.Comment: A Computing Community Consortium (CCC) white paper, 6 page