Mental and physical health is a multi-million dollar industry that avows to increase life expectancy but we constantly face the challenges and consequences of growing older. Pakistan is a third world country with lack of proper health infrastructures and adequate facilities for the elderly. The quality of life greatly diminishes as a person ages in Pakistan due to the constant physical, psychological and socio economic hardships they have to face. The UN-backed Global Age-watch Index 2016 has ranked Pakistan among one of the worst countries in the world to grow old in due to the low life and health expectancy after the age of sixty. One of the major concerns in Pakistan is the lack of companionship the elderly have as their loved ones are either caught up in the fast pace of the world or are estranged from them due to familial or social issues. The elder care facilities in Pakistan are a safe haven for those senior citizens who have nowhere else to go or no one to take care of them. While living in such assistive care facilities, the elderly rarely get any visits from their families and are very often subjected to bouts loneliness and depression. The old age homes in Pakistan are not state facilities and the private homes often run on donations due to which there is not much funding given to recreational activities for the residents. Time is also a critical issue for the woefully understaffed facilities and there is shortage of volunteers as well. Improving the quality of life of the elderly is a major area of research and assistive technology is being seen as one of the most promising solutions. Social Robotics is a fast growing field that has not yet been deeply explored in Pakistan, especially in the elderly context. It has been proved through several researches that conversational robots can elicit a positive emotional change in the user. Our goal was to introduce appropriate technology in the form of a tablet PC and a robot equipped with a tablet to help understand the needs of the elderly in old age homes and examine the difference between the acceptability, interaction and engagement rates of the two technologies while determining their preference of physical attributes , embodiment, audiovisual interfaces and tasks that they would accept help for from a robot or tab. The within-subject study was conducted over a period of one week with three sessions. The first session was an introductory talk with all the participants and a pre-test survey to gather the socio economic and technological fluency background of the users. The second session saw 14 participants take part in each of the three tasks controlled through Wizard of Oz on a tablet PC whereas the third session was conducted with 10 users on the robot and tab combination. Each session was concluded with a post-test semi-structured interview and the study was ended with a post sessions focus group to help us gain a better understanding of the elderly’s needs, preferences and acceptability rates.
The basis of a systematic review was to critically analyze the research that has already been done in the area of our interest. This helped in examining what can be improved, what was missing or what has not yet been covered in the previous work when mapping it to the framework of our research topic. The below explained protocol was developed using the PRISMA checklist for protocol guidance. The steps involved in conducting a thorough systematic review involved planning the research questions first and narrowing down the topic to a single focus. The methodology to select the research papers was then identified, after which the inclusion and exclusion criteria was determined so that only relevant papers are selected for the review. Once the data was gathered, it was systematically analyzed and the evaluation is presented in the paper.
The first session was conducted with 14 participants, 8 female and 6 male. A pre-test survey was given to each participant, however due to low literacy rates the surveys were filled out by the researchers who read out each question and recorded the answers manually. The survey was used as a tool to gather the participants’ socio-economic background, technological literacy and a baseline. They were also asked if they knew what a robot was, had they seen or heard about it and whether they would like to interact with Aisoy after a picture of it was shown to them.
We designed three different tasks to understand what the elderly preferred and which technology was better suited to them.
The first task was a communication based task. We used the voice of the cat from the “Talking Tom” app in all our tasks to give it a robotic cat like feel. The tablet PC showed the Tom Cat speaking whereas the display on the Robot+Tab was a pitch waveform whereas the audio was of the Tom Cat. Both the videos and audios for both technologies were operated through Wizard of Oz and asked the user questions and replied with pre-defined appropriate answers. It asked them their names, how they were, their favorite food, hobbies, places etc. to establish some common ground for a conversation.
TASK 2: GAMES
The second task was about playing games. We used two non strategic existing apps on the tablet PC and the robot+tab so it wasn’t redundant and wouldn’t bore the participants. The first was just a bricks breaking game where a cluster of the same colored bricks had to be popped. The second was a balloon popping game where the balloon had to be popped before it flew away as shown in figure 2.
TASK 3: EXCERCISE
The last task was a physical exercise task where we showed the participants a video demonstrating how to the simple exercise while sitting. The instructions were given using the Tom Cat voice in the background. It also counted with the participants the number of times they had to perform the exercise. Both the exercises on the robot + tab and the tab were slightly different to reduce redundancy.
6.3. FOCUS GROUP
After the sessions and semi-structured interviews were ended. We conducted two focus group sessions, one with 7 males and one with 7 females. Even though some had not participated in the robot+tab experiment, they had observed the others’ interaction and their opinions were recorded and observed by us. We asked them their preference of the two technologies, which one was more user friendly and which one was more entertaining. We also asked questions about religion based tasks as we could not incorporate those in our activities as we did not know how the elderly would react to them and whether or not it would be a sensitive matter.
The interviews were transcribed word by word. Deductive analysis approach was then used to group the data using our research question. Data was then explored for relationships between the two studies. The videos of the studies were encoded to figure out the average gazing time, number of time participant uses gestures while interacting and the frequency of cross questioning.
Participants rated robot higher in terms of enjoyment because of the movement of its eyes, eyelids, mouth and neck when it responded. P4 said: “Yh bolta ha na is ki batain piyari lagti hain.” They cross questioned the robot more as compared to the tablet and smiled at the robot throughout. The tone of responses of participants was also very different for the two cases. In case of tablet their responses were straightforward whereas in the case with embodiment they used satire and adopted a more jolly tone. For example during the communication task, for both cases, when the robot asked: “apko muj sy batain kr k maza aya?” In case of tablet P11 replied “haan aya.” Whereas in case of robot he replied “haan buht maza aya mujy toh sari raat neend nahin aay gi.” This variation in tone also proved that they enjoyed interacting with the robot more as compared to the tablet.
Tablet was rated higher in terms of likeability and ease of use as compared to the robot. P4 shared: “phone sahi ha hath mein ajata ha jaisy marzi lait k istemal krlo. Isski (robot) toh tarain hi buht hain, itni machninery ha sath.” As some participants had hearing issues they could easily bring the tablet closer to their ear or hold it close to their eyes if they couldn’t see it properly. This comfort of interacting with the tablet at their ease made them rate tablet higher in terms of likeability. Moreover, some prefered tablet over robot because they thought of robot as a toy. P6 said: “phone bahtar ha yh (robot) toh bachon k lia ha.”
Participants rated both the technologies equally in terms of trust because they believed that the technology is not intelligent enough, it speaks or does what the researcher wants it to say or do. P8 said “Yh khud toh nahin kuch kahta na jo ap kahalwatay hain wohi kahta ha. Quran ki ayat bhi khud toh nahin bolay ga na ap jo feed karain gy wohi bolay ga toh galat kaisy ho sakta ha.”
Overall, this study found that though elderly in Pakistan find new technologies such as smartphones and robots engaging but this is not something they would want to use each day for the rest of their life. It’s only the novelty factor that motivated them to give it a try. Upon interaction they found it too complex and a hassle for daily use. Even though the participants found the robot to be more interactive, they liked the simpleness of the tablet PC more. They also proposed audio based solutions as the physical attributes and embodiment did not have a major effect on their preference. Some suggested the robot should have had limbs and be able to move around but it was again just a minor detail as they emphasised more on audio than visual.
Longitudinal studies could be conducted in future for generalisability of results. This study can be replicated eliminating the presence of researcher from the equation to see what effect it has on elderly’s willingness to engage with the technology.
An important result of this study was that elderly are more inclined towards the idea of audio interaction rather than visuals or 3D interactions. In line with this outcome a future study can be designed to gauge in what context audio interactions are favoured over visuals and vice versa for this particular user group.
Moreover, this study fails to substantiate the factor of trust in both technologies because only one scenario was presented to the participants. The study can thus be extended to evaluate the element of trust contextually. If the context is changed to playing a game against the tablet and getting a biased result every single time or giving advice regarding health, will the trust factor still be the same.
Qualitative data suggested that participants are quite open to the idea of teaching religion through technology. This hypothesis can be evaluated by a research study to see how demographic and cultural differences affect this stance.