Using Behavioural Insights to Increase Older Adults' Acceptance of Camera-Based Active and Assisted Living Technologies

Abstract

Two certainties characterise societal change in the twenty-first century: changing demographics, marked by a growing number of older adults, and technological advancements that have reshaped and now uphold everyday life. These parallel trends pave the way for innovative solutions to the anticipated socio-economic challenges of population ageing. At the forefront of these solutions are camera-based active and assisted living (AAL) technologies, which aim to help older adults live longer and better quality lives while avoiding the increasingly exorbitant costs of acute or long-term care. By monitoring, responding to, and even anticipating older adults' needs at home, camera-based AAL technologies can ensure timely intervention during hazardous events, support greater independence and social engagement, and enact preventive measures to target morbidity and disability upstream. Widespread adoption of these technologies is thought to help societies leverage the benefits of ageing while avoiding its perils.

Notwithstanding their acclaimed promise, camera-based AAL technologies are slow to be incorporated into older adults' homes. The technology is fraught with issues of acceptability stemming from, among other factors, its privacy-intrusive and stigmatising quality. Consequently, well-intentioned appeals to consider the use of the technology are typically met with resistance or outright derision from older adults. This technological resistance has received sparse empirical treatment: few studies have adequately canvassed the causes of non-acceptance, and even fewer have attempted interventions to encourage acceptance. This oversight risks establishing a troubling third certainty about the future of societies: technological solutions to population ageing, as exemplified in camera-based AAL technologies, may come to exist only in rhetoric and not in reality.

This thesis anticipated and sought to mitigate the realisation of this third certainty. It theoretically conceived, developed, and evaluated the efficacy of a novel behaviour change intervention to increase older adults' acceptance of camera-based AAL technologies. To facilitate the development of more effective acceptance-facilitating interventions and contribute to theoretical advancements in the field, it additionally examined the reasons, or the mechanisms of action, underpinning the intervention's efficacy.

Following a comprehensive review of the factors influencing acceptance (Study 1), a novel theoretical conjecture was derived: non-acceptance of camera-based AAL technologies may stem in part from older adults' lack of psychological continuity to their future selves. Ostensibly, accepting the technology imposes costs (e.g., privacy violations) on the present self while promising benefits (e.g., improved wellbeing and longevity) to the future self. According to a future self-continuity hypothesis, individuals can feel so disconnected from their future selves that they devalue the rewards that accrue to these future selves. On this reading, older adults with lower future self-continuity may be less inclined to accept the technology due to a diminished valuation of its long-term benefits, which accrue disproportionately to the future self rather than the present self. By this logic, an intervention that bridges the psychological gap between present and future selves should promote greater acceptance of the technology.

Results from a series of interrelated studies provided support for this conjecture. Findings from a cross-sectional survey of n = 183 older adults (Study 2) revealed significant positive associations between future self-continuity and acceptance of camera-based AAL technologies, which were mediated by greater endorsements of the technology's long-run benefits. Subsequently, a "future-self intervention"—comprising a question-and-answer exercise designed to encourage reflection on the future self—was adapted and optimised to increase future self-continuity among older adults. A mixed-methods, person-based intervention development study (Study 3) with n = 7 older adults ensured that the intervention was relevant, acceptable, usable, and engaging, positioning it well for promoting behaviour change. The intervention was subsequently evaluated in a randomised controlled study (Study 4). Data from n = 181 older adults aged 60 to 80 revealed that exposure to the future-self intervention significantly increased acceptance in older adults aged below 65—an effect mediated by an increased affinity for the future self.

By conceptualising the acceptance of camera-based AAL technologies as involving a conflict of interest between temporally separated selves, this thesis enriches an understanding of novel psychological levers for fostering acceptance. Given that most consequential decisions—such as those concerning one's health and finances—entail competing interests between present and future selves, the developed future-self intervention holds substantial promise for facilitating positive behaviour change across various important life domains.