**2.4 What is likely to increase robot acceptability for OA and people with dementia**

Robot acceptance is increased through personalisation of the robot, to make it meet the needs and preferences of the user and support their personhood [7, 14, 17, 44]. Personhood has been defined as 'a standing or a status that is bestowed on one human being by another, in the context of relationship and social being' [59] p.8. For example, the acceptability of the robot Maltida was increased due to personalisation that supported personhood, through the robot using human-like emotive expressions and accounting for the user's disabilities [7]. Other ways to support personhood and increase the acceptability of a robot is if the robot enables the OA and person with dementia to feel empowered, respected, and able to participate in activities that are meaningful to them [6, 10].

It is well recognised in current discourses about dementia care, that people with dementia do not experience a 'loss of self' as dementia progresses [39]. Whilst a person's identity, and personality may change, a person's central being, core values remain [39] and people with dementia maintain the potential to adapt and grow [38]. It is not enough to discern the requirements of the robot user on one occasion and personalise the robot. To ensure ongoing acceptance of the robot, there must be ongoing review and adaptation of the robot as the person uses it over time. The investigation with MARIO described above found that the creation of meaningful activity was made possible through a skilled facilitator and person with dementia working in partnership to use the robot in a way that was meaningful to the user [6]. Facilitators learned about the user's preferences and used the robot creatively in ways that were not identified before usage, even though MARIO was initially

*Collaborative and Humanoid Robots*

was sociable.

introduced.

participants about their schedule and health-promoting activities in the presence of guests. Furthermore, how acceptable individual users find a robot depends on the

The personality of the user, their interests, and values impact their response to a social robot and their perception about its social presence [9]. Rossi et al. found that having the personality trait of 'openness to experience' positively impacted the human-robot interaction. This study used a prototype of the humanoid robot Pepper to investigate if personality traits and user's empathy (a feature of personality) impacted the acceptance of a robot-led cognitive test. Participants were OA (n = 21; aged = 53–82 with average of 61). Acceptance of the robot was assess using, the UTAUT constructs and a psychologist evaluated personality traits, empathy, using the NEO Personality Inventory-3 (NEO-PI-3) [47]; the Empathy Quotient (EQ ) [48]. After the psychological evaluation, the robot administered to participants psychometric tasks of the MoCA [49], and in a second task the person performed activities whilst Pepper monitored them. Dialogues of the participantrobot conversation and videos of the interaction were captured by Pepper. Rossi et al. found that empathy correlates with the amount the user perceived that the robot

People with dementia can experience volatility in their mood and difficulty regulating their emotions [39]. Variations in mood are likely to impact robot

acceptability [28]. When MARIO was being used by people with dementia, who had moderate and severe dementia, facilitators had to support participants to enable them to be ready to use the robot [6]. If participants were disorientated in time or space, facilitators had to acknowledge their perception of reality at that time and help the participants to deal with whatever was causing their anxiety. For example, at the start of one session with the robot, the participant welcomed MARIO and the facilitator into her room in the nursing home, but she was concerned, believing erroneously that a person had been into her house without her permission. This participant was not ready to use MARIO until she was calmed as a result of talking

OA and people with dementia are also motivated to use a robot if they find that interacting with it is enjoyable [19, 41, 50]. Novelty effects may enhance the enjoyment of robot usage initially, but these can decrease over time [46, 51]. How robots can be used to sustain a person's enjoyment and its relevance to their needs and capabilities, are discussed below. But first, the factors involving significant others and wider society that impact an individual's motivation to accept robots will be

The perceptions of significant others, particularly caregivers can have a substantial impact on robot acceptability. Significant others, as social influences, are strong predictors of the adoption of home healthcare robots [52] and the ITU the Kompai robot [53]. Significant others can enable the usage of robots through encouragement and facilitation [6, 53] or they can impede a robot's implementation into care settings [36, 44]. There is substantial evidence that professional health and social caregivers may have negative preconceptions about the use of robots for OA and people with dementia [44]. Caregivers may be concerned about the compatibility of robots with their work processes [41]. Casey et al. [8] explored the perceptions and experiences of using MARIO with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13) in UK, Italy, and Ireland. They found that although MARIO was positively received by most of the participants, some formal care workers voiced concern that robots might replace care staff.

with the facilitator and being reassured that all was well [6].

*2.3.2 Factors that involve significant others and wider society*

individual person, the purpose of the robot, and the context [14].

**26**

#### *Collaborative and Humanoid Robots*

personalised for each individual using information obtained from each person with dementia, their caregivers, and relatives. For example, the following conversation was observed between a participant, Margaret, who had moderate dementia, and a facilitator whilst they used MARIO's applications. It illustrates how new knowledge of a participant's interests were used to further personalise MARIO.

The facilitator and Margaret were chatting through the photographs then Margaret chose the music application.

*Margaret 'It's very good', looking at MARIO's face while the music is playing for 1 minute and then she says, 'I would like to get home'.*

*Facilitator 'Yes. Does the music remind you of something?'*

*Margaret 'I would like to do that myself … .. the same as other people'*

*Facilitator 'You'd like to be more independent?'*

*Margaret 'Yes (pause) … Do you like the music?'*

*Facilitator 'Yes, it's lovely … ..does it remind you of something?'*

*Margaret 'Jeanie of the light brown hair'.*

*Facilitator 'Is that a song?'*

*Margaret 'Yes'*

*Facilitator 'Would you like MARIO to play it?'*

*(OME Margaret Session 10, [6]).*

Another way in which robots may be made more acceptable is if their investigation, design, development, and deployment are guided by models of gerontology that focus on the strengths and abilities of OA and people with dementia, rather than their disabilities. New ways of using robots may be possible if the lens of successful aging or resilience as strength-based models of care are applied to social robots [6, 44]. Such models would facilitate the development of guidelines and protocols for robot usage that aim to ensure the autonomy and dignity of OA and people with dementia are upheld [12] and that their priorities and goals are central to the robot design and usage.

The robot's physical appearance, behaviour, and communication style, and ability, combine to impact the robot's social presence and perceived sociability. There is huge variability in the optimal appearance of social robots [14]. But, robot acceptability will increase when robots are technically improved and able to behave and communicate in a convincing human-like way [14]. To support human communication, robots need to: enable a convincing emotional exchange; understand the user's intention; and provide complementary reactions [28]. This is because people anthropomorphise about a robot [60] and want this autonomous embodied presence to be compatible with human norms of behaviour, (or that of an animal if it is a zoomorphic robot). There is some evidence that OA are more likely to regard robot interaction as pleasurable if robots are designed to display positive emotion [28]. However, the user must interpret that the robot behaves in a way that is compatible with their status and is appropriate for the psych-social context [61, 62].

**29**

impaired.

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

Cobot or collaborative robots are currently being developed and used in the manufacturing industry. These robots are designed to move and perform delegated repetitive tasks, working alongside humans. Unlike other robots, Cobots can be taught by human users through example, rather than through programming. As such they are intended for direct human-robot interaction, to be used in a shared space in close proximity to humans. They can be smaller, more mobile, and they are reputedly safer than their traditional robotic counterparts [63]. No research to date has explored the usage of collaborative robots in health and social care settings. However, it may be possible to design collaborative robots that support the independence of people with dementia and older adults and that support the work of human caregivers. As discussed above, one of the moral and ethical objections to using robots in the health and social care setting is that human-human contact will be reduced. Because collaborative robots work alongside human workers, as a tool, these fears may be mitigated. In addition, the ability to learn by example could make collaborative robots easier to use in a clinical and practical context by people who don't have programming capability. Collaborative robots have the potential to be used more flexibly in response to the individual needs of users and to meet their requirements as these needs change. It has been argued above that flexibility, attention to individual needs, and ease of use, are key requirements for robots to be acceptable to users in the health and social care context. Collaborative robots could potentially help individuals, alongside the care provided by humans, to take food and drink and to perform other daily living activities. Indeed, the collaborative element of cobots could also improve the person-centred usability of other robotic and non-robotic devices that currently assist the movement of people who are physically

The acceptability of all robots will be enhanced if robots are designed, developed, and deployed with the significant, early, and repeated input of OA, people with dementia, and significant others, including health and social care professionals. All these stakeholders need to work in partnership with researchers and developers, in participatory design processes [11] so that robots are optimally relevant and able to meet the needs of users. Iterative participatory design was used in the development of the robots Matilda and MARIO. Both robots were improved and customised to meet the needs of people with dementia with prolonged, iterative phases that involved the assessment of needs [64], development using the feedback

There have been some developments that will facilitate the participation of stakeholders in research and will encourage a focus on issues of safety and ethics [44]. A European Commission framework requires that users, innovators, and society mutually interact and engage in processes that are transparent so that products are developed to be acceptable, sustainable, and desirable [65]. Dementia-specific developments have also been advanced. For example, in Europe, the Alzheimer's Society has produced comprehensive guidelines on how the ethical challenges of involving people with dementia in research can be managed [66] and best practice guidelines have been produced [67]. In addition, a European funded project (prospero.via.dk/en) is also underway that aims to understand what health and social care professional needs regarding robotic technologies and how caregivers

Very few longitudinal studies have investigated robot acceptability [14, 20]. Robot acceptability will also improve if developers and researchers consider, in-depth, the context into which the robot is going to be deployed. The technology must be examined in the context it will be used, with longitudinal research designs [44], for over two months [4]. An in- depth understanding of the context, including the needs and motivations of all stakeholders, will also be facilitated by

of users, and testing in clinical environments [7, 8].

can contribute to the development of robots.

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

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

Cobot or collaborative robots are currently being developed and used in the manufacturing industry. These robots are designed to move and perform delegated repetitive tasks, working alongside humans. Unlike other robots, Cobots can be taught by human users through example, rather than through programming. As such they are intended for direct human-robot interaction, to be used in a shared space in close proximity to humans. They can be smaller, more mobile, and they are reputedly safer than their traditional robotic counterparts [63]. No research to date has explored the usage of collaborative robots in health and social care settings. However, it may be possible to design collaborative robots that support the independence of people with dementia and older adults and that support the work of human caregivers. As discussed above, one of the moral and ethical objections to using robots in the health and social care setting is that human-human contact will be reduced. Because collaborative robots work alongside human workers, as a tool, these fears may be mitigated. In addition, the ability to learn by example could make collaborative robots easier to use in a clinical and practical context by people who don't have programming capability. Collaborative robots have the potential to be used more flexibly in response to the individual needs of users and to meet their requirements as these needs change. It has been argued above that flexibility, attention to individual needs, and ease of use, are key requirements for robots to be acceptable to users in the health and social care context. Collaborative robots could potentially help individuals, alongside the care provided by humans, to take food and drink and to perform other daily living activities. Indeed, the collaborative element of cobots could also improve the person-centred usability of other robotic and non-robotic devices that currently assist the movement of people who are physically impaired.

The acceptability of all robots will be enhanced if robots are designed, developed, and deployed with the significant, early, and repeated input of OA, people with dementia, and significant others, including health and social care professionals. All these stakeholders need to work in partnership with researchers and developers, in participatory design processes [11] so that robots are optimally relevant and able to meet the needs of users. Iterative participatory design was used in the development of the robots Matilda and MARIO. Both robots were improved and customised to meet the needs of people with dementia with prolonged, iterative phases that involved the assessment of needs [64], development using the feedback of users, and testing in clinical environments [7, 8].

There have been some developments that will facilitate the participation of stakeholders in research and will encourage a focus on issues of safety and ethics [44]. A European Commission framework requires that users, innovators, and society mutually interact and engage in processes that are transparent so that products are developed to be acceptable, sustainable, and desirable [65]. Dementia-specific developments have also been advanced. For example, in Europe, the Alzheimer's Society has produced comprehensive guidelines on how the ethical challenges of involving people with dementia in research can be managed [66] and best practice guidelines have been produced [67]. In addition, a European funded project (prospero.via.dk/en) is also underway that aims to understand what health and social care professional needs regarding robotic technologies and how caregivers can contribute to the development of robots.

Very few longitudinal studies have investigated robot acceptability [14, 20]. Robot acceptability will also improve if developers and researchers consider, in-depth, the context into which the robot is going to be deployed. The technology must be examined in the context it will be used, with longitudinal research designs [44], for over two months [4]. An in- depth understanding of the context, including the needs and motivations of all stakeholders, will also be facilitated by

*Collaborative and Humanoid Robots*

Margaret chose the music application.

personalised for each individual using information obtained from each person with dementia, their caregivers, and relatives. For example, the following conversation was observed between a participant, Margaret, who had moderate dementia, and a facilitator whilst they used MARIO's applications. It illustrates how new knowledge

The facilitator and Margaret were chatting through the photographs then

*Margaret 'It's very good', looking at MARIO's face while the music is playing for 1* 

Another way in which robots may be made more acceptable is if their investigation, design, development, and deployment are guided by models of gerontology that focus on the strengths and abilities of OA and people with dementia, rather than their disabilities. New ways of using robots may be possible if the lens of successful aging or resilience as strength-based models of care are applied to social robots [6, 44]. Such models would facilitate the development of guidelines and protocols for robot usage that aim to ensure the autonomy and dignity of OA and people with dementia are upheld [12] and that their priorities and goals are central

The robot's physical appearance, behaviour, and communication style, and ability, combine to impact the robot's social presence and perceived sociability. There is huge variability in the optimal appearance of social robots [14]. But, robot acceptability will increase when robots are technically improved and able to behave and communicate in a convincing human-like way [14]. To support human communication, robots need to: enable a convincing emotional exchange; understand the user's intention; and provide complementary reactions [28]. This is because people anthropomorphise about a robot [60] and want this autonomous embodied presence to be compatible with human norms of behaviour, (or that of an animal if it is a zoomorphic robot). There is some evidence that OA are more likely to regard robot interaction as pleasurable if robots are designed to display positive emotion [28]. However, the user must interpret that the robot behaves in a way that is compatible with their status and is appropriate for the psych-social context [61, 62].

of a participant's interests were used to further personalise MARIO.

*minute and then she says, 'I would like to get home'.*

*Facilitator 'You'd like to be more independent?'*

*Margaret 'Yes (pause) … Do you like the music?'*

*Margaret 'Jeanie of the light brown hair'.*

*Facilitator 'Would you like MARIO to play it?'*

*Facilitator 'Is that a song?'*

*(OME Margaret Session 10, [6]).*

*Margaret 'Yes'*

to the robot design and usage.

*Facilitator 'Yes. Does the music remind you of something?'*

*Margaret 'I would like to do that myself … .. the same as other people'*

*Facilitator 'Yes, it's lovely … ..does it remind you of something?'*

**28**

triangulating the data from multiple data sources that include qualitative research methods [4, 6]. Currently, robot acceptance is mostly measured using indirect methods such as questionnaires, and interviews, rather than direct observation during human-robot interactions [20]. Observational 'in the moment' methods are particularly advantageous to understand the experiences of people with dementia, who may not recall accurately and in detail, their experiences after interactions have taken place. Furthermore, people with severe dementia may be unable to use questionnaires, and reliance on proxy recordings of their attitude and beliefs [12] may not be accurate.
