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Designing a simple technology interface to help dementia caregivers use COACH in the home

Keywords: Assistive technology, caregivers, informal caregivers, user interface design, participatory design, human-computer interaction (HCI), usability evaluation, usability testing, user experience.


With the number of people with dementia expected to double by 2030 worldwide, the financial burden of dementia will pose the most significant health and social crisis of the century [1]. While medical treatments hold promise to slow disease progression, “smart home” technologies that assist with activities of daily living hold potential to mitigate healthcare utilization, reduce caregiver dependency, delay long-term care placement and improve overall quality of life. Our COACH system (Cognitive Orthosis for Assisting aCtivities in the Home), for example, has been successful in guiding individuals through hand-washing using audio and video prompts [2]. However, in a real home setting, COACH in its current design would still require technical personnel to set up and manage the system and dementia caregivers to standby to support individuals during use. Our research team believes that providing caregivers with easy-to-use, computer-based tools to interact with smart home technologies could help overcome these barriers to home deployment. Thus, the overall goal of this research project is to collaborate with informal dementia caregivers to design, prototype and evaluate a technology interface that will facilitate their interaction (i.e. system set-up, alerts, reporting) with COACH in the home.

Research Approach

Phase 1: Participatory design in groups (n=6)

Initial data were collected using a participatory design approach to understand caregivers’ problems, gather technology requirements, select desired features and technology modalities, and design a user interface (UI) prototype to support informal dementia caregivers’ interactions with the COACH system. Participatory design (also known as cooperative design and collective resource) involves direct, active and ongoing collaboration between end users (in this case, informal dementia caregivers) and technology designers (i.e. IATSL’s research team). The approach aims to combine diverse knowledge sets and expertise; instill ownership and commitment from both designers and end users; and create opportunities for end users to participate in design decision-making [3, 4]. The concept of “mutual learning” is central to participatory design, where two-way collaboration helps designers learn about the application area, and helps end users learn about technical possibilities or think about opportunities for technology [4]. This project phase interpreted caregivers’ needs and requirements, generating design alternatives and considerations for low-fidelity design.

Phase 2: Low-fidelity prototype design

Following participatory design, the team synthesized the functional requirements of the “caregiver interface” for COACH and translated them into five contextualized tasks: initial system setup, modifying COACH support of an existing activity of daily living (ADL), creating a new custom ADL in COACH, generating an report on COACH’s assistance for a particular ADL, and using COACH to monitor the home environment while the caregiver is away from home.  A low-fidelity paper prototype of the caregiver interface was then built for user evaluation of these five tasks.

Phase 3: Formative evaluation of the paper prototype using scenarios(n=2)

During this formative evaluation, participants were asked to complete five tasks using the paper prototype of the COACH caregiver interface.  Participants were given a description of the scenario, any information they would need to complete the task, and the goal of the given task.  The purpose of this evaluation was to test the usability of the designed interface, invite participants to elaborate on previously discussed design considerations, and elicit new design considerations.  The paper prototype served as a research probe to facilitate this discussion between participants and the research team.

Funding Sources

Canadian Institutes for Health Research (CIHR)

Everyday Technologies for Alzheimer Care (ETAC)


  1. Wimo A, Prince M. World Alzheimer Report 2010: The global economic impact of dementia. Alzheimer’s Disease International (ADI); 2010.
  2. Mihailidis A, Boger JN, Craig T, Hoey J. The C.O.A.C.H. prompting system to assist older adults with dementia through handwashing: an efficacy study. BMC Geriatr. 2008 Nov 7;8:28.
  3. Muller, MJ. Participatory design: the third space in HCI. In: The Human- Computer Interaction Handbook: Fundamentals, Evolving Technologies and Emerging Applications. Mahwah, NJ: Lawrence Erlbaum; 2002.
  4. Kyng, M. Designing for cooperation: cooperating in design. Communications of the ACM 1991 Dec; 34(12): 65-73.
  5. Nielsen, J. Ten usability heuristics. 2005.


  1. Hwang, A. and Hoey, J. (2013, accepted). DIY Smart Home: Narrowing the gap between users and technology [Extended abstract].  Interactive Machine Learning Workshop, International Conference Intelligent User Interfaces, March 19, 2013 at Santa Monica, California, USA.
  2. Hwang, A. and Hoey, J. (2012). Smart home, the next generation: closing the gap between users and technology [Full paper]. AAAI Technical Report FS-12-01, AI for Gerontechnology, 2012 AAAI Fall Symposium, November 2-4, 2012 at Arlington, Virginia, USA.
  3. Hwang, A., Truong, K., and Mihailidis, A. (2012). Using participatory design to determine the needs of informal caregivers for smart home user interfaces [Full paper]. 2012 6th International Conference on Pervasive Computing Technologies for Healthcare (pp. 41-48), May 21-24, 2012 at San Diego, California, USA.

Research Team

Amy Hwang, University of Toronto

Khai Truong, University of Toronto
Alex Mihailidis, University of Toronto