The Presence of Humanoid Robot With Older Adults at Homes
Phase: NA
Conditions: Loneliness, Cognitive Impairment, Depression, Self Efficacy, Sense of Coherence
Sponsor: The Hong Kong Polytechnic University

1 
 
 
 
 
Proposal title: The Presence of Humanoid Robot with Older Adults at 
Homes 
 
Date: 2022/01/13 
 
Investigators 
Prof Angela Leung (PI) 
Dr Ivy Zhao 
Mr Terence Lau 
School of Nursing 
The Hong Kong Polytechnic University 
 
 
 
 
 
 
 
 
 
 
 
 
 

2 
 
Background  
Population ageing is rising rapidly across the globe. According to the Hong Kong Census 
and Statistics report, by 2021, one out of six Hong Kong people (15.7%) will be aged 65 
or over.1 This number will be doubled to 2.37 million (31.1%) in 2036.2 According to the 
2016 Hong Kong census3, about 150,000 adults aged 65 and above lived alone, and 
almost 300,000 lived with their older spouse. Older adults experience significant 
physical, cognitive and environmental losses in their later life. A recent survey in Hong 
Kong has shown that 75% of local adults aged 65 or over, and 45% of soon-to-be-aged 
people in the 45 to 64 age groups are suffering from one or more chronic diseases.4 Older 
adults are vulnerable to loneliness due to their health deterioration and age-related losses, 
which prevent them from participating in social activities and engaging in interpersonal 
relationships.5 Moreover, the experiences of loneliness can be worsened for older adults 
when they live alone or only with their spouses (who are also older adults). By 2040, the 
number of older people, who need support is expected to more than double, with the 
direct cost of this “ageing care” rising from HK$38.8 billion (US$5 billion) in 2018 to 
HK$126 billion in 2040, and HK$222.4 billion by 2060.6 
In the field of gerontological nursing, person-centered holistic care highlights the 
importance of enabling older people and their significant others (such as older spouse or 
other family caregivers) to establish healthful relationships so to improve older adults’ 
physical, psychological, mental and social wellbeing7. Communications within the family 
and with friends is crucial for the ageing population and it has impacts on older adults’ 
psychological and mental health.8  
Social robots are robotic technologies that are designed to interact autonomously with 
people, with a variety of application features, by using the same repertoire of social 
signals used by humans.9 Research on the use of robots addressing older adults’ 
loneliness is given increasing attention in the globe, but most of them were focused on 
aiding older adults who are living with dementia or residing in nursing homes,5 while 
very limited studies have been undertaken in Chinese population. Self-supported aging-
in-place has positive benefits for social connection, social inclusion and the quality of life 
for older people10. Studies suggest that social robot and digital communication 

3 
 
technologies can contribute to the reduction of loneliness and social isolation in old age  
and such technology becomes a kind of social capital at their own homes.11 12 A recent 
study showed that older Chinese adults had high interests in having social robots during 
dining and entertainment in home-based aged care.13 Evidence showed that age, gender, 
education and computer experience on robot could impact on the acceptance of robot 
among older people.14 Another research in Hong Kong reported that individual attributes, 
such as gerontechnology self-efficacy and anxiety, health and ability characteristics, also 
affect the acceptance.15 However, more evidences are needed to examine the acceptance 
and feasibility of putting a social robot at home – investigation should be made to find 
out whether older adults, their spouses or other family caregivers at their homes accept, 
use and even live with these robots. Their experiences and perspectives on the use of the 
robots would be valuable to determine the use of technology in supporting ageing-in-
place among older adults in the community.  
 
Humanoid Robot ‘HUMANE’  
 
The humanoid robot is developed for integrating technology with human-like 
engagement, to support the wellbeing of older people and sustainability when aging-in-
place by enriching an interactional environment, improving older adults’ social and 
emotional engagement and delivering person-centered care. The robot has five main 
features:  

4 
 
1. Games and Quiz  
The robot provides assessment and training in cognition. Quizzes and games are tailor-
made according to different levels of cognitive abilities.  
 
2. Personalized services – story telling, music playing, event reminder 
The robot can tell stories, play music (according to older adults’ preference) and remind 
older adults about date and time of the social events/health activities. Quizzes can be 
tailor-made by family members according to older adults’ understanding and cognitive 
ability.  
 
3. Socially connect to family members or friends: making phone calls 
This feature provides connectivity services to reduce older people’s social isolation and 
help foster connections with family, friends and community. The phone application 

5 
 
inside the robot connects the older adults with family members, relatives and friends, 
extending their social connections. 
 
4. Promoting Healthy Lifestyle 
The robot has an exercise system which encourages older people to exercise regularly. It 
will remind the older adults about daily health-related activities: drinking water, doing 
exercise and reading books. 
 
Interactive modalities 
The robot can talk, sing, play games, report weather and read the news. Older people can 
communicate with the robot via voice commands or a touch panel. 

6 
 
 
 
Aims of the study 
This study aims to investigate the feasibility and acceptability of home-based physical 
robot HUMANE by community-dwelling Chinese older adults and soon-to-be-aged 
adults.  
Objectives of the study 
The objectives of the study are: 
1. To investigate the feasibility of using different features of this robot HUMANE at 
home within 6 weeks; 
2. To investigate the acceptability of the robot at home by older adults, their spouse, 
and other family members;  
3. To assess the preliminary efficacy of this robot on loneliness, depression and 
mood and calculate the effect size of the use of the robot at home for a full RCT. 
Methods  
Study design  
This study will employ a two-arm pilot randomized control trial with qualitative 
interviews.  
Participants  
The participants of this study are people aged 50 or above who are receiving home care 
from family members. Purposive sampling will be adopted in recruitment. We 
purposively look for people with different gender, age groups (20 people per each age 

7 
 
group: 50-60 years; 60-70 years; and 70-80 years), educational backgrounds and 
occupations, to reflect a diversity of views from the aged population. We will also recruit 
six computer ambassadors from a non-government organization in Hong Kong; these 
ambassadors have at least one-year experience in computer use. The ambassadors will be 
trained to support the study participants to use the robot during the intervention period. 
As a pilot RCT study, a minimum sample size between 24 and 50 have been 
recommended. 16 17  In this study, a total of 60 community-dwelling soon-to-be-aged or 
older adults will be recruited. They would be randomized to two groups (intervention 
group, IG, and control group, CG), that is, 30 adults will be randomized to IG while the 
other 30 adults will be assigned to CG. Thirty family caregivers will also be recruited 
through participants assigned in IG group.  
The inclusion criteria  
1.1 For community-dwelling soon-to-be-aged or older adults 
• Ethnic Chinese aged 50 years and above; 
• Need home-based care from family caregiver, including spouses; 
• Live with at least one family caregiver at his/her own home (not in residential 
care homes) in Hong Kong;  
• Are able to communicate in Cantonese or Putonghua.  
1.2 For family caregivers  
• Live with the participating older adult in the same household or in other 
household but with regular contacts (at least once per week) with the participating 
older adults 
• Are able to communicate in Cantonese or Putonghua  
The exclusion criterion for the participants are those:  
• With acute mental disorders or disabling diseases that may limit the practice of 
engaging with robot; and 
• have limited access to electricity and this makes them hard to use technology at 
home. 
Intervention 

8 
 
The robot HUMANE will be used by the IG (30 participants) for an 6-week trial. Project 
team will set up a physical robot at their homes. Each participant will be given a protocol 
to engage with different features of the robot every day.  Participants are asked to 
complete the assigned daily tasks at their own homes. Table 1 shows the 6-week tasks 
with the robot HUMANE.  
Phone counselling will be given to support the study participants by the trained 
ambassadors. A training workshop will be given to the ambassadors by the technical team 
before the intervention starts. A hotline will be set up for the participants and volunteers 
during the trial period to provide technical support. Participants will be encouraged to 
contact the ambassadors if they need support and when they had completed daily tasks. 
The ambassadors will contact the assigned participants (one ambassadors will be 
assigned with 5 participants) every three days by phone to ensure continued participation 
and to follow up on their progress.  
 
 

9 
 
Table 1. 6-week tasks of engaging with the robot HUMANE 
Days 
Tasks  
Week 1  
 
• Set up the robot 
• Complete the baseline assessment#  
Week 2 
• Explore the features of the robot with the caregiver 
• Talk to the robot  
Week 3 
• Communicate with two relatives using the robot 
• Record the appointments in the next 2 months 
Week 4 
• Check the calendar, weather forecast and read news 
• Search and listen music with the robot 
• Do 30-minute exercises with the robot 
Week 5 
• Check the calendar, weather forecast and read news 
• Play games with the caregiver on the robot 
• Communicate with a friend using the robot 
• Perform a task according to the calendar 
• Play cognitive training games with the robot 
Week 6 
• Check the calendar, weather forecast and read news 
• Share at least one interesting news to the caregiver  
• Play cognitive training games with the robot 
#Assessment: 6-item Chinese De Jong Gierveld loneliness scale, the Chinese version of 
the 2Q questionnaire, The Chinese version of the General Self-Efficacy Scale, the 
Chinese version of the social capital scale, the Chinese version of mutuality scale and the 
5-item Abbreviated Memory Inventory for the Chinese (AMIC) 
 
 
Outcome measures of feasibility and acceptability study 
The measures in the feasibility and acceptability study include: 1) recruitment rate of 
participants, 2) completion rate of the assigned tasks, 3) retention rate of the participants 
and 4) experiences for using the robot. 

10 
 
Quantitative method  
Demographic data will be collected at baseline before intervention. Upon completing 
each session, login frequency and durations of engaging each feature of robots will be 
collected and counted via the robotic management system to examine home care 
receivers’ compliance of engaging the robot HUMANE and preferences of specific 
features. ‘Video capture’ function of the HUMANE will be utilized to capture the 
situation when a home care receiver is using the robot on some time slots. The usability 
of robot will be assessed by the Chinese version of the system usability scale (SUS)18 
upon the completion of the intervention. The System Usability Scale (SUS) is a widely 
used instrument that measures the subjective usability of products and systems. The 
Chinese SUS has been tested and showed to be reliable, effective and sensitive. The scale 
contains 10 questions based on the Likert five-point scale; questions 1, 3, 5, 7, and 9 are 
positive and questions 2, 4, 6, 8, and 10 are negative. The 10 questions are closely related 
and are employed for the comprehensive evaluation of a product. A higher SUS score 
indicates better product usability. 
Qualitative method  
The perspectives and experience of using home-based robot HUMANE will be collected 
from home care receivers and their family caregivers through a 30mins in-depth 
individual interview. The questions that will be asked are framed with reference to the 
guideline on feasibility studies for intervention trials19. The guiding questions are as 
follows: 1) Acceptability: what do you think about the acceptability or satisfaction of 
using the robot at home? 2) Integration: what do you think if the robot can be integrated 
into the normal routine of your life? 3) Practicality: wat are the practical concern 
regarding the robot? 4) Efficacy: what changes do you have after you have engaged with 
the robot (for family caregiver: what changes do you observe the family member have 
after engaged with the robot)? The interview will be ceased until research team were 
satisfied that thematic saturation 20 was reached.  
Recruitment Rate 

11 
 
Research assistant will maintain a detailed record of the total number of target population 
accessed, recruited and retained. The study costs, human resources, the time taken for 
recruitment, the number of contacts, visits, the challenges encountered, reasons for 
withdrawal from the study, and factors that influenced recruitment and study completion 
rates will be recorded accordingly. 
Outcome measures in pilot RCT 
The following outcomes will be measured: 1) loneliness, 2) cognitive function, 3) 
emotional status, 4) self-efficacy, 5) social capital and 6) mutuality. The measurements 
will be utilized at baseline (day-1) and immediately post-intervention (week-6) to 
examine preliminary effect of using robot at home. 
Loneliness 
The loneliness status of participants will be explored to inform the selection of outcome 
measures in a full RCT to assess the effectiveness of the intervention. The 6-item Chinese 
de Jong Gierveld Loneliness Scale 21 consists of emotional loneliness and social 
loneliness two subscales, each of them contains three items. They are three response 
categories for each item: “no”, “more or less”, and “yes.” The scale has been validated 
and recommended as a reliable (Cronbach’s α of the 6-item scale was 0.76, the intra-class 
correlation coefficients ranged from 0.98 to 1.00) and valid (the content validity was high 
as shown by the results of the Delphi panel) measure of loneliness in older Chinese 21. 
Cognitive function  
In this study, a 5-item Abbreviated Memory Inventory for the Chinese (AMIC) 16 will be 
used to assess participants’ cognitive function. AMIC is an abbreviated version of the 
original 27-item Memory Inventory for Chinese people, with a sensitivity of 54.6%-
65.3% and specificity of 57.4%. There are five items: “Do you always forget where you 
put your stuff?”, “Do you feel that your memory is worse than your peers?”, “Do you 
always forget what you want to say during a conversation?”, “Do you always fail to find 
the appropriate word to express your idea during a conversation?”, and “Do you forget 
your acquaintances’ names when you meet them?”. AMIC scores range from 0-5 (1 point 
for each item; 0-best to 5-worse). An AMIC score ≥ 3 is predictive of MCI.  

12 
 
Emotion status  
The Chinese version of 2Q questionnaire was chosen because of the high sensitivity and 
that it was simple to use22. The 2Q was derived from the Primary Care Evaluation of 
Mental Disorders Procedure (PRIME-MD). The questionnaire includes two questions 
about depressed mood and anhedonia: "During the past month, have you often been 
bothered by feeling down, depressed, or hopeless?” and "During the past month, have 
you often been bothered by little interest or pleasure in doing things?" It is recommended 
a useful measure for screening depression in primary care in Hong Kong22.  
Self-efficacy  
The Chinese version of the General Self-Efficacy Scale is a reliable and valid scale that 
can be used with confidence in community Chinese soon-to-be-aged adults23. The CGSE 
Scale consists of 10 items that measure a generalized sense of competence. All items are 
rated on a 4-point Likert scale ranging from 1=‘Not at all true’ to 4=‘Exactly true’. The 
higher the score, the greater self-efficacy the respondents possess. 
Social capital  
Social capital will be evaluated using the social capital scale to cover the two dimensions 
of social capital (social cohesion and social interaction) developed by Mujahid 24. The 
social cohesion subscale consists of 4 items: 1) People around here are willing to help 
their neighbors, 2) People in my neighborhood generally get along with each other, 3) 
People in my neighborhood can be trusted, 4) People in my neighborhood share the same 
values. Each item ranged from 1 to 5 (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = 
agree, and 5 = strongly agree). Cronbach’s alpha was 0.81 among the Chinese 
community-dwelling older adults25. 
Mutuality  
Mutuality was assessed with the Chinese version of the Mutuality Scale, which consisted 
of questions related to love, shared activities, values, and reciprocity 26. Each item was 
rated with a 5-point Likert scale ranging from 0 (“not at all”) to 4 (“a great deal”); the 
total score was the mean of all items (ranging from 0 to 4). Higher scores implied greater 

13 
 
mutuality. Cronbach’s alpha was 0.96 for dementia patients and 0.94 for caregivers 
respectively26. 
Data analysis 
SPSS Statistics 26 will be adopted for all analyses. Descriptive statistics will be used to 
summarize the participant characteristics. Differences between the intervention and 
control groups in relation to outcome measures will be compared across multiple time 
points using generalized estimating equations (GEE) models or generalized linear mixed 
model (GLMM). The effect size will be computed to show the magnitude and direction 
of the effect of the intervention group relative to the control condition for each outcome 
variable. The usage statistics will be calculated and used to reflect the feasibility of the 
intervention. A deductive content analysis approach will be used to analyze the 
transcribed interview verbatim in relation to the feasibility of the intervention, which is 
considered suitable for a detailed analysis of the four indicators of the feasibility of the 
intervention: acceptability, integration, practicality, and efficacy19. 
Ethical and safety considerations  
Ethics approval and permission will be obtained from the study university before study 
undertaken. The research participants’ privacy, safety, health, social sensitivities, and 
welfare will be adequately protected according to the university ethics’ requirements. 
There will be no serious risks anticipated for this research. The surveys and interviews 
were not designed to place participants in an uncomfortable position. Researchers will 
provide participants with contact details for the study if they have any concerns.  
 
Before enrolment into this study, all participants will give written informed consent and 
they will be free to refuse to any assessments and withdraw from the study at any time. 
All study documents will be stored in a locked filing cabinet at the study university. Only 
the project team members have access to the consent forms. All study relevant data will 
be permanently deleted by the primary researcher after 7 years. Confidentiality will be 
maintained through replacing all names of individuals with pseudonyms and changing 
any potentially identifiable details in the transcripts and any reports, presentations, or 
publications arising from the research.  

14 
 
 
 
 

15 
 
Study timeline 
 
month 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
Recruit research staff     
x 
 
 
 
 
 
 
 
 
 
 
 
IRB submission and approval  
x 
 
 
 
 
 
 
 
 
 
 
 
Recruit 60 participants 
x 
 
 
 
 
 
 
 
 
 
 
 
Training for 6 ambassadors 
x 
x 
 
 
 
 
 
 
 
 
 
 
6-week trial for using the robot (1-10 
participants)  
 
 
x 
x 
x 
 
 
 
 
 
 
 
6-week trial for using the robot (11-20 
participants) 
 
 
 
 
x 
x 
x 
 
 
 
 
 
6-week trial for using the robot (21-30 
participants) 
 
 
 
 
 
 
x 
x 
x 
 
 
 
Baseline assessment 
 
 
x 
 
x 
 
x 
 
 
 
 
 
Post-intervention assessment 
 
 
 
 
x 
 
x 
 
x 
 
 
 
Qualitative interviews 
 
 
x 
x 
x 
x 
x 
x 
 
 
 
 
Data analysis  
 
 
 
x 
x 
x 
x 
x 
x 
x 
x 
 
Report 
preparation 
and 
results 
dissemination 
 
 
 
 
 
 
 
 
 
x 
x 
x 
 
 
Reference  
1. Census and Statistics Department. Population by Sex and Age Group 2021 [Available from: 
https://www.censtatd.gov.hk/en/web_table.html?id=1A accessed 30 October 2021. 
2. Census and Statistic Department. Population Projections Census and Statistic Department 
Web site2017 [Available from: 
https://www.censtatd.gov.hk/en/EIndexbySubject.html?pcode=FA100061&scode=190 
accessed 30 October 2021. 
3. Census and Statistic Department. Domestic Households in Hong Kong. Retrieved from HKSAR 
Census and Statistic Department Web site2016 [Available from: 
https://www.bycensus2016.gov.hk/en/Snapshot-04.html accessed 30 October 2021. 
4. Elderly Commission. Report on Healthy Ageing Executive Summary 2021 [Available from: 
https://www.elderlycommission.gov.hk/en/library/Ex-sum.htm accessed 23 Nov 2021. 
5. Gasteiger N, et al. Older adults’ experiences and perceptions of living with Bomy, an assistive 
dailycare robot: a qualitative study. Assistive Technology 2021 doi: 
10.1080/10400435.2021.1877210 
6. Moncreiffe E. As Hong Kong ages, carers of elderly relatives need more support at work, at 
home and for their own old age Hong Kong: South China Morning Post; 2019 [Available 
from: https://www.scmp.com/comment/insight-opinion/article/3009572/hong-kong-
ages-carers-elderly-relatives-need-more-support accessed 23 Nov 2021. 
7. World Health Organization. Integrated care for older people: guidelines on community-level 
interventions to manage declines in intrinsic capacity. Geneva, 2017. 

16 
 
8. He AJW, Tang VFY. Integration of health services for the elderly in Asia: A scoping review of 
Hong Kong, Singapore, Malaysia, Indonesia. Health Policy 2021;125(3):351-62. doi: 
https://doi.org/10.1016/j.healthpol.2020.12.020 
9. Vollmer A-L, Read R, Trippas D, et al. Children conform, adults resist: A robot group induced 
peer pressure on normative social conformity. Science Robotics 2018;3(21):eaat7111. 
10. Barrett P, Hale B, Gauld R. Social inclusion through ageing-in-place with care? Ageing & 
Society 2012;32(3):361–78. doi: https://doi.org/10.1017/S0144686X11000341  
11. Chen S, Moyle W, Jones C, et al. A social robot intervention on depression, loneliness, and 
quality of life for Taiwanese older adults in long-term care. International 
Psychogeriatrics 2020;32(8):981-91. doi: doi:10.1017/S1041610220000459 
12. Barbosa Neves B, Franz R, Judges R, et al. Can Digital Technology Enhance Social 
Connectedness Among Older Adults? A Feasibility Study. Journal of Applied Gerontology 
2019;38(1):49-72. doi: 10.1177/0733464817741369 
13. Chen N, Song J, Bin L. Providing Aging Adults Social Robots’ Companionship in Home-Based 
Elder Care. Journal of Healthcare Engineering 2019 doi: 10.1155/2019/2726837 
14. Heerink M. Exploring the influence of age, gender, education and computer experience on 
robot acceptance by older adults. 6th ACM/IEEE International Conference on Human-
Robot Interaction (HRI), 2011:147-48. 
15. Chen K, Chan AHS. Gerontechnology acceptance by elderly Hong Kong Chinese: a senior 
technology acceptance model (STAM). Ergonomics 2014;57(5):635-52. doi: 
10.1080/00140139.2014.895855 
16. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 
2005;4(4):287-91. doi: 10.1002/pst.185 
17. Hooper R. Justifying sample size for a feasibility study: research design service. London: NIHR 
2014. 
18. Wang YH, Lei T, Liu XX. Chinese System Usability Scale: Translation, Revision, Psychological 
Measurement. International Journal of Human-computer interation 2020;36(10):953-63. 
doi: 10.1080/10447318.2019.1700644 
19. O’Cathain A, Hoddinott P, Lewin S. Maximising the impact of qualitative research in 
feasibility studies for randomised controlled trials: guidance for researchers. Pilot 
Feasibility Stud 2015;1(32) doi: 10.1186/s40814-015-0026-y 
20. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its 
conceptualization and operationalization. Qual Quant 2018;52:1893-907. 
21. Leung GT, de Jong Gierveld J, Lam LC. Validation of the Chinese translation of the 6-item De 
Jong Gierveld Loneliness Scale in elderly Chinese. Int Psychogeriatr 2008;20(6):1262-72. 
doi: 10.1017/S1041610208007552 
22. Cheng CM, Cheng M. To validate the Chinese version of the 2Q and PHQ-9 questionnaires in 
Hong Kong Chinese patients. The Journal of the Hong Kong College of Family Physicians 
2007;29:381-90. 
23. Leung DYP, Leung AYM. Factor structure and gender invariance of the Chinese General Self-
Efficacy Scale among soon-to-be-aged adults. Jouranl of Advaned Nursing 
2011;67(6):1383-92. doi: 10.1111/j.1365-2648.2010.05529.x 
24. Mujahid MS, Diez Roux AV, Morenoff JD, et al. Assessing the measurement properties of 
neighborhood scales: from psychometrics to ecometrics. Am J Epidemiol 2007;165:858–
67. 
25. Wang LQ, Li JP, Wang ZZ, et al. Social capital and cognitive decline: Does sleep duration 
mediate the association? PLOS ONE 2021 doi: 10.1371/journal.pone.0252208 

17 
 
26. Shyu Y-Y, Yang C-T, Huang C-C, et al. Influence of mutuality, preparedness, and balance on 
caregivers of patients with dementia. J Nurs Res 2010;18:155–63.