Mind Your Heart: A Mindful Eating and Diet Education eHealth Program.

OBJECTIVE: Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system. METHODS: Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis. RESULTS: State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement. CONCLUSIONS AND IMPLICATIONS: Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.

"At First It Wasn't so Bad": How Adults Aged 60 and Older Feel About Social Distancing During COVID-19.

We conducted an exploratory study to describe the emotional experience of adults aged 60 and older in the United States practicing social distancing during COVID-19. The survey asked respondents how they were feeling during social distancing. Responses (n=673) were coded into segments by affect and then specific emotional states. A large portion of respondents reported negative emotions (e.g. anxiety, loneliness). A smaller portion reported positive emotions (e.g. optimism, gratitude). Younger respondents (aged 60-70) reported more feelings of anxiousness and fear compared to older respondents (71+). Older respondents were more likely to report negative feelings towards the government. For both age groups, female respondents were significantly more likely to report feeling afraid and having negative feelings about their own health. We conclude that many older adults are vulnerable to negative emotional outcomes during the pandemic. This highlights the importance of interventions targeting vulnerable older adults.

Socially Assistive Robots for Dementia Care: Exploring Caregiver Perceptions of Use Cases and Acceptance.

As the older population increases, the number of persons living with dementia (PWD) will increase as well. Yet, at the same time, there are fewer health care professionals per care recipient. To address the rising demand on healthcare professionals and informal care partners of PWD, socially assistive robots (SARs) can potentially facilitate care provision. It is crucial to understand the divergent tasks of these two caregiver groups so that the SAR's intervention can meet each group's needs. This qualitative study investigated and compared both caregiver groups' acceptance of a SAR. Six use cases involving a SAR (NAO, SoftBank) were demonstrated to both caregiver groups (N=20 persons). Both groups expressed willingness to adopt such technology and found that it could be useful in dementia care. However, participants' perceptions varied by task. Results indicate that healthcare professionals focused more on the assistive aspects, whereas care partners focused more on the social aspects of the SAR.

A Focus Group Evaluation of Breathe Easier: A Mindfulness-Based mHealth App for Survivors of Lung Cancer and Their Family Members.

PURPOSE: To explore attitudes and acceptance (i.e., intent for future adoption) of survivors of lung cancer and their family members toward a dyad-focused mHealth mindfulness-based intervention (MBI). APPROACH: Focus groups. SETTING: Community hospital setting in South Carolina. PARTICIPANTS: Survivors n = 11 (M = 64.6 years; 73% female; 64% African American) of non-small cell lung cancer (stage I-IIIa) and their family members, n = 8 (M = 58.6 years; 38% female; 75% African American). INTERVENTION: A fully functional prototype mHealth app to deliver a tailored MBI for survivors of lung cancer and their family members. METHOD: Semi-structured focus groups were conducted and assessed using thematic data analysis to identify the benefits, concerns, needs, and expectations of the app. RESULTS: Convenience and health were the top benefits of using the app, while cost and difficulty of use were the top concerns. Survivors mentioned benefits more than their family members did. Participants felt positively about adding a community network to the app. Finally, participants expected to hear about Breathe Easier from their care provider. CONCLUSION: Participants perceived a benefit to having credible health information delivered through an mHealth app. Guidance and credible health information regarding lung cancer survivorship should be accessible and convenient for everyone impacted by the disease. Thus, future research should explore platforms for a virtual support system and understanding dissemination of mHealth apps through health care providers.

The Role of Healthcare Robotics in Providing Support to Older Adults: a Socio-ecological Perspective.

PURPOSE OF REVIEW: In this review, we provide an overview of how healthcare robotics can facilitate healthy aging, with an emphasis on physical, cognitive, and social supports. We next provide a synthesis of future challenges and considerations in the development and application of healthcare robots. We organize these considerations using a socio-ecological perspective and discuss considerations at the individual, care partner, community healthcare, and healthcare policy levels. RECENT FINDINGS: Older adults are the fastest growing segment of the US population. Age-related changes and challenges can present difficulties, for older adults want to age healthily and maintain independence. Technology, specifically healthcare robots, has potential to provide health supports to older adults. These supports span widely across the physical, cognitive, and social aspects of healthy aging. SUMMARY: Our review suggests that while healthcare robotics has potential to revolutionize the way in which older adults manage their health, there are many challenges such as clinical effectiveness, technology acceptance, health informatics, and healthcare policy and ethics. Addressing these challenges at all levels of the healthcare system will help ensure that healthcare robotics promote healthy aging and are applied safely, effectively, and reliably.

A Qualitative Cultural Sensitivity Assessment of the Breathe Easier Mobile Application for Lung Cancer Survivors and Their Families.

PURPOSE: To evaluate the cultural sensitivity of the Breathe Easier mobile health application for African American lung cancer survivors and their families. Breathe Easier is an intervention designed to teach strategies to combat symptoms related to lung cancer. PARTICIPANTS & SETTING: 12 African American lung cancer survivors and their family members were recruited from an American College of Surgeons-approved cancer program in South Carolina. METHODOLOGIC APPROACH: Participants completed in-depth interviews, which were guided by the Cultural Sensitivity Assessment Tool and the Cultural Sensitivity Checklist. Two researchers performed open and axial coding to conceptually organize the data. FINDINGS: Multiple culturally relevant themes emerged, including benefits, concerns, and suggestions related to content literacy and inclusiveness, as well as acceptability of and motivations for using the mobile application. However, lung cancer survivors and their family members reported being more concerned about accessing accurate survivorship information. IMPLICATIONS FOR NURSING: Attention to health literacy, eHealth literacy, and cultural sensitivity may enhance patient outcomes, and nurses can advocate for patients regarding these communication issues.

Systematic Review of Commercially Available Mobile Phone Applications for Prostate Cancer Education.

Prostate cancer is the most commonly diagnosed non-skin cancer among all men and the second most common cause of death. To ameliorate the burden of prostate cancer, there is a critical need to identify strategies for providing men with information about prostate cancer screening and the importance of informed decision making. With mobile phones becoming more ubiquitous, many individuals are adopting their phones as sources for health information. The objective of this systematic review is to identify and evaluate commercially available apps for promoting informed prostate cancer screening decisions. Two keywords "prostate cancer screening" and "prostate cancer" were entered into the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on apps' (a) quality, (b) grade-level readability, (c) cultural sensitivity, and (d) usability heuristics. None of the 14 apps meeting the inclusion criteria contained the full breadth of information covered in the 2016 American Cancer Society's Prostate Cancer Prevention and Early Detection Guidelines, but over half were inclusive of topics consistent with these guidelines. Most apps' readability was higher than an eighth-grade reading level. Most apps were also not framed and had a neutral tone. Only four apps met most criteria for being culturally sensitive to African Americans. Usability among apps was variable, but some contained major usability concerns. Recommendations for improving educational apps for prostate cancer screening include: disseminating evidence-based information; using culturally sensitive language; knowing the implications of the one and framing of content; making apps interactive; and following common usability principles.

Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores.

BACKGROUND: Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual's quality of life. OBJECTIVE: The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). METHODS: For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps' (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. RESULTS: The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. CONCLUSIONS: This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language.

Older adults' acceptance of a robot for partner dance-based exercise.

Partner dance has been shown to be beneficial for the health of older adults. Robots could potentially facilitate healthy aging by engaging older adults in partner dance-based exercise. However, partner dance involves physical contact between the dancers, and older adults would need to be accepting of partner dancing with a robot. Using methods from the technology acceptance literature, we conducted a study with 16 healthy older adults to investigate their acceptance of robots for partner dance-based exercise. Participants successfully led a human-scale wheeled robot with arms (i.e., a mobile manipulator) in a simple, which we refer to as the Partnered Stepping Task (PST). Participants led the robot by maintaining physical contact and applying forces to the robot's end effectors. According to questionnaires, participants were generally accepting of the robot for partner dance-based exercise, tending to perceive it as useful, easy to use, and enjoyable. Participants tended to perceive the robot as easier to use after performing the PST with it. Through a qualitative data analysis of structured interview data, we also identified facilitators and barriers to acceptance of robots for partner dance-based exercise. Throughout the study, our robot used admittance control to successfully dance with older adults, demonstrating the feasibility of this method. Overall, our results suggest that robots could successfully engage older adults in partner dance-based exercise.

Older Users' Acceptance of an Assistive Robot: Attitudinal Changes Following Brief Exposure.

INTRODUCTION: Many older adults wish to age-in-place. Robot assistance at home may be beneficial for older adults who are experiencing limitations in performing home activities. In this study we investigate older Americans' robot acceptance before and after exposure to a domestic mobile manipulator, with an emphasis on understanding trialability (i.e., "trying out" a robot for a short time period) and result demonstrability (i.e., observing the results of the robot's functionality). METHOD: Older adult participants observed a mobile manipulator robot autonomously demonstrating three tasks: delivering medication, learning to turn off a light switch, and organizing home objects. We administered pre and post exposure questionnaires about participants' opinions and attitudes toward the robot, as well as a semi-structured interview about each demonstration. RESULTS: We found that demonstration of a mobile manipulator assistive robot did, in fact, influence older adults' acceptance. There was a significant increase, pre vs. post, in positive perceptions of robot usefulness and ease of use for 8 of the 12 Robot Opinions Questionnaire items. Furthermore, in the Assistance Preference Checklist, eighteen tasks significantly differed between pre and post exposure, with older adults showing a greater openness to robot assistance after exposure to the robot. CONCLUSION: Thus, demonstration of robot capability positively affected older adults' preferences for robot assistance for tasks in the home. Interview data suggest that the robot's capability and reliability influenced older adults' first impressions of the robot.

Acceptance of televideo technology by adults aging with a mobility impairment for health and wellness interventions.

Televideo technology (e.g., Skype) has potential to support adults as they age by facilitating their interactions with people remotely; this potential may be even greater for adults aging with pre-existing mobility impairments, who face challenges interacting with others in person due to lack of transportation or accessibility. Our research employed questionnaire and interview methodologies to investigate this understudied population about their attitudes toward televideo technology for supporting social engagement, healthcare provider access, and physical activity. Participants were 14 adults aging with self-reported mobility impairments (50-70 years of age). Overall, participants were open to accepting televideo technology for social engagement, healthcare provider access, and physical activity. Participants perceived these technologies to be useful and perceived additional benefits, including the feeling of "being there" by enabling the viewing of facial expressions and the environment of the other person. Concerns included perceptions that televideo technologies lack security and privacy. Participants also expressed concerns that these technologies are difficult to use and are difficult to learn to use. The findings have implications for education, training, and deployment of televideo technology for home-based interventions for adults aging with pre-existing mobility impairments.

Younger and Older Users' Recognition of Virtual Agent Facial Expressions.

As technology advances, robots and virtual agents will be introduced into the home and healthcare settings to assist individuals, both young and old, with everyday living tasks. Understanding how users recognize an agent's social cues is therefore imperative, especially in social interactions. Facial expression, in particular, is one of the most common non-verbal cues used to display and communicate emotion in on-screen agents (Cassell, Sullivan, Prevost, & Churchill, 2000). Age is important to consider because age-related differences in emotion recognition of human facial expression have been supported (Ruffman et al., 2008), with older adults showing a deficit for recognition of negative facial expressions. Previous work has shown that younger adults can effectively recognize facial emotions displayed by agents (Bartneck & Reichenbach, 2005; Courgeon et al. 2009; 2011; Breazeal, 2003); however, little research has compared in-depth younger and older adults' ability to label a virtual agent's facial emotions, an import consideration because social agents will be required to interact with users of varying ages. If such age-related differences exist for recognition of virtual agent facial expressions, we aim to understand if those age-related differences are influenced by the intensity of the emotion, dynamic formation of emotion (i.e., a neutral expression developing into an expression of emotion through motion), or the type of virtual character differing by human-likeness. Study 1 investigated the relationship between age-related differences, the implication of dynamic formation of emotion, and the role of emotion intensity in emotion recognition of the facial expressions of a virtual agent (iCat). Study 2 examined age-related differences in recognition expressed by three types of virtual characters differing by human-likeness (non-humanoid iCat, synthetic human, and human). Study 2 also investigated the role of configural and featural processing as a possible explanation for age-related differences in emotion recognition. First, our findings show age-related differences in the recognition of emotions expressed by a virtual agent, with older adults showing lower recognition for the emotions of anger, disgust, fear, happiness, sadness, and neutral. These age-related difference might be explained by older adults having difficulty discriminating similarity in configural arrangement of facial features for certain emotions; for example, older adults often mislabeled the similar emotions of fear as surprise. Second, our results did not provide evidence for the dynamic formation improving emotion recognition; but, in general, the intensity of the emotion improved recognition. Lastly, we learned that emotion recognition, for older and younger adults, differed by character type, from best to worst: human, synthetic human, and then iCat. Our findings provide guidance for design, as well as the development of a framework of age-related differences in emotion recognition.

Domestic Robots for Older Adults: Attitudes, Preferences, and Potential.

The population of older adults in America is expected to reach an unprecedented level in the near future. Some of them have difficulties with performing daily tasks and caregivers may not be able to match pace with the increasing need for assistance. Robots, especially mobile manipulators, have the potential for assisting older adults with daily tasks enabling them to live independently in their homes. However, little is known about their views of robot assistance in the home. Twenty-one independently living older Americans (65-93 years old) were asked about their preferences for and attitudes toward robot assistance via a structured group interview and questionnaires. In the group interview, they generated a diverse set of 121 tasks they would want a robot to assist them with in their homes. These data, along with their questionnaire responses, suggest that the older adults were generally open to robot assistance but were discriminating in their acceptance of assistance for different tasks. They preferred robot assistance over human assistance for tasks related to chores, manipulating objects, and information management. In contrast, they preferred human assistance to robot assistance for tasks related to personal care and leisure activities. Our study provides insights into older adults' attitudes and preferences for robot assistance with everyday living tasks in the home which may inform the design of robots that will be more likely accepted by older adults.

Understanding challenges in the front lines of home health care: a human-systems approach.

A human-systems perspective is a fruitful approach to understanding home health care because it emphasizes major individual components of the system - persons, equipment/technology, tasks, and environments - as well as the interaction between these components. The goal of this research was to apply a human-system perspective to consider the capabilities and limitations of the persons, in relation to the demands of the tasks and equipment/technology in home health care. Identification of challenges and mismatches between the person(s) capabilities and the demands of providing care provide guidance for human factors interventions. A qualitative study was conducted with 8 home health Certified Nursing Assistants and 8 home health Registered Nurses interviewed about challenges they encounter in their jobs. A systematic categorization of the challenges the care providers reported was conducted and human factors recommendations were proposed in response, to improve home health. The challenges inform a human-systems model of home health care.

Toward a framework for levels of robot autonomy in human-robot interaction.

A critical construct related to human-robot interaction (HRI) is autonomy, which varies widely across robot platforms. Levels of robot autonomy (LORA), ranging from teleoperation to fully autonomous systems, influence the way in which humans and robots may interact with one another. Thus, there is a need to understand HRI by identifying variables that influence - and are influenced by - robot autonomy. Our overarching goal is to develop a framework for levels of robot autonomy in HRI. To reach this goal, the framework draws links between HRI and human-automation interaction, a field with a long history of studying and understanding human-related variables. The construct of autonomy is reviewed and redefined within the context of HRI. Additionally, the framework proposes a process for determining a robot's autonomy level, by categorizing autonomy along a 10-point taxonomy. The framework is intended to be treated as guidelines to determine autonomy, categorize the LORA along a qualitative taxonomy, and consider which HRI variables (e.g., acceptance, situation awareness, reliability) may be influenced by the LORA.

Older Adults' Medication Management in the Home: How can Robots Help?

Successful management of medications is critical to maintaining healthy and independent living for older adults. However, medication non-adherence is a common problem with a high risk for severe consequences [5], which can jeopardize older adults' chances to age in place [1]. Well-designed robots assisting with medication management tasks could support older adults' independence. Design of successful robots will be enhanced through understanding concerns, attitudes, and preferences for medication assistance tasks. We assessed older adults' reactions to medication hand-off from a mobile manipulator robot with 12 participants (68-79 yrs). We identified factors that affected their attitudes toward a mobile manipulator for supporting general medication management tasks in the home. The older adults were open to robot assistance; however, their preferences varied depending on the nature of the medication management task. For instance, they preferred a robot (over a human) to remind them to take medications, but preferred human assistance for deciding what medication to take and for administering the medication. Factors such as perceptions of one's own capability and robot reliability influenced their attitudes.

The smooth (tractor) operator: insights of knowledge engineering.

The design of and training for complex systems requires in-depth understanding of task demands imposed on users. In this project, we used the knowledge engineering approach (Bowles et al., 2004) to assess the task of mowing in a citrus grove. Knowledge engineering is divided into four phases: (1) Establish goals. We defined specific goals based on the stakeholders involved. The main goal was to identify operator demands to support improvement of the system. (2) Create a working model of the system. We reviewed product literature, analyzed the system, and conducted expert interviews. (3) Extract knowledge. We interviewed tractor operators to understand their knowledge base. (4) Structure knowledge. We analyzed and organized operator knowledge to inform project goals. We categorized the information and developed diagrams to display the knowledge effectively. This project illustrates the benefits of knowledge engineering as a qualitative research method to inform technology design and training.

The Domesticated Robot: Design Guidelines for Assisting Older Adults to Age in Place.

Many older adults wish to remain in their own homes as they age [16]. However, challenges in performing home upkeep tasks threaten an older adult's ability to age in place. Even healthy independently living older adults experience challenges in maintaining their home [13]. Challenges with home tasks can be compensated through technology, such as home robots. However, for home robots to be adopted by older adult users, they must be designed to meet older adults' needs for assistance and the older users must be amenable to robot assistance for those needs. We conducted a needs assessment to (1) assess older adults' openness to assistance from robots; and (2) understand older adults' opinions about using an assistive robot to help around the home. We administered questionnaires and conducted structured group interviews with 21 independently living older adults (ages 65-93). The questionnaire data suggest that older adults prefer robot assistance for cleaning and fetching/organizing tasks overall. However their assistance preferences discriminated between tasks. The interview data provided insight as to why they hold such preferences. Older adults reported benefits of robot assistance (e.g., the robot compensating for limitations, saving them time and effort, completing undesirable tasks, and performing tasks at a high level of performance). Participants also reported concerns such as the robot damaging the environment, being unreliable at or incapable of doing a task, doing tasks the older adult would rather do, or taking up too much space/storage. These data, along with specific comments from participant interviews, provide the basis for preliminary recommendations for designing mobile manipulator robots to support aging in place.

CHALLENGES OF TRAINING OLDER ADULTS IN A HOME HEALTH CARE CONTEXT.

The health care domain is experiencing a shift from traditional hospital-based care to care delivered in a patient's home setting. Although home health care provides many benefits, it creates new challenges and difficulties for professional caregivers (e.g., registered nurses) who are performing complex medical tasks without the support often present in a health care environment. In addition to performing these tasks themselves, registered nurses are also responsible for training patients to perform many of these tasks, which may include using medical devices and managing complex medication regimens. The purpose of this research was to identify and systematically categorize the issues facing registered nurses (RNs) when training older adult patients. Eight RNs participated in individual structured interviews wherein they were asked to describe the difficulties and frustrations associated with training older adult patients to use medical devices and manage medication independently. The data were categorized as patient-related, RN-related, or situation-related issues. The results highlight the complexity of training device use and medication management, as well as the needs of RNs for forms of additional support in training older adult patients.

"Commanding Your Robot" Older Adults' Preferences for Methods of Robot Control.

Home robots have the potential to assist older adults in maintaining their independence. However, robots deployed in older adults' homes will be required to interact with untrained, novice users. The way untrained users, such as older adults, provide commands or control the robot (i.e., "method of robot control") will likely impact the ease of use and adoption of the robot. The current study explored older adults' preferences for controlling robots. Twelve independently-living older adults (ages 68-79) observed a functioning personal robot in a home setting, and were interviewed about their opinions regarding specific methods of robot control (i.e., laser pointer, physical manipulation, and devices). The older adults perceived advantages and disadvantages of these specific methods, including 'specificity in command', 'accurate robot performance', 'limitations in their own physical capability', and 'challenges in using control device.' The older adults also completed a questionnaire measuring their willingness to use 10 different types of methods of robot control. These data revealed that older adults were willing to use a variety of methods. Although older adults were limited in their spontaneous ideas about robot control (i.e., limited to voice command), once exposed to other options they were willing and open to a variety of control methods.