In total, 48 older adults, of which 20 males and 28 females, with a mean age of 81.19 (SD = 8.10), of which 16 persons lived in nursing homes and 32 persons visited day care facilities were included in the feasibility study. Furthermore, 12 healthcare professionals (2 males and 10 females, with a mean age of 29.67 (SD = 8.55), were included in the feasibility study.
Quantitative assessment
Table 1 includes the descriptive analysis of the 3 outcome measurements, i.e. IMI, SUS and CEQ collected in the aged participants.
Table 1 Descriptive data of main outcome measures
Assessment
|
Scores
|
IMI
|
|
Interest/enjoyment
|
5.17 (4.61-5.71)
|
Perceived competence
|
5.17 (4.95-5.80)
|
Effort
|
4.40 (3.80-4.85)
|
Felt pressure/tension
|
3.40 (2.55-3.60)
|
Value/usefulness
|
5.86 (5.25-6.86)
|
Relatedness
|
4.20 (3.40-4.60)
|
SUS
|
72.50 (67.50-85.00)
|
CEQ
|
|
Credibility
|
20.50 (16.80-24.00)
|
Expectancy
|
15.90 (8.60-19.60)
|
IMI: Intrinsic Motivation Inventory (maximum score on all subscales is recalculated to 7);
SUS: System Usability Scale (maximum score of 100);
CEQ: Credibility/Expectancy Questionnaire (maximum score on all subscales is 27).
Data of IMI, SUS and CEQ are presented as median (interquartile range).
Regarding the results on the IMI, all but one subscale scored above 4.20/7.00, which indicates good to very good motivation. The median SUS score is 72.50 (67.50 – 85.00) which indicates a good usability of the system. The CEQ shows a high score on the credibility subscale (= 20.50), while the scores on the expectancy subscale are considered moderately positive (= 15.90).
Qualitative assessment
Feedback of the users during and after use of the i-ACT system pertained to two main themes, i.e. perceived experience and developmental opportunities of the i-ACT. Within the perceived experience theme, older adults expressed feelings of joy, pressure, ability, and assurance when using technology. The healthcare professionals mentioned a positive experience with the i-ACT as they observed involvement of the older adults, but also that they think the i-ACT is better used in day care facilities. There were 2 subthemes found in developmental opportunities: visual and technical opportunities. Under visual opportunities, a more attractive context and game-like environment were suggested. Regarding technical opportunities, a more attractive feedback and a multi-player feature were suggested by the users. The fact that i-ACT is based on the Kinect, and thus a vision-based data capture system, was mentioned as a positive developmental opportunity. The themes and subthemes are presented in figure 2.
Regarding the first main theme, perceived experience, the older adults expressed feelings of joy by stating that they liked “the game”.
“The little guy did some weird things that I also had to do. A bit like a mirror, but then with 2 people.” (Participant 4, female, age 79, from nursing home facility).
“I liked it. Maybe not in the beginning because you don’t know what to do. But when you told me to hit those balls, I was on a roll! … It was something new, you know. And you know what, now I can brag about it to my grandkids. Imagine they’re faces as I tell them grandpa used one of those game things”. (Participant 33, male, age 68, from day care facility).
There were also older adults who experienced some feelings of pressure or tension.
“I’m not used to working with computers, so I was a bit tensed and anxious to use it beforehand. Luckily the nice girl (i.e. student occupational therapy) comforted me and told me she would stay with me to explain everything.”
(Participant 27, male, age 83, from day care facility).
As mentioned in the method section, a prototype was used. So the i-ACT could not be used independently, a healthcare professional as supervisor was necessary. The older adults stated that the presence of the healthcare professional was making them feel more comfortable and better able to use the i-ACT.
“I’m glad you’re here. I could never do this alone.” After about 10 minutes of trying exercises, this person stated “I’m getting the hang of it … thanks to you and your help (i.e. explanation)“. (Participant 41, female, age 88, from day care facility).
“Without X (name of the healthcare professional), I would never try things like this. I’m glad I did though. Even at my age … you’re never too old to learn something new.” (Participant 46, female, age 84, from day care facility).
Eleven participants clearly stated that they were anxious beforehand about using something new, some sort of technology. But after some time, they felt assured when using technology.
“All that technical stuff, it’s not my cup of tea. I never used a computer or those cordless phones (i.e. mobile phones). So my first thought was, this is not something for me, but when the girl explained to me that it was on the television and showed me what I had to do, I was reassured. I tried it, and I was actually happy that I could do it, you know, make those balloons explode and stuff.” (Participant 38, female, age 85, from day care facility).
In general the professionals were positive about using the i-ACT to stimulate PA in older adults, mostly due to the involvement they saw of the participants. The healthcare professionals observed happiness, competition within the participant to reach the targets, etc.
“It was surprising really, I never saw X (person’s name) engaged so much in an activity, unless during singing or watching an old television program. During other activities we have to keep him involved every 5 minutes or so”. (Therapist 1, female, age 33, from nursing home facility).
“You see that people get more involved the longer they play with it (i.e. i-ACT). It’s like they just forget about their surroundings … it’s incredible how focused they are on just a little dot on the screen”. (Therapist 8, female, age 31, from day care facility).
Although the healthcare professionals were overall positive about the i-ACT system, taking into account that a prototype was used, they reported that they think/feel that i-ACT could be better implemented in day care centres and not so much in nursing homes. The main reason for this is that the healthcare professionals report that people who go to day care facilities have, on average, better cognitive and physical functions than people in nursing homes.
Concerning the second main theme, i.e. developmental opportunities, two subthemes were found both in the older adults and healthcare professionals. Regarding the first subtheme, visual opportunities, it can be stated that the participants were overall satisfied with the visual features of the i-ACT system. But six persons would like to have a more attractive context, such as a kitchen as background, an open field with clouds and trees, etc. But also a more “game-like”, interactive environment such as flying birds that persons need to catch, grasping a cup from a cupboard, kicking against a football, etc.
This is in correspondence with the answers that concern the technical opportunities, i.e. the feedback “should not be so plain. You only have those balloons you need to touch and they explode. Can’t you put some birds there and that I have to catch the birds?” (participant 12, male, age 72, from nursing home). Furthermore, 17 participants suggested to make “the game” – as called by almost all participants – “a multiplayer game, so that we can play against each other”.
Another technical opportunity lies in the hard- and software of the Microsoft Kinect. As it uses vision-based data capture, no extraneous hardware or sensors on the body are required, and therefore easy to use for older adults as no wires are attached or they do not need to hold a controller.
“Hey, that guy is doing what I’m doing. How’s that possible? I’m not connected with the tv or anything”. After explaining that there is a camera in front of him, the person stated, “how funny. How amazing is technology nowadays. Almost scary! …. So the camera sees me, but he doesn’t really see me because I’m not the person on the screen?” (Participant 37, male, age 69, from day care facility).
As a prototype of the i-ACT was used, some technical problems occurred and so the feedback of 6 participants was that the system “should work properly”. Two people said “it would be a great thing to get this on my television at home. You know, like those aerobic exercises on television in the old days”.