=Paper=
{{Paper
|id=Vol-1582/11Baez
|storemode=property
|title=Personalized Persuasion for Social Interactions in Nursing Homes
|pdfUrl=https://ceur-ws.org/Vol-1582/11Baez.pdf
|volume=Vol-1582
|authors=Marcos Baez,Chiara Dalpiaz,Fatbardha Hoxha,Alessia Tovo,Valentina Caforio,Fabio Casati
|dblpUrl=https://dblp.org/rec/conf/persuasive/BaezDHTCC16
}}
==Personalized Persuasion for Social Interactions in Nursing Homes==
https://ceur-ws.org/Vol-1582/11Baez.pdf
Personalized Persuasion for Social Interactions in
Nursing Homes
Marcos Baez, Chiara Dalpiaz, Fatbardha Hoxha, Alessia Tovo,
Valentina Caforio, Fabio Casati
Dipartimento di Ingegneria e Scienza dell’Informazione,
University of Trento, Italy
{marcos.baezgonzalez, chiara.dalpiaz, fatbardha.hoxha,
alessia.tovo, valentina.caforio, fabio.casati}@unitn.it
Abstract. This paper presents our preliminary investigation and approach
towards a mixed physical-virtual technology for stimulating social interactions
among and with older adults in nursing homes. We report on set of surveys,
apps and focus groups aiming at understanding the different motivations and
obstacles in promoting social interactions in institutionalized care. We then
present our approach to address some of the key themes found, e.g., the
technological disparity, lack of conversation topics and opportunities to
interact.
Keywords: social interactions, older adults, nursing homes, persuasion
strategies
1 Context and Motivation
The transition to residential care is one of the most difficult experiences in the life of
elderly and the family, requiring the adaptation to a completely new personal and
social context [6]. Family involvement, and especially maintaining an emotional
bond through visits and family updates, is important to preserve the resident’s sense
of stability and connectedness along this process [5]. Social integration with peers is
also largely regarded as beneficial. Connecting to others helps in the adaptation, can
foster friendships and sense of belonging, and has been found to be one of the key
elements contributing to the quality of life in residential care [1]. In contrast, failing to
keep socially active contributes to feelings of loneliness, boredom, and helplessness,
regarded as the plagues of nursing home life [12, 7].
Different physical, psychological and contextual factors influence the opportunities
and motivations of older adults to interact with others. Poor physical health and
mental illness can pose a barrier to participating in social activities thus contributing
to social isolation [3]. People with poor psychological resources, socially intimidated,
or with fear of intimacy might also find difficulties developing relationships and
feeling connected [13, 11]. Other factors such as kinship and social network closeness
have also been found to be related to level of visits and calls by family [10]. All these
factors explain the effectiveness of interventions aiming at reducing social isolation
targeting specific groups [2].
Copyright © by the paper’s authors. Copying permitted for private and academic
purposes.
In: R. Orji, M. Reisinger, M. Busch, A. Dijkstra, A. Stibe, M. Tscheligi (eds.):
Proceedings of the Personalization in Persuasive Technology Workshop, Persuasive
Technology 2016, Salzburg, Austria, 05-04-2016, published at http://ceur-ws.org
102 Personalized Persuasion for Social Interactions in Nursing Homes
Technology supporting social interactions in this context has largely focused on
enabling social interactions, exploring technologies ranging from email and video
calls to social networks [8], without considering the personal traits and the context
that determine the user intentions, abilities and motivations to interact.
In this research project we aim at addressing the above scenario by providing the
technology that can enable and motivate social interaction of the nursing home
residents with peers and family. We recognize the potential of persuasion
technologies as an instrument to empower social interactions by creating sustainable
and more meaningful conversations. However, for the same reasons explained before,
we believe that the vision that “one-design-fits-all” would not be feasible [9], and
thus, we set to explore the tailoring of tools and persuasion strategies to the intentions,
motivations, preferences and needs of the various actors.
In what follows we report on the early steps towards this idea, with the design of a
tailored newspaper, where the content is generated semi-automatically with
contributions from older adults and family members, and that serves as a tool for
creating meaningful conversations and ultimately increasing the wellbeing of the
older adults and their interactions with children and grandchildren. The design
incorporates ideas from the reminiscence therapy and crowdsourcing, with tasks that
are sensitive to the motivations of the various actors. The project is in collaboration
with the leading technology provider for nursing homes in Italy and with the nursing
homes of the Trentino province in Italy.
2 Problem exploration
To gain a deeper understanding of the problem we developed and run a set of surveys,
apps and focus groups to get qualitative and quantitative information on
intergenerational interactions, with particular attention (for the focus groups in
particular) to interactions in institutionalized care.
A first survey aimed at understanding interactions (and, specifically, the reasons
for non-interaction) among young adults and their grandparents. We collected 100
responses from a convenience sample of university students in Trento, Italy. The
results show that
1. The majority of young adults have rather infrequent contact with some
grandparents (82% report physical and phone contacts of less than once a
week, 52% reports no contact at all in the last month)
2. The reasons for infrequent phone contact are lack of time (55%) and lack of
common topics of conversation (also 55%). 23% of respondents also cite
cognitive difficulties as a limiting factor as well as pain in thinking at the
relative in a physically or cognitively challenged condition.
A second survey focused on those cases where interactions with grandparents
was more frequent, to understand which are the activities they do together (in case of
F2F meetings) or which are the common topics of conversation. A similar
convenience sample also of 100 respondents, suggested that the most common
activities are eating and watching TV (69 and 43% respectively) followed by reading
about recent news, home activities (cleaning) and watching pictures. Common topics
Personalized Persuasion for Social Interactions in Nursing Homes 103
of conversations includes progress in school (70%), family news (68%), health
condition of the grandparent (55%), and food (41%).
An additional broader set of surveys asked young adults to look at their Facebook
posts and state for each of them if they would share them with their grandparents if it
was easy to do so, or if not, why. We collected results for over 2000 posts with
respondents from around the world, and the result we got quite consistently is that
younger adults would feel comfortable in sharing their picture-based posts (over 75%
of them) with grandparents. Only for less than 25% of the picture-based posts do
people feel that they prefer not to share for privacy reasons, that grandparents would
not understand them, or that would not be interested in them. The intention to share
went significantly down (to less than 50%) for posts related to link or status updates.
Given that interactions with grandchildren is a major source of joy for older
adults, this picture points to the need for stimulating interactions, and it suggests that
the key to doing so lies in i) creating common topics of conversation (with specific
ideas on which ones these may be, such as family news, photos, or food) and ii) trying
to initiate a “conversation” by making it, at least at first, almost quick and effortless
for young adults to interact.
Focus groups conducted in three nursing homes in the Trentino province with
staff and relatives helped understand more about the interactions among nursing home
residents as well as between residents and their children, who are often their primary
caretakers. What we learned is that:
1. Friendship relations are difficult in a nursing homes: people are not there by
choice and do not see things in common with the other residents, besides the
fact that they all need assistance and are in the same nursing home.
2. The primary caretaker spends a lot of time in the nursing home and visit very
frequently – often they do so daily. However, many members of the
immediate family (brothers or other children of the resident) are more absent
and this causes frustration and even anger in both the resident and the
primary caretaker.
3. Grandchildren rarely visit. This does not cause anger in the primary
caretaker, but the caretaker tries to involve them and make them interested
often failing to do so.
The take-home message from the focus group is that an opportunity to improve
the social interactions and quality of relations for people in nursing homes and their
families is to persuade other family members to visit. In addition, the large amount of
time spent by the primary caretaker in the nursing homes means that we have the
opportunity to “leverage” their presence there to facilitate IT-mediated interaction
with other family members even in the (quite common) case that the resident lacks the
cognitive ability to carry out the virtual interaction.
3 Users, groups, and objectives
From our survey and analysis of the literature we identified groups of users, the
behaviors that we need to motivate and the potential barriers that they face. These
aspects are summarized in Table 1.
104 Personalized Persuasion for Social Interactions in Nursing Homes
Table 1. Summary of desired outcome and constraints
Target behavior Constraints
Residents Physical interaction with Physical, mental or psychological factors,
peers lack of opportunities, lack of conversation
topics, perceived lack of common history
and topics of conversations
Children Virtual interactions with Distance, lack of time, suffering resulting
parents from seeing parents in difficult condition,
Physical interactions with disinformation, delegation of
parents (visits) responsibilities
Grandchildren Virtual interactions with Lack of time, lack of conversation topics,
the grandparents lack of awareness of the positive impact
For each group, different characteristics define their ability and willingness to
interact, which we take as the starting point:
- For residents in the nursing homes we are collaborating with, distinction is
made based on the type of care, defining subgroups such as intensive care,
Alzheimer and (semi)independent;
- Children behavior seems to be related to being the main caretaker in the
family, and
- Grandchildren, behavior seems to be related to previous living
arrangements, i.e., whether it was living with the grandparents, and distance.
All the above actors are clearly defined by particular interests (topics), which also
define the level of affinity.
4 Approach and work in progress
In this project we enable and stimulate interaction by combining:
i) Technologies for semi-automatically building a physical newspaper that
includes “family news” by enhancing and curating information available
from social networks
ii) Reminiscence techniques that, in addition to the intrinsic benefits of
reminiscence, give us a way to collect information helpful to find
common stories among residents
iii) Middleware technologies to simplify and mediate interaction among ad
hoc applications to be used in nursing homes with social network
commonly used by children and most of all by grandchildren.
The basic idea and usage patterns consist of collecting information (pictures, life
stories, etc) from older adults with the help of the visiting children (the primary
caretaker) or volunteers, through an application designed for this purpose. This
information is processed to find common aspects with the life of other residents
(people who lived the same experiences, or in the same city), thereby providing the
Personalized Persuasion for Social Interactions in Nursing Homes 105
opportunity for creating a bonding and initiating therefore a conversation. Information
semi-automatically obtained from social networks (typically from Instagram
accounts) of children and grandchildren can also be used to derive common topics of
conversation (through common aspects of the life of the children or grandchildren).
The usage scenario is illustrated in Fig. 1.
Fig. 1. Technological scenario of the approach
The newspaper is the primary interface towards the resident and is provided in
both physical and virtual form. It contains snippets of the life of relatives of residents
as well as reports on life in nursing homes and, weekly, feature stories about one
resident.
All news items are related to one or more residents and, where possible, point to
possible commonalities among residents. The newspaper is also meant as an
instrument that makes visit more fun and as a way to bond children (as commonalities
are also through children) so that they also are enticed to visit more often – especially
children besides the primary caretaker.
Finally, collecting pictures about life stories, and also enabling residents to view
and talk about what they see about grandchildren in the newspaper is also an
opportunity to involve grandchildren in a conversation, by probing them with snippets
of information or feedback through a channel they already use (chat software or
Instagram/Facebook), without the need of a new app on their side that they would
need to install and open.
In general, what we are aiming at is the creation of topics of conversations, the
creation of awareness of common history and common aspects in life, and the
reduction of barriers to interaction. These aspects play out differently for the three
target groups, with common history being instrumental to persuasion to “make
friends” among residents and to make visits more fun for children, and reduction of
barriers more oriented towards resident-grandchildren interaction.
We believe this technological support provides the environment that will enable
the different actors to develop stronger and more meaningful conversations. The
personalization we are aiming at, however, is not limited to content and activities, but
extends to the strategies that will enable sustainable contributions and interactions.
106 Personalized Persuasion for Social Interactions in Nursing Homes
Our hypothesis based on our preliminary work that includes a literature review,
surveys and focus groups, is that the support will range from simple enabler to
coaching mechanisms sensitive to the characteristics of the peers in a conversation.
Further studies will help us identify the subgroups of users, select the persuasion
strategies to use in the personalization, and understand what strategies work and for
whom.
Acknowledgements. This project has received funding from the European Union’s
Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie
grant agreement No 690962. This work was also supported by the project “Evaluation
and enhancement of social, economic and emotional wellbeing of older adults” under
the agreement no. 14.Z50.310029, Tomsk Polytechnic University." and by the
Trentino project “Collegamenti”.
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