**2. Examining the acceptability of robots for older adults and people with dementia**

#### **2.1 What is robot acceptability?**

#### *2.1.1 Definitions of technology acceptability*

Definitions of technology acceptability vary and they establish acceptance in relation to other concepts like technology usability, adherence, and adoption. It can be defined as the intention to use technology [17]. Such a definition regards the actual usage of the technology as occurring after acceptance. Other definitions, for example, Heerink et al. [19], regard acceptance as including usage of the technology over a long period. Technology acceptance is regarded as a process [20] in which the user is involved in ongoing evaluation and re-evaluation of the technology and their decision whether to adopt the technology [4]. Ongoing decision-making is informed by information and experiences that approve discontinuance of use or confirm the initial decision to use the technology. Cruz [20] defines technology acceptance as a process and argues that acceptance only occurs when a technology

**19**

*Examining Social Robot Acceptability for Older Adults and People with Dementia*

Expectation Before using, initial opinion for various information sources.

Confrontation Re-evaluate ideas due to trying out or observing others for the first time.

Adaptation After 1 month, using according to personal needs and preferences.

Identification After 6 months, is an expression of lifestyle or a group.

sufficiently satisfies all the needs and requirements of its users. The concept of technology adoption has been distinguished from acceptance. De Graaf [4], who writes from the perspective of social robots for usage in the domestic home environment, defines adoption as being the initial decision to buy and start using the technology. The process of technology acceptance has six phases [4] that start with an individual becoming aware of a technology and end with the incorporation of that technology into everyday life to the extent that its functional purpose is exceeded and the individual becomes attached to it. These phases are summarised in **Table 1**)

Integration After 2 months, meaningfully integrated and no longer noticed in everyday life.

The expectation phase occurs when users form an initial opinion about a technology and an expectation about it. This opinion is formed by information they receive from the media, other people, and information they might seek out wanting to know more about the technology. When users try out or observe others encountering a technology for the first time, they enter the confrontation phase. Being exposed directly to the technology may cause the user to re-evaluate and adjust their expectations. The user enters the adoption phase when they use technology in a private environment and gain their first serious user experiences. This is followed by the adaptation phase when, after approximately a month, users have a broad idea of what the technology is about and they have encountered its flaws and features. As a result of exploring its features, users adapt the technology and use it according to their personal needs. Approximately two months after confrontation, during the integration phase, the technology becomes meaningfully integrated into the user's life, to the extent that it is not noticed by them and it has been personalised to their preferences. The final acceptance phase is the Identification phase. This occurs approximately six months after confrontation. Here the technology has more than a functional purpose. It can also then express a lifestyle and potentially be used to differentiate or connect groups of people. In order for robotic technologies to reach the integration and identification phases of acceptance, they need to offer users something that traditional technologies do not [4]. Before examining acceptance in relation to robotic technologies further, it is necessary to clarify how social robots differ from traditional technologies, and what this means for their acceptance.

Robots are a relatively new genre of technology and they are not widely used in society. The level of robot technology acceptance changes over time and between contexts. Changes are impacted by the stage of the technology's development

*DOI: http://dx.doi.org/10.5772/intechopen.98365*

Adoption Initial serious user experiences

*The Phases of Technology Acceptance (Adapted from de Graaf [4]).*

**Phase Key Features**

and described below.

**Table 1.**

*2.1.2 Phases of technology acceptance*

*2.1.3 Robots as a new technology genre*

*Examining Social Robot Acceptability for Older Adults and People with Dementia DOI: http://dx.doi.org/10.5772/intechopen.98365*


**Table 1.**

*Collaborative and Humanoid Robots*

Some OA and people with dementia positively evaluate using robots [6, 8, 10]. But a recent review involving n = 90 research studies found that the deployment of current assistive robots into healthcare practice is low [11]. Technology acceptance

Acceptance has been defined as the robot being willingly incorporated into the older person's life [13]. Robot acceptance is impacted by multiple interacting factors, that concern the individual, significant others, and wider society [14]. But the factors that impact robot acceptability need to be understood in more depth because individual people and groups greatly differ regarding how acceptable they find robots [15, 16]. A recent literature review that included studies investigating robots (n = 4) found there was low acceptance of robotic technologies amongst OA and people with cognitive impairment and their caregivers [17]. Korblet [18] also found that the acceptance of a mobile telepresence robot in a nursing home setting was lower in people with dementia (n = 5) than in people who visited the nursing home

This chapter provides an overview of the state of the art regarding technology acceptance theory and the empirical research on robot acceptance that involves OA and people with dementia. It also examines what is likely to increase the acceptability of robots in this context. The chapter proceeds in the following sequence. Firstly, the definition of robot acceptability is discussed and phases in technology acceptance are introduced in relation to robots as a new technology genre. It is highlighted that social robots have different features in comparison to traditional technologies. These differences affect their acceptance and how acceptance needs to be conceptualised and investigated in practice. Secondly, examples of models of technology acceptance are presented and discussed in relation to their adequacy to explain and predict the acceptance of robots in the concept of OA and people with dementia. Then, empirical research is described that has examined the acceptance factors that are important for OA and people with dementia. The final section of the chapter focuses on what is likely to increase the acceptability of robots for OA and people with dementia and recommendations are made for the future design, development, and deployment of social robots. This final section introduces the concept of collaborative robots and it draws on research findings and literature that

is an important predictor of the usage and adoption of technology [12].

centre weekly (n = 3) and a third who had physical disabilities (n = 3).

describes current discourses in gerontology and policy recommendations.

**2. Examining the acceptability of robots for older adults and people** 

Definitions of technology acceptability vary and they establish acceptance in relation to other concepts like technology usability, adherence, and adoption. It can be defined as the intention to use technology [17]. Such a definition regards the actual usage of the technology as occurring after acceptance. Other definitions, for example, Heerink et al. [19], regard acceptance as including usage of the technology over a long period. Technology acceptance is regarded as a process [20] in which the user is involved in ongoing evaluation and re-evaluation of the technology and their decision whether to adopt the technology [4]. Ongoing decision-making is informed by information and experiences that approve discontinuance of use or confirm the initial decision to use the technology. Cruz [20] defines technology acceptance as a process and argues that acceptance only occurs when a technology

**18**

**with dementia**

**2.1 What is robot acceptability?**

*2.1.1 Definitions of technology acceptability*

*The Phases of Technology Acceptance (Adapted from de Graaf [4]).*

sufficiently satisfies all the needs and requirements of its users. The concept of technology adoption has been distinguished from acceptance. De Graaf [4], who writes from the perspective of social robots for usage in the domestic home environment, defines adoption as being the initial decision to buy and start using the technology. The process of technology acceptance has six phases [4] that start with an individual becoming aware of a technology and end with the incorporation of that technology into everyday life to the extent that its functional purpose is exceeded and the individual becomes attached to it. These phases are summarised in **Table 1**) and described below.

### *2.1.2 Phases of technology acceptance*

The expectation phase occurs when users form an initial opinion about a technology and an expectation about it. This opinion is formed by information they receive from the media, other people, and information they might seek out wanting to know more about the technology. When users try out or observe others encountering a technology for the first time, they enter the confrontation phase. Being exposed directly to the technology may cause the user to re-evaluate and adjust their expectations. The user enters the adoption phase when they use technology in a private environment and gain their first serious user experiences. This is followed by the adaptation phase when, after approximately a month, users have a broad idea of what the technology is about and they have encountered its flaws and features. As a result of exploring its features, users adapt the technology and use it according to their personal needs. Approximately two months after confrontation, during the integration phase, the technology becomes meaningfully integrated into the user's life, to the extent that it is not noticed by them and it has been personalised to their preferences. The final acceptance phase is the Identification phase. This occurs approximately six months after confrontation. Here the technology has more than a functional purpose. It can also then express a lifestyle and potentially be used to differentiate or connect groups of people. In order for robotic technologies to reach the integration and identification phases of acceptance, they need to offer users something that traditional technologies do not [4]. Before examining acceptance in relation to robotic technologies further, it is necessary to clarify how social robots differ from traditional technologies, and what this means for their acceptance.

#### *2.1.3 Robots as a new technology genre*

Robots are a relatively new genre of technology and they are not widely used in society. The level of robot technology acceptance changes over time and between contexts. Changes are impacted by the stage of the technology's development

regarding its capacity and its level of diffusion in society [21]. The relatively little diffusion of robots in society currently impacts acceptability factors such as attitudinal beliefs about the technology. Lack of familiarity also impacts how at ease people are with a technology and their need for information in order to understand how it can be useful to them.

#### *2.1.4 What is different about social robots?*

The acceptance of robots is also impacted by the additional features that robots possess in comparison to traditional technologies. Robots are embodied devices that share the space with their users. Embodiment impacts how robots are perceived, and how people interact with robots and the type of relationship humans can build with them. OA prefer to interact with an embodied social robot rather than a computer screen [22].

Robots are also designed to behave and move more autonomously than traditional technologies. In addition, robots are designed with the intention to promote social interaction between themselves and the human user. These features impact their acceptability because the robot has a social presence and to be effective it must cause the human user to perceive it as a social identity. Variables including social presence and perceived sociability will be discussed further below in relation to the theoretical models that have used these concepts to explain and predict technology acceptance. Some examples of these models and how they have been used in research practice will now be presented.

#### **2.2 Models used to explain and examine robot acceptability**

#### *2.2.1 Traditional technology models of acceptability*

The Theory of Planned Behaviour was developed from the Theory of Reasoned Action [23]. This model proposes that people are influenced to behave in a certain way by making rational decisions about the personal and social outcomes that they anticipate as a result of their behaviour. This model may be helpful to explain the intention to use robots [4]. However, it cannot adequately explain the acceptance of robots, without being adapted. Because the decision to use robots can be impacted by emotional reactions rather than rational decisions [24].

The Technology Acceptance Model (TAM) [25] was derived to focus on the acceptance of computerised information systems in workplace contexts. TAM has been reported to explain 40% of variance in acceptance [26]. This model regards acceptance in terms of Intention to Use (ITU) the technology. Actual usage of the technology may or may not follow a potential user having ITU a robot. ITU is considered to be dependent on the user's attitudes towards the technology which is derived from their assessment of its Perceived Usefulness (PU) and on users' Perceived Ease of Use (PEOU). TAM was developed further [27] to include the impact of social influence, facilitating conditions, and habitual usage on technology acceptance.

The Unified Theory of Acceptance of Technology (UTAUT) offers a social psychological approach that can explain 70% of acceptance variance [27]. It uses constructs from eight previous theoretical models. It has four independent variables: performance expectancy, effort expectancy, social influence, and facilitating conditions. The independent variables affect the dependent variables: ITU and actual usage. Their effect on ITU and actual usage is moderated by gender, age, experience, and voluntariness of use. The UTAUT has been criticised as not being parsimonious and for combining highly correlated variables that provide an artificially high variance [4].

**21**

**Table 2.**

*Examining Social Robot Acceptability for Older Adults and People with Dementia*

All the traditional acceptance models cannot adequately explain the acceptance of robots as social actors and the social aspects of human-robot interaction. They can also not fully enable the evaluation of pleasure-orientated factors that are necessary to motivate people to use robots in voluntary non-working environments [4, 28].

The Almere Model was developed using experiments (n = 4) that involved three

The Almere model has been used to explore levels of acceptance and engagement with a humanoid robot, Matilda [7]. This study involved people with dementia (n = 115) living in care homes (n = 4). It used a mixed-method longitudinal experience in which the reactions of participants were coded (n = 8304) according to emotional visual behavioural and verbal engagement measures. Participants used Matilda in three repeated 4–6 hour stages of field trials and as a result of the feedback received from participants, Matilda was further developed and improved. The Model of Social Robot Acceptance was developed by expanding and adapting the theory of planned behaviour using some elements of the UTAUT and including factors relevant to robots [4]. This model utilises eight constructs that are summarised in **Table 3**. De Graaf's model regards users' attitudes as being comprised of both hedonic and utilitarian beliefs and it includes consideration of control beliefs and that people may use a robot, and any other assistive devise, due to habitual behaviour rather than making a rational decision to use it. This

robots, to test acceptance of social robots by OA (188) [19]. The Almere model extends and adapts the UTAUT. It has eleven constructs which are defined in **Table 2**. These constructs enable the measurement of acceptability to focus on aspects of the technology pertinent to social robots and the perception of humans towards them as autonomous embodied social entities. Heerink et al. [19] found that the model was strongly supported accounting for 59–79% of the variance in usage intentions and 49–59% of the variance in actual use. However, this was achieved using equation modelling on four separate databases without confirming their similarities [4]. It has also been suggested that users' beliefs about their self-efficacy to use and control the

*DOI: http://dx.doi.org/10.5772/intechopen.98365*

*2.2.2 Acceptance models adapted for social robots*

robot are underrepresented in the Almere model [18].

**Construct Definition**

Anxiety Evoking anxious reactions when using the robot. Attitude Positive or negative feelings about the robot.

Intention to Use The outspoken intention to use the robot over a long period. Perceived Usefulness The extent to which a user thinks a robot will be helpful. Perceived ease of use The degree to which the user believes they can use the robot. Perceived enjoyment Feelings of pleasure associated with the use of the robot. Social Presence The experience of sensing a social entity when interacting. Perceived sociability The perceived ability of the robot to perform sociably. Trust The belief the robot performs with personal integrity. Perceived adaptability The perceived ability of the robot to be adaptive.

Facilitating conditions Factors in the environment that facilitate using the robot.

*Constructs in the Almere Model (Adapted from Heerink et al. [29]).*

Social Influence The user's perception of what other people think about them using the robot.

All the traditional acceptance models cannot adequately explain the acceptance of robots as social actors and the social aspects of human-robot interaction. They can also not fully enable the evaluation of pleasure-orientated factors that are necessary to motivate people to use robots in voluntary non-working environments [4, 28].
