Participatory Design, Development, and Testing of Assistive Health Robots with Older Adults: An International Four-year Project

May combine two claims.

The final robot and games were useful for delivering stimulating activities and for providing reminders about medication, health, and wellbeing checks.

“The final robot and games were acceptable to older adults, and useful for delivering stimulating activities and providing reminders for medication, health and wellbeing checks.”

May combine two claims.

Participants in Phase 2 reported that the robot would be useful for companionship, giving reminders, responding to emergencies, providing safety checks, keeping a routine, and prompting exercise.

“The second theme focused on the benefits of the robot, with participants reporting that it would be useful for companionship, giving reminders, responding to emergencies, providing safety checks, keeping a routine, and prompting exercise:”

May combine two claims.

Half of the older adults (56%, 5/9) and 38% (6/16) of experts felt that monitoring health and wellbeing could be useful to monitor co-morbid conditions, like blood pressure.

“Some experts did not perceive this to be relevant for cognitive impairment, however, half of the older adults (56%, 5/9) and 38% (6/16) of experts felt that this could be useful to monitor co-morbid conditions, like blood pressure.”

May combine two claims.

Participants in Phase 2 suggested improving the interaction by showing text on the robot's screen, having a bigger screen and buttons, and speaking much more slowly.

“Participants made many suggestions for improving the interaction, including showing text on the robot's screen, having a bigger screen and buttons, and speaking much more slowly.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some Phase 3 experts commented that the speech was still too fast and needed to be louder.

“Some commented that the speech was still too fast and needed to be louder:”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Phase 3 experts reported that the scenarios were useful and some expected that the robot could reduce caregiver burden.

“Experts reported that the scenarios were useful and some expected that the robot could reduce caregiver burden.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 2 participants thought that reminders needed to be personalized to each user.

“Some thought that these reminders needed to be personalized to each user.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A participant had difficulty playing the games because the robot's instructions were unclear and they did not know what to do.

“One of the observers reported the participant had difficulty playing the games because”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Phase 4, four older adults played one session, three played two and three played three sessions.

“Four older adults played one session, three played two and three played three sessions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Phase 3, ten experts participated.

“Ten experts participated (nine females, one male).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some Phase 2 participants thought the humanlike appearance would help with building a relationship, while others liked the robotic aspects and did not want it to appear human-like.

“Some participants thought the humanlike appearance would help with building a relationship, while others liked the robotic aspects and did not want it to appear human-like.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Phase 4 participants highlighted advantages of the games, such as engaging their minds, making them concentrate and focus on the present.

“Participants highlighted advantages of the games, such as engaging their minds, making them concentrate and focus on the present:”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 3 experts desired for the medication reminders to be more detailed.

“Some also desired for the medication reminders to be more detailed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Phase 4 older adults were between 75 to 101 years old.

“The older adults were between 75 to 101 years old.”

May combine two claims.

There were mixed reactions in Phase 4 when asked if they would like to play the games again, with mean scores 1.95 (SD 0.83) and 2.00 (SD 0.89) on a scale of 1 'very much' to 3 'not much'.

“However, there were mixed reactions when asked if they would like to play the games again (on a scale of 1 'very much' to 3 'not much', mean scores were 1.95 (SD 0.83) and 2.00 (SD 0.89), respectively).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Many Phase 2 participants questioned the purpose of the arms, which were distracting and too noisy.

“Many questioned the purpose of the arms, which were distracting and too noisy:”

May combine two claims.

Some Phase 4 participants found the games boring and repetitive and lost interest.

“Other participants found the games boring and repetitive and therefore lost interest:”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 3 experts believed that the face and body language humanized the robot.

“Again, some believed that the face and body language humanized the robot;”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Phase 3 experts stated that the interaction was stimulating and believed that the reminders especially would help to trigger memory.

“Overall, the experts stated that the interaction was stimulating and believed that the reminders especially would help to trigger memory.”

May combine two claims.

Touch sensitivity and problems with dragging motion across the screen were barriers in Phase 4.

“Another barrier was the touch sensitivity and problems with the dragging motion across the screen.”

May combine two claims.

Phase 4 participants were satisfied with the dressing and cooking games overall, with mean ratings 1.50 (SD 0.85) and 1.33 (SD 0.52) on a scale from 1 'satisfied' to 3 'dissatisfied'.

“The questionnaire results demonstrated that the participants were satisfied with the dressing and cooking games overall, (mean ratings 1.50 (SD 0.85) and 1.33 (SD 0.52), respectively, on a scale from 1 'satisfied' to 3 'dissatisfied').”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Other Phase 3 experts reported that the robot was too automated and looked robotic, and that arm movements, flashing lights and facial expressions could overload someone with MCI/MD.

“However, others reported that it was too automated and looked robotic.The arm movements, flashing lights and facial expressions were identified to possibly overload someone with MCI/MD.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Phase 2, nine older adults and nine experts participated.

“Nine older adults (five females, four males) and nine experts (six females, three males) participated by watching the video scenarios of Silbot interacting with a user and responding to interview questions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Phase 3 experts suggested adding more activities, more reminders and personalizing the interaction to a user's needs.

“Examples included adding more activities, more reminders and personalizing the interaction to a user's needs.”

May combine two claims.

Phase 3 experts were satisfied with the simplicity of the interaction, clear screen, big buttons and voice activation, and perceived the robot to be easy to use.

“The experts were satisfied with the simplicity of the interaction, clear screen, big buttons and voice activation, and perceived the robot to be easy to use.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Phase 4, a total of 10 older adults and two experts helped to test the cognitive games.

“A total of 10 older adults (six females, four males) helped to test the cognitive games, while two experts were also involved.”

May combine two claims.

Bomy acted as a companion, with Phase 5 participants petting, naming, and dressing it up for Christmas.

“Theme three highlighted that Bomy acted as a companion, with participants petting it, naming it, and dressing it up for Christmas.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 5 participants expected future users to adapt to new technologies more quickly because they will have grown up using them.

“Some expected that future users would be able to adapt to new technologies more quickly, given that they will have grown up with using them.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Retirement villages that supported the research and many experts were involved across multiple phases, including data collection in Phase 4.

“The retirement villages that supported the research, and many of the experts were involved across multiple phases, including data collection in Phase 4.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Experts suggested improvements including touching rather than dragging items and more positive reinforcements for correct answers.

“The experts suggested improvements that included touching rather dragging items across the screen, and the games giving more positive reinforcements when participants gave the right answers.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Phase 6 participants observed slight improvements in their own cognition.

“They had observed slight improvements in their own cognition:”

May combine two claims.

Phase 6 participants reported the robot was easy to use and possibly useful in improving cognitive functioning.

“Participants reported that the robot was easy to use and possibly useful in improving cognitive functioning.”

May combine two claims.

Phase 5 participants reported the reminders were useful for their health-related needs and expected them to be especially beneficial for those with lower cognitive functioning.

“Participants reported that they were useful for their various health-related needs and expected them to be especially beneficial for those with lower levels of cognitive functioning.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Phase 6 participants identified possible technical developments including using contrasting color schemes to accommodate visual impairment such as macular degeneration.

“However, some possible technical developments were identified, including using contrasting color schemes to accommodate visual impairment (e.g., macular degeneration):”

May combine two claims.

The early phases of the project involved participants in scenario design, interface, and applications of the robot, while later phases tested how it could be used in context and adapted to health needs in collaboration with users.

“Instead, the early phases of our project involved participants in the scenario design, interface, and applications of the robot, while later phases tested how it could be used in context and adapted to health needs in collaboration with users (e.g., by introducing personalized reminders).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 5 participants predicted that lack of digital confidence and experience could create barriers to using Bomy.

“This was predicted to possibly create barriers to using Bomy:”

Probably not a substantial claim: may not pass S3 (load-bearing).

Phase 5 participants suggested that more technical support be provided on an ongoing basis.

“Overall, they suggested that more technical support be provided and that this should be offered on an ongoing basis.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

Phase 5 participants suggested personalized tasks such as cooking help and greater emphasis on safety.

“Some suggested personalized tasks, such as”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 5 participants raised concerns about a lack of digital confidence and experience.

“In theme four, some participants raised concerns about a lack of digital confidence and experience:”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Phase 6 participants suggested that imagery and specific language should reflect each user's culture; New Zealand participants desired a New Zealand accent and British participants desired a British accent.

“Participants also suggested that the imagery and specific language should also reflect that from each user's culture.For example, those from New Zealand desired a New Zealand accent, while British participants desired a British accent:”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Phase 5 participants suggested making some cognitive games more stimulating and the robot's voice more human-like.

“Suggestions included making some of the cognitive games more stimulating and making the robots voice more human-like.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some Phase 5 participants were more confident that most people would not find Bomy difficult to use.

“Others were more confident, e.g.,”

May combine two claims.

Participants with a range of health issues were included and perceived the robot as useful.

“However, participants with a range of health issues were included, and perceived the robot as useful.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Phase 5 participants reported technical issues for mass use: loud charger, game blocks sometimes not responding, and screen sometimes lagging.

“Participants also suggested that for mass use, some technical issues require resolving, such as the loudness of the charger, the game blocks sometimes not responding and the screen sometimes lagging.”

May combine two claims.

Phase 5 participants reported the robot was fun and useful to use.

“They were reported to be fun and useful to use:”

May combine two claims.

Over multiple phases, older adults, relatives, and experts contributed vital ideas and feedback about appropriate robot functions and highlighted potential pitfalls.

“Over multiple phases, the older adults, relatives, and experts contributed vital ideas and feedback about appropriate robot functions and highlighted potential pitfalls.”

May combine two claims.

Partners in the project previously tested similar games in Korea and found them to be acceptable and to have health benefits.

“Partners in the project previously tested similar games in Korea and found them to be acceptable and to have health benefits [42].”

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Classified as probably not a substantial claim.

Cognitive functioning was determined prior to enrollment, using the Mini Mental State Examination.

“Cognitive functioning was determined prior to enrollment, using the Mini Mental State Examination [46].”

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May combine two claims.

Cognitive abilities decline with age, and monotonic age-related cognitive decline has been reported from between 20 and 75 years of age.

“Salthouse [48] supports this, stating that monotonic age-related cognitive decline has been reported from between 20 and 75 years of age.”

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  Not checked in the free run.

May combine two claims.

Participatory design is crucial for technology adoption and in ensuring that older adults can and want to continue to use technologies, including robots.

“Participatory design is crucial for technology adoption and in ensuring that older adults can and want to continue to use technologies [32], including robots.”

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Classified as probably not a substantial claim.

The Geriatric Depression Scale, Geriatric Anxiety Scale, and Cambridge Neuropsychological Test Automated Battery were administered at baseline and follow-up to assess for changes in mood and cognitive functioning.

“The Geriatric Depression Scale [49], Geriatric Anxiety Scale [50], and Cambridge Neuropsychological Test Automated Battery [51] were administered at baseline and follow-up to assess for changes in mood and cognitive functioning.”

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Themes in Phase 5 were generated during an in-person meeting and discussed until consensus was met.

“Themes were generated during an in-person meeting and discussed until consensus was met.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The use of video scenarios was useful to speed up the process of testing and development with experts in aged care and older adults, to gain user feedback before the next phase.

“The use of video scenarios was also useful to speed up the process of testing and development with experts in aged care and older adults, to gain user feedback before the next phase.”

May combine two claims.

This level of participation is uncommon, as few developers involve older adults in the design process and little is known about their in-depth opinions of care robots.

“However, this level of participation is uncommon, as few developers involve older adults in the design process and little is known about their in-depth opinions of care robots, as current research primarily focuses on technical development and one-off use [20].”

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Probably not a substantial claim: may not pass S3 (load-bearing).

The same inductive analysis approach as in Phase 2 was conducted, but with three independent researchers in Phase 3.

“The same inductive analysis approach as in Phase 2 was conducted, but with three independent researchers.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Robots need to be evaluated in the settings they are developed for and during long-term use.

“Importantly, robots need to be evaluated in the settings they are developed for and during long-term use, as this is essential to encountering real-world challenges [21][22][23].”

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May combine two claims.

Assistive technologies and cognitive stimulation activities have been found to promote independent living and to help protect against age-related cognitive decline.

“Assistive technologies (also called gerontechnologies) and cognitive stimulation activities (e.g., games) have been found to promote independent living and to help protect against age-related cognitive decline [6].”

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Probably not a substantial claim: may not pass S3 (load-bearing).

Saturation was reached after the eighth interview in Phase 6.

“Saturation was reached after the eighth interview.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Only one potential participant was excluded, due to scores indicating severe impairment.

“Only one potential participant was excluded, due to scores indicating severe impairment.”

May combine two claims.

Many researchers only provide users with a single session to test a robot or ask participants to imagine using it, after seeing it.

“However, a review of social robotics found that many researchers only provide users with a single session to test a robot or ask participants to imagine using it, after seeing it [20].”

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Probably not a substantial claim: may not pass S3 (load-bearing).

The University of Auckland Human Participants Ethics Committee approved the studies.

“The University of Auckland Human Participants Ethics Committee approved the studies.”

Probably not a substantial claim: may not pass S2 (checkable).

Ongoing participatory and user-centered design of robotic technologies with intended users and experts is vital for developing effective, useful, acceptable, and user-friendly products.

“Ongoing participatory and user-centered design of robotic technologies with intended users and experts is also vital for developing effective, useful, acceptable, and user-friendly products.”

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interviews in Phase 5 were transcribed verbatim and analyzed thematically by two researchers, using an inductive approach that aligned with the established Braun and Clarke method.

“Interviews were transcribed verbatim and analyzed thematically by two researchers, using an inductive approach that aligned with the established Braun and Clarke method [47].”

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Including patients as well as clinicians resulted in a gamified robotic system for post-stroke long-term rehabilitation that was motivating, engaging, and met the needs of the end users.

“Polak et al. [33] found that including patients as well as clinicians resulted in a gamified robotic system for post-stroke long-term rehabilitation that was motivating, engaging, and met the needs of the end users.”

• cites [33]Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The specific methods were determined iteratively, depending on the findings from previous phases.

“As is consistent with a participatory design approach [24,30], the specific methods were determined iteratively, depending on the findings from previous phases.”

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Probably not a substantial claim: may not pass S3 (load-bearing).

The Montreal Cognitive Assessment scale was used to determine cognitive function at screening.

“At screening, the Montreal Cognitive Assessment scale was used to determine cognitive function [38].”

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Probably not a substantial claim: may not pass S3 (load-bearing).

Two researchers independently read the transcripts and extracted emergent themes in Phase 2.

“Two researchers independently read the transcripts and extracted emergent themes.”

May combine two claims.

The participatory process promoted collective ownership and avoided a deficit-framing approach, focusing on the robot as a tool to help older adults without compromising their autonomy.

“Third, the participatory process promoted collective ownership and avoided a deficit-framing approach [26,31], whereby the robotic product was focused on as a tool that could be used to help older adults, without compromising their autonomy.”

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Three robots (Bomy 1, Bomy, and Silbot) were used in the project, which strengthened the study.

“Importantly, three robots (Bomy 1, Bomy, and Silbot) were used in the project, which strengthened the study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The small sample sizes in some phases must be acknowledged.

“The small sample sizes in some of the phases must be acknowledged.”

May combine two claims.

Single-use or imagined-use research may bias results, as technology may not be reliable if used long-term.

“This may bias results, as the technology may not be reliable if used long-term.”

Classified as probably not a substantial claim. May combine two claims.

The project highlights the importance of ongoing stakeholder participation, product refinement and long-term testing robotics in the environments for which they have been developed.

“This project highlights the importance of ongoing stakeholder participation, product refinement and long-term testing robotics in the environments for which they have been developed.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Unsupervised autonomous use of the robots in later phases may have eliminated potential social desirability bias and encouraged more genuine feedback on human-robot interaction.

“Unsupervised autonomous use of the robots in later phases may have also eliminated potential social desirability bias and encouraged more genuine feedback on human-robot interaction.”

May combine two claims.

The Phase 4 evaluation produced limited results and mixed feedback.

“This resulted in limited results and mixed feedback.”

May combine two claims.

This ensured that the functions of the robot would meet their needs and be acceptable and user-friendly.

“This ensured that the functions of the robot would meet their needs and be acceptable and user-friendly.”

May combine two claims.

The sample sizes were appropriate for qualitative research and feasibility studies, but small for randomized trials.

“The sample sizes were appropriate for qualitative research and feasibility studies, but small for randomized trials.”

May combine two claims.

The multi-methods approach in this project meant that data were both reliable (due to randomization) and rich (due to qualitative interviews).

“The multi-methods approach in this project meant that data were both reliable (i.e., due to randomization) and rich (due to qualitative interviews).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Member checking gave participants the opportunity to contribute more information or validate that the information they provided during interviews was correct.

“This gave our participants the opportunity to contribute more information or to validate that the information they had provided during their interviews was correct.”

May combine two claims.

Overall, the robot shows potential in elderly care, especially in providing reminders for medication, health and wellbeing, and delivering cognitively stimulating games.

“Overall, the robot shows potential in elderly care, especially in providing reminders for medication, health and wellbeing, and delivering cognitively stimulating games.”

May combine two claims.

Issues identified in the earlier version were not reported by Phase 6 participants, indicating that they had been resolved.

“Issues identified in the earlier version were not reported by these participants, highlighting that they had been resolved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The blocks needed to be fixed by Robocare before they could be evaluated.

“Likewise, the blocks needed to be fixed by Robocare, to be able to evaluate them.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Individuals with mild cognitive impairments may respond better to shorter sessions where they are observed interacting with a robot, rather than long in-depth interviews about their interaction.

“For example, individuals with mild cognitive impairments may respond better to shorter sessions where they are observed interacting with a robot, rather than long in-depth interviews about their interaction.”

Probably not a substantial claim: may not pass S2 (checkable).

The project exemplifies how participatory design might be employed in a multi-phase project.

“This project exemplifies how participatory design might be employed in a multi-phase project.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Moharana et al. support that informal caregivers are often invisible within the design space.

“Moharana et al. [62] support this in their work, stating that informal caregivers are often invisible within the design space.”

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May combine two claims.

By centralizing older adults and experts in various multi-methods studies, the design of the robot was user-friendly and the functions were useful.

“By centralizing older adults and experts in various multi-methods studies, the design of the robot was user-friendly and the functions were useful.”

Classified as probably not a substantial claim.

The project highlights the importance of stakeholder involvement when developing robots for older adults.

“This international and multi-phase project highlights the importance of stakeholder involvement when developing robots for older adults.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Similar methods were used and recommended by Ostrowski et al.

“Similar methods were used and recommended by Ostrowski et al. [36].”

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Classified as probably not a substantial claim. May combine two claims.

Although both robots were perceived as potentially useful, they require further refinement to ensure usability and reliability, including resolving technical issues associated with long-term use.

“Although both robots were perceived to be potentially useful, they require some further refinement to ensure that they are usable and reliable, including resolving the technical issues associated with long-term use.”

May combine two claims.

Even small samples can provide important information in robotic studies, as previous research has shown that major technical issues in robots were identified in a sample of five participants.

“Even small samples can provide important information in robotic studies, as previous research has shown that major technical issues in robots were identified in a sample of five participants [10].”

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May combine two claims.

Participatory design requires contextual consideration and works best when products are designed and evaluated in the environments where end users spend their time.

“As emphasized in literature, participatory design requires contextual consideration, and works best when products are designed and evaluated in the environments where end users spend their time [24].”

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May combine two claims.

Previous research in human-robot interaction tends to consist of single use or often requires participants to imagine using the robot.

“Previous research in human-robot interaction tends to consist of single use, [10,11,22,43,[58][59][60] or often requires participants to imagine using the robot [20].”

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May combine two claims.

This ensured intercoder reliability and resulted in findings being interpreted accurately.

“This ensured intercoder reliability and resulted in findings being interpreted accurately.”

May combine two claims.

Previously developed technologies for older adults rely on developers and engineers imagining the health needs of older adults and often begin by creating a product and then searching for a problem for it to solve.

“This differs from previously developed technologies for older adults, which rely on developers and engineers imagining the health needs of older adults [20,57] and often begins by creating a product and then searching for a problem for it to solve [40].”

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Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Involvement of a range of key stakeholders and testing in multiple retirement villages may have improved the transferability of the robot.

“Lastly, the involvement of a range of key stakeholders and testing in multiple retirement villages may have improved the transferability of the robot.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Including caregivers of older adults helped them to understand the role that robots could play at each stage of dementia.

“They found that including caregivers of older adults helped them to understand the role that robots could play at each stage of dementia.”

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May combine two claims.

Experts, relatives, carers and older adults were empowered to collaborate on a project that may benefit them in the future, with a practical and clearly defined focus.

“Additionally, experts, relatives, carers and older adults were empowered to collaborate on a project that may benefit them in the future, with a practical and clearly defined focus.”