In Conversation with...
In this interview series, Michele Boden, speaks to members of the the ACT™ Research Network.
Michele Boden, Head of the ACT™ Research Network, speaks to Slawomir Tobis from Poznan University of Medical Sciences about his extensive and varied career, including his studies in art therapy, as well as his interest in the field of geriatrics and passion for helping others.
Good afternoon Slawek, thank you for joining me today in my “In Conversation with …” series at ACT.
Hello Michele, I’m glad to be here with you.
Thank you. Thank you for your time. So I would first like to introduce the call with your very fascinating background, academic background. You have a master’s degree in Telecommunications, then you went onto doing a PhD specialising in Photography and then Health Sciences, and you’re currently working in the field of Geriatrics. So would you mind taking us through your career and explaining how you’ve ended up in this field?
Well, the story has a few branches but it’s simple, in the matter of fact, because it was through Art Therapy that I came to the University of Medical Sciences in Poznan. I was invited to be part of a postgraduate study in Art Therapy. And this is kind of the place and point in time where I discovered my passion for helping others. You know, it’s better late than never, something like that, and that’s why I started researching the area of Health Sciences, a broad category. And I also did a second PhD in that because, well, it’s related to the formal situation in Poland: when you have a degree in Arts you certainly can be employed in a Scientific University but you don’t have full possibilities, so it was just wise to do a second PhD. Besides, it was very interesting because I also used the EASY-Care tool in my PhD thesis so it combines very well with our topic of today’s interview I think. So, yes, I started as an Art Therapist and then got a few other qualifications like community therapy, this is a certificate awarded by the Polipsychiatrist Society, of which I am also a member. And I am also interested in Occupational Therapy because it’s the topic that I am teaching now.
Thank you. So could you tell us about your PhD and the use of the EASY-Care in it? And why you focused on the elderly population?
Well, it’s definitely one of the vulnerable societal groups and the one that perhaps doesn’t get enough attention, at least in certain areas. And besides, we have this very clear situation, at least in the developed part of the world, that we have more and more older people, especially the oldest old, I mean the age category of 80+ or 85+ is growing the fastest and it’s certainly an age group were you can expect, statistically, seeing the most need for support. And that’s why this interest in this age group, and I particularly decided to concentrate my PhD thesis on the use of new technologies in the care for older people and particularly so the use of social humanoid robots because this is the form of technology and machine that has quite a few features, and this is also quite well-researched, that is received in a different way than, say, a tablet. Because I presented my results in quite a lot of conferences and I got, a number of times I got a question from the younger participants: “hey, what the hell with the home robots? just give them a tablet”. And you know the communication would be similar but it’s not the case because the shape of the robot has a major influence in how older people – I think I also saw some research done on students, not only older people, I think on all of us – the appearance of the robot, the shape of the robot, the fact that it resembles a human, perhaps, has a major influence on how we perceive this robot. We tend to give that machine quite a bit more credibility than we would do that with a tablet, for example. So, you know, young people, like students, they are kind of born with mobile technologies so they are used to that and to them it’s probably a very natural way of communicating. It’s a different story with people, say, perhaps they did not have this privilege, and they had to learn those new technologies, and for them probably this humanoid shape of a robot has a role.
So I did, I concentrated, my PhD thesis on the use of robots and I tried to assess the prerequisites that are necessary for the implementation, because you have to imagine whenever in your life the PSA, a unit, a something, that is meant to accompany you all day long, it provokes a change in your life. I tried to imagine what the necessary prerequisites are, so the potential users feel comfortable with the machine and then what functions, what features, such a robot should have to be accepted, to be useful for the older users. And then I tried to find relationships between, for example, the EASY-Care Index, summarising index, and the acceptance, values, and the results were encouraging work, I would say.
I read in one of your research papers that you looked into having robots and how, perhaps, this could serve as a replacement of maybe a human companion? Is that something that you were looking at?
Well, I think I looked at something a bit broader in this theme because, well, one of the first answers, one of the first statements that you encounter when doing research, and talking to people and interviewing them, it’s that “a robot will never replace a human. Full stop”. So this is the first thing that you hear. But, I mean it depends a bit on the situation of the individual. The second sentence maybe, but if there is no human, let’s try with a robot. Something like that. And actually what my and my team’s research was about, is about others trying to find the areas where the use of robots makes sense. Because obviously the robot …, we can’t imagine that. The current state of the art, and perhaps the near future as well, the robot will entirely replace a human. It doesn’t seem viable so far. So we tried to find the areas in which the use of robots makes sense. Because I, just to finish one of my first sentences, we have more and more older people, and less and less younger counterparts that would perhaps be able to give them support, the older people support. And especially so the qualified person, the qualified caregivers. So we will have to. It’s not the question if, but it’s the question of how we will involve new technologies. It may start with, like, smart technologies for some monitoring of tasks, which may be difficult to older adults, but I decided to concentrate on the robots because it’s a very interesting technology that will be able to, at least partially, analyse relationships. Like, you know, people develop relationships with the machines.
Just to go beyond the scope of my PhD thesis and talk a bit about the research we did within the horizon of the 2020 framework. I think we were the first in the world, I may be wrong, but with this I didn’t find any evidence back then of such action, to really put the robots in the homes of older people, physically, you know, into their apartments and let the robots for 10 weeks just live with them. It was the first time, I think, for such a long time validation had been performed and we observed that all our participants developed a very strong, like, personal-type bond with the machine. I mean regardless of they were really lonely or socially isolated, or they were good functioning socially, in all cases, this bond was very strong so we had to provide some additional psychological support due to the effect of getting the machine …, the withdrawal effect of getting the machine removed from their life. I remember one of the participants moved, rearranged the furniture, so as to not to see the gap, the void, that the robot left. It was there, and suddenly it’s no more there. So, yes, I think the robots have this something that we tend to kind of develop relationships and it’s also a potential that we might use in our consideration when we’re speaking about care for older people.
So you mentioned it depends on the shape of the robot. So the more it looks like a human being, the more it can be personified and the more it can lead to an emotional attachment, is that correct?
So the research results are a bit contradicting, I think, from what I have read so far, and there are thousands of papers on robotics, social robotics every year. So it’s difficult just to know everything. But still the results are contradicting and there’s actually just this axis: the robot should be like a human so we can touch it, we can hug it, we can, we can … it should feel nice, perhaps it should resemble a skin, a human skin, something like it should be warm, it shouldn’t be cold. There are quite a lot of requirements that are being voiced out. On the other pole we have a situation, and we have people who say “no, it should never resemble a human being because it would be scary. It would be afraid of such a kind of person, so it should not resemble a human being”. But I think the majority tends to have a … it’s human-like.
And you mentioned the areas that you identified where it could work, could you explain what these areas are?
Absolutely. We have the headlist, like the statements that were ranked as the highest, because I get a validation of a tool that was initially developed within this EnrichMe programme within the horizon 2020 framework. And I did an adaptation of this instrument because we received some redundancy within the questions, within the statements, and then we used this tool continuously, just consequently, in all the studies that we did. And the first, you know, the top position is the safety, definitely. The robot should be able to call an emergency number when something bad happens. The robot should, for example, verify that the doors are closed, that gas is not leaking, you know. All those things related to safety and the security, you know, both the home, of the apartment, and the person himself. And then the robot should be able to measure some physiological parameters like pulse or blood pressure, or should detect also the mood of the older person, like, based on the face, for example, and there is also quite a broad consent to store this data and make it available for example for a medical professional, for a medical doctor for example, to visit the older person. So these are the things. So safety security.
Then the next, the top but one position, is the usefulness of the machine, like providing some opportunity to play some music, read aloud, … But quite many people, especially in the qualitative part of the study, voiced out the wish to that the robot reads for them. So reading must be probably a difficult thing to accomplish, so the question was just “can I just present the robot a book and it would read for me? Or a newspaper?” Like reading aloud was quite high on the wishlist. So the … all the things people think the robot is a useful thing, some kind of an assistive device, I’d say.
Then we have, actually I was a bit surprised, it’s pretty constant in our studies, that I was actually expecting that people would like the robot to provide a kind of companionship, to be a companion. And this role of the robot is rated still quite high because whenever when we rate our statements from 1 to 5 it’s got a rating of around 4 point small something, so it’s still quite high. But compared to the other wishes, the wish that the robot accompanies the older person was relatively lower score. And I just try to figure out why, because at the same time we have a question in the metrics part of the questionnaire, “if the respondent feels lonely”, so many of them said yes. You can also just give rating from 1 to 5 but many of them, and at the same time, I believe it’s not proven, definitely, but it’s my believe that just people do not perceive the technology as it is now, as mature enough that the robot could really provide companionship. So it’s my interpretation of this phenomenon because otherwise I don’t see any cause why this score is statistically significantly lower than the other ones. So this one. So these are probably the things, the areas, that we could address, the robot being useful, but at the same time, when I reach out to our qualitative part of the study, of our studies, there are multiple studies done, then older people very often express the wish that the robot doesn’t do everything for them. So they want to do those, or perform those tasks, that they are able to perform. So they fear losing abilities when they are kind of substituted by the robots in the everyday chores. To me it’s also a sign that the answers they provide are quite mature, that they are quite well-thought. So they can pretty well imagine a situation where they have a robot, and they can also imagine what they would like the robot to do, and what they don’t want the robot to do. So, yes, there are also areas that have been declared, and it goes on.
Do you find there is a, maybe, a clash of mentality? So is there some reluctance, or maybe some hesitancy on behalf of older people to welcome a robot into their homes or into their daily lives?
I would say no. I mean, there are individual cases where people said “no, don’t want any robots” but these were all, I think, all of them were persons, good functioning, with a big family, you know, being member of a big, good functioning something, bigger body. And they scored this perspective of having a robot quite low. But I think also they were of the average of 2.5, so I … it’s safe to assume that robots are universally accepted as potential caregivers for older people at least in those designated areas. There is also, you know, quite a significant ethical part to that, phrased in different ways: both in our quantitative study we have a section on ethics, and we also analysed transcripts of our focus group discussions which I know an enormous source of information as far as those are less structured formulations are concerned. And there are quite a lot of ethical concerns and they should be addressed, definitely.
By the way, I proposed a workshop on the ethics for the new upcoming EU Robotics forum in Rotterdam and in Munchen so if anybody is …, I would like to welcome anybody to this workshop because this subject, ethics related to new technologies, gains lots of traction now and rightly so because let’s imagine, a simple situation, if you want an example, a daughter buys a robot for an older mother. And we come across this situation where both persons have different opinions, like the daughter says “do something” and the mother says “no, don’t do this something, do this other something”. So, what should the robot do? Should it obey the daughter or the mother? Not an easy task. I mean, who is more important: the owner or the user? So this is one of the very simple examples that we probably need some regulation, or at least guidelines, for the legal systems and the individual countries, to have kind of a guideline: how to cope with, I mean, traditionally, with such cases? And they will come, I mean, it’s just a question of time, actually. So we will propose an EU regulation, to start thinking about an EU regulation and write it to AI, to Artificial Intelligence, and to social robotics as well. I don’t know how much success we can have, but we will try to do that.
With such a rapid phenomenon like technology, AI, you need ethics and you need society to catch up with it at the same time, but it’s very difficult. We can add a link to the event so people can have a look.
Okay, I’m happy to provide you with the link.
So I would like now to focus on your work with ACT and the ACT™ Assessment. You’ve already conducted studies with the EASY-Care tool and you are now going to be doing it with the ACT™ Assessment, so could you tell us what your plans are? And specifically, maybe, what it is about the ACT™ Assessment, about this method, that you find appealing, that you like?
Let me start with what we did so far. We have, for example, a large database of people living in the community, which is always the more difficult audience to reach than for example those persons living in situations which is easier to reach, and we have well over 1,300,000 records to analyse. So we first of all performed an analysis of this data, it’s based on the EASY Standard 2010 still, but I think it will give us some clues because I am very much convinced by the shape of the EASY-Care and the ACT tools because they are comprehensive, they just give us …they are able to characterise a person, a patient or a client, with a few numbers and give us some kind of quick impression, how this person functions and what kind of support this person might need. So this is actually why I selected EASY-Care and now ACT to work with.
The next stage will be to try to incorporate or find some relationships between the domains of ACT and some kind of technology assessment. I’m thinking of extending the UNRAQ to be compatible with the ACT, so when have like this analysis of the abilities and requirements versus new technology, and we have, on the other hand we have the assessment of the functional status of the person, the needs of this person, we can probably very much better adjust our offer as far as the technology is concerned.
So the other plans, I mean the plans are not quite finished because I think ACT will also live and will be probably extended. We have quite a few observations and I need to discuss with Professor Philp and perhaps refine some of the mechanisms in ACT, but I think that in general it makes sense to use this tool. One of the advantages is that it’s fairly quick, when you are used to this tool you can do the assessment in, say, 20 minutes or something. And having this comprehensive nature in mind, it’s not a lot. So it’s a pretty quick tool and it can be used … well I once demonstrated that it can also be used in self-assessment, which is I think something quite important. It was related to EASY-Care 2010. Maybe we should do similar analysis with ACT as well, but I would say ACT is so similar to EASY-Care 2010 that we can safely assume that also this kind of assessment tool can also be in this way or another used in self-assessment. So that would make things, I think, a bit easier, especially when we envision other case studies.
Well, one of the things that you are doing is the translation of the tool.
Well, it’s not happening yet, unfortunately. But it is happening in the close future, the near future. So we will translate the ACT™ Assessment tool into Polish. We are already now validating a Russian version of the EASY-Care Standard 2010 because we have performed some studies with our Kazakh partners and Russian is one of the languages that they can use, reasonably use, because the majority of Kazakhs speak Russian. So, yes, we will probably have a validated version of the EASY-Care Standard 2010 too, and maybe when things get fortunate, a bit more fortunate I would say, we could try to validate the similar version of ACT.
And hopefully it will happen soon. But you have a plan to translate it into Polish …
Yes, we will. I think the technical translation will be ready for the first half of this year, so it’s a very realistic perspective. We will have to see to what an extent this tool must be validated. Perhaps we could do some upcoming studies to the validation of this tool, probably, or just the tool’s psychometric properties.
We’ll wait and see until that happens and catch up to talk about it. Is there anything you would like to add to what we’ve spoken about: your career, advice to people interested in the field of Geriatrics, or anything else?
Not really. I think the areas that I kind of catched during this interview are quite important ones because I would like to repeat that we have no other choice but think to use technologies to support older people, it’s just inevitable. We should just try to imagine how to do it right, to not do any damage, and to do good, so to say. And the other thing is to really facilitate rapid assessment, rapid and effective assessment, so we can do screening on a larger scale for older people in need, so we can just precisely say: this person needs that and that kind of support, and it can be then quickly arranged.
Thank you very much Slawek. Thank you for your time.
Thank you Michele, it was a pleasure talking to you.
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