Running head: INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES
I would use a fitness tracker that fulfils my needs!
User-centred design of motivating functionalities targeting active elderly to increase acceptance of wearable fitness devices
E. Oude Groote Beverborg | ANR u920033| SNR 2020901
Master’s Thesis
Communication and Information Sciences
New Media Design
School of Humanities and Digital Sciences
Tilburg University, Tilburg
Supervisor: dr. L. Elloumi
Second Reader: dr.ir. N. van der Laan
June 2019
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 2
Abstract
Background: In the broader research of wearables for elderly, wearable fitness devices
(WFDs) can benefit elderly by motivating them to become more physically active.
Unfortunately current WFDs are not suited for the elderly target group, due to different user needs.
Objective: The present study specifically dives into the motivating functionalities of a WFD by developing motivating functionalities, utilizing the self-determination theory, that would be accepted by the elderly target group.
Method: The study followed the 4 phases of user-centred design, with every phase answering one sub research questions and providing results as input for the next phase. The participants of the study were active elderly within the age group of 60 and 75 years. In phase 1, a related systems analysis was performed. In phase 2, user interviews were conducted with 5 participants.
In phase 3, the prototype was developed along with acceptance factors, two scenarios, and personas. In phase 4, the eHealth End-user Walkthrough was conducted with 7 participants to test the prototype for end user acceptance and gather feedback.
Results: Existing WFDs mainly motivate through goal setting and lack to support autonomy with motivating functionalities. It turned out that the elderly did not want to be motivated to move more through the WFD. This insight shifted the intent for the motivating functionalities from directly motivating to supporting the user. From the user interviews the need for a companion, a destination, and to be informed about self-health were set. The motivating functionalities (destination, buddy, and health functionality) were developed in an low-fidelity interactive prototype. The developed prototype was accepted (n=5). INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 3
Conclusion: Motivating functionalities targeted at elderly are better accepted when aimed at supporting the user. The found results can benefit future research on wearables for elderly and existing WFDs by including the elderly target group.
Keywords: wearable, physical activity, motivation, elderly, technology acceptance, UCD
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 4
Table of contents
Chapter 1: Introduction ...... 6 Chapter 2: Theoretical framework ...... 10 2.1 Wearable devices ...... 10 2.2 The use of wearables among elderly ...... 11 2.3 Measure acceptance of technology ...... 14 2.4 Motivate elderly to exercise ...... 20 2.5 Self-Determination Theory ...... 22 2.6 The research questions ...... 22 Chapter 3: Method ...... 24 3.1 Design of the study and ethics ...... 24 3.2 Phase 1: Related systems analysis ...... 25 3.3 Phase 2: User interviews ...... 26 3.4 Phase 3: Development ...... 28 3.5 Phase 4: EEW ...... 29 Chapter 4: Results ...... 32 4.1 Related systems analysis results ...... 32 4.1.1 Product functionalities ...... 32 4.1.2 Motivating functionalities ...... 33 4.1.3 Suited to be tested in the user interview ...... 34 4.2 User interviews results ...... 34 4.2.1 Elderly characteristics ...... 34 4.2.2 Elderly daily life ...... 36 4.2.3 Acceptance factors ...... 36 4.2.4 Motivations for being physically active ...... 36 4.2.5 Barriers for being physically active ...... 40 4.2.6 Motivating functionalities of existing WFDs ...... 42 4.2.7 User needs ...... 44 4.3 Development results ...... 44 4.3.1 Prototype development ...... 44 4.3.2 Personas & scenarios development ...... 45 4.3.3 Acceptance factors ...... 46 4.4 EEW results ...... 46 4.4.1 Buddy functionality ...... 46 4.4.2 Destination functionality ...... 48 INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 5
4.4.3 Health functionality ...... 51 4.4.4 The total prototype ...... 53 Chapter 5: Discussion and conclusion ...... 56 5.1 Summary of the results ...... 56 5.2 Discussion and theoretical implications ...... 57 5.3 Limitations and future studies ...... 60 5.3.1 Practical implications ...... 61 5.4 Conclusion ...... 62 References ...... 63 Appendices ...... 71 Appendix A: Phase 2 - User interview questions ...... 71 Appendix B: Study information and informed consent ...... 79 Appendix C: Phase 2 - Codebook user interview ...... 82 Appendix D: Personas and scenarios ...... 85 Appendix E: Screenshots of the prototype ...... 88 Appendix F: Phase 4 - User test interview questions ...... 91 Appendix G: Phase 4 - Codebook user test interview ...... 93 Appendix H: Related systems analysis ...... 95 Appendix I: Interview quotes of the participants daily life activities ...... 106
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 6
Chapter 1: Introduction
The world population is aging, in 2050 there will be 2.1 billion individuals over the age of 60
(United Nations, 2017; World Health Orgnization, 2015). This increase is largely due to improvements in health care which allow individuals to live longer. Meng et al. (Meng, Guo,
Peng, Lai, & Zhao, 2019) indicate that the growing elderly population will get in conflict with the limited medical resources. Mobile health (mHealth), which belongs to electronic health
(eHealth), is a dignified replacement to health care performed by medical experts, mHealth is able to assist with health care services and clinical interventions.
A part of mHealth are wearable devices (WDs), these allow the elderly to monitor their vital signs through the embedded sensors. The current study supposes that within the near future elderly will become increasingly dependent on WDs for health care. Such a device is convenient to use since it is able to collect personal biochemical, physiological, and physical activity information automatically (Dobkin & Dorsch, 2011). This information enables the user to gain personal knowledge about their own health and identifies irregularities to take appropriate action (Lazar, Koehler, Tanenbaum, & Nguyen, 2016). WDs’ ability to monitor an individual’s health without providing manual input makes them an excellent eHealth device for the elderly.
So far there is a lot of ongoing research into WDs for elderly such as monitoring health (Lutze
& Waldhör, 2017), detecting falls (Danielsen, Olofsen, & Bremdal, 2016), giving medication reminders (Deutsch & Burgsteiner, 2016), and stimulating physical activity (Changizi &
Kaveh, 2017).
This last mentioned type of WDs are wearable fitness devices (WFDs). These aim to prevent the elderly from low levels of physical activity. After all, physical activity decreases with age while the risk of diseases such as hypertension, diabetes and metabolic diseases increases with age. Luckily, maintaining an active lifestyle has a positive effect on the reduction of the risk of such diseases (Fausset et al., 2013; Sui et al., 2007; Wijsman et al., 2013). The INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 7
WFD can be helpful in becoming physically active through guiding and monitoring physical activity. The use of a WFD is proven to increase the physical activity of the elderly (Walden &
Sell, 2017).
WFDs (such as fitbit (fitbit, 2019a), Garmin vivosport (Garmin, 2019), and Samsung gear fit (Samsung, 2019)) or smart watches working with fitness applications (such as Google fit (Google, 2019), The activity app (Apple, 2019), and Endomondo (Endomondo, 2019)) measure the users’ daily physical activity. The WFDs have a number of sensors included, depending on the users need, like the number of steps taken, heart rate, calories burned, the number of floors climbed, and distance bicycled (Mackinlay, 2013). These current WFDs are generally targeted at the working age population and already physically active consumers
(Tedesco, Barton, & O’Flynn, 2017; Walden & Sell, 2017). Tedesco, et al. (2017) argue that the elderly population have different needs, and therefore question the usability of these WFDs among older users. These researchers concluded that the WFDs in the current form are not suited for older adults.
Warraich (2016) has found the current WFDs not to be competent for elderly.
Nevertheless it is needed to let the elderly accept these wearables to be able to develop healthy habits and routines before they enter the old age group. Previous studies identified difficulties among elderly using WFDs. Firstly, Fausset et al. (2013) studied the attitudes of elderly toward
WFDs. The study showed that over half of the participants did not see the technology as useful and stopped using the technology. This study recommends tailoring the devices to activities that older adults are most likely to do. Secondly, a large survey seized information of a broad group of participants including the elderly (Gartner & Forni, 2016). This study showed that individuals easily abandon their WFDs with a rate of 29% abandonment of smartwatches and
30% for fitness trackers. Overall the motivation for long-term use of a WFD is not present for everyone. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 8
The lack of motivation to continue use of a WFD is partly due to the lack of suited motivational affordances (Rupp, Michaelis, McConnell, & Smither, 2018). It has been indicated that the standard motivational affordances present in WFDs are not salient for all users. This research finding gives a possible explanation for abandoning wearables. The motivational affordances are functionalities of the WFD that are based on motivational theory to support the user’s needs or goals. A motivational theory commonly used to motivate physical activity is the self-determination theory (SDT). This theory uncovers the physiological needs of self- determination. Factors influence self-determined motivation through the satisfaction of three core psychological needs: autonomy, competence, and relatedness. When a WFD meets these needs, it will fully support the individual's self-determining needs and motivate individuals to engage in long term use (Ryan & Deci, 2000; Zhang, 2008). The need for autonomy causes the individual wanting to be in control and make meaningful choices. The need for relatedness makes the individual wanting to feel connected to others and have social support. The need for competence is the calling to be skilful, effective, meet challenges, and achieve goals (Rupp et al., 2018; Ryan & Deci, 2000). Wrongfully implementation of these needs may rather demotivate individuals and lead to disuse of the devices.
Existing research recognizes the positive effect of applying the SDT to WFDs for physical activity concerning the elderly. A study explored whether motivational messaging and feedback would increase physical activity by elderly (Parker et al., 2011). It showed that individualized motivational messaging and/or providing feedback results into an increase in physical activity. This shows the positive effect of having motivational affordances. Another research investigated whether the affordance of a social group would benefit elderly using and continuing to use a WFD (Walden & Sell, 2017). As a result having competition helped them to reach the set physical activity goal. Overall the affordance of a social group did benefit the elderly and has the potential to lower the abandonment rate of a WFD. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 9
So far it is proven that existing WFDs are not suited for and thereby not easily accepted by elderly. Also, no research has been executed on developing a WFD around the elderly target group. The current study is set up to develop motivating functionalities for elderly based on the
SDT and following the user-centred design (UCD) framework. The measurement of acceptance is used instead of the measurement of behaviour over long term use, since this is not a long term study. The use of the UCD is effective for developing a product for a specific target group. This study focusses on the active young elderly target group, this name refers to the younger tear of the elderly population ranging between 60 and 75 years of age who are physically active. From here on, the active young elderly will be referred to as elderly, to simplify the writing of this thesis. The active elderly are targeted because they will presumably provide more relevant insights and their lifestyle will better fit the use of a WFD.
This study researches the following research question: “What motivating functionalities determine the acceptance of WFDs by elderly?”. The results of this study provides a starting point for the future development of a WFD targeted at elderly.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 10
Chapter 2: Theoretical framework
This theoretical framework provides an overview of related research and concepts that will be used in this study. The concepts that are introduced in the introduction will be explained in a more detailed manner with in depth information. The relevant literature will be discussed to be able to make advised choices for the design of the current study. Inspiration and examples are given with the intention to be useful for the execution of this study. In this theoretical framework the following topics will be discussed starting with the origination of WDs, followed by the relation between elderly and WFDs, next different theories on how technology acceptance can be measured, then motivators for elderly to exercise, and lastly how the SDT can be of use in this study.
2.1 Wearable devices
This study focusses on WDs which are specifically developed to coach and monitor physical activity. To be able to address this type of WDs the term wearable fitness devices (WFDs) will be used when referring to wearables ranging from pedometers to smartwatches. The development of WDs started in 1980 (Sultan, 2015). Most of the early WDs had separate compartments for input (e.g. keyboard, camera) and output (e.g. glasses, monitor) and a characteristic bulkiness with no aesthetic appeal (Sultan, 2015). The pedometer became commercially available even before WDs started being developed. In Japan, the pedometer became commercially available in 1965 (Tudor-Locke, 2002). In the 1990s the electronic pedometers were found accurate on recording walking-generated activity. At that time, the pedometer was a small device that could be attached to the wearers belt. It had a display presenting the number of steps taken and a number of buttons to be able to start a new cycle of activity (Tudor-Locke, 2002). From the mid-2010s, the WFDs began emerging, with the fitbit
Flex in 2013 being the first wristband device of fitbit. Designed to track the number of steps taken, calories burned, activity intensity and sleep (Crawford, Lingel, & Karppi, 2015; Sultan, INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 11
2015). Alongside fitbit other companies started developing their own WFDs, the early devices worked together with a companion website that provided tailored feedback to the user.
Subsequently the WFDs had their own mobile application to provide tailored feedback and more information alongside the wristband. In general the WFDs promote goal setting and self- efficacy, through providing visual representations of activity data, and some of them provide a social connection (Mercer et al., 2016). Currently, the fitbit Versa is the latest fitbit version this device incorporates many new functionalities (e.g. hi-res touchscreen, smartphone notifications, guided breathing sessions) and functions as a watch (fitbit, 2018). This device proposes functionalities that could be of use in a WFD targeting elderly, for example a heart rate monitor, GPS-tracker, and guided workouts. This device is largely similar to smartwatches, because of the connection it has with the users smartphone. However a smartwatch can also be used as WFDs when a physical activity application is being installed. This research is focussed on the functionalities of the latest WFDs that have a touch display.
The current WDs that are targeting elderly are safety watches, for example Lively
(GreatCall, 2016), Tempo (CarePredict, 2017), Kanega Watch (UnaliWear, 2017), Wherecom
S3 (Omate, 2016), and WatchRx (WatchRx, 2017). The corresponding feature of the previously mentioned WDs is an emergency function that locates the elderly, establishes a connection with an relative or helpline, and provides emergency assistance. Next to that all the mentioned WDs have an accelerometer which is providing the taken steps. Only, this is the extent to which the monitoring of physical activity is being executed. As this indicates, none of the current WDs is having physical activity as main target or provide further guidance in physical activity. To my knowledge there is no current WFDs that is targeting elderly.
2.2 The use of wearables among elderly
With the rise of technological developments, there is an upcoming field of wearables that can benefit the elderly in health care. Whilst at the moment the actual use of wearables among INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 12 elderly is low. A survey performed by Islam, et al.(2017) shared insight into the use of WDs among elderly; only one third of the elderly population was found to be using wearables for monitoring step counts. The intended use among elderly of WFDs lays at the half of the elderly population. This shows that not too long ago the elderly where almost not using WFDs and a future rise of elderly using WFDs can be predicted. Besides these results a few years ago elderly showed to see the benefits of technology to support their health activities (Mitzner et al., 2010), the elderly acknowledging benefits from the technology shows that they have a positive view towards the use of technology. Overall, the WFDs are becoming widely adopted among the younger and adult population (Shih, Han, Shehan Poole, Rosson, & Carroll, 2015), it seems that the older population is falling behind. At the same time the step for elderly to adopt WFDs might become smaller, when they see the devices are broadly used among other populations.
Throughout the literature elderly are hardly using WFDs to stay physically active, although there are multiple indications that direct the elderly wanting to use WFDs in the near future.
Studies have been performed to identify the acceptance of WDs among elderly. The different studies have identified factors that contribute to the acceptance of WDs among elderly.
Firstly, Araullo & Potter (2016) have described the elderly to be resistive to technology in case when the benefits of using the technology have not been exposed. For example when elderly used fitbits with an initial doubtful view towards the technology. When the individuals started to see and believe that the use of the fitbit would be of benefit to their health their view changed to acceptance of the WFDs. This indicates that the need to be convinced of value is a predictor in the acceptance of WFDs. Secondly, a different study investigated the factors that are an influence on whether elderly do accept and therefore intend to use a WD (Li, Ma, Chan, & Man,
2019). They found perceived usefulness, compatibility, facilitating conditions, and self- reported health status indirectly predicting the intention to use of older adults toward WDs. For example self-reported health negatively influenced intention to use, since individuals with INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 13 poorer health are more eager to invest in their own health. Also a couple of factors that entail performance risk negatively influence perceived usefulness like privacy concerns and low measuring accuracy. Other variables that negatively influence acceptance of WFDs are found by Tedesco, Barton & O’Flynn (2017) and appear to entail the data that the device presents about its user. Stating that the given feedback can negatively influence the behaviour of the user, for example underperformance can demotivate the user. As discussed previous studies show a multiple of influential factors that are external to the WDs. The current research focusses on motivating the users from within the WFDs itself, but external factors also have to be taken into account. To sum up, when positive influencers of acceptance of WFDs are activated and the negative ones are repressed or resolved the elderly can fully accept the technology and start to use WFDs to guide their physical activity.
In the near future, the interaction between WDs and elderly will be increasing, due to the ageing population the medical care has to depend on technology to be able to take care of all patients. In 2019, over 2,5 million elderly of 65 years and older live in The Netherlands this group represents 19 per cent of the total population (CBS, 2018). The total world population aged 60 or above is growing with a roughly 3 per cent per year. The estimated number of older persons in the world is 1.4 billion in 2030 and 2.1 billion in 2050. In 2050 nearly all regions of the world will have a quarter or more of their populations at ages 60 and above (United Nations,
2017). This aging has a big impact on the medical care. To be able to handle the growing elderly population the medical branch needs to put from newly found technology to be able to manage the elderly patients. The use of WDs are naturally the most beneficial to the health of elderly, since they are able to monitor multiple vital signs. Next to those the benefits the use of a WFDs has should not be underestimated, managing your own physical activity in combination with blood pressure can already be of great help, since physical activity is a preventor in illness.
Taking previous studies in mind it seems likely when the WFDs are altered and in tune with the INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 14 elderly needs elderly will start to see benefits of using the WFDs and start using. Besides this, the focus on being healthy and living longer in combination with healthcare not being able to manage all patients as they have been doing up until recently, elderly are inclined to take responsibility and improve their own health. A simple device such as a WFDs can help tremendously.
2.3 Measure acceptance of technology
To be able to analyse, this study needs to be able to predict whether and which motivating functionalities lead to elderly accepting the WFD. A common model that is being used to predict if a technology product will be accepted is the technology acceptance model (TAM) originated in 1985 (Davis, 1985). Fred Davis notified the need for a valid measurement scale to be able to predict acceptance of technology. He proposed the technology acceptance model (TAM) as shown in figure 1. This model suggests the potential user’s overall attitude toward using a system to be the determining factor on whether he or she actually uses it. The model shows that attitude toward using was influenced by perceived usefulness and perceived ease of use.
Perceived usefulness is stated as "the degree to which a person believes that using a particular system would enhance his or her job performance"(Davis, 1989, p.320). Perceived ease of use is defined as "the degree to which a person believes that using a particular system would be free of effort" (Davis, 1989, p.320), this variable also has a direct influence on perceived usefulness.
At the start of this model both variables are influenced by system design characteristics, embodied by X1, X2, and X3 in figure 1. This model indicates that perceived usefulness and perceived ease of use are the strongest predictors of technology acceptance. This version of the
TAM model is not ideal to be used for analysis in this study. This state of the TAM model seems to be lacking variables that are specific for using WFDs or testing the acceptance among elderly. Also, this model is mostly used to test acceptance on technology in an organisational setting, this is not applicable to the WFDs. Lastly, this model is often used in a quantitative INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 15 setting using a questionnaire, this research is hoping to find actual feedback on certain features in the design and receive design recommendations a questionnaire is not the most straightforward approach to receive these. Therefore this type of TAM model is valuable, although cannot be used in this form within this study.
Figure 1. The original TAM proposed by Fred Davis (Davis, 1985, p.24).
A later version of TAM is the Unified theory of acceptance and use of technology
(UTAUT) model (Morris, Davis, Davis, & Venkatesh, 2003). The UTAUT was formed after testing eight previous models being the theory of planned behaviour (TPB), the technology acceptance model (TAM), a model combining TAM and TPB, the motivational model, the model of PC utilization, the social cognitive theory, the theory of reasoned action, and the innovation diffusion theory. Out of incorporating the eight above mentioned models the
UTAUT model was formed, to capture the most important elements of the previous models into one unified model. The UTAUT model as seen in figure 2. has three variables (performance expectancy, effort expectancy, and social influence) who influence behavioural intentions, together with facilitating conditions use behaviour can be predicted. The first variable performance expectancy defines the level to which the individual beliefs the system will be of use to generate a higher job performance. The second variable effort expectancy defines the INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 16 ease of use of the system. The third variable social influence measures to what extend an individual is informed by others that he or she should use the new system. Lastly facilitating conditions entail the belief of an individual to what extend an organizational technical infrastructure exists to support use of the system (Morris et al., 2003). The relationship between the four variables and use behaviour are moderated by gender, age, experience, and voluntariness of use. Because of its wide theoretical foundation the UTAUT model is set up to be able to test any technological system. A specific field where this model is adopted is mHealth the UTAUT model is also applicable when the acceptance of elderly towards mHealth systems are analysed (Hoque & Sorwar, 2017). Besides the original variables in the UTAUT model,
Hoque & Sorwar did find two other variables, technology anxiety and resistance to change, to be influencing behavioural attention to adopt mHealth services. The UTAUT model is able to predict whether an mHealth product will be accepted by its users. Nevertheless, mHealth is an overarching term for many technologies entailing health practices form telecommunication that falls in the sector of eHealth to the WDs the current study entail. Besides, mHealth does not entail one specific user group it entails all possible groups of users. It seems relevant to find a more specific model that is able to predict the user acceptance of WFDs. Overall TAM and
UTAUT provide a decent basis to be able to determine whether elderly will accept a WFDs
Figure 2. The UTAUT (Morris, Davis, Davis, & Venkatesh, 2003, p.447). INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 17 they might not be the most relevant to refer to. Luckily other studies did investigate how to analyse the acceptance of WDs.
Recently the smart wearable acceptance model (SWAM) (Li et al., 2019) was created the indicators that predict intention to use are partly sourced from the TAM and UTAUT models. The SWAM as illustrated in figure 3. is developed to suit the growing need for healthcare by the ageing population the goal is to enable technology to serve older adults better.
With this model elderly-specific factors that predict the acceptance of smart wearable systems are indicated. Besides this the factors have similar definitions to the definitions they had before
(in other models), the only change that was made is to change the general term “system” to
“smart wearable device”, this means definitions stay intact. The SWAM indicated the intention to use which measures the willingness of individuals to use the smart wearable systems. The
SWAM has seven factors (perceived social risk has no influence) that influence intention to use. Perceived ease of use does influence perceived usefulness which does influence intention to use. The facilitating conditions for elderly, which include cost and availability of technical support, are influencing perceived ease of use and intention to use. Compatibility for smart wearable systems is affecting perceived ease of use, intention to use, and perceived usefulness.
Social influence of smart wearable systems is affected by important family members and peers, and commercial advertisements and has an influence on perceived usefulness. Performance risk is whether the users trusts the technology of the system to be without technological flaws is influencing perceived usefulness. This model differs from the TAM and UTAUT models in regards to the focus field and focus user group. The SWAM is specifically directed to the elderly users and smart wearables. It is a suitable model that is able to effectively predict the intention to use wearables among older adults it has the ability to explain 68.7% of the variance in intention to use, 52,5% of the variance in perceived usefulness, and 36,4% of the variance in perceived ease of use (Li et al., 2019). Unfortunately, from the perspective of this study the INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 18 model does have a few downsides namely it has variables that are measuring constructs that are external of the smart wearable. In this study, the external factors are not being manipulated or tested and therefore have no use. Also, the definition of smart wearable system is similar to
WDs and WFDs, the only big difference is that the first includes all types of wearable that can be worn (e.g. smart t-shirt, skin devices) this is bigger than the wrist devices this study is investigating. Lastly, with the quantitative method this model entails it is not achievable to gather feedback to able to improve the specific product. The current study can use this model to have an indication of the external factors that come along when examining WDs on perceived acceptance by elderly.
*p < 0.05, ***p < 0.001; Two dotted lines indicating non-significant paths were added in
making all proposed factors shown in an integral model.
Figure 3. The smart wearables acceptance model (Li et al., 2019, p.167).
In line with the before mentioned models that are able to predict the acceptance of technology a method is proposed that can be used in user-centred design. This method is the eHealth End-user Walkthrough (EEW) (Van Velsen et al., 2018) (as can be seen in figure 4).
This method is useful in the design stage and when the product is being evaluated. This method INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 19 was specifically designed to suit electronic health products, eHealth are health services and information that are of service through the internet and related technologies. The EEW entails a preparation stage and the conducting of the walkthrough itself. During the walkthrough, a participant is presented with a simple prototype of the future technology and on the basis of the prototype its functionalities and interfaces are introduced. Directly after every introduction of a feature, questions about the acceptance factors are proposed in the form of an interview. At the end of the walkthrough the general factors (e.g. perceived usefulness, willingness to pay) are being questioned. As preparation, before the walkthrough a persona is created, the most important factors that potentially affect acceptance of the eHealth service are specified, a scenario is written about using the features of the product, a low-fidelity prototype is developed, and finally an interview is created with specific questions for each factor. This specific methodology is of use in this study because EEW is particularly suitable to use at the start of the development of a product in a user-centred design and can be used on a low-fidelity prototype. The preparation of this method allows finding the factors that are of importance for the elderly to accept WFDs. So far, a good indication of acceptance factors (such as perceived ease of use, perceived usefulness, and attractiveness) of WDs by elderly are given in previous research (Holzinger et al., 2010; Li et al., 2019). Besides this the EEW allows the user to accept or reject the main functionalities individually. This can be translated to which specific features should be in or out the product in order for it to be accepted. Also the feedback can be translated to alterations in the prototype. Further it can be defined whether features are considered to be a technology push for elderly or acceptable. Overall, with the EEW the acceptance of an eHealth application can be quickly assessed. This is a benefit due to the restricted duration of this study and will be the most profound method to use in the current study. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 20
Figure 4. The main stages of preparing and conducting an eHealth End-User Walkthrough.
2.4 Motivate elderly to exercise
Since the current study is developing motivating functionalities for a WFD that will stimulate the elderly to become more active, it is of relevance to investigate how elderly are motivated to do physical activity. Previous studies have investigated the motivational factors that do influence elderly to become physically active. The study by Markland & Ingledew (1997), has researched the general motivators women and men have to do physical activities, this study specifies the following motives: psychological, interpersonal, health, body-related, and fitness.
A study specifically directed to the motivations of elderly was performed by Stiggelbout et al.
(2008) in this study elderly were given opportunities to exercise in sports classes for elderly.
The motivation of these elderly to perform physical activity was placed in three groups the first one is relax and enjoy, the second one cure and care, and the last one competition. What can be taken from this research is the finding that individuals interested in different sports also have a different type of motivation and that the type of sport can be linked to a specific type of motivation. A different study (Beck, Gillison, & Standage, 2010) investigating the motivations for physical activity among elderly, specifically investigated retired elderly. This study found the following three motivations: the need for social connections, the desire to keep up lifelong fitness habits, and to find a sense of purpose and challenge. In another study investigating a fitness robot for elderly, it was found that the enjoyability of the system and value of the system positively affected intrinsic motivation (Fasola & Matarić, 2013). With this a broad overview of motivators that can be applicable to elderly using a WFDs to do physical activity is presented. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 21
On the other side of motivation a study has investigated what beliefs are demotivating physically inactive elderly (Vlachopoulos & Gigoudi, 2008). The specific types of exercise amotivation were in the following categories: capacity beliefs, outcome beliefs, effort beliefs, and value beliefs. The capacity beliefs defining the lack of self-efficacy, meaning not having sufficient physiological resources to be able to handle regular exercise participation. The outcome beliefs are the benefits the elderly expect to gain from physical activity, it is proven that physically inactive elderly naturally see more negative sides to exercising compared to physically active elderly. The effort beliefs are the negative perspective from elderly towards the effort and energy required to integrate physical activity in their lifestyle. Finally the value beliefs define the lack of value towards an activity to be a source of amotivation. Together these beliefs do form the Amotivation Towards Exercise Scale (ATES). As previously described the beliefs are quite wide and can entail multiple factors.
Concluding, previous studies have found motivating factors that motivate and demotivate elderly to be physically active. Many of these researches did not investigate the motivating effect of a technology on physical activity, but what motivations elderly have to do physical activity. Also what can be seen is that every specific target group has its own motivators that are found most important. The current study is attempting to find motivating functionalities that are most fitted in a WFDs targeting elderly. In this process the way in which the motivation is been applied is different in the sense that it will mostly be the functionalities of the technology motivating the elderly and targeting their intrinsic and extrinsic motivation and psychological needs. The motivations still arise from the individuals themselves only the technology is now been used to refresh the motivation. The current study has decided to conduct research along the Self-Determination Theory (SDT) to investigate what motivating functionalities best fit elderly to get motivated to do physical activity from a WFDs and make them accept the technology. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 22
2.5 Self-Determination Theory
The framework that the current study uses to assess which motivating functionalities the users need is the SDT. The theory ranges from intrinsic motivation to extrinsic motivation to amotivation. Where extrinsic motivation entail external forces of motivation (e.g. the wish to become healthier) and intrinsic motivation originates from a personal need or interest. Beside from the different types of motivation the SDT forms around three psychological needs namely: the need for autonomy, the need for relatedness, and the need for competence.
The current study focusses on using the SDT to be able to design suitable heuristics to enable the user to keep up their physical activity. Why the SDT is for example more suited to use as a guide than the self-efficacy theory is due to the reason that the latter theory only describes the psychological need of competence. Which means leaving out essential elements to be able to stay dedicated, being the need for autonomy and relatedness (Ryan, Patrick, Deci,
& Williams, 2008). Besides this the SDT is suited to structure the motivating functionalities in categories. It is claimed that when all psychological needs are satisfied, possibly through external motivators, intrinsic motivation will be maintained. This will improve exercise participation, result in more physical activity, and will make it easier to maintain exercising as part of your daily routine (Jones, Alicea, & Ortega, 2019; Ryan et al., 2008). Overall the goal is stimulate and maintain intrinsic motivation to stay physically active.
Overall it is of importance to let the WFDs stimulate all three psychological needs of the user. When these are accomplished and intrinsic motivation is maintained it will be easier for the user to stick to the guidance and stay physically active or improve on physical activity.
2.6 The research questions
To be able to justify the main research question “What motivating functionalities determine the acceptance of WFDs by elderly?” this research can best be subdivided into four sub research questions. This divides the research into the four subphases of the UCD as shown in the method. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 23
Every research question will be answered before continuing to the following phase, since the information and work developed in one phase are needed as input for the next one. However performing these phases in not strict to the chronological order, in the UCD process iteration is key and makes it always possible to go back and iterate. The following sub research questions will be answered:
1) What motivating functionalities do existing WFDs use?
2) What are the needs of the elderly for a WFD?
3) How can the motivating functionalities of the WFD be matched to the needs of the target
group (when considering SDT)?
4) Do the young elderly accept the WFD and the according functionalities that was developed
around their needs?
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Chapter 3: Method
3.1 Design of the study and ethics
This chapter presents an overview of the methods which were used. This study followed the
UCD process (ISO 9241-210, (International Organization of Standardization, 2010). In this method the needs, wants, and limitations of the sports watch end users were the focus in each stage of the UCD process. It allowed them to give insights and provide feedback in the early development stages. As an advantage, this user involvement makes it more likely that the final product will be accepted by the end users.
Figure 5. User-centred design process with implemented methods.
In each UCD phase, one sub research question was answered. Different methods were used in each of the four phases of UCD. Figure 5. presents the UCD process along with the used INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 25 methods. In this process the results of one phase were the input for the next phase. In phase 1, a related systems analysis was performed to gain insights on motivating functionalities of related existing WFDs. Then in phase 2, user interviews were conducted to identify the needs of the target audience. In the phase 3, different methods were used, personas, acceptance factors, and scenarios were developed. They will be used later for testing the prototype. Then the WFD prototype was build based on the functionalities of the scenario. In phase 4, EEW was conducted in order to evaluate the prototype. This method was able to test the acceptance of the elderly population in the early development of the sports watch. Within this thesis only one round of iteration was done, no iteration on the developed prototype was done after analysis.
Ethics
The procedure of the study and the data collection were approved in advance by the Ethics
Review Board (ERB) of the school of social and behavioural sciences of Tilburg University.
The participants were informed about the goal and intention of the study before recruiting and informed with the details and specific procedure of the study before taking part. At the first participation before the start the participants had the chance to ask questions. All participants signed informed consent agreeing to the terms of the research including audio taping the interviews. To be able to guarantee the privacy of the participants all data was processed anonymously.
3.2 Phase 1: Related systems analysis
Materials
The used materials were the official websites of WFDs brands and retailers.
Procedure
An analysis about related systems was carried out, started by selecting WFDs suited for analysis. These products were based on internet sources indicating that these WFDs can be used INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 26 by the elderly generation and finding the most recent version. Then, categories were set for the information needed from the analysis, followed by an accordingly analysis.
Besides this, the researcher has gained feeling for the WFD by using a fitbit for one week.
Data analysis
The collected data was categorized using the predefined categories and presented in an overview. Motivating functionalities of current WFDs were collected and arranged on occurrence and the category of SDT (competence, relatedness, autonomy).
3.3 Phase 2: User interviews
Participants
The target group of this study was the younger tear of the elderly population, aged 60-75 years named young elderly. In particular the elderly who are active were recruited. They were recruited through elderly walking groups in Tilburg. Two walking groups were visited at their coffee break and informed about the study. During this visit the elderly who were willing to participate provided their contact information. From this list of interested elderly, 5 participants
(1 men and 4 women M=70.60 years old) were invited for the interview. The inclusion criteria for the study where: the participant needed to be physically active and within the age group.
The first criteria was controlled for through recruiting from walking groups, the second criteria was controlled for at the collection of contact information. If participants did not fulfil these two criteria’s, they were excluded from the list of potential participants.
Materials
The interview schedule consisted mainly of open questions about general demographical data, the participants technology skills, physical activity behaviour, motivators and barriers of INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 27 physical activity, and the participants opinion about WFDs. The questions about existing motivating functionalities were combined with five user scenarios. The motivating functionalities were inspired by the existing WFDs from the similar product analysis.
Procedure
In this phase of the study interviews were carried out to collect insights from the elderly, to be able to from their needs for a WFD. The semi-structured interviews (Appendix A) were held with 5 respondents to identify:
- Their physical activity behaviour.
- Their motivations and barriers of physical activity.
- Opinions about existing motivating functionalities of WFDs.
- Opinions about WFDs.
The semi-structured interviews were individual and took place at the participants home. Before starting the interview the participant received the letter with study information and informed consent (Appendix B). With this, the participant got informed about the setting of the interview, what data would be collected and the voluntary nature of the study. The fact that the interview was audio recorded was pointed out, as well as the ability for the participant to quit the study at any time. After all questions were answered, the respondents were asked for informed consent.
Before the interview started, the participant was quickly introduced to the fitbit to get familiarized with WFDs and their functionalities. The interview started with questions about general demographical data and the technology use. Followed by questions about their current physical activity behaviour, their motivations and barriers of physical activity ending with their opinion about WFDs. Lastly the participant was guided through 5 scenarios (Appendix A) where a fictive user experienced different motivating functionalities that current WFDs have. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 28
The participants were asked what their reaction would be and whether such a functionality would motivate them to move more. The interviews lasted between 30 and 60 minutes.
Data analysis
The analysis of the interviews used codes, the codebook can be found in appendix C. The interviews were transcribed. The software Atlas.ti was used to analyse and code the transcripts.
At this phase the transcripts were coded by one researcher.
3.4 Phase 3: Development
Procedure
In this phase the persona, scenario, acceptance factors, and prototype were developed. The demographics of the participants in the interview were used to build two personas (male and female) representing the end users. The scenario portraying the personas life was elaborated using the motivating functionalities of the prototype. The acceptance factors were formed on earlier studies about technology acceptance in accordance with the results of phase 2.
These motivating functionalities were based on the analysed interviews of the previous phase. From this information, points were found in the sports routine were the elderly could need help, to answer the user’s needs. These insights were used to form three complementing motivating functionalities, each one supporting another category of SDT. The scenario tells how the user (persona) uses the WFD, to explain the functionalities to the participant. Based on this scenario the low-fidelity interactive prototype was build using the software ProtoPie.
Working out the scenario and the prototype were two simultaneous processes, whenever changes were made in the one the other needed to follow to match and be coherent.
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3.5 Phase 4: EEW
Participants
The fourth sub question is explored through presenting the prototype to a sample group of 7 elderly (1 men and 6 women M=72,71 years old). The sample was a mix of participants phase
2 and new participants; 3 from phase 2 and 4 new participants. The new participants were contacted through the collected contact details from previously recruited elderly. The inclusion criteria were the same as phase 2. Based on the study by van Velsen et al. (2018) 7 participants were judged as a decent number for this study.
Materials
Persona & scenario
Two sets of persona (Gerda and Joop) and 2 scenarios representing each persona (Appendix D) were used. The scenarios were used to help the participants better understand and imagine what the WFD prototype entails and how it can be used.
Prototype sports watch
The used prototype can be found under this link: https://share.protopie.io/iPCiLC6tLPo and screenshots and interaction between interfaces in appendix E. The prototype was simulated using a mobile phone.
Interview questions
The interview questions (Appendix F) questioned the acceptance factors that were determined in phase 3 and asked for feedback.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 30
Procedure
In this procedure the prototype was evaluated following the EEW method. The elderly were visited again at their home and the procedure of the user test was first explained to the participant. When the participant did not participate in the first round of the study, he/she got the information letter and informed consent. The EEW started by showing the prototype to the participant. The three main functionalities were presented and the interaction was explained.
After this quick introduction, the participant got acquainted with the persona acting as the main character of the walkthrough. This was done by reading together through the persona text and the researcher reading the text out loud. From here on the scenario started with reading the first part out loud. Then the participant explored this functionality by interacting with the prototype along the scenario. When the participant totally understood the treated functionality, the researcher asked the interview questions related to that function. This form of reading scenario, testing out the prototype, and interviewing continued two more times for each of the remaining functionalities. To finalize the EEW, the participants were asked their opinion about the acceptance factors regarding the entire prototype. The prototype test lasted between 25 and 35 minutes.
Data analysis
The interviews were analysed. The audio files of the interviews where transcribed. This data was analysed using codes, the codebook can be found in appendix G. The codes where assigned to the quotes of the interview using the software Atlas.ti.
Intercoder reliability was applied. The second coder did code two interviews of the user test. The second coder did agree on the existing codes. However he suggested to further specify the acceptance factors for every main functionality, to make it easier to write results for the INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 31 separate functionalities. This resulted into subdivided codes for usefulness, learnability, feedback, and intention to use for each of the three functions.
The two versions coded by the two independent researchers where compared and additions of the second coder where taken into consideration and sometimes implemented into the final version to provide a more complete analysis.
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Chapter 4: Results
4.1 Related systems analysis results
The analysed related systems were chosen based on two sources who recommended fitness trackers that are the best buy for elderly (The Best for Seniors Editors, 2019; Wilson, 2019).
From the recommended WFDs seven related systems with a well-known brand were chosen and the latest type was analysed. Table 1 presents the analysed WFDs:
Table 1. Related systems.
MOOV NOW (Moov Inc., 2018) fitbit charge 3 (fitbit, 2019) Garmin vívosmart 4 (Garmin Ltd., 2018b) fitbit inspire HR (fitbit, 2019) Garmin vívofit 4 (Garmin Ltd., 2018) Lively wearable (GreatCall, 2016) Samsung Gear Fit 2 (Samsung, 2019)s
Analysis was performed on the WFDs and corresponding applications on different categories: product functionalities, physical activity tracked, motivating functionalities, and product specifications. The complete related systems analysis can be found in appendix H. Most relevant to this study were the product functionalities and motivating functionalities, those results are presented in the following sections.
4.1.1 Product functionalities
The product functionalities were the general functions the WFDs and their corresponding applications offered. In table 2 the occurring functionalities and the number of WDFs with the function were presented.
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Table 2. Product functionalities.
Product Number of Product Number of functionality occurrences functionality occurrences Activity tracking 7 Guided exercises 2 Sleep tracking 6 Fall detection 1 Food tracking 3 Exercise calendar 1 Emergency support 2
4.1.2 Motivating functionalities
The motivating functionalities of a WFDs help the user to achieve his or her fitness goals, by providing incentives. The motivating functionalities of the related systems (table 3) were analysed on; the number of occurrences and placed in the corresponding category of the SDT.
In addition, some identified motivating functionalities did not fit within the SDT categories.
Table 3. Motivating functions.
Category Motivating function Number of occurrences Competence Goal setting 5 Daily/workout goal setting 5 Feedback 5 Workout coach 2 Reminders & notifications 2 Expert health advice 1 Relatedness Challenge others 5 Share exercise results 4 Give cheers & taunts 2 Groups 3 Leader board 2 Community 1 Autonomy Workout levels 2 Additional Reminder to move 5 Earning badges 2 Earning points 1 Cardio fitness level 1
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4.1.3 Suited to be tested in the user interview
Results from the analysis will be used in the user interview of the following phase. Five motivating functionalities: receiving a reward, notification after inactivity, receiving feedback, goal setting, and sharing achievements were chosen to be tested with the elderly during these interviews.
4.2 User interviews results
The interviews provided results in the following categories. Starting with the elderly characteristics and their daily life, both to be useful for developing the personas and scenarios in the next stage. Followed by their acceptance factors towards a WFD. Next their motivation and barriers to be physically active are given. Lastly, their opinions about whether an motivating functionality of existing WFDs would be motivating are presented.
4.2.1 Elderly characteristics
Five elderly, (1 men and 4 women) participated on the interviews, all Dutch. The mean age of the participants was 70.63 years and ranged from 67 to 73 years. All the participants lived at their own home. Two of the participants lived with their partner; two where widow; one was divorced. All participants were in pension, two were doing voluntary work (such as running a board and working for The Red Cross), and three where enjoying their retirement with having a hobby (such as listening to music, crafting, and playing games) and going on day trips. The mindset all participants shared was being retired liberated them from having compulsory activities, activities are only undertaken by their freewill.
The participants were all more or less using technology. All the participants had a mobile phone, four of them had a smartphone, and one had a GSM. Three participants had a activity tracker, one participant had a pedometer. Four participants were in possession of a INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 35 computer. The preferred technology was a laptop. In general the participants were not really in need for technology and were using technological products for practical reasons and communication. Two participants even felt like technology such as a WFD was not intended for them, but for the younger generation. Overall they saw the advantages and cannot live without the technological products they own, although their use was linked to certain moments and not throughout all day. Overall the elderly did have a hard time learning new technologies, luckily many of them (n=4) had relatives who were teaching and helping them.
As sports, the participants were walking (n=5), cycling (n=4), swimming (n=2), and going to the gym (n=1). In addition, the elderly mentioned sports they were not able to do anymore. Team sports such as football (n=1) and handball (n=1) where mentioned as well as racked sports (n=4). The participants did not have a particular goal in mind to be physically active, only to maintain their health. One woman had the goal to learn how to swim and another woman had the dream to do the four-day hike in Nijmegen. On average the five participants did about five and a half hours of sports every week, with sporting times ranging from two hours and three quarters to seven hours a week. The participants stated to walk together in a walking group (n=5). Besides the walking group elderly were sporting with a friend (n=2) or a relative
(n=4). All of the participants were satisfied with how much sports and physical activity they did.
Three participants shared that they were monitoring their physical activity; two with a mobile application; one with a WFD. Both WFDs and sports application were used for the same functionalities, namely to track distance, steps, and calories during the workout. Overall the participants only wore the sports watch when they were sporting and none of them used the
WFD with the matching application. Not all participants used their phone when sporting (n=3), due to accidentally or intentionally leaving the phone at home. A woman had a different manner INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 36 on monitoring her sports activity, she was using the provided data in sports machines at the gym (such as heartbeat, duration, and calories burned).
The participants who did use a sports application found two downsides when using it, namely their inconsistency in results and having to keep your mobile phone on you. Another participant had a functionality she would like to add onto the WFD. In her opinion it was a good idea if the leg cycles when cycling and number of arm and leg movements when swimming were also tracked. In general the participants did not have an absolute opinion about WFD because the product was not familiar to them. What they thought was the product not being intended for people their age, and the product being unuseful to them.
4.2.2 Elderly daily life
A number of selected daily activities (in appendix I) allowed understanding of the target user group. These results are useful for writing the scenarios in the next phase.
4.2.3 Acceptance factors
Throughout the interview the participants shared their concerns around using a WFD. These concerns were categorized into the following acceptance factors: usefulness, price, battery life, having use outside of a sports activity, and waterproof.
4.2.4 Motivations for being physically active
In the interview the elderly were asked for their reasons and motivation to be physically active.
The reasons were categorized into three different categories and different sub-categories (see table 4). All five participants gave health reasons, recreation reasons and practical reasons for being physically active. The health reasons were to keep moving (n=4), stay fit (n=1), manage condition (n=1), maintain mental health (n=1), stay healthy (n=1), and to maintain weight (n=1). INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 37
The recreation reasons were to be able to relax (n=1), socialize (n=3), discover (new) places
(n=4), and get outdoors (n=4). These answers showed that the elderly had many intrinsic motivations to move. This indicated that the elderly only moved for their wellbeing. Besides these two main motivators, the elderly also did move for practical reasons such as keeping the house organised and clean (n=5) and doing groceries (n=5).
Table 4. Reasons for being physically active.
Category Sub-category Citation Health Keep moving “Yes and to be in action and to live kind of healthy so to say. As reason far as that is possible.” (Female, 69 years) “Of course I find it good to keep moving” (Female, 72 years)
Stay fit “To be fit for as long as possible. For me that is the only reason.” (Female, 73 years)
Manage “Also to keep up my condition because I notice it when I skip a condition walk. That your condition is rapidly declining. In fact that is my biggest motivation.” (Female, 67 years)
Maintain “Well, I don’t get messed up in my head so easily. But when you mental health don’t feel good in your head then you should go sporting to empty it out.” (Female, 73 years)
Stay healthy “To stay healthy.” (Male, 69 years)
Maintain “Not get too heavy. When you only sit still and do nothing, then weight of course you will gain weight. Yes and that is what I do not want. “ (Male, 69 years) Recreation Relax “Yes because it also works relaxing of course.” (Male, 69 years) reasons Socialize “Yes also cosines and we have to become a member of the elderly association and those also offer activities that you can participate one. But there is not much in it for me.” (Female, 72 years)
Discover “So actually I come at places I would never come, If it was up to (new) places me.” (Female, 72 years)
Get outdoors “Yes and I cannot sit inside all day between these walls. That drives me crazy.” (Female, 69 years) Practical House “Yes out of necessity, not because I like it.” (Female, 72 years) reason keeping “Well, I do like it clean of course.” (Female,72 years)
Doing “I have to do the groceries myself. Then I will take a look and groceries decide for myself what I want to eat, that is just the way it is.” (Female, 73 years) INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 38
The physical activity motivations were organised based on the SDT and organized into the three categories and under different sub-categories (see table 5).
Autonomy:
The elderly mentioned their health (n=5) as a motivation for being physically active.
They knew that doing physical activity is good for their health and keeps them healthy. Some participants were motivated to be able to keep doing their favourite activities (n=2), they were aware that doing physical activities helped maintain their condition and mobility.
Competence:
Nearly all the participants were self-motivated to go sporting (n=4). Another motivator was the good feeling elderly got from the recreational aspect of physical activity (n=5).
Relatedness:
During the interviews there was one participant who stated that she was motivated to do physical activities because of her role models. Some participants were benefitting from having others convince them to go sporting (n=2). Then the last motivator was having a sports buddy
(n=3) (such as a relative, a friend or a sport group).
In addition, a factor that was mentioned multiple times, but did not belong to the SDT, was the weather (n=4). The elderly were more motivated to go for a walk or cycling when the weather was nice.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 39
Table 5. Motivations for being physically active.
Category Sub-category Citation Autonomy Health “Yes to maintain my fitness and mobility.” (Female, 67 years)
“After sporting you feel fitter than you did before.” (Female, 73 years)
Favourite “Yes, I would like to stay fit for as long as possible and to go activities cycling. I also go away a lot to visit a place for a couple of days. Then I go walking on the Veluwe or somewhere else with a couple of girlfriends. When you are not fit you can’t do any of that, that’s why.” (Female, 73 years)
Competence Self- “R: So I understand that you are mostly motivated out of motivation yourself to go sporting. There is no outside pressure? Female, 73 years: No there is totally nothing, I always did it myself, whenever I wanted to do it.”
“Yes, then I just have to do it. Then I say come on just do it. That is what I do then.” (Female, 72 years)
Recreation “Yes because it also works relaxing of course.” (Male, 69 years)
Relatedness Role models “So I have a sister and yes nowadays it is going a little better she can get without oxygen a little longer, but I see that she is sitting in the chair for the whole day. That something you can also see on her figure and that is an example for me and also for her own children. To see when you don’t do anything how you can turn out to be.” (Female, 72 years)
“But you also have examples that I see at the walking group. There are people aged 86 and when you see how good they are and can move well. Well I think that is fantastic!” (Female, 72 years)
Getting “When they say come along, it is not that bad. Maybe the convinced weather will be okay. Then she tries to convince me and I go with her again. So they can try to convince me when it is necessary. And in the end when it turned out to be not that bad I am happy I went along.” (Male, 69 years)
Sports buddy “So one time I feel more like going another time I don’t feel like it. I also go when I don’t feel like it. But then I do it for my partner so to say.” (Male, 69 years)
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 40
4.2.5 Barriers for being physically active
The elderly described the barriers they were experiencing, hindering them from being physically active. It was important to discover these barriers to be able to take them into account when prototyping. The WFD for elderly was possibly able to help overcome these. The mentioned barriers were categorized according to Wallace and Lahti’s (2005); physical barrier, psychological barrier, and environmental barrier (see table 6).
For the physical barriers, participants mentioned injuries (n=5) and illnesses, which stopped them from being physically active or forced them to give up a type of sports. For the psychological barriers, participants mentioned having conflicts with their regular sporting time
(n=2), having no time (n=1), not being in the mood (n=1), not knowing routes (n=1), and feeling too old (n=1). Two participants stated that sometimes they preferred doing something else instead of physical activity. For the environmental barriers, they mentioned the weather (n=3), the sports centre changing location (n=1), and not having a sports partner (n=3), and possible hazards and safety concerns (n=1).
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 41
Table 6. Barriers for being physically active.
Category Sub- Citation category Physiological Injury “Ehm, when I for example would have an issue with my feet barrier or something like that. When walking is not going easily, then I would decide not to go. Because, I think it is already a year ago, when I had a lot of pain at my feet. I turned out that I needed arch supports. So at that time I skipped multiple times, because I was not walking good.” (Male, 69 years) Illness “I had to be sick and so annoying that I can’t go.” (Female, 67 years) Psychological Another “No or we really have to had planned something else, but in barrier appointment principle we do take it into account. No in principle we are cancelling little.” (Female, 72 years) No time “But most of the times it is just lack of time.” (Female, 67 years) Not in the “When you had a very busy day for example or you had to do mood a lot of activities during the day […]. Then I am not able to get myself in the mood to go.” (Female, 72 years) Rather doing “Yes when for example I would like to do something else. something When I think I feel like watching that one concert or that else movie, that is what keeps me home, what I preferred doing better at that time.” (Male, 69 years) Not “I do live here now for five years. Because of that I am not knowing any able to come up with places to go walking.” (Female, 72 routes/spots years) Thinking “I think I am just too old for that.” (Female, 72 years) that you are too old Environmental Weather “When it is raining cat’s and dog’s than we of course would barrier not go.” (Female, 72 years) Sports “We used to do condition training with my sister in law on a centre different location, but then a closer establishment opened. But changing they did not do condition training as a group lesson. So we location would only have the machines and we did not like those that much.” (Female, 72 years) Not safe to “At a certain moment you have to be able to set borders. sport in a When you think that, with for example with cycling, I am not group that flexible and you are cycling in a group and have to step off your bike unexpectedly. That is than much harder with older people. Yes with electrical bikes and you are close together. There have been people falling regularly. In that case you have to be sensible and make the choice to stop.” (Female, 72 years) No sports “I don’t do individual sports at the moment, because that is partner when I drop out very fast. So I will do it with someone with me, than you will stimulate each other.” (Female, 67 years) “No, I don’t go more than necessary. Not like I am going for a nice round of walking. No, because I think that is so boring to do alone. No that’s not happening.” (Female, 72 years) INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 42
4.2.6 Motivating functionalities of existing WFDs
In the interview five different motivating functionalities of existing WFDs were presented along a scenario. Those were based on the discoveries in the related systems analysis. Based on the opinions the participants gave about the scenario it was decided whether this functionality would be useful. The participants also indicated whether this functionality would motivate them to be physically active or not. The motivating functionalities and the participants opinion can be found in table 7.
Overall, the elderly did not want to get motivated to move more. They have served their time working and taking care of others. They felt like now was their time to enjoy and to spend it the way they decided. They did not like to be told what to do or when to do it. The elderly did not want to set a goal before doing a walking or cycling exercise (n=3) (such as duration, distance or calories). Instead, they preferred to set a destination such as a café, a sight, or a particular point of nature as their goal. The reminders to get active after an inactive day, did not work well for the elderly (n=4). Because they did not like to get told what to do and felt like they were active enough. Then setting rewards such as badges or stars also did not work (n=4).
The stars did not add anything and the participants said not to get motivated by receiving stars.
Sharing achievements with friends and family (n=3) did not work for the elderly, they felt like the only valid reason to do physical activity was for yourself. The motivating functionality the majority was motivated by was receiving personal health information (n=4). The participants did feel motivated by this feature and shared that they would like to receive personal information. They were eager to receive tips about their health and nutrition.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 43
Table 7. Motivating functionalities.
Motivational Label Citation feature Receiving stars Neutral “For me that is not a motivator. It does not give the opinion motivation to go further or do more, no.” (Female, 72 years)
“Well, that does not add anything for me, because I will walk ten kilometres anyways. Whether I receive a star or not, that does not bother me.” (Female, 73 years) Motivated “When I am able to earn something? That is something that opinion would motivate me.” (Male, 69 years) Getting a Neutral “No it would not demotivate me but also not motivate me, physical activity opinion because at that moment I would decide for myself what to reminder do. Not when you think I have been reading all day, now I have to get active, no.” (Female, 72 years) Motivated “When there still would be a long enough time of day light, opinion I would experience this well. Then I would be tempted to go cycling. Because sitting inside all day is not good.” (Male, 69 years) Receiving Neutral “I think I am active enough, because I cycle to the city and personal health opinion to the grocery store. Not just a round for fun. I am not information comfortable doing that, because only the lonely is something that bothers me, so I don’t do that.” (Female, 72 years) Motivated “That is something that would motivate me a little. Yes you opinion know that it is good for yourself to keep physically active.” (Female, 72 years) Setting a sport Neutral “Well I never have such a goal. When I go walking, then I goal opinion just go for a walk. I don’t decide that I have to walk for a specific number of minutes.” (Female, 72 years) Motivated “I would do the same I think. You would not go, for opinion example you would decide to walk thirty kilometres or thirty minutes. When you are half way you do not decide to turn around, because then you would walk the same distance anyway.” (Male, 69 years) Sharing an Neutral “No, I never do that. No I don’t do that.” (Female, 73 years) achievement opinion “No then I would do it for myself, just for myself. In that case their pride would not matter. That is something I told them as well because when you do a walking route, walk it for yourself. No you do not walk it for others because when you are half way there and you regret that you started. But then you are walking it for someone else, while you would rather be doing something different. That does not motivate you to walk on.” (Female, 67 years) Motivated “I would do the same I think. I would also like to involve opinion others and show then what I achieved. I would be proud too and want to share it with people.” (Male, 69 years)
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 44
4.2.7 User needs
With the insights the user interviews provided the following user needs were formulated:
- Not wanting to get motivated to be (more) physically active.
- Be in control of your own decisions.
Generally these needs pointed out that motivating functionalities who directly motivate would not be accepted by the elderly target group and therefore transformed into the general need for the elderly to make physical activity easier. The specific points that the elderly could need help with were taken from the user interviews (barriers and motivating functionalities), resulting into the following needs:
1. The need to have a companion
2. The need to find a destination
3. The need to be informed about self-health
4.3 Development results
4.3.1 Prototype development
Every need was translated into a motivating functionality. 1. The buddy functionality, would help the elderly to find a buddy for their walks and bicycle tours. With this functionality the user can search for likeminded elderly in his/her environment and make a connection. The user can chat with his/her buddies to set an appointment for a sports activity. This functionality supports relatedness by having others to share your physical activity with. 2. The destination functionality, would help the elderly to find a destination as a goal for their walks or bicycle tours. By listing a couple of filters the user receives a list of suited destinations. When a destination is chosen this functionality is able to navigate the user to the destination. This functionality supports autonomy by giving choice to the user and allowing them to initiate their INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 45 own decisions. 3. The health functionality, monitors values of the users health (weight, body temperature, heart rate, and blood pressure). Based on these values the health functionality can indicate the health status of the user. This function supports the need for competence by providing feedback and tips about the health of the user. 4. The step counter, this is an additional functionality for the prototype. A step counter is found relevant by the elderly and completes this prototype. The function allows the user to count several physical activities (such as swimming, cycling, fitness, and walking).
The prototype can be visited and tried out under this link: https://share.protopie.io/iPCiLC6tLPo. The screenshots and interactions between interfaces can be found in appendix E.
The prototype was build using a low visual
fidelity with mostly greyscale colours. Icons,
headings, buttons, and lorem ipsum text were used
to make the prototype feel as complete as possible.
The prototype was developed using pen and paper
sketches followed by an interactive prototype using
ProtoPie. The design of the prototype was framed
into a smartwatch (as seen in figure 6) to simulate a
WFD. The prototype could be interacted with
through tapping and swiping.
4.3.2 Personas & scenarios development
Based on previous phase results two personas and
Figure 6. Sports watch prototype two scenarios (appendix D) were developed. screenshot. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 46
4.3.3 Acceptance factors
The acceptance factors were determined: usefulness, intention to use, and learnability for every functionality and the prototype as a whole. One extra acceptance factor was established for the product as a whole: target audience.
4.4 EEW results
The user tests provided output about the acceptance of the sports watch by active young elderly.
The user test focused on the results of the end-user acceptance and feedback on the prototype.
It gave insights about the users view of the acceptance factors for the three main functionalities and for the prototype as a whole. Next to that the appreciation towards the functionalities and the factors influencing the appreciation were analysed. Lastly, feedback was received, this is of great use for future iterations on the prototype.
4.4.1 Buddy functionality
Appreciation
All participants favoured having a buddy to sport with over doing sports alone. This was already observed in all the participants as they are members of an elderly walking group. Different reasons were formulated among the participants for appreciating the functionality (see table 8).
Some participants (n=4) appreciated it because it helps them to find a buddy to walk or cycle with. Two of them mentioned that this function would be handy if one of their current buddies had to cancel. Two of them found having contacts on their WFD an easy way to make a connection. Another participant appreciated the functionality as a way to contact buddies, not to connect with new buddies. This participant already had many buddies and too little time left to sport with a new buddy. Lastly some participants (n=2) did not appreciate the buddy functionality. One preferred going to the walking group to find a buddy over using the sports INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 47 watch. The other was not interested in walking on her own and therefore had no need in finding a buddy.
Table 8. Appreciation - Buddy functionality.
Label Citation Appreciation of the “Well whenever my usual walking buddy is ill or I last minute decide buddy functionality to go out and have not planned anything yet. That is when I would use that functionality.” (Female, 75 years)
“In this way I would always have someone to go walking with, so yes it would make me more active.” (Female, 67 years)
No appreciation of “So, on my own I am not looking for a person to walk with.” (Female, the buddy 72 years) functionality
The appreciation of the buddy functionality was influenced by multiple factors mentioned by the participants, table 9 presents the appreciation factors.
Table 9. Appreciation factors - Buddy functionality.
Factors positively influencing appreciation Factors negatively influencing appreciation • Always having a sports buddy (n=2) • Having fixed appointments (n=1) • Not wanting to walk alone (n=1) • Having many sports contacts (n=3) • Wanting to walk or cycle more often • People around me don’t have a sports (n=2) watch (n=1) • The sports watch making it more easy • Not searching for a sports buddy (n=1) to contact someone (n=3)
Acceptance factors
The participants were asked whether the buddy functionality would help them to be active. The given answers were used for the usefulness results of the buddy function giving that participants perceive the function as useful (n=4), a participant was unsure about the usefulness (n=1), and participants not finding this function useful (n=2). INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 48
The participants also gave their estimate on how easy or hard they would find it to learn to use the buddy functionality. Resulting in all participants being convinced to be able to easily learn how to use it.
During the interview the participants tried to estimate how much they would intend to use the buddy functionality. How many times the participants did intend to use the buddy functionality varied from three times a week to never. On average it is safe to say that the participants intended to use the buddy functionality once a week. Two participants found it hard to tell how many times they would use it, they would use it, but how many times would depend on multiple factors.
Feedback
One point of feedback was about the need for autocorrect and automatically completing sentences.
“Only my thick fingers. But here on WhatsApp in time, and I don’t know whether that function is possible, you will click one letter and you will get about one whole sentence. I makes it very easy.” (Male, 75 years)
4.4.2 Destination functionality
Appreciation
Currently not all participants had to find their own destinations for a walk or round of cycling, four participants were picking their own destinations. The appreciation of the destination functionality was mixed between participants (see table 10). Some participants (n=4) appreciated the function for both helping them find a destination and way finding. The rest
(n=3) did not appreciate the destination functionality, with two participants not needing to find a destination for themselves and one did prefer to use her current method for finding a destination. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 49
Table 10. Appreciation - Destination functionality.
Label Citation Appreciation of the “This functionality would help me with cycling both for finding a destination destination and wayfinding.” (Female, 67 years) functionality “Yes when I have a destination, no multiple destinations to pick from. Then you are more likely to pick one of those destinations. At a given moment I would go and set one of the destinations as a goal for a cycling route, I would like that.” (Female, 67 years)
No appreciation of “Also not because I never go cycling with a couple.” (Female, 72 the destination years) functionality “No I would not click on it because I live near a beautiful forest. I would not go further than that forest. Yes then I would go further to different destination, but for people who do like that it is indeed very easy. I call it a nice initiative.” (Female, 72 years)
The appreciation of the destination functionality was influenced by multiple factors mentioned by the participants, table 11 presents the appreciation factors.
Table 11. Appreciation factors – Destination functionality.
Factors positively influencing appreciation Factors negatively influencing appreciation • Being able to specify the type of • Not having to search for a destination destination (n=1) (n=2) • Having many ready to use destinations • Preferring to find a destination on to choose from (n=3) his/her own way (n=1) • Receiving directions (n=4) • Lack of inspiration (n=2) • Discovering new destinations (n=1)
Acceptance factors
The participants were asked whether the destination functionality would help them to be active.
The given answers were used for the usefulness results of the destination functionality. Some participants (n=4) perceive the functionality as useful, and other participants (n=3) do not perceive this useful. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 50
The participants also gave their estimate on how easy or hard they would find it to learn to use the destination functionality. Resulting in all participants being convinced to be able to easily learn how to use the destination functionality. The majority of the participants were able to use the destination functionality without any difficulty (n=6). Only one participant indicated to foresee difficulty when learning to use the navigation. That participant had a hard time doing wayfinding in general.
During the interview the participants tried to estimate how much they would intend to use the destination functionality. Overall the participants indicated to use the destination functionality for cycling and also for walking. On average participants (n=5) intended to use the functionality about once every two weeks, with intention to use ranging between participants from once a week to never. Besides this two participants could not specify intention to use with an amount. One participant indicated to use it regularly and another participant would use the destination functionality every time the participant went cycling.
Feedback
A point of feedback was about requiring more practical information about the route. For example, the WFD can clearly indicate bicycle café’s and charging stations for electrical bikes on the navigation.
“Does it also indicate that there are bicycle cafes on the route?” (Female, 73 years) “Okay so for when you feel like stopping during the route? No that is not yet the case.” (Interviewer) “Yes a cycling café where you can drink a cup of coffee and people can charger their electrical bike.” (Female, 73 years) “Yes so that that it is made more clear during the route.” (Interviewer) “Yes, because when I go myself I will always check that. Elderly people will have to go to the toilet on the route and like to drink something. We always stop for a cup of coffee or a bottle of soda.” ( Female, 73 years)
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 51
4.4.3 Health functionality
Appreciation
The health functionality (see table 12) was appreciated by participants (n=5) for the easy to reach health feedback it gave them. The other participants (n=2) did not appreciate the health functionality. One participant did not find the functionality useful and did not want it. The other participant thought this functionality would not help.
Table 12. Appreciation - Health functionality.
Label Citation Appreciation of the “Yes because now with everything I think. I have to measure my blood health functionality pressure and you don’t know that. To do that you need to go to the doctor or the pharmacy. Well, I hate to do that” (Female, 73 years)
“When I see that I get good results, so for my heartrate and blood pressure and such. That is nice to know.” (Female, 75 years)
No appreciation of “I am currently doing swimming lessons and I am getting better. But I the health would not want to keep track of that using such a sports watch” functionality (Female, 72 years)
The appreciation of the health functionality was influenced by multiple factors mentioned by the participants, table 13 presents the appreciation factors.
Table 13. Appreciation factors - Health functionality.
Factors positively influencing appreciation Factors negatively influencing appreciation • The tips would help being active (n=1) • Not wanting to change (n=1) • Knowing the meaning of the health • Distrust in the information pedometers values (n=1) give (n=1) • Being able to get the health results on • There is nothing wrong with me (n=1) their own (n=3) • Knowing your health values (n=4)
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 52
Acceptance factors
The participants were asked whether the health functionality would help them to be active. The given answers were used for the usefulness results of the health functionality, participants (n=6) perceived the health functionality as useful. One participant out of the six, only found the heart rate function of use. The other participant did not find the health functionality useful and did not want to use it.
The participants also gave their estimate on how easy or hard they would find it to learn to use the health functionality. Resulting in all participants expecting to be able to learn how to use the health functionality.
During the interview the participants tried to estimate how much they would intend to use the health functionality. How many times the participants did intend to use the health functionality ranged from every day to never. The average of intention to use laid around twice a week. Two participants could not exactly state how many times they intended to use the health functionality. One would only use it when in need and the other would use it when being active.
Feedback
The feedback the health functionality received was to give the user an explanation about the results of the health functions that are monitored. The participants were especially curious towards the heart rate and would like to know what value would be a good or bad result for them. Also one point of feedback was to advice the user to consult the doctor when the values are bad, to let the doctor provide results and a cure. One participant would like to see the history of the recorded health functionalities. As a final feedback on usability, according to two participants it would be more logical to operate the calendar by a swiping gesture, since the main interaction is like that. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 53
“But that heart rate is then measured. Does it also say whether it is good or not good?” (Female, 75 years) “That is something you would like to know?” (Interviewer) “Yes because I would not know how my heart beat regularly needs to be.” (Female, 75 years)
“But I can imagine that someone else would get scared. So that person would need to get information about what that heart rate means and tips to get you heart rate back to normal, before they call a doctor.” (Female, 67 years)
“I think they also need to mention to consult a doctor otherwise you don’t know where you stand.” (Female, 75 years)
“When I see my heart rate I would also like to see it from other points in time.” (Female, 67 years) “Ah I see so you would like to be able to compare with other days?” (Interviewer) “Yes.” (Female, 67 years)
“Yes with the calendar it would be easier to be able to swipe from one week to the other, in the whole product you can swipe and now all of a sudden you have to click.” (Female, 67 years)
4.4.4 The total prototype
In the last part of the interview, the participants were questioned about the prototype. To see whether the participants were accepting the product as a whole. The before mentioned acceptance factors and one new factor (target audience) were questioned, as well as general feedback for the WFD.
Acceptance factors
The participants were asked whether they experienced the usefulness of the WFD. The results for usefulness were divided over three groups. The first group of participants (n=5) found the
WFD very useful, the second group of one participant said to only find the health functionality useful, and lastly one participant did not find the WFD useful.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 54
All the participants were determined they could learn to use the WFD without too much difficulty. To learn how to use the WFD one group (n=2) preferred to learn it individually, the other group (n=5) preferred some help with learning how to use the product. Potential help can be in the form of a helping hand when setting the product up. Another potential help was providing an instruction manual. It should be noted that two participants mentioned to have difficulties using such manuals.
The participants were asked to estimate how much they would use the WFD and when they would wear it. Two participants did not intend to use the WFD. The rest of participants indicated to intend to use it every day. The participants indicated that they would wear the WFD during physical activity. Most of the participants would wear the WFD during the day. None of the participants would constantly wear the it and none of the participants would it when sleeping.
In order to better understand the target user, participants were asked whether they think that the WFD was intended for them. Some participants (n=5) did see themselves as the fitted target group, and the other participants (n=2) thought that they were not the target audience.
The participants who indicated to not see themselves as the target audience, indicated that persons who are conscious about their health and physical activity are a good target group for the WFD.
Feedback
Feedback given about the product as a whole was on the design of the sports watch:
- The need for a clear border around the buttons of the home screen (coming from an
colour blind participant).
- Add a little stylus pen, to make it easier to click smaller buttons.
- The need for clearer colour contrasts. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 55
- A bigger font, for better readability.
Another feedback was about the functionalities of the step count function. One participant would like to see a more detailed overview including: kilometres, fitness log, specifying walking up hill.
“Yes then I would keep track of that. I am following my program with fitness, I have to build up a little bit every time. That is something I could keep track of on that.” (Female, 73 years) “Yes exactly and the number of movements you have done” (Interviewer) “And the weight that has been set.” (Female, 73 years) “That is important for you?” (Interviewer) “Yes and that is the same with walking when I am doing fitness, the kilometres and hills I do, I also walk up hill.” (Female, 73 years) “So you would like a more detailed overview?” (Interviewer) “Yes a more detailed overview” (Female, 73 years)
In addition, some participants could not give any feedback on the prototype. They never experienced the use of such a product before, leaving them without an example to compare it to. Also the lack of technical abilities limited the knowledge about possibilities that such a product can offer.
“No I would not know, I have gotten too little into that to be able to give feedback.” (Female, 72 years)
“No I would not make any changes, because it is everything you could possibly use. I would not know what.” (Female, 72 years)
“No at this moment not, I think everything is good because it is new to me. Yes I regret I don’t have any experiences with that.” (Female, 75 years)
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 56
Chapter 5: Discussion and conclusion
The aim of the present study was to investigate what motivating functionalities would increase the elderly acceptance of a WFD. This research is contributing to the research on wearables for elderly. With this, a first step was taken in the development of a WFD targeting elderly users.
To be able to develop and test the prototype, the UCD process was followed. First, a related systems analysis was performed to learn the functionalities of existing WFDs. Second the user needs were specified through user interviews. Third, the prototype was developed and the personas and scenarios needed for the user test were made. Lastly, the developed WFD prototype was tested by conducting the EEW, to find out whether the motivating functionalities would be accepted by the elderly.
5.1 Summary of the results
This section lists the most important results found in every UCD phase. The results of phase 1 are various motivating functionalities that existing WFDs use (e.g. goal setting, giving reminders to move, feedback, challenge others, etc.).
The results of phase 2 are about understanding the target group and their daily lifestyle around physical activity. The elderly agreed about the mindset, not having to do anything compulsory and enjoying retirement. In addition, they are physically active for health, recreation, and practical reasons. They only do it for themselves and their only external motivator can be a sport’s buddy. Besides that, only their intrinsic motivation makes the elderly do physical activity. Next, two barriers towards physical activity stood out “not knowing any walking/cycling routes” and “not having a sports partner”. Lastly, the only existing motivating functionality that is found motivating is the feedback function, where personal health information and tips are received. The other motivating functionalities discovered in phase 1 were rejected. Based on these results, the following needs were identified: to have a sport buddy, to find destinations, and to be informed about personal health. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 57
Based on the results of phase 2, in phase 3 the needs were translated into three motivating functionalities (buddy, destination, and health functionality) and implemented in the developed prototype. In addition, two personas, two scenarios and the acceptance factors were developed in this stage.
In phase 4, testing the prototype and the motivating functionalities showed an acceptance by potential users, and gathered general feedback.
5.2 Discussion and theoretical implications
Phase 1
The motivating functions of existing WDFs are mainly motivating through focussing on the users’ capability to reach a physical activity goal. Goal setting supports the need for competence. On the other side, the need for autonomy was under supported with a lack of motivating functionalities. Motivating functionalities that are not supporting a psychological need are also present in existing WDFs. This indicates that existing WFDs are not following the SDT, by not fulfilling all three psychological needs (Deci & Ryan, 1985). This signifies that the users of current WFDs are not inclined to do physical activity due to all three psychological needs being fulfilled. Presumably existing WFDs can let their users benefit from following the
SDT.
Phase 2
In addition to the finding in phase 1, the results of phase 2 indicate that elderly are not accepting motivating functionalities of existing WFDs (except for the health feedback). A possible explanation can lay in the lack of autonomy support. The elderly are very keen on taking action by their own choice, as found in the user interviews. Supporting autonomy actually implies supporting the feeling of being the initiator of your own behaviour, a point the existing WFDs do not focus on. To continue on the existing motivating functionalities, elderly do not want to INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 58 set a goal for their physical activity. Instead they are more likely to set a destination goal for their walk or round of cycling and see it as a recreational activity.
The found results can be compared to the study of Rasche et al. (2015) which showed opposing results about the elderly acceptance of a WFD. The needs the elderly showed in the current study do not match with the motivating functionalities existing WFDs have. This is not in line with the research (Rasche et al., 2015) showing that the elderly appreciate an off the shelf WFD for its motivating effect. The difference can be explained by the samples and the context of both studies. The sample of the current study are elderly who are moderately active.
In the previous study a sample of very sporty and active elderly was used. The context of this study is a natural interview setting, opposing to the previous study were the elderly were motivated to move more to reach the daily 10.000 step goal set by the researches. Along the result by Rupp et al. (2018), less active users are less likely to perceive motivational affordances, this explains why previous research has found an existing WFD to fulfil the need of the elderly users, because the elderly users were motivated to move more. In this case the motivation to move more helps with appreciating the functions, according to the sample of the current study, elderly are in their daily life not motivated to move more.
Another surprising finding is that the elderly do not want to be motivated to move more.
This is an interesting point and will be further discussed along the made choices in phase 3.
Phase 3
In the prototype development, the choice was made to use totally different motivating functionalities than existing WFDs use, answering to the insight that elderly do not want to be motivated to move more. The choice was made to support the elderly with physical activity by developing motivating functionalities that makes certain aspects around physical activity easier
(finding a destination, a sports buddy, and health advice). By using this type of functionalities INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 59 it was hoped that the WFD would be accepted and that the functionalities would support the elderly to keep up their physical activity.
Developing the prototype using ProtoPie turned out to be the right choice. The program allows to easily implement interaction, this clarifies the use of the product over using non interactive mock-ups with a storyboard. The product was also easy to learn, this is an advantage considering the constrained time. The only downside to using ProtoPie, it does not allow prototyping for a wearable. An alternative can be the use of the online prototyping tool
InVision. It is able to realise a wearable prototype. In this tool the UI design cannot be made and have to be made with another design software (such as Photoshop or Sketch), in opposite to ProtoPie where no extra software is required.
The use of the SDT appeared to be a useful backbone and ground of theory to make the prototype stronger and support all three psychological needs. The use of relatedness, competence, and autonomy supporting functions made the prototype diverse.
Phase 4
As a result of the EEW the developed prototype is accepted by the elderly. This result is no surprise, the methods used to lead up to this prototype focus around the end user. The needs of the elderly are incorporated in the prototype. A striking result is that the motivating functionalities that are accepted by elderly are supporting functions and focus on how physical activity can be made easier for elderly. For the active elderly target group this seems to be a better choice than directly motivate them imposing being physically active. Unfortunately no previous result can be used to compare these results to. Besides this the prototype appears to respond to an unknown need of the participants. One participant felt like a sports watch would not have added value for her, after the first procedure. After the user test she mentioned she did not expect this but she actually found the prototype very useful. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 60
The use of the EEW to test acceptance was an excellent choice. Making use of two personas in combination with two scenarios makes it for the technically unskilled elderly clear for what the WFD can be used. The use of the interactive prototype makes it clear how the
WFD works and gives a base to judge learnability, usability and intention to use. Next to that it is easier for elderly to answer questions along an interview opposed to a questionnaire, and interview questions provide more insights. Also this method allowed to receive feedback, which is important for making improvements. Unfortunately it was difficult for elderly to find points for feedback, due to inexperience with WFDs.
5.3 Limitations and future studies
One limitation of the current study lays at the small sample size. The sample does not approximate the target group of active young elderly in The Netherlands. This could mean that possible needs of the target group are not fulfilled because they were not detected in this sample.
This makes the results less reliable and not generalizable over the whole target group.
One experienced limitation of the EEW was in having a scenario. The scenario sets the use of the prototype, this makes it difficult for the elderly participant to envision other purposes of use. As experienced on the scenario that plans out a destination for a route of cycling. It appeared to be difficult for some participants to envision to use this functionality for a walking event. In future work when dealing with a scenario presented to elderly it is important to stress other ways the functionality can be used before starting the user test.
Another limitation of the chosen procedure lays in the measurement of end user acceptance.
The EEW was set out to measure acceptance, but the measurements are based on the participants opinions and not on their real behaviour. With this method the actual acceptance and acceptance factors could not be measured. Which indicates that the results might turn out differently for the actual user acceptance behaviour. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 61
A final limitation is a potential social desirability bias in the interview of the user test. It is possible that in the face to face interview some elderly tend to try to please the researcher by answering in a manner that they think the researcher prefers. This bias in results was hopefully prevented by the researcher stressing that there are no right or wrong answers. In general the participants gave an honest impression.
Future research could continue developing the WFD around the accepted motivating functionalities. This can be done with starting from the implementation of the feedback the current research provided and developing a high-fidelity coded prototype which can be used on a wearable. Followed by a long term study examining whether the developed motivating functionalities do work, by measuring whether the use of the WFD does increase the physical activity of the elderly. The sample of the future research can include inactive elderly, to widen the target group. In addition the sample should be larger and more diverse for better generalizable results.
5.3.1 Practical implications
A practical implication of the found results can be implementing the motivating functionalities into existing WFDs, to broaden their target audience by including elderly.
Existing WFD brands can use this information to make their device better accepted by elderly.
A possible execution of this can be in the form of a different product set up for the multiple user groups. This opportunity is in tune with the solution Schlomann, Storch, Rasche, & Rietz (2016) offer to handle the issue that existing WFDs are not suited for elderly. They propose to focus on universal design, instead of creating a WFD specifically for elderly. In the form of a design that can be tailored to the individual including all ages and capabilties. The current research offers the idea to WFD brands, to offer different functionalities to different user groups.
Executed in the set-up of the product were the user needs to specify the user group, the user INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 62 will receive the functionalities tailored to their needs. In this way no new product or brand needs to be developed, and current brands can expand their target audience.
5.4 Conclusion
This study makes a first step in the development of a WFD suited for the active elderly. The results can be used to build on, to further develop the product. To conclude on the sub research question in phase 1 the current motivating functionalities existing WFDs have are wide and can be found in the results of phase 1. The main motivating functionality of existing WFDs is goal setting. The most important needs found in phase 2 are the elderly need to initiate their own behaviour and the need not to be motivated by a WFD that notifies them. Among other user insight these answered the sub research question of phase 2. In phase 3 the before mentioned needs are translated into three practical needs for the prototype, based on insights of the user interviews. The sub question of this phase is answered by structuring the motivating functionalities as supporting functionalities each functionality addressing one of the three SDT categories. In phase 4 the sub research question is answered by the finding that the elderly do accept the prototype. The motivating functionalities are all individually accepted by the elderly.
Leading to the answer of the research question of this thesis: “What motivating functionalities determine the acceptance of WFDs by elderly?” This question is answered by the conclusion that supporting functionalities are best accepted as motivating functionalities by the active young elderly. A high-fidelity WFD working prototype has to be developed and assessed for having a motivating effect, tested over long term use.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 63
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INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 71
Appendices
Appendix A: Phase 2 - User interview questions
1. Persoonlijke informatie Voor mijn beeldvorming en de analyse van dit onderzoek begin ik met een aantal persoonlijke vragen.
• Wat is uw leeftijd? • Klopt het dat uw nationaliteit Nederlands is? • Wat is uw woonsituatie? • Heeft u werk? Bent u met pensioen? Of doet u vrijwilligers werk?
2. Gebruik van technologie Voor de ontwikkeling van het sporthorloge is het van belang dat ik te weten kom in hoeverre u gebruikt maakt van technologie. Vandaar dat ik daar nu een aantal vragen over stel.
• Maakt u gebruik van technologie? Zo ja: o Kunt u een aantal van deze technologische producten en services noemen? o Welke ervaring heeft u met een (of meerdere) van deze producten? o Met welke technologische producten kunt u goed overweg en waarom? Zo nee: (de volgende vragen zijn dan ook niet meer van toepassing) o Welke technologische producten zou u willen gebruiken? o Wat weerhoud u van het gebruiken van deze producten?
• Gebruikt u een sporthorloge? o (Gebruikt u een smartwatch? ) Zo ja: o Welke gebruikt u? o Hoe gebruikt u uw sporthorloge? ▪ Waarvoor gebruikt u dit horloge? INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 72
▪ Van welke functies maakt u gebruik? ▪ Wanneer draagt u het horloge? ▪ Maakt u ook gebruik van de smartphone applicatie die het sporthorloge ondersteund? Zo ja: ▪ Van welke functies van de applicatie maakt u gebruik?
• Zijn er andere apps en websites die u gebruikt ter ondersteuning van sporten? Zo ja: o Welke gebruikt u? o Met welke reden gebruikt u deze? Zo nee: o Heeft u deze in het verleden gebruikt? o Waarom bent u daarmee gestopt?
3. Sport en beweging
Graag zou ik willen weten wat u aan lichaamsbeweging doet in een doorgaande week. Onder lichaamsbeweging versta ik in dit geval sporten die u doet zoals tennis, zwemmen of fitness, maar ook activiteiten die u doet waarbij u lichamelijk in beweging bent zoals huishouden, wandelen naar de winkel, of fietsen naar een afspraak.
De eerste vragen die ik u stel gaan specifiek over sporten. • Zou u willen beschrijven wat uw sportroutine is in een typische week? o Op welke momenten doet u aan sporten? o Welke sporten of activiteiten doet u? o Hoeveel uur per week bent u gemiddeld aan het sporten? o Doet u deze sporten individueel of samen? • Wat vind u van uw huidige sportroutine? o Zou u hier iets aan willen veranderen? o Heeft u ook interesse in andere sporten? • Heeft u een doel dat u wilt behalen met betrekking tot sporten? o Traint u voor een specifiek evenement? INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 73
De volgende vragen die ik stel gaan over activiteiten die u doet waarbij u in beweging bent. • Wat zijn activiteiten die u doet waarbij u in beweging bent? • Kunt u een voorbeeld noemen van een activiteit die u deze week heeft gedaan? • Waarom doet u deze activiteiten? • Ervaart u deze activiteiten als lichaamsbeweging?
4. Motivatie omtrent sporten
Een belangrijke functie van een sporthorloge is het motiveren van de gebruiker. Vandaar dat ik graag meer zou willen weten over uw motieven en barrières betreft sporten en uw motieven en barrières betreft activiteiten waarbij u in beweging bent.
Motieven • Om welke redenen doet u aan sporten? • Wat motiveert u om te gaan sporten? • Welke voordelen biedt sporten aan u? • Kun u een situatie noemen waarin u erg gemotiveerd was om te gaan sporten?
Ik kan mij best voorstellen dat u zich niet altijd gemotiveerd voelt om te gaan sporten. • Kunt u een voorbeeld van deze situatie noemen? • Welke motivatie mist u wanneer u zich ongemotiveerd voelt? • Wat zou u op zo’n moment kunnen motiveren?
• Om welke reden doet u activiteiten waarbij u lichamelijk in beweging bent? • Wat motiveert u om deze activiteiten te doen?
In het algemeen o Wat kan u motiveren om meer te gaan bewegen? INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 74
Barrières Sporten is natuurlijk een uitdaging en gaat niet vanzelf. Ik zou graag willen weten welke barrières u er soms van weerhouden te gaan sporten. Deze barrières kunnen op fysiek gebied, psychologisch gebied of in uw omgeving liggen.
• Wat houd u soms tegen te gaan sporten? • Welke reden geeft u wanneer u niet gaat sporten? • Wat vind u een nadeel aan sporten?
Ook zou ik graag willen weten wat u er soms van weerhoudt om activiteiten te doen waarbij u in beweging bent. Bijvoorbeeld waarom u toch besluit om binnen te blijven of toch met de auto of het openbaar vervoer te gaan in plaats van met de fiets.
• Wat houd u tegen om activiteiten te doen waarbij u in beweging bent?
5. Acceptatie van een sporthorloge
1.Wanneer de deelnemer geen sporthorloge heeft:
• Wat vindt u van een sporthorloge? • Als u een sporthorloge tot uw beschikking zou hebben, zou u deze gebruiken?
• Wat zijn de factoren die u weerhouden van het gebruik maken van een sporthorloge?
• Hoe denkt u dat een sporthorloge u gaat helpen met sporten?
• Zou u uw huidige horloge vervangen voor een sporthorloge?
2.Wanneer de deelnemer wel een sporthorloge gebruikt: • Wat zijn uw ervaringen met een sporthorloge?
• Wat vindt u van een sporthorloge? • Hoe helpt een sporthorloge u met sporten?
3.Wanneer de deelnemer een sporthorloge heeft gebruik, maar is gestopt:
• Wat vindt u van een sporthorloge? INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 75
• Wat zijn de factoren die u weerhouden van het gebruik maken van een sporthorloge?
4.Wanneer de deelnemer een sporthorloge bezit, maar nooit heeft gebruikt: • Wat vindt u van een sporthorloge?
• Hoe denkt u dat een sporthorloge u gaat helpen met sporten? • Wat zijn de factoren die u weerhouden van het gebruik maken van een sporthorloge?
6. Motiverende factoren
Nu ga ik u een aantal scenario’s voorleggen met betrekking tot het gebruiken van een sporthorloge. Een scenario is eigenlijk een situatie of een verhaal dat een ander persoon heeft ervaren. Na het vertellen van het scenario vraag ik u hoe u deze situatie zou ervaren en wat u mogelijk anders zou ervaren? Ook vraag ik u hoe motiverend u deze situatie zou ervaren?
Scenario 1
Vrouw Wanneer Gerda klaar is met haar wandeling van 6 km, ziet ze op haar sporthorloge dat zij 2 sterren heeft ontvangen als beloning voor haar prestatie. Ze denkt Yes! Nu heb ik eindelijk 30 sterren verzameld! Dit motiveert mij om de volgende keer weer 6 km te wandelen.
Man Wanneer Joop klaar is met zijn wandeling van 6 km, ziet hij op zijn sporthorloge dat hij 2 sterren heeft ontvangen als beloning voor zijn prestatie. Hij denkt Yes! Nu heb ik eindelijk 30 sterren verzameld! Dit motiveert mij om de volgende keer weer 6 km te wandelen.
• Hoe zou u deze situatie ervaren? • Hoe zou u hier op reageren? INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 76
• Zou deze situatie u motiveren, demotiveren of niet veranderen?
Scenario 2
Vrouw Gerda heeft een dag thuis gezeten en in haar boek gelezen. Rond 7 uur ‘s avonds krijgt ze een bericht op haar sporthorloge: “Het is een goed idee is om in beweging te komen!”. Het horloge stelt aan haar voor om te gaan wandelen of fietsen. Ze denkt waarom ook niet, ik ben de hele dag nog niet buiten geweest. Ze pakt haar fiets uit de schuur en besluit een stuk te gaan fietsen.
Man Joop heeft een dag thuis gezeten en in zijn boek gelezen. Rond 7 uur ‘s avonds krijgt hij een bericht op zijn : “Het is een goed idee is om in beweging te komen!”. Het horloge stelt aan hem voor om te gaan wandelen of fietsen. Hij denkt waarom ook niet, ik ben de hele dag nog niet buiten geweest. Hij pakt zijn fiets uit de schuur en besluit een stuk te gaan fietsen.
• Hoe zou u deze situatie ervaren? • Hoe zou u hier op reageren? • Zou deze situatie u motiveren, demotiveren of niet veranderen?
Scenario 3
Vrouw Gerda zit achter haar computer en ziet dat zij een email heeft ontvangen van haar sporthorloge. In de mail leest ze welke positieve effecten sporten de afgelopen maand op haar gezondheid heeft gehad. Ook leest ze tips over hoe ze deze actieve levensstijl kan behouden. Ze voelt zich gemotiveerd om haar sportieve gedrag vol te houden.
Man Joop zit achter zijn computer en ziet dat hij een email heeft ontvangen van zijn sporthorloge. In de mail leest hij welke positieve effecten sporten de afgelopen INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 77 maand op zijn gezondheid heeft gehad. Ook leest hij tips over hoe hij deze actieve levensstijl kan behouden. Hij voelt zich gemotiveerd om zijn sportieve gedrag vol te houden.
• Hoe zou u deze situatie ervaren? • Hoe zou u hier op reageren? • Zou deze situatie u motiveren, demotiveren of niet veranderen?
Scenario 4
Vrouw Voordat Gerda aan haar wandeling begint stelt zij op haar sporthorloge haar wandel doel in op 30 minuten. Tijdens haar wandeling bekijkt ze een keer haar sporthorloge om te controleren hoe lang ze al loopt, ze ziet dat ze nog 10 minuten te gaan heeft en besluit verder te lopen. Wanneer ze thuis komt heeft ze een voldaan gevoel, “Ik heb mij doel behaald”.
Man Voordat Joop aan zijn wandeling begint stelt hij op zijn sporthorloge zijn wandel doel in op 30 minuten. Tijdens zijn wandeling bekijkt hij een keer zijn sporthorloge om te controleren hoe lang hij al loopt, hij ziet dat hij nog 10 minuten te gaan heeft en besluit verder te lopen. Wanneer hij thuis komt heeft hij een voldaan gevoel, “Ik heb mij doel behaald”.
• Hoe zou u deze situatie ervaren? • Hoe zou u hier op reageren? • Zou deze situatie u motiveren, demotiveren of niet veranderen?
Scenario 5
Vrouw Gerda doet mee met de wandelvierdaagse op de afstand van 10 km. De laatste dag van de vierdaagse haalt ze haar snelste tijd van 1:45. Ze is erg trost op haar zelf en INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 78 heeft een erg leuke ervaring gehad. Ze besluit om haar prestatie de delen met haar familie via de applicatie van het sporthorloge. Direct hierna ontvangt ze allemaal positieve reacties op haar prestatie, “Dit maakt me nog trotser.”
Man Joop doet mee met de wandelvierdaagse op de afstand van 10 km. De laatste dag van de vierdaagse haalt hij zijn snelste tijd van 1:45. Hij is erg trost op hem zelf en heeft een erg leuke ervaring gehad. Hij besluit om zijn prestatie de delen met zijn familie via de applicatie van het sporthorloge. Direct hierna ontvangt hij allemaal positieve reacties op zijn prestatie, “Dit maakt me nog trotser.”
• Hoe zou u deze situatie ervaren? • Hoe zou u hier op reageren? • Zou deze situatie u motiveren, demotiveren of niet veranderen?
Ik ga even kijken of alle vragen zijn beantwoord.
Heeft u nog iets toe te voegen aan het interview?
Hartelijk bedankt voor uw moeite en tijd!!
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 79
Appendix B: Study information and informed consent
Onderzoek informatie & Geïnformeerde toestemming Onderzoek: de motiverende functionaliteiten voor een ouderen sporthorloge
Beste deelnemer, In dit onderzoek van Tilburg Universiteit onderzoeken wij hoe een sporthorloge ouderen kan motiveren te gaan sporten. Het doel van dit onderzoek is het zetten van een eerste stap in de ontwikkeling van een sporthorloge dat geaccepteerd wordt door de oudere doelgroep. Om er voor te zorgen dat het sporthorloge en haar motiverende functionaliteiten zijn afgestemd op de oudere doelgroep is het van belang dat deze doelgroep wordt gehoord en betrokken bij het ontwerpproces, uw participatie is hiervoor van belang. Wij zijn verheugd dat u zich interesseert voor ons onderzoek en bereid bent om deel te nemen. Wanneer u aan het eerste deel van het onderzoek deelneemt waarderen wij het zeer wanneer u bereid bent aan het vervolg onderzoek deel te nemen, enkele weken later.
1. De onderzoekers
Lamia Elloumi Emma Oude Groote Beverborg Assistent professor Master student New Begeleider Media Design Onderzoeker
2. Het doel
In het kader van mijn masterscriptie aan de Universiteit Tilburg onderzoek ik, Emma Oude Groote Beverborg, welke motiverende functionaliteiten geschikt zijn in een sporthorloge voor ouderen en in hoeverre ouderen dat stophorloge accepteren.
3. De inhoud
Het onderzoek bestaat uit twee delen en vindt plaats op twee afzonderlijke dagen. In het eerste deel van het onderzoek wordt een individueel interview afgenomen. In het tweede INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 80 deel van het onderzoek worden delen van de vereenvoudigde eerste versie van het sporthorloge getest.
Onderzoek deel 1. Het interview In het eerste deel van het onderzoek wordt het interview afgenomen. Het interview zal naar verwachting 30 minuten duren en worden opgenomen, middels een audio opname. Voorafgaande aan het interview krijgt u informatie over sporthorloges en hun functionaliteiten, aan de hand van een korte presentatie en een product presentatie wordt u deze informatie verschaft. Hierna begint het interview, eerst worden u een aantal demografische vragen gesteld daarna volgen de interview vragen. Het interview zal gaan over uw sportroutine, wat u motiveert te gaan sporten en hoe u motivatie mogelijk wordt belemmerd. Onderzoek deel 2. Het testen van het sporthorloge In het tweede deel van het onderzoek worden de functionaliteiten van het sporthorloge getest aan de hand van he prototype van het sporthorloge. Een prototype is de eerste versie van een product in de ontwikkelingsfase en ziet er versimpelt uit. Het testen van het prototype zal naar verwachting 60 minuten duren. Deze test zal worden opgenomen middels een audio opname, zodat het interview later kan worden geanalyseerd. In deze prototype test wordt u gevraagd om samen met de onderzoeker de functionaliteiten van het sporthorloge te ontdekken en hierover uw mening te geven. Als eerst wordt voor u een gebruiker van het product en een situatie geschetst. Hierna krijgt u het prototype te zien en neemt de onderzoeker u aan de hand van een verhaal mee langs elke functionaliteit van het product. Tijdens dit verhaal kunt u de interacties met het product daadwerkelijk zelf ervaren, door te interacteren met het prototype. Na het uitleggen van een van de hoofdfuncties van het product wordt uw mening gevraag en uw acceptatie tegenover deze functie. Op deze manier doorloopt u samen met de onderzoeker het gehele product en wordt u aan het einde gevraagd om een mening over het product in zijn geheel te geven.
4. Privacy en vertrouwelijkheid
Alle data die gedurende dit onderzoek wordt verzameld, worden hoogst vertrouwelijk behandeld. Uw naam zal niet worden verbonden aan de data. Uw naam, telefoonnummer en emailadres worden enkel bewaard voor het initiële contact en worden na het onderzoek verwijderd. In beide delen van het onderzoek wordt een audio-opname gemaakt. De audio- opname van het interview wordt uitgetypt en daarna voor een periode van 10 jaar bewaard. De verzamelde data worden geheel versleuteld, anoniem en op een veilige plek opgeslagen.
Gedurende het onderzoek zal deze data opgeslagen worden op een versleutelde laptop van de onderzoeker en op de surfdrive van de universiteit. Het consentformulier en de verzamende data worden gescheiden van elkaar opgeslagen. Alleen de onderzoekers hebben toegang tot deze data. Na het onderzoek wordt deze data overgezet naar een beveiligde en vergrendelde locatie (Dataverse) van Tilburg University. In navolging van het INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 81 beleid van Tilburg University zal de data gedurende 10 jaar worden bewaard op een beveiligde server. Hier hebben alleen bevoegde onderzoekers toegang toe.
Om anonimiteit te waarborgen worden uw naam en contactinformatie niet in het uitgetypte interview opgenomen. Ook zullen de gegeven antwoorden nooit worden herleid naar het individu. Ook wijzen wij u er graag nog op dat u op ieder moment kunt stoppen met het onderzoek als u niet meer mee wenst te doen. Het onderzoek is getoetst en goedgekeurd door de Research Ethics and Data Management Committee van TSHD.
5. Vrijwillige deelname
U bent niet verplicht om aan dit onderzoek deel te nemen. Als u instemt met deelname, kunt u op ieder moment de deelname aan het onderzoek opzeggen. U bent hiervoor geen uitleg verschuldigd en dit zal ook geen negatieve consequenties hebben. U bent daarnaast niet verplicht om vragen te beantwoorden die u niet wenst te beantwoorden. U kunt geen foute antwoorden geven, alle informatie die u geeft is bruikbaar. Wanneer u op dit moment zelf vragen heeft kunt u deze stellen voor het ondertekenen van het consent.
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Toestemming
Ik erken dat ik de gelegenheid heb gehad deze verklaring te lezen en het onderzoek is aan mij uitgelegd. Daarnaast heb ik de mogelijkheid gehad om vragen te stellen over het onderzoek en zijn mijn vragen beantwoord. Ik ben bereid om mee te doen in het huidige onderzoek en geef toestemming dat mijn data gebruikt mag worden voor analyses en dat mijn data 10 jaar bewaard mag worden door Tilburg University. Ook geef ik toestemming voor het maken van audio-opnamen van de interviews en eventueel hergebruik van mijn anonieme data voor een ander onderzoek dat betrekking heeft op digitale technologieën, waarover mogelijk een research paper gepubliceerd kan worden.
Handtekening van de deelnemer ______Datum______
Handtekening van de onderzoeker ______Datum______
Mocht u na afloop van dit onderzoek nog vragen hebben, kunt u contact opnemen met mij
Hartelijk dank voor uw deelname! INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 82
Appendix C: Phase 2 - Codebook user interview
Code Comment ● age The participants age
● barrier to do physically active activity A reason or obstacle that prevents the participant from doing physically active activities. ● barrier to move more A reason the participant gives for not wanting to move more. ● barrier to sport Something that hinders or has hindered the participant from sporting.
● benefit of sports A advantage the participant has experienced, gained from sporting.
● daily activities Mandatory activities such as volunteering or being part of a board.
● forbidden sports A sport the participant did play but is not able to do anymore (including reason).
● learning technology The way the participant learns to use technology. ● living situation With whom the participant lives.
● mindset A typical elderly mindset.
● motivating feature The scenario presents a feature that does motivate the participant to move more.
● motivation insight Elderly point of view on getting motivated to do sports. ● motivation to do physically active activity A factor that motivates the participant to do a physically active activity.
● motivation to move more The participants point of view on moving more. ● motivation to sport Something that can motivate the participant to sport. ● nationality Whether the participants nationality is Dutch.
● neutral feature The scenario presents a feature that leaves the participant untouched to move more.
● opinion sport routine What the participant thinks about his/her own sport routine. ● physical activities Activities the participant does (next to sports) that are active and make the participant move. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 83
● preferred technology A type of technology the participant sees as most favourite. ● reason new sport The reason the participant gives to do or not do a different sport than usual.
● scenario Daily experiences of the participant.
● seeing activities as exercise Whether or not the participants feels like exercising when doing an activity.
● sport activities Sports the participant does.
● Sport hours The number of hours the participant sports a week. ● sports app frustration Something that frustrated the participant when using the sports app.
● sports application A mobile phone application the participant has/uses to track their sport activities.
● sports application use For what functions the participant uses the sports application. ● sports disadvantage A disadvantage of sporting.
● sports goal A goal the participant has that he/she wants to achieve doing sports.
● sports insight An insight on how elderly sport.
● sports opinion A opinion of the participant about sports.
● sports partner Another person the participant is sporting with.
● Sports watch acceptance A factor that influences whether the participant will accept the sports watch.
● Sports watch functionalities For what functions the participant uses the sports watch. ● Sports watch new function A new function for the sports watch the participant proposes. ● Sports watch opinion What the participant thinks about a sports watch. ● Sports watch use Whether the participant uses a sport watch.
● Sports watch wearing When the participant wears his/her sports watch. ● Sports watch with app The participant uses or does not use the sports watch in combination with the app. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 84
● technology barrier Something that hinders the participant from using technology. ● technology mindset What the participant thinks about technology and his/her own skills.
● technology product A technological product the participant owns.
● technology use Specific features or tasks the participant uses the technology for. ● technology use while sporting What technologies the participant uses while sporting. ○ type of bike Whether the participant has a regular bike or an e-bike.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 85
Appendix D: Personas and scenarios
Persona female Maak kennis met Gerda.
Gerda is 70 jaar en geniet al zes jaar van haar welverdiende pensioen. Nadat haar man is overleden is zij alleen blijven wonen in hun appartement aan de rand van de stad. Gerda steekt haar handen uit haar mouwen als vrijwilliger in het bestuur van haar appartementen complex. Ze vind het belangrijk om van haar oude dag te kunnen genieten en daarnaast zo lang mogelijk gezond te blijven. Vandaar dat zij het belangrijk vind om in beweging te zijn, zo heeft ze haar wekelijkse wandeling met de wandelgroep en gaat ze regelmatig zwemmen met haar goede vriendin. Ze is tevreden met de hoeveelheid beweging die zij doet. Wanneer ze thuis is beantwoord ze haar email op haar laptop en zorgt ze voor de huishouding. Als ontspanning houdt ze van knutselen en het nieuws lezen op haar tablet. Af en toe heeft ze last van haar rug, bewegen gaat dan moeizamer. Onlangs heeft ze van haar zoon een nieuw technologisch horloge gekregen, een sporthorloge heet het. Dit horloge maakt het haar gemakkelijk om gezond te blijven en geeft haar een zeker gevoel over haar gezondheid.
Persona female Maak kennis met Joop.
Joop is 70 jaar en geniet al zes jaar van zijn welverdiende pensioen. Nadat zijn vrouw is overleden is hij alleen blijven wonen in hun appartement aan de rand van de stad. Joop steekt zijn handen uit zijn mouwen als vrijwilliger in het bestuur van zijn appartementen complex. Hij vind het belangrijk om van zijn oude dag te kunnen genieten en daarnaast zo lang mogelijk gezond te blijven. Vandaar dat hij het belangrijk vind om in beweging te zijn, zo heeft hij zijn wekelijkse wandeling met de wandelgroep en gaat hij regelmatig zwemmen met zijn goede vriend. Hij is tevreden met de hoeveelheid beweging die hij doet. Wanneer hij thuis is beantwoord hij zijn email op zijn laptop en zorgt hij voor de huishouding. Als ontspanning houdt hij van film kijken en het nieuws lezen op zijn tablet. Af en toe heeft hij last van zijn rug, bewegen gaat dan moeizamer. Onlangs heeft hij van zijn zoon een nieuw technologisch horloge gekregen, een sporthorloge heet het. Dit horloge maakt het hem gemakkelijk om gezond te blijven en geeft hem een zeker gevoel over zijn gezondheid.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 86
Scenario female Maandag Op maandag bedenkt Gerda dat ze in de middag nog niks heeft om te doen. Het is vandaag mooi weer om naar buiten te gaan. Helaas heeft ze geen zin om alleen te gaan wandelen. Haar vriendin waar ze normaal mee gaat wandelen heeft op maandag de kleinkinderen in huis, dus die kan niet mee. Gerda besluit om een van haar sportmaatjes via haar sporthorloge uit te nodigen. Vorige maand heeft ze met haar sporthorloge een aantal contacten gemaakt met andere ouderen en kennissen in de buurt die graag fietsen en wandelen. Een aantal van de contacten die ze heeft gevraagd als sport maatje hebben haar verzoek geaccepteerd en nu zijn ze sport maatjes. Gerda klikt op haar sporthorloge en gaat naar de pagina sport maatjes, daar klikt ze door naar mijn maatjes. Ze kijkt naar haar lijstje met sport maatjes ze besluit om Truus uit te nodigen daar heeft ze vorige week ook zo leuk mee gewandeld. Ze nodigt Truus uit voor vanmiddag en Truus gaat akkoord met de uitnodiging. Die middag maken Truus en Gerda een leuke wandeling door de buurt.
Donderdag Op donderdag die week heeft Gerda afgesproken met haar fietsclubje en zij is die week aangewezen voor het bedenken van de route. Op donderdag heeft Gerda nog geen idee waar ze naar toe wil fietsen. Gerda weet dat op het sporthorloge leuke bestemmingen staan waar ze nog niet eerder zijn geweest. Dit weet zij doordat ze laatst een notificatie heeft ontvangen dat er nieuwe bestemmingen in haar buurt waren toegevoegd, omdat ze nieuwsgierig was heeft ze daar toen tussen gekeken. Ze besluit om er daar eentje van uit te zoeken. Ze klikt op haar sporthorloge en gaat naar de pagina bestemmingen. Ze kiest fietsbestemmingen. Ze kiest voor een fietstocht tussen de 20 en 30 kilometer. Ze wil graag de natuur in over verharde wegen. Ze klikt op zoeken. Ze klikt op De Engelse Tuin. Aha en je kunt daar koffie ook drinken! Perfect! Hier fietsen we naar toe. Dit is een locatie die ze niet kent, vandaar dat ze besluit de route planner te starten. Gerda en haar fietsgroep beginnen de fietstocht, de stem van de navigatie leidt hen de weg. Zondag Op zondag die week voelt Gerda zich trots op haar sportieve ondernemingen. Ze wil graag weten hoe het er met haar gezondheid voorstaat en besluit haar gezondheid overzicht te bekijken op haar sporthorloge. Ze kijkt naar haar overzicht met waardes zoals haar hartslag en temperatuur. Daarna gaat ze naar het informatie overzicht en klikt op score om haar gezondheid score te bekijken en bekijkt haar informatie. Daarna gaat ze naar de pagina over tips voor haar gezondheid. Als laatste bekijkt ze haar kalender met het overzicht van hoeveel minuten per dag ze die week actief was. Ze besluit om haar waardes van nu en vorige week te vergelijken. Ze denkt dit is de reden dat ik het sporthorloge altijd draag, zodat ik kan zien hoe het er met mijn gezondheid voor staat. Het geeft haar een veilig gevoel om zelf haar gezondheid in de gaten te kunnen houden.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 87
Scenario male Maandag Op maandag bedenkt Joop dat hij in de middag nog niks heeft om te doen. Het is vandaag mooi weer om naar buiten te gaan. Helaas heeft hij geen zin om alleen te gaan wandelen. Zijn vriend waar hij normaal mee gaat wandelen heeft op maandag de kleinkinderen in huis, dus die kan niet mee. Joop besluit om een van zijn sportmaatjes via zijn sporthorloge uit te nodigen. Vorige maand heeft hij met zijn sporthorloge een aantal contacten gemaakt met andere ouderen en kennissen in de buurt die graag fietsen en wandelen. Een aantal van de contacten die hij heeft gevraagd als sport maatje hebben zijn verzoek geaccepteerd en nu zijn ze sport maatjes. Joop klikt op zijn sporthorloge en gaat naar de pagina sport maatjes, daar klikt hij door naar mijn maatjes. Hij kijkt naar zijn lijstje met sport maatjes ze besluit om Wim uit te nodigen, daar heeft hij vorige week ook zo leuk mee gewandeld. Hij nodigt Wim uit voor vanmiddag en Wim gaat akkoord met de uitnodiging. Die middag maken Wim en Joop een leuke wandeling door de buurt.
Donderdag Op donderdag die week heeft Joop afgesproken met zijn fietsclubje en hij is die week aangewezen voor het bedenken van de route. Op donderdag heeft Joop nog geen idee waar hij naar toe wil fietsen. Joop weet dat op het sporthorloge leuke bestemmingen staan waar ze nog niet eerder zijn geweest. Dit weet hij doordat hij laatst een notificatie heeft ontvangen dat er nieuwe bestemmingen in zijn buurt waren toegevoegd, omdat hij nieuwsgierig was heeft hij daar toen tussen gekeken. Hij besluit om er daar eentje van uit te zoeken. Hij klikt op zijn sporthorloge en gaat naar de pagina bestemmingen. Hij kiest fietsbestemmingen. Hij kiest voor een fietstocht tussen de 20 en 30 kilometer. Hij wil graag de natuur in over verharde wegen. Hij klikt op zoeken. Hij klikt op De Engelse Tuin. Aha en je kunt daar ook koffie drinken! Perfect! Hier fietsen we naar toe. Dit is een locatie die hij niet kent, vandaar dat hij besluit de route planner te starten. Joop en zijn fietsgroep beginnen de fietstocht, de stem van de navigatie leidt hen de weg. Zondag Op zondag die week voelt Joop zich trots op zijn sportieve ondernemingen. Hij wil graag weten hoe het er met zijn gezondheid voorstaat en besluit zijn gezondheid overzicht te bekijken op zijn sporthorloge. Hij kijkt naar zijn overzicht met waardes zoals zijn hartslag en temperatuur. Daarna gaat hij naar het informatie overzicht en klikt op score om zijn gezondheid score te bekijken en bekijkt zijn informatie. Daarna gaat hij naar de pagina over tips voor zijn gezondheid. Als laatste bekijkt hij zijn kalender met het overzicht van hoeveel minuten per dag hij die week actief was. Hij besluit om zijn waardes van nu en vorige week te vergelijken. Hij denkt dit is de reden dat ik het sporthorloge altijd draag, zodat ik kan zien hoe het er met mijn gezondheid voor staat. Het geeft hem een veilig gevoel om zelf zijn gezondheid in de gaten te kunnen houden.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 88
Appendix E: Screenshots of the prototype
The red dots indicate the place that was clicked, the path indicates where the click leads to.
Figure 7. Buddy functionality.
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Figure 8. Destination functionality.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 90
Figure 9. Health functionality.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 91
Appendix F: Phase 4 - User test interview questions
Stelt u voor u gebruikt deze functie van het sporthorloge. Bruikbaarheid - Zou deze functie het makkelijker voor u maken om actief te zijn? o Waarom? - Zou deze functie u helpen om makkelijker een maatje te vinden om samen mee te gaan sporten? o Hoe komt dat? Leerbaarheid - Hoe makkelijk of moeilijk denkt u te kunnen leren om gaan met deze functie? o Hoe komt dat? Intentie tot gebruik - Hoe vaak denkt u deze functie te gaan gebruiken?
Heeft u verbeter punten voor deze functie van het sporthorloge?
Vragen over het sporthorloge in het algemeen. Stelt u voor u maakt gebruik van dit sporthorloge.
Bruikbaarheid - Zou u het sporthorloge als bruikbaar ervaren? o Waarom? - Zou het sporthorloge het makkelijker voor u maken om actief te zijn? o Waarom?
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 92
Leerbaarheid - Hoe makkelijk of moeilijk denkt u te kunnen leren om gaan met dit sporthorloge? o Hoe komt dat? - Denkt u zelfstandig dit horloge te kunnen leren gebruiken? o Waarom denkt u dat?
Intentie tot gebruik - Hoe veel denkt u gebruik te gaan maken van dit sporthorloge? - Wanneer bent u van plan het sporthorloge te dragen?
De doelgroep - Heeft u het idee dat dit sporthorloge voor u bedoelt is? o Zo nee: Wie ziet u als de doelgroep van dit product?
Heeft u feedback voor het sport horloge?
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 93
Appendix G: Phase 4 - Codebook user test interview
Code Comment ● Appreciation factors: Buddy function A factor that affects the users appreciation of the buddy function. ● Appreciation factors: Destination function A factor that affects the users appreciation of the destination function.
● Appreciation factors: Health function A factor that affects the users appreciation of the health function. ● Appreciation: Buddy function The users opinion about the buddy function, showing how the user appreciates the buddy function. ● Appreciation: Destination function The users opinion about the destination function, showing how the user appreciates the destination function. ● Appreciation: Health function The users opinion about the health function, showing how the user appreciates the health function. ● Feedback A point of improvement the user has.
● Feedback (none) explanation When the user does not have any feedback, the explanation that has been given.
● Feedback: Buddy function A point of improvement from the user for the Buddy function. ● Feedback: Destination function A point of improvement from the user for the Destination function. ● Feedback: Health function A point of improvement from the user for the Health function. ● Feedback: step count function A point of improvement from the user for the Step count function. ● Intention to use: Buddy function How much the user intents to use the Buddy function. ● Intention to use: Destination function How much the user intents to use the Destination function. ● Intention to use: Driver A factor the drives the users intention to use the sports watch. ● Intention to use: Health function How much the user intents to use the Health function. ● Intention to use: Inhibitor A factor the inhibits the users intention to use the sports watch. ● Intention to use: Times How much does the user intend to use.
● Intention to use: When When does the user intend to use.
● Learnability How the user feels about learning how to use the sports watch. INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 94
● Learnability explanation The explanation the user provides on their estimation on learnability.
● Learnability help Whether the user thinks he/she will need help learning to use the sports watch and what form of help. ● Learnability: Buddy function How the user feels about learning how to use the Buddy function. ● Learnability: Destination function How the user feels about learning how to use the Destination function.
● Learnability: Health function How the user feels about learning how to use the Health function. ● Target audience Who the user sees as target audience of the sports watch. ● Usefulness How the user experiences the usefulness of the sports watch. ● Usefulness: Buddy function How the user experiences the usefulness of the Buddy function. ● Usefulness: Destination function How the user experiences the usefulness of the Destination function.
● Usefulness: Health function How the user experiences the usefulness of the Health function.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 95
Appendix H: Related systems analysis
Activity trackers (WFD) Various ranking websites recommended these fitness trackers to be used by elderly: - Garmin vivofit 2 (used newest version: Garmin vivofit 4 for analysis) o Also analysing the Garmin vivosmart 4, since it has slightly different functions - fitbit charge 2 (used newest version: fitbit charge 3 for analysis) o Also analysing the fitbit inspire HR, since it has slightly different functions - Samsung gear fit 2 - Moov now
Then there was one fitness tracker found currently on the market targeting elderly: - Lively wearable
MOOV NOW
Garmin vivosmart 4 Related systems analysed for their features and specifications are Garmin vivofit 4
Samsung Gear Fit 2 fitbit charge 3 fitbit inspire HR Lively wearable
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 96
MOOV NOW Sports: running, cycling, exercises, boxing, swimming
Exercise with Audio Guidance
The Moov app guides you while you work out based on your movement or heart rate in real time.
Dive Deep Into Your Data
Track your laps and heart rate at the same time. Improve your technique and efficiency by Moov app analysis.
Garmin vivosmart 4 Sports: walking, running, weight training, yoga, swimming Accent your style while enhancing your fitness with our vívosmart 4 activity tracker. This slim, swim-friendly wearable comes loaded with fitness and wellness features to help you make the most of a healthier, more active lifestyle. A wrist- based Pulse Ox sensor lets you estimate blood oxygen saturation while you’re sleeping — or you can spot-check your oxygen levels anytime during the day. The device also monitors heart rate at the wrist and includes helpful tools such as all-day stress tracking, a relaxation breathing timer and VO2 max readings. Plus, Body Battery energy monitoring helps you know when you’re primed to be active or when you may need to rest. Safe for the pool or shower, vívosmart 4 keeps you going strong with up to 7 days of battery life — while smart notifications with vibration alerts help you stay connected on the go (when connected to a compatible smartphone). Stylish, smart design
This slim wristband tracker, available in multiple colours, complements your style with its distinctive design, metal trim accents and bright, easy-to-read display. The display is only on when you need it. And when it's on, it auto-adjusts to ambient light levels, so it's visible even in bright sunlight. Whether you're going to the office, the gym, the pool or anywhere in between, vívosmart 4 is the perfect fit for your lifestyle.
Pulse Ox at your wrist
The Pulse Ox sensor on vívosmart 4 estimates your body’s blood oxygen saturation level. Your Pulse Ox measurements are dependent upon a number of factors, including your overall health and fitness. Checking your Pulse Ox can help gauge how your body is absorbing oxygen. Turn on the feature to gauge your SpO2 overnight, or use it to take a spot measurement anytime to learn more about your body.
Advanced sleep monitoring INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 97
Sleep is important to your overall health, well-being and physical performance. To give you an idea of how you’re sleeping, vívosmart 4 tracks your light, deep and REM stages of sleep, along with movement throughout the night. For added insight, turn on the Pulse Ox feature to view your blood oxygen levels during your sleep. When you wake up, you can easily review and compare your sleep stats in the Garmin Connect™Mobile app.
Optimise your body's energy
Body Battery energy monitoring on vívosmart 4 uses a combination of stress, heart rate variability (HRV), sleep and activity data to gauge your body's energy reserves at any moment, so you can plan your day to optimise times for activity and rest. A higher number indicates you're ready to be active, while a lower number suggests you might need to relax and rest a bit before tackling a workout. Body Battery can also help you make sense of patterns throughout your weeks, so you can understand how the past few days have influenced how you're feeling today.
All-day stress tracking
You most likely experience stress at some point in your day, but how much? Your vívosmart 4 lets you know when you are having a calm, balanced or stressful day and everything in between. Tracking your HRV (the time interval between each heartbeat), vívosmart 4 calculates and displays your stress level. There's also an optional "Relax Reminder" feature that you can turn on in the Garmin Connect app. If your stress level gets elevated during your day, it will provide a vibration alert on your wrist and display a message ("Take a moment to breathe?") to let you know it's time to relax. Use the relaxation breathing timer, which walks you through the Fourfold breathing technique, proven to calm your mind and body.
Keep track of your active life
Your vívosmart 4 greets you each day with a personalised step goal. Then it tracks and displays your progress. In addition to steps, its activity tracking capabilities include floors climbed, calories burned, intensity minutes and more. You'll also see a move bar and get vibration alerts to remind you when it's time to get up and move.
Track your workouts
You can use the preloaded activity timers to keep track of your exercise times and more. When using the strength training activity, it will capture your exercises, reps and sets along with your work and rest times so you can leave the notebook at home. And if you forget to start a timer, the Move IQ® feature on vívosmart 4 will automatically detect exercises such as walking, swimming, cycling and elliptical training — and it even starts timing select activities. When finished, your activities are pushed INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 98 to Garmin Connect, our online community, where you can review, edit and share the activities with your connections and friends. Daily fitness and wellness monitoring
Using the Elevate™ heart rate data collected from your wrist, vívosmart 4 can — with a VO2 max estimate — give you an idea of your current fitness level. In general, as your aerobic fitness increases, your VO2 max does the same. Based on your VO2 max, vívosmart 4 is also able to estimate your fitness age — a stat that you may be able to decrease over time with hard work and exercise. For added insight, vívosmart 4 will notify you if your heart rate unexpectedly rises above a threshold you’ve set. If you're inactive for more than 10 minutes and your heart rate stays above your set threshold, you’ll get an alert.
Stay connected
With a vívosmart 4 tracker on your wrist, you don't have to choose between staying connected and staying more active. Check the weather, control your music, receive smart notifications, find your phone, even reply with preset text responses (Android only), and access social media notifications on your tracker's display — all while keeping your smartphone stowed away.
Share and compete
Keeping an eye on your activities and achievements is easy with vívosmart 4. Your tracker automatically syncs to our Garmin Connect online community, where you can review your progress, join challenges, earn colourful badges and even share via social media. Garmin Connect is free and available on the web or on your smartphone with the Garmin Connect app.
Garmin vivofit 4 Sports: walking and running Find more ways to beat yesterday with easy-to- use vívofit 4. It brings you activity tracking and the freedom to keep moving without taking a break to recharge. With its 1+ year battery life, vívofit 4 is perfect to wear 24/7, so you’re always tracking your activity, automatically classifying it with Move IQ and so much more.
24/7 Wearable
The vívofit 4 activity tracker follows your progress 24/7 and lets you ditch the charging cord, thanks to its 1+ year battery life. It’s also safe for the pool or the shower, and its always-on colour display is bright and easy to see, even in the sunlight. Let your personality shine through by customising the screen with colour themes, watch faces and text phrases or by swapping out the band for a different one. Accessory bands are available in various colours and styles.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 99
Convenience on Your Wrist
With vívofit 4, we’re bringing you several new tools designed to make life a little more convenient. Use the weather widget for a quick, illustrated look at what the day is going to bring. Set an alarm in the app that will go off on your device, or even set a countdown timer right from your wrist to remind you when it’s time to turn off the oven. Misplaced your phone? vívofit 4 can help you with that, too.
Get Moving, the Easy Way
No need to manually start and stop your activity timer — Move IQ has you covered. It can automatically capture and classify different activities such as walking, running, biking, swimming and using an elliptical. For walks and runs, it can even start an activity timer automatically. Review the captured data later on Garmin Connect. Personalised Activity Tracking Plus Motivation vívofit 4 inspires you to get up and move. In addition to tracking steps, distance, calories burned and sleep, it also tracks periods of inactivity. A coloured move bar fills up to alert you if you’ve been stationary for too long. Reset it by walking for a couple of minutes. vívofit 4 even learns your current activity level then assigns an attainable daily step goal. As you meet your milestones, it will adjust your goal for the next day, gradually nudging you toward a healthier lifestyle.
Share and Compete
Throughout your day, vívofit 4 periodically syncs to Garmin Connect. The Garmin Connect™ app makes it easier than ever to beat yesterday. Bold, colourful activity cards provide all your statistics at a glance. Scroll down to easily compare today’s totals to past results, or tap in for more detailed information. Activities and other health measurements recorded by your device are presented in vivid detail. And the data you see is customised just for you and the way you move, without all the filler.
Step Challenges with Your Kids
Use the Toe-to-Toe™ feature to challenge your kids to a step competition. Your vívofit 4 activity tracker can wirelessly connect to your child’s nearby vívofit jr. 2 or even another vívofit 4 to kick off an instant timed step competition. It's all controlled right from the wrist, and once the competition is over, you'll both see the total number of steps during the one-on- one challenge and find out who triumphed.
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 100
Samsung Gear fit 2 Sports: running, cycling, swimming, triathlon, golf Make every move count
The Gear Fit 2 Pro is like a personal training partner that brings fitness into your everyday life. It tracks your activity levels 24/7 so you can see how everything adds up, even outside of your workouts.
Dive In
Take the Gear Fit2 Pro into the pool for a deeper look at your swimming stats. The 5ATM water resistance and on-board GPS let you monitor your progress accurately. Endurance game
The battery lasts up to five days between charges – even with the super bright, curved sAMOLED screen.
On the beat
Improved, continuous heart-rate monitoring and auto-detection ensures more informative data on your daily activities. Stay on track
The Gear Fit2 Pro syncs with the Samsung Health app for always-on fitness tracking, even when your phone’s elsewhere. It updates data from the Gear S3 and Gear IconX too, so you still see accurate stats if you’re using multiple wearables.
Split the difference
Ideal for those long runs to get away from it all, time splits can help you pace yourself and break down your training. fitbit charge 3
Sports: walking, running, aerobics, elliptical, cycling, sports, swimming Know yourself on a whole new level fitbit Charge 3™ reveals insights about your body, your fitness and everything in between–because the better you know yourself, the better you can be. Get guidance to make moves on your goals
The more you wear Charge 3, the more you learn about yourself and your workouts so you can start making changes that matter.
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Get your favorite smart features,right on your wrist
This advanced fitness tracker is packed with smart features that are compatible with iPhone, Android & Windows Phones. Windows compatibility coming soon. fitbit inspire HR
Sports: walking, running, aerobics, elliptical, cycling, sports, swimming Simplify the journey and enjoy it too These trackers are easy to use thanks to a touchscreen, backlit display and on-screen dashboard that helps you track sleep, activity and more—right from your wrist.
Designed for life Swimproof You can wear Inspire & Inspire HR in the shower, pool and beyond. Plus, they automatically track how long you’re swimming.* Up to 5 Days of Battery With up to 5 days of battery, Inspire & Inspire HR keep the encouragement and inspiration coming day and night.** Timer & Stopwatch Instant access to tools that make your life easier—like a timer for when you cook healthy meals & a stopwatch for tracking gym sets. See the heart rate difference on fitbit Inspire HR
The journey goes deeper when you add a heart rate sensor to the mix, and Inspire HR is still approachable and easy to use.
Lively wearable
Sports: walking, and running The new Lively Wearable brings together the health benefits of a fitness tracker and the safety advantages of one-touch access to an urgent response service. GreatCall’s exclusive 5Star service provides 24/7 access to highly-trained professionals who can assess a situation, get the help that is needed, and stay on the line until the situation is resolved. The Lively Wearable can be worn with either the wristband or lanyard and pairs with a smartphone via Bluetooth. Through the companion Lively Wearable app, active aging adults are encouraged to complete daily challenges and earn rewards. Family caregivers interact through the GreatCall Link app, cheering positive events and sending messages of encouragement, while also getting peace of mind that their loved one is safe and enjoying INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 102 the activities they love to do. Service is just $14.99/month making Lively the most affordable mobile health & safety plus urgent response product available!
PRODUCT FUNCTIONALITIES
Product Activity Sleep Food Emergency Guided Fall Exercise tracking tracking tracking support exercises detection calendar
MOOV x x - - x - - NOW Garmin x x - - - - x vivosmart 4 Garmin x x - - - - - vivofit 4 Samsung x x x x x - - Gear Fit 2 fitbit x x x - - - - charge 3 fitbit x x x - - - - Inspire HR Lively x - - x - x - wearable
FUNCTIONS THAT ARE BEING TRACKED
Product Steps Calories Distance Stairs Stress Body Energy burnt travelled climbed battery
MOOV - x x - - - - NOW Garmin x x x x x x x vivosmart 4 Garmin x x x - - - - vivofit 4 Samsung x x x x - - - Gear Fit 2 fitbit x x x x - - - charge 3 fitbit x x x x - - - Inspire HR Lively x ------wearable INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 103
MOTIVATING FUNCTIONALITIES Features along the self-determination theory (A) = autonomy (C) = competence (R) = relatedness
Product Goal setting Daily/ Reminder to Challenge Feedback (C) workout goal move in an others (C) setting inactive period (R) (C)
MOOV - - - - x NOW Garmin x x x x - vivosmart 4 Garmin x - x x x vivofit 4 Samsung x x x x x Gear Fit 2 fitbit x x x x x charge 3 fitbit x x x x x Inspire HR Lively - x - - - wearable
Product Exercise Groups (R) Workout Cheers & Badges sharing (R) coach taunts (R) (C)
MOOV - - x - - NOW Garmin x - - - - vivosmart 4 Garmin x - - - - vivofit 4 Samsung - x x - - Gear Fit 2 fitbit x x - x x charge 3 fitbit x x - x x Inspire HR Lively - - - - - wearable
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 104
Product Little Workout Leader Cardio Points Community reminders & levels board fitness (R) notifications (A) (R) level (C)
MOOV - x x - - - NOW Garmin ------vivosmart 4 Garmin ------vivofit 4 Samsung - - x - - x Gear Fit 2 fitbit x - - - - - charge 3 fitbit x - - x - - Inspire HR Lively - x - - x - wearable
Product Expert health advice (C)
MOOV - NOW Garmin - vivosmart 4 Garmin - vivofit 4 Samsung x gear fit 2 fitbit - charge 3 fitbit - Inspire HR Lively - wearable
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 105
PRODUCT SPECIFICATIONS
Product Battery duration Resistance Heartrate tracker Vibration motor MOOV 6 months Water, dirt, No: Supports one - NOW and sweat Garmin 7 days Waterproof x - vivosmart 4 Garmin 1 year Waterproof - - vivofit 4 Samsung 3-4 days Waterproof x x geat fit 2 fitbit 7 days Waterproof x x charge 3 fitbit 5 days Waterproof x x Inspire HR Lively Not specified Waterproof - - wearable (long lasting)
Product Hight Accelerometer Oxymeter GPS Gyroscope meter MOOV x x - - x NOW Garmin x x x - - vivosmart 4 Garmin - x - - - vivofit 4 Samsung x x - x x geat fit 2 fitbit x x - - - charge 3 fitbit - x - - - Inspire HR Lively - Unknown - Unknown Unknown wearable
INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 106
Appendix I: Interview quotes of the participants daily life activities
“We get up at a quarter to eight. Every Monday we clean a little, the house and such.
Tuesday in the morning we are going walking. At Thursday afternoon we go cycling
with our cycling club. If it is possible. Further we read a little, hang around and sit,
play chess, listen to music, make photographs. Yes that is about it.” (Male, 69 years)
“Yes at Thursday afternoon we cycle when the weather is good. That will be around
twenty to thirty kilometres. Tuesday morning walking that is always around ten
kilometres. And when the weather is good we go walking around the block for ourselves.
So every day we will walk one time so to say. And then we usually cycle to the market
or to my daughter, just cycling in between we also do that.” (Male, 69 years)
“I am with my pension. Yes I am at the board here and I visit people who are ill. Also I
have a lot of meetings at the housing construction union, I am at the board of residents
and the activities around here I organise them.” (Female, 73 years)
“Well I rise at seven then I took a shower and dressed. I did make coffee for the painters
around a quarter to eight and then I went on and did the kitchen. I cleared all cupboards
and cleaned them and packed them again. Then I went to do the bathroom and
afterwards I made my bed. So, that all I did before nine thirty.” (Female, 73 years)
“Every Friday morning we start at the elderly home with walking with the group and
that group is also there on Mondays. I also used to walk that group at first but in the
end I did not have enough time for that anymore. Not really no time, but I wanted to
keep the Mondays off to be able to function better through the rest of the week. On
Wednesdays I go swimming as long as the indoor pool is opened or else we go cycling
on Wednesday for about thirty kilometres just at our own pace.” (Female, 67 years) INCREASING ELDERLY ACCEPTANCE OF WEARABLE FITNESS DEVICES 107
“Mondays I go to the hobby club and that is at the community centre and in the afternoon
usually I go on and hobby a bit for myself or do the groceries and check what I want to
do for my home. Well on Tuesday morning I go walking with the walking club. That is
about eight kilometres a bit more and in the afternoon we play games in het shared
room of this building, it is similar to the community centre but way smaller.” (Female,
72 years)
“Yes I did my regular walk on Tuesday and that starts at half past nine until about
twelve. It totally depends on how long the walk is that they set out for us, because we
have a precursor, that is really ideal. In between we go and drink a coffee.” (Female,
72 years)