# Experiences from a Touch-Based Interaction and Digitally Enhanced Meal-Delivery Service for the Elderly

Authors: Minna Isomursu; Juha Häikiö; Arto Wallin; Heikki Ailisto
Journal: Advances in Human-Computer Interaction
 (2008)

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## Abstract

This paper reports the results of a field experiment where home-dwelling elderly people used a mobile technology-based service to interact with a home care service to order meals to be delivered to their homes. The primary research focus was on examining the suitability of touch-based interaction in the everyday life activities of elderly users. The eight-week experiment took place in the autumn of 2006. The findings are based primarily on user experience and on the socioeconomic analysis done from the data collected before, during, and after the experiment. The results show that touch-based interaction was easy to learn and adopt, and that the users were able to successfully use it regardless of their physical or cognitive weaknesses. However, the socioeconomic value of the service was questionable. The paper also summarises methodological issues and findings related to user experience evaluation in an experimental setting.


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## Body

## 1. Introduction

As the demographics of
developed countries have rapidly changed resulting in an increase in the number
of elderly people in the total population, there is a growing need to adopt new
practices for supporting the elderly in their everyday lives. New technology
can play a significant role in supporting elderly people and allowing them to
lead high-quality lives. One of the most difficult problems in adopting
technology has been that user interfaces are often not well-suited for elderly
users, as growing old inevitably changes the physical and cognitive
capabilities of humans. Here, we examined a novel user interface paradigm in
the context of supporting elderly users in their everyday lives.Tag-based user interfaces make it possible to embed the user interface
(i.e., the tags) into the everyday living environment of the user. Older users
have been found to prefer direct mobile interaction techniques [1] thus avoiding the physical effort of having to use a
keypad. By embedding the user interface in the phone and using direct
interaction techniques, we can have a more ‘‘natural’’ and ‘‘intuitive’’ user
interface. Basically, there are three alternatives for implementing a tag-based
user interface: scanning (i.e., providing information about all tags identified
in a current space), pointing (i.e., using an optical beam for selecting a tag
in sight), and touching (i.e., bringing a reader and a tag into physical
contact) [2]. Older people may have problems at pointing to the
tag which they want to choose [3], especially when the tags are located close to one
another as this requires a steady hand. Furthermore, data transfer delays are
more visible compared with touching. Therefore, our hypothesis is that touch
could provide a feasible user interface option for elderly users.As mobile phones are so common,
becoming almost ubiquitous, it is lucrative to combine the tag reading
functionality with the mobile phone. Modern mobile phones often have camera
capability which enables detecting and processing visual tags [4, 5]. Also, mobile phones with RFID-based readers are
available [6].The user interface implementation described here relies on an near fieldc
(NFC) enabled mobile phone and NFC-compatible radio frequency identification (RFID)
tags which can be touched with the mobile phone. When a tag is touched, the tag
reader integrated into the mobile phone reads the information embedded in the
tag and is then able to perform predefined actions. Many researchers have
considered the touch-based user interface paradigm promising especially after
the launch of NFC technology [1, 7, 8].The touch-based interaction was used in an application which allowed its
users to order a meal from a home care service. With the help of this
application, the users were able to select their meal choosing from two
options, or cancel their meal delivery altogether. Without the application, all
users would receive the same meal, and cancellations needed to be done by
telephone. The application was intended to be used by home-dwelling elderly
persons who were eligible for home care provided by the city of Oulu. The goals
of the new service were the following:(i)
empowering home care
clients by providing better feeling of control of their lives by allowing them
to choose their meals, and(ii)
ensuring the satisfaction with the meals
and thus decreasing the risk of malnutrition which has been found to be
surprisingly common among the elderly [9].
The aim of this study was to investigate user experiences evoked by the touch-based
interaction paradigm and the service itself, and the socioeconomic aspects
concerning the new service and, furthermore, to investigate the suitability of
the touch-based user interface and the related interaction technique for the
elderly.


## 2. Research Setting

The research method used was
based on a field experiment that was arranged by the city of Oulu in
co-operation with the Oulu regional home care service and logistics. The field
experiment involved preselected home care clients who were first evaluated for
suitability by the home care personnel, and then asked if they would volunteer
as trial users.The duration of the use of the
new mobile service was spread over three to eight weeks depending on the
starting time and the rehabilitation or hospital periods of a client. The
average age of the participants was 76.6 years. The youngest participant was
just under sixty years of age and the oldest was 88 years old. The group of
participants consisted of two women and seven men. The participants were
volunteers who were asked to participate by an employee of the Oulu regional
care service for the elderly. The request to participate was presented to those
whom the employee of the care service for the elderly thought to be most
capable of adopting and using new technology successfully.All participants lived alone
in their own homes. They were all clients of a meal service as they were not
able to shop and cook a balanced diet due to different constraints. The living
environment of most participants was confined to their apartment and backyard.
Few participants were able to carry a small amount of groceries from a local
shop to their home. Different physical constraints impeded wider outdoor activities.
In order to support their mobility, the participants had different kinds of
aids, such as walkers and walking sticks.Most participants had memory
disorders of differing levels. They received daily help from their children,
neighbours and the local citizen centre. The clients who were asked to participate
in the pilot scheme test were among the most alert persons in the group of
clients. However, in order to get access to home care services, the elderly are
assessed with the RAVA index [10] (measuring the functional capacity of a person), and
only those elderly persons with lowered functional capabilities are accepted as
clients.


### 2.1. User Experience Evaluation

User experience is a subjective state. It does not have an objective
reference, and therefore it cannot be objectively measured. An experience of
one person cannot be lived as such by another person. Therefore, systematic
capture and analysis of user experience is very difficult.Furthermore, it is extremely difficult for humans to compare even their
own experiences when the experiences are separated by time. Human memory about
experiences is utterly unreliable thus rendering our ability to recall past
experiences so that we could compare them with other experiences (e.g., [11]), or to describe them reliably after time has passed.
Also, our ability to predict our own experiences in a hypothetical or future
setting is very limited [12, 13]. Therefore, the hypothesis of the research reported
here is that the most reliable understanding of user experience can be achieved by
(i)
evaluating user
experience in a situation as close to actual realistic usage situation as
possible to avoid the need for users to imagine or predict their experiences in
a hypothetical situation;(ii)
collecting
information on and description of the experience at the time it happens to
avoid the need to rely on the memories of the user in describing the
experience, and(iii)
using the direct
subjective information given by the person having the experience for defining
and measuring the experience.
The research setting aimed at fulfilling these conditions. However, the
facts that the research period was limited in time may have had and probably did
have an effect on the user experience. As users are aware that the evaluated
technology is part of their lives only for a limited period of time, their
commitment to adopt the technology as an integral part of their lives may be
weak. If the users were to think that they are stuck with the technology (e.g.,
if they had invested a significant amount of their own money for buying the
technology), they would need to create strategies to successfully integrate it
into their everyday life. If problems were to arise, knowing that they would
need to use the technology in spite of problems would trigger a process for reducing
cognitive dissonance [14] which might make them feel and behave differently
than in an experimental pilot scheme. Irrevocability of decision has been shown
to be an important contributor to user experience [15, 16].Since describing and understanding user experience are complex as user
experience is always multifaceted and difficult to verbalise and describe, the combining
of different data collection methods increases the reliability and validity of
the results. The following chapters describe the methods used and data
collected in different phases of the experiment.


#### 2.1.1. Before-Use Evaluation

Two complimentary methods were used for evaluating the user experience
before the actual use of the new service.(i)
Interviews which aimed at exploring(a)
the attitudes of the trial users related to
technology under evaluation, and(b)
the satisfaction of the trial users towards
the service which was enhanced with the new technology.(ii)
Observation of the training situation
where the trial users had their first visual encounter with the physical
interface components of the system and their first hands-on experience on using
the novel interaction paradigm and the service.
The interviews were
semistructured and they took place at the home of the user. Open questions were
asked during the interview session and the interviewer gave opportunity for
discussion. A total of eleven elderly users volunteered and all were
interviewed. The main focus was on the background of the participants and their
experience and attitude towards new technologies.After the first interview, the
users were trained in using the new system. This was the first visual and
physical encounter with the system for the users. It was observed that for many
users, the real functionality and nature of the system were revealed at this point, even though
the functionality of the system had been briefly explained to them when they
were first asked to volunteer. Of course, also the memory problems of the
participants had an effect on this observation. At this point, two of the
eleven volunteers decided not to participate. Therefore, a total of nine users
actively participated in the trial. During their training, observations were
made on how the users adopted the technology and how they learned to use it.As our results later show, the attitudes observed before the use proved
to be a strong impacting factor towards the perceived usefulness of the
service. However, the experiences also show that it is difficult to predict
before the experiment what could be relevant parameters related to expectations
and attitudes which would be needed for interpreting the results, as the values
and attitudes of users often unfold only during the pilot scheme. This could be,
at least partially, solved by deeper user study concentrating on the values and
attitudes of the users already before the pilot scheme. Also, better models and
methods for describing and modelling expectations and attitudes towards ubiquitous
and mobile technology would be needed.One of the main goals of this service was to provide the elderly clients
with an improved service experience. In order to evaluate if improvement
happens, the situation before the trial needs to be recorded and evaluated. For
evaluating improvement, it is crucial to identify correct value parameters which
are then used for evaluation. For example, for some meal-ordering service users,
the social contact provided by the visit of the meal delivery person could be
the most valued parameter of the service. In this case, measuring the
satisfaction at the quality of the meal may not give a reliable or complete
view of user experience related to the pilot scheme service.


#### 2.1.2. During Use

Collecting information about user experiences at the time they happen
requires in situ data collection methods [17] which can be applied during the use of technology.
This means that the tools and methods used for collecting user experience data
need to be integrated into the everyday practices of the pilot scheme users,
just as the technology under evaluation. Our experiences show that when the
technology under evaluation is well integrated into the everyday practices of
the user and therefore quite invisible, the user experience evaluation method
may actually “steal the show” [18] if it is more visible and needs more attention and
cognitive processing from the user than the actual technology under evaluation.
Humans are not very good at analysing what actually caused an experience [19], so it can be difficult for users to identify if the
experience was caused by the technology under evaluation or the user experience
evaluation method (or any other event in the life of the pilot scheme user).
Even though the goal should be to use user experience collection methods which
would disturb and alter the usage situation as little as possible, it must be
noted that the fact that the measurement activities exist are highly likely to
affect how the users behave and what kind of user experience is evoked [20, 21].As interviews required the user to rely on memory and storytelling to
express the experience, the diary was adopted to capture data about experiences
as they happened instead of relying only on memories. The diary consisted of
printed pages with questions. One page would represent the description of an
experience. The user could use the diary daily or less frequently. Each page included
emoticons which could be used for expressing emotions during use and space for
free text entry.In addition to data collection based on self-report, user experiences
were collected by monitoring the status information recorded by the meal
ordering background system and observations made by other people involved in
the trial. During the trial use, the system status was constantly monitored by
the home care personnel and the researchers involved. If no order was received,
the users were given a phone call to check that everything was well. There were
also some technical problems which blocked the orders so that they were not processed
by the system correctly. Therefore, monitoring the system and order status was
essential. Some problems required visits. This provided one more opportunity to
observe the user’s experience related to the use of the system and they were
also recorded and analysed. In addition, other people involved in the trial,
such as meal delivery personnel and home care employees, were interviewed to
evaluate the total impact of the system. The delivery personnel were involved
daily with the elderly users and were therefore able to observe the use of the
system.


#### 2.1.3. After Use

After-use evaluation was utilised to evaluate possible changes in
attitudes of the users by comparing situations before and after use, and listening
to the explanations of users for the possible attitude changes. Immediately
after the end of the trial period, all pilot scheme users were interviewed again
to collect user experiences related to the trial.The interviews took place at the homes of the trial users. As interviews
after the actual use strongly rely on storytelling and on the memory of the
trial users, their limitations need to be acknowledged. Humans are not very
good at memorising experiences after time has passed. Therefore, the main focus
of the interviews was not on memorising experiences, but on evaluating the
attitudes and satisfaction of the user towards the service and technology
evaluated at the time of the interview.


#### 2.1.4. Follow-Up Study

A follow-up study was made for
estimating the long-term effects of the experiment. The attitudes of trial
users can fluctuate with time, and this does not necessarily end right after the
pilot scheme. As the pilot scheme use often provides the users with new
possibilities to control their lives, depriving them of this feeling of control
may have negative and even tragic effects [22] which can be observed only after some time has
elapsed after the experiment. The effects of the pilot experiment should be
analysed not only for collecting information about user experience, but also
for evaluating the ethical issues related to the experiment. The aim of the
follow-up study was to investigate
(i)
if there were changes in attitudes of trial participants concerning the
technology adoption (e.g., mobile phones and computers), when the attitudes
before, during, and immediately after the trial period were compared to the
attitudes eleven months after the trial period finished;(ii)
if there were changes in attitudes of trial participants concerning the
value of the NFC-based catering service and general attitude towards the pilot scheme
testing, when the attitudes immediately after the pilot scheme test were
compared to the attitudes eleven months later;(iii)
if there were any changes in satisfaction
concerning the catering service, when the situation immediately before the
pilot scheme test was compared to the situation about a year after the trial
period was finished.
For a follow-up study, semistructured interviews which were arranged at
the homes of the users were used. All trial participants were asked to
participate in follow-up interviews eleven months after the trial was finished.
During those eleven months, the condition of the trial users had changed both
for the better (e.g., one of the users was no more a home care client because
of a better health condition), and for the worse (e.g., one of the users had
died after the experiment had concluded). Five out of nine trial participants
were interviewed. The focus was in observing changes in attitudes, and effects
of the pilot experiment in the lives of the pilot scheme users. Also, the
follow-up study involved participatory elements, as the users were asked if any
ideas for improved or new uses of technology had emerged after the experiment.


### 2.2. Socioeconomic Evaluation

As the age structure of people
in developing countries is changing, relative costs of elderly care are
expected to rise. Also, there will be a relatively smaller number of working
age people to take care of a larger number of elderly people. At the same time,
there is a need to improve the quality of services which are provided for
elderly people and thus improve their living conditions.In consequence, the elderly
care sector is constantly looking for new solutions which would extend the possibility
for the elderly to live in their own homes and which could also lower the costs
of elderly care. Hence, one of the goals of this experiment was to find out if services
utilising the touch-based interaction paradigm could support the independent
living of elderly clients and so increase the effectiveness of elderly care
services. Also, the quality improvement of home care services was considered as
an important factor from the viewpoint of participants.The socioeconomic value of the
pilot scheme service was analysed with the help of data gathered using theme
interviews with business actors involved in the service chain. Companies interviewed
included a meal provider, a logistics service provider, and an elderly care
service provider. In order to identify a wide range of benefits and costs, the
personnel on both management and operational level were interviewed.The fact that the experiment
involved simulated components probably has an effect on how effective and
efficient the service is and was perceived from the viewpoint of the service
provider. As the service was used only for a limited period of time, the level
of integration with existing systems and effort which could be used for
workflow redesign was not as extensive as it could have been if the system
would have been adopted for a longer period of time. Also, the small and
limited size of the group of users had effects on the reliability of the
results, as a larger user group would require, for example, different kinds of
support activities.


## 2.1. User Experience Evaluation

User experience is a subjective state. It does not have an objective
reference, and therefore it cannot be objectively measured. An experience of
one person cannot be lived as such by another person. Therefore, systematic
capture and analysis of user experience is very difficult.Furthermore, it is extremely difficult for humans to compare even their
own experiences when the experiences are separated by time. Human memory about
experiences is utterly unreliable thus rendering our ability to recall past
experiences so that we could compare them with other experiences (e.g., [11]), or to describe them reliably after time has passed.
Also, our ability to predict our own experiences in a hypothetical or future
setting is very limited [12, 13]. Therefore, the hypothesis of the research reported
here is that the most reliable understanding of user experience can be achieved by
(i)
evaluating user
experience in a situation as close to actual realistic usage situation as
possible to avoid the need for users to imagine or predict their experiences in
a hypothetical situation;(ii)
collecting
information on and description of the experience at the time it happens to
avoid the need to rely on the memories of the user in describing the
experience, and(iii)
using the direct
subjective information given by the person having the experience for defining
and measuring the experience.
The research setting aimed at fulfilling these conditions. However, the
facts that the research period was limited in time may have had and probably did
have an effect on the user experience. As users are aware that the evaluated
technology is part of their lives only for a limited period of time, their
commitment to adopt the technology as an integral part of their lives may be
weak. If the users were to think that they are stuck with the technology (e.g.,
if they had invested a significant amount of their own money for buying the
technology), they would need to create strategies to successfully integrate it
into their everyday life. If problems were to arise, knowing that they would
need to use the technology in spite of problems would trigger a process for reducing
cognitive dissonance [14] which might make them feel and behave differently
than in an experimental pilot scheme. Irrevocability of decision has been shown
to be an important contributor to user experience [15, 16].Since describing and understanding user experience are complex as user
experience is always multifaceted and difficult to verbalise and describe, the combining
of different data collection methods increases the reliability and validity of
the results. The following chapters describe the methods used and data
collected in different phases of the experiment.


### 2.1.1. Before-Use Evaluation

Two complimentary methods were used for evaluating the user experience
before the actual use of the new service.(i)
Interviews which aimed at exploring(a)
the attitudes of the trial users related to
technology under evaluation, and(b)
the satisfaction of the trial users towards
the service which was enhanced with the new technology.(ii)
Observation of the training situation
where the trial users had their first visual encounter with the physical
interface components of the system and their first hands-on experience on using
the novel interaction paradigm and the service.
The interviews were
semistructured and they took place at the home of the user. Open questions were
asked during the interview session and the interviewer gave opportunity for
discussion. A total of eleven elderly users volunteered and all were
interviewed. The main focus was on the background of the participants and their
experience and attitude towards new technologies.After the first interview, the
users were trained in using the new system. This was the first visual and
physical encounter with the system for the users. It was observed that for many
users, the real functionality and nature of the system were revealed at this point, even though
the functionality of the system had been briefly explained to them when they
were first asked to volunteer. Of course, also the memory problems of the
participants had an effect on this observation. At this point, two of the
eleven volunteers decided not to participate. Therefore, a total of nine users
actively participated in the trial. During their training, observations were
made on how the users adopted the technology and how they learned to use it.As our results later show, the attitudes observed before the use proved
to be a strong impacting factor towards the perceived usefulness of the
service. However, the experiences also show that it is difficult to predict
before the experiment what could be relevant parameters related to expectations
and attitudes which would be needed for interpreting the results, as the values
and attitudes of users often unfold only during the pilot scheme. This could be,
at least partially, solved by deeper user study concentrating on the values and
attitudes of the users already before the pilot scheme. Also, better models and
methods for describing and modelling expectations and attitudes towards ubiquitous
and mobile technology would be needed.One of the main goals of this service was to provide the elderly clients
with an improved service experience. In order to evaluate if improvement
happens, the situation before the trial needs to be recorded and evaluated. For
evaluating improvement, it is crucial to identify correct value parameters which
are then used for evaluation. For example, for some meal-ordering service users,
the social contact provided by the visit of the meal delivery person could be
the most valued parameter of the service. In this case, measuring the
satisfaction at the quality of the meal may not give a reliable or complete
view of user experience related to the pilot scheme service.


### 2.1.2. During Use

Collecting information about user experiences at the time they happen
requires in situ data collection methods [17] which can be applied during the use of technology.
This means that the tools and methods used for collecting user experience data
need to be integrated into the everyday practices of the pilot scheme users,
just as the technology under evaluation. Our experiences show that when the
technology under evaluation is well integrated into the everyday practices of
the user and therefore quite invisible, the user experience evaluation method
may actually “steal the show” [18] if it is more visible and needs more attention and
cognitive processing from the user than the actual technology under evaluation.
Humans are not very good at analysing what actually caused an experience [19], so it can be difficult for users to identify if the
experience was caused by the technology under evaluation or the user experience
evaluation method (or any other event in the life of the pilot scheme user).
Even though the goal should be to use user experience collection methods which
would disturb and alter the usage situation as little as possible, it must be
noted that the fact that the measurement activities exist are highly likely to
affect how the users behave and what kind of user experience is evoked [20, 21].As interviews required the user to rely on memory and storytelling to
express the experience, the diary was adopted to capture data about experiences
as they happened instead of relying only on memories. The diary consisted of
printed pages with questions. One page would represent the description of an
experience. The user could use the diary daily or less frequently. Each page included
emoticons which could be used for expressing emotions during use and space for
free text entry.In addition to data collection based on self-report, user experiences
were collected by monitoring the status information recorded by the meal
ordering background system and observations made by other people involved in
the trial. During the trial use, the system status was constantly monitored by
the home care personnel and the researchers involved. If no order was received,
the users were given a phone call to check that everything was well. There were
also some technical problems which blocked the orders so that they were not processed
by the system correctly. Therefore, monitoring the system and order status was
essential. Some problems required visits. This provided one more opportunity to
observe the user’s experience related to the use of the system and they were
also recorded and analysed. In addition, other people involved in the trial,
such as meal delivery personnel and home care employees, were interviewed to
evaluate the total impact of the system. The delivery personnel were involved
daily with the elderly users and were therefore able to observe the use of the
system.


### 2.1.3. After Use

After-use evaluation was utilised to evaluate possible changes in
attitudes of the users by comparing situations before and after use, and listening
to the explanations of users for the possible attitude changes. Immediately
after the end of the trial period, all pilot scheme users were interviewed again
to collect user experiences related to the trial.The interviews took place at the homes of the trial users. As interviews
after the actual use strongly rely on storytelling and on the memory of the
trial users, their limitations need to be acknowledged. Humans are not very
good at memorising experiences after time has passed. Therefore, the main focus
of the interviews was not on memorising experiences, but on evaluating the
attitudes and satisfaction of the user towards the service and technology
evaluated at the time of the interview.


### 2.1.4. Follow-Up Study

A follow-up study was made for
estimating the long-term effects of the experiment. The attitudes of trial
users can fluctuate with time, and this does not necessarily end right after the
pilot scheme. As the pilot scheme use often provides the users with new
possibilities to control their lives, depriving them of this feeling of control
may have negative and even tragic effects [22] which can be observed only after some time has
elapsed after the experiment. The effects of the pilot experiment should be
analysed not only for collecting information about user experience, but also
for evaluating the ethical issues related to the experiment. The aim of the
follow-up study was to investigate
(i)
if there were changes in attitudes of trial participants concerning the
technology adoption (e.g., mobile phones and computers), when the attitudes
before, during, and immediately after the trial period were compared to the
attitudes eleven months after the trial period finished;(ii)
if there were changes in attitudes of trial participants concerning the
value of the NFC-based catering service and general attitude towards the pilot scheme
testing, when the attitudes immediately after the pilot scheme test were
compared to the attitudes eleven months later;(iii)
if there were any changes in satisfaction
concerning the catering service, when the situation immediately before the
pilot scheme test was compared to the situation about a year after the trial
period was finished.
For a follow-up study, semistructured interviews which were arranged at
the homes of the users were used. All trial participants were asked to
participate in follow-up interviews eleven months after the trial was finished.
During those eleven months, the condition of the trial users had changed both
for the better (e.g., one of the users was no more a home care client because
of a better health condition), and for the worse (e.g., one of the users had
died after the experiment had concluded). Five out of nine trial participants
were interviewed. The focus was in observing changes in attitudes, and effects
of the pilot experiment in the lives of the pilot scheme users. Also, the
follow-up study involved participatory elements, as the users were asked if any
ideas for improved or new uses of technology had emerged after the experiment.


## 2.1.1. Before-Use Evaluation

Two complimentary methods were used for evaluating the user experience
before the actual use of the new service.(i)
Interviews which aimed at exploring(a)
the attitudes of the trial users related to
technology under evaluation, and(b)
the satisfaction of the trial users towards
the service which was enhanced with the new technology.(ii)
Observation of the training situation
where the trial users had their first visual encounter with the physical
interface components of the system and their first hands-on experience on using
the novel interaction paradigm and the service.
The interviews were
semistructured and they took place at the home of the user. Open questions were
asked during the interview session and the interviewer gave opportunity for
discussion. A total of eleven elderly users volunteered and all were
interviewed. The main focus was on the background of the participants and their
experience and attitude towards new technologies.After the first interview, the
users were trained in using the new system. This was the first visual and
physical encounter with the system for the users. It was observed that for many
users, the real functionality and nature of the system were revealed at this point, even though
the functionality of the system had been briefly explained to them when they
were first asked to volunteer. Of course, also the memory problems of the
participants had an effect on this observation. At this point, two of the
eleven volunteers decided not to participate. Therefore, a total of nine users
actively participated in the trial. During their training, observations were
made on how the users adopted the technology and how they learned to use it.As our results later show, the attitudes observed before the use proved
to be a strong impacting factor towards the perceived usefulness of the
service. However, the experiences also show that it is difficult to predict
before the experiment what could be relevant parameters related to expectations
and attitudes which would be needed for interpreting the results, as the values
and attitudes of users often unfold only during the pilot scheme. This could be,
at least partially, solved by deeper user study concentrating on the values and
attitudes of the users already before the pilot scheme. Also, better models and
methods for describing and modelling expectations and attitudes towards ubiquitous
and mobile technology would be needed.One of the main goals of this service was to provide the elderly clients
with an improved service experience. In order to evaluate if improvement
happens, the situation before the trial needs to be recorded and evaluated. For
evaluating improvement, it is crucial to identify correct value parameters which
are then used for evaluation. For example, for some meal-ordering service users,
the social contact provided by the visit of the meal delivery person could be
the most valued parameter of the service. In this case, measuring the
satisfaction at the quality of the meal may not give a reliable or complete
view of user experience related to the pilot scheme service.


## 2.1.2. During Use

Collecting information about user experiences at the time they happen
requires in situ data collection methods [17] which can be applied during the use of technology.
This means that the tools and methods used for collecting user experience data
need to be integrated into the everyday practices of the pilot scheme users,
just as the technology under evaluation. Our experiences show that when the
technology under evaluation is well integrated into the everyday practices of
the user and therefore quite invisible, the user experience evaluation method
may actually “steal the show” [18] if it is more visible and needs more attention and
cognitive processing from the user than the actual technology under evaluation.
Humans are not very good at analysing what actually caused an experience [19], so it can be difficult for users to identify if the
experience was caused by the technology under evaluation or the user experience
evaluation method (or any other event in the life of the pilot scheme user).
Even though the goal should be to use user experience collection methods which
would disturb and alter the usage situation as little as possible, it must be
noted that the fact that the measurement activities exist are highly likely to
affect how the users behave and what kind of user experience is evoked [20, 21].As interviews required the user to rely on memory and storytelling to
express the experience, the diary was adopted to capture data about experiences
as they happened instead of relying only on memories. The diary consisted of
printed pages with questions. One page would represent the description of an
experience. The user could use the diary daily or less frequently. Each page included
emoticons which could be used for expressing emotions during use and space for
free text entry.In addition to data collection based on self-report, user experiences
were collected by monitoring the status information recorded by the meal
ordering background system and observations made by other people involved in
the trial. During the trial use, the system status was constantly monitored by
the home care personnel and the researchers involved. If no order was received,
the users were given a phone call to check that everything was well. There were
also some technical problems which blocked the orders so that they were not processed
by the system correctly. Therefore, monitoring the system and order status was
essential. Some problems required visits. This provided one more opportunity to
observe the user’s experience related to the use of the system and they were
also recorded and analysed. In addition, other people involved in the trial,
such as meal delivery personnel and home care employees, were interviewed to
evaluate the total impact of the system. The delivery personnel were involved
daily with the elderly users and were therefore able to observe the use of the
system.


## 2.1.3. After Use

After-use evaluation was utilised to evaluate possible changes in
attitudes of the users by comparing situations before and after use, and listening
to the explanations of users for the possible attitude changes. Immediately
after the end of the trial period, all pilot scheme users were interviewed again
to collect user experiences related to the trial.The interviews took place at the homes of the trial users. As interviews
after the actual use strongly rely on storytelling and on the memory of the
trial users, their limitations need to be acknowledged. Humans are not very
good at memorising experiences after time has passed. Therefore, the main focus
of the interviews was not on memorising experiences, but on evaluating the
attitudes and satisfaction of the user towards the service and technology
evaluated at the time of the interview.


## 2.1.4. Follow-Up Study

A follow-up study was made for
estimating the long-term effects of the experiment. The attitudes of trial
users can fluctuate with time, and this does not necessarily end right after the
pilot scheme. As the pilot scheme use often provides the users with new
possibilities to control their lives, depriving them of this feeling of control
may have negative and even tragic effects [22] which can be observed only after some time has
elapsed after the experiment. The effects of the pilot experiment should be
analysed not only for collecting information about user experience, but also
for evaluating the ethical issues related to the experiment. The aim of the
follow-up study was to investigate
(i)
if there were changes in attitudes of trial participants concerning the
technology adoption (e.g., mobile phones and computers), when the attitudes
before, during, and immediately after the trial period were compared to the
attitudes eleven months after the trial period finished;(ii)
if there were changes in attitudes of trial participants concerning the
value of the NFC-based catering service and general attitude towards the pilot scheme
testing, when the attitudes immediately after the pilot scheme test were
compared to the attitudes eleven months later;(iii)
if there were any changes in satisfaction
concerning the catering service, when the situation immediately before the
pilot scheme test was compared to the situation about a year after the trial
period was finished.
For a follow-up study, semistructured interviews which were arranged at
the homes of the users were used. All trial participants were asked to
participate in follow-up interviews eleven months after the trial was finished.
During those eleven months, the condition of the trial users had changed both
for the better (e.g., one of the users was no more a home care client because
of a better health condition), and for the worse (e.g., one of the users had
died after the experiment had concluded). Five out of nine trial participants
were interviewed. The focus was in observing changes in attitudes, and effects
of the pilot experiment in the lives of the pilot scheme users. Also, the
follow-up study involved participatory elements, as the users were asked if any
ideas for improved or new uses of technology had emerged after the experiment.


## 2.2. Socioeconomic Evaluation

As the age structure of people
in developing countries is changing, relative costs of elderly care are
expected to rise. Also, there will be a relatively smaller number of working
age people to take care of a larger number of elderly people. At the same time,
there is a need to improve the quality of services which are provided for
elderly people and thus improve their living conditions.In consequence, the elderly
care sector is constantly looking for new solutions which would extend the possibility
for the elderly to live in their own homes and which could also lower the costs
of elderly care. Hence, one of the goals of this experiment was to find out if services
utilising the touch-based interaction paradigm could support the independent
living of elderly clients and so increase the effectiveness of elderly care
services. Also, the quality improvement of home care services was considered as
an important factor from the viewpoint of participants.The socioeconomic value of the
pilot scheme service was analysed with the help of data gathered using theme
interviews with business actors involved in the service chain. Companies interviewed
included a meal provider, a logistics service provider, and an elderly care
service provider. In order to identify a wide range of benefits and costs, the
personnel on both management and operational level were interviewed.The fact that the experiment
involved simulated components probably has an effect on how effective and
efficient the service is and was perceived from the viewpoint of the service
provider. As the service was used only for a limited period of time, the level
of integration with existing systems and effort which could be used for
workflow redesign was not as extensive as it could have been if the system
would have been adopted for a longer period of time. Also, the small and
limited size of the group of users had effects on the reliability of the
results, as a larger user group would require, for example, different kinds of
support activities.


## 3. Application

The mobile service which was
taken into use in the experiment allowed the meal service clients to choose
their daily meals from two meal options. Traditionally, all clients get the
same meal and no options are provided. Therefore, the enhanced service can
offer the clients added value by giving them the freedom of choice with their
daily meals. In addition, the traditional meal service requires clients to call
a meal service provider during the morning of the delivery day if they want to
cancel their daily meal which would otherwise be automatically delivered to
them. The new application provides the possibility of cancelling the meal by
touching a tag with an NFC-enabled mobile phone. The application concept was
developed by the technology providers in co-operation with the meal service and
home care personnel. The primary research goals were related to evaluating the
touch-based interaction paradigm in a real-life usage context.


### 3.1. Application Logic

The application user interface
consisted of an NFC-enabled mobile phone and an NFC-enhanced meal menu
displayed in a plastic stand. The client placed meal orders by touching a
preferred meal option displayed on the menu with the mobile phone. The meal
order for delivery had to be placed before midnight on the previous day. Only the
most recent meal selection would be processed. Therefore, it was not possible
to order more than one meal per day. If the client repeated orders, only the
last order was processed. The actual meal selections were printed on paper, and
the paper was attached to the plastic stand. The person making the deliveries
changed it weekly. The actual tags were attached to the plastic stand—not to the paper
menu.Meal delivery personnel also
used NFC-enabled mobile phones (Nokia 5140i) in a trial for reporting that all
meal deliveries had been successfully completed. The delivery-personnel user
interface was also implemented using a touch-based user interface paradigm. The
delivery persons started their daily delivery process by touching a tag which
identified the driver and a second one which identified the delivery route.
This allowed logistics to check who delivered which meals on a given day.
During each successful delivery, the delivery person also touched a tag which
was placed on the inside of the client’s door to confirm that the delivery had
been effected. Having returned to the logistics centre after delivering all
meals, the driver would then touch a tag to confirm that the meal delivery route
had been completed. Using this information, the back-end system could
automatically check that all clients had received their meals. In addition, a
web-based monitoring system was available for the manual monitoring of the care
of the elderly and of the provision of their meals.


### 3.2. User Interface Solution

#### 3.2.1. Near Field Communication Technology

Near field communication (NFC)
is a short-range wireless connectivity technology which evolved from a
combination of existing contactless identification and interconnection
technologies [24]. NFC operates at 13.56 MHz which is a commonly used
frequency endorsed by ISO, ECMA, and ETSI standards. The main difference
between traditional RFID and NFC is that NFC is both a ‘‘read’’ and a ‘‘write’’
technology. Two NFC devices brought into close proximity, that is, a couple of
centimetres, can open a two-way communication channel with speeds up to 424 Kbps.
Since communication is initiated by touch, the perceived security and feeling
of user control are seen as the strong points of NFC. The foreseen applications
of NFC include payment, mass transit ticketing, initiating information transfer
between digital devices, and initiating service request which is the case in
our study.The technology used in this
field study is based on a Nokia Field Force Solution. Here, the information
transfer is unidirectional, that is, the mobile phone is a reader and the tag
is a passive target. The most essential components are an NFC-enabled mobile
phone, NFC tags, and J2EE-based Field Force Service Manager and Field Force
client software. In the trial, users employed Nokia 3220 and Nokia 5140i mobile
phones equipped with an NFC reader shell. In the trial, a reader shell made it
possible to read tag information and transfer this information from the tag to the
reader as the reading range is but a few centimetres. After a mobile phone is
identified, information concerning the meal selection can be transferred
through a GPRS connection to a middleware server and onwards to the back-end
system. Figure1 represents the architecture of the Nokia Field Force Solution.
On the left, there are the mobile phones which are used for selecting a tag.
After selection, information about the selection is transferred through the
operator network to the Service Manager and then via the Internet to the
back-end system.Figure 1
Nokia FFS architecture [23].


#### 3.2.2. User Interface

The user interface utilised
was implemented by VTT  (Oulu, Finland),
a research partner, and ToP Tunniste  (Tampere, Finland), a company developing
NFC-based products. The application concept and the user interface were
developed in collaboration with the regional elderly care centre of Oulu, the
meal provider and the meal delivery service.The primary design drivers in
the user interface design were the physical and cognitive changes introduced by
growing old with differing capabilities. For example, the use of a keypad of a
mobile phone was avoided completely as the elderly might have problems with
small keys (as a result of impaired motor skills) and reading small fonts on a
screen (as a result of impaired eyesight). Navigating menus and selecting
objects from the screen were also completely avoided. The activity steps
required for ordering a meal were designed so that no task sequences needed to
be remembered. Meal ordering could be done with a single touch. The application
did not require the user to remember whether the order had already been placed
or not as it allowed repeated selections. If the user was unsure whether or not
the order had already been placed, it could be placed again. The aim was to
avoid causing an excessive memory load on users. If no order was received by the meal
service, the user would be given a phone call to double-check.The tag symbols were designed
to be simple and large. A large and clear font was also used in the mobile
application. Only the most necessary information for use was displayed on a
screen. After every successfully completed order, feedback was given both by
displaying a confirmation message on the screen (visual feedback) and by the
phone vibrating (tactile feedback). The aim was to keep feedback unobtrusive
and immediate.The UI was created in a
development environment implemented at VTT. Many alternative application
versions were developed rapidly in order to receive feedback from all parties.
Based on iterations, the required activity steps for meal ordering decreased
notably during the development process. The demonstration environment was built
to examine the functionality of the application and the user interface. This
environment was used to illustrate how the meal orders were processed and how
they were transferred between parties. Furthermore, the environment visualised
the user interfaces which were designed for each party. The functionality of
the system was demonstrated several times to all parties and they had the
possibility to give feedback based on their own viewpoints. The feedback was
used for iterating the application concept and related user interfaces.The final version of the UI consisted
of the following parts:(i)
an NFC tag stand (shown in Figure2) where the following items were
attached:
(a)
a tag representing the meal option ‘‘A’’;(b)
a tag representing the meal option ‘‘B’’; and(c)
a tag labelled ‘‘C’’ to indicate that there was no need for a meal,(ii)
a paper-based meal menu (illustrated in Figure3) which was changed
weekly by meal delivery personnel, and(iii)
a mobile phone equipped with an NFC reader shell.Figure 2
An NFC-enhanced plastic stand.Figure 3
An example of a menu (translated from Finnish).


## 3.1. Application Logic

The application user interface
consisted of an NFC-enabled mobile phone and an NFC-enhanced meal menu
displayed in a plastic stand. The client placed meal orders by touching a
preferred meal option displayed on the menu with the mobile phone. The meal
order for delivery had to be placed before midnight on the previous day. Only the
most recent meal selection would be processed. Therefore, it was not possible
to order more than one meal per day. If the client repeated orders, only the
last order was processed. The actual meal selections were printed on paper, and
the paper was attached to the plastic stand. The person making the deliveries
changed it weekly. The actual tags were attached to the plastic stand—not to the paper
menu.Meal delivery personnel also
used NFC-enabled mobile phones (Nokia 5140i) in a trial for reporting that all
meal deliveries had been successfully completed. The delivery-personnel user
interface was also implemented using a touch-based user interface paradigm. The
delivery persons started their daily delivery process by touching a tag which
identified the driver and a second one which identified the delivery route.
This allowed logistics to check who delivered which meals on a given day.
During each successful delivery, the delivery person also touched a tag which
was placed on the inside of the client’s door to confirm that the delivery had
been effected. Having returned to the logistics centre after delivering all
meals, the driver would then touch a tag to confirm that the meal delivery route
had been completed. Using this information, the back-end system could
automatically check that all clients had received their meals. In addition, a
web-based monitoring system was available for the manual monitoring of the care
of the elderly and of the provision of their meals.


## 3.2. User Interface Solution

### 3.2.1. Near Field Communication Technology

Near field communication (NFC)
is a short-range wireless connectivity technology which evolved from a
combination of existing contactless identification and interconnection
technologies [24]. NFC operates at 13.56 MHz which is a commonly used
frequency endorsed by ISO, ECMA, and ETSI standards. The main difference
between traditional RFID and NFC is that NFC is both a ‘‘read’’ and a ‘‘write’’
technology. Two NFC devices brought into close proximity, that is, a couple of
centimetres, can open a two-way communication channel with speeds up to 424 Kbps.
Since communication is initiated by touch, the perceived security and feeling
of user control are seen as the strong points of NFC. The foreseen applications
of NFC include payment, mass transit ticketing, initiating information transfer
between digital devices, and initiating service request which is the case in
our study.The technology used in this
field study is based on a Nokia Field Force Solution. Here, the information
transfer is unidirectional, that is, the mobile phone is a reader and the tag
is a passive target. The most essential components are an NFC-enabled mobile
phone, NFC tags, and J2EE-based Field Force Service Manager and Field Force
client software. In the trial, users employed Nokia 3220 and Nokia 5140i mobile
phones equipped with an NFC reader shell. In the trial, a reader shell made it
possible to read tag information and transfer this information from the tag to the
reader as the reading range is but a few centimetres. After a mobile phone is
identified, information concerning the meal selection can be transferred
through a GPRS connection to a middleware server and onwards to the back-end
system. Figure1 represents the architecture of the Nokia Field Force Solution.
On the left, there are the mobile phones which are used for selecting a tag.
After selection, information about the selection is transferred through the
operator network to the Service Manager and then via the Internet to the
back-end system.Figure 1
Nokia FFS architecture [23].


### 3.2.2. User Interface

The user interface utilised
was implemented by VTT  (Oulu, Finland),
a research partner, and ToP Tunniste  (Tampere, Finland), a company developing
NFC-based products. The application concept and the user interface were
developed in collaboration with the regional elderly care centre of Oulu, the
meal provider and the meal delivery service.The primary design drivers in
the user interface design were the physical and cognitive changes introduced by
growing old with differing capabilities. For example, the use of a keypad of a
mobile phone was avoided completely as the elderly might have problems with
small keys (as a result of impaired motor skills) and reading small fonts on a
screen (as a result of impaired eyesight). Navigating menus and selecting
objects from the screen were also completely avoided. The activity steps
required for ordering a meal were designed so that no task sequences needed to
be remembered. Meal ordering could be done with a single touch. The application
did not require the user to remember whether the order had already been placed
or not as it allowed repeated selections. If the user was unsure whether or not
the order had already been placed, it could be placed again. The aim was to
avoid causing an excessive memory load on users. If no order was received by the meal
service, the user would be given a phone call to double-check.The tag symbols were designed
to be simple and large. A large and clear font was also used in the mobile
application. Only the most necessary information for use was displayed on a
screen. After every successfully completed order, feedback was given both by
displaying a confirmation message on the screen (visual feedback) and by the
phone vibrating (tactile feedback). The aim was to keep feedback unobtrusive
and immediate.The UI was created in a
development environment implemented at VTT. Many alternative application
versions were developed rapidly in order to receive feedback from all parties.
Based on iterations, the required activity steps for meal ordering decreased
notably during the development process. The demonstration environment was built
to examine the functionality of the application and the user interface. This
environment was used to illustrate how the meal orders were processed and how
they were transferred between parties. Furthermore, the environment visualised
the user interfaces which were designed for each party. The functionality of
the system was demonstrated several times to all parties and they had the
possibility to give feedback based on their own viewpoints. The feedback was
used for iterating the application concept and related user interfaces.The final version of the UI consisted
of the following parts:(i)
an NFC tag stand (shown in Figure2) where the following items were
attached:
(a)
a tag representing the meal option ‘‘A’’;(b)
a tag representing the meal option ‘‘B’’; and(c)
a tag labelled ‘‘C’’ to indicate that there was no need for a meal,(ii)
a paper-based meal menu (illustrated in Figure3) which was changed
weekly by meal delivery personnel, and(iii)
a mobile phone equipped with an NFC reader shell.Figure 2
An NFC-enhanced plastic stand.Figure 3
An example of a menu (translated from Finnish).


## 3.2.1. Near Field Communication Technology

Near field communication (NFC)
is a short-range wireless connectivity technology which evolved from a
combination of existing contactless identification and interconnection
technologies [24]. NFC operates at 13.56 MHz which is a commonly used
frequency endorsed by ISO, ECMA, and ETSI standards. The main difference
between traditional RFID and NFC is that NFC is both a ‘‘read’’ and a ‘‘write’’
technology. Two NFC devices brought into close proximity, that is, a couple of
centimetres, can open a two-way communication channel with speeds up to 424 Kbps.
Since communication is initiated by touch, the perceived security and feeling
of user control are seen as the strong points of NFC. The foreseen applications
of NFC include payment, mass transit ticketing, initiating information transfer
between digital devices, and initiating service request which is the case in
our study.The technology used in this
field study is based on a Nokia Field Force Solution. Here, the information
transfer is unidirectional, that is, the mobile phone is a reader and the tag
is a passive target. The most essential components are an NFC-enabled mobile
phone, NFC tags, and J2EE-based Field Force Service Manager and Field Force
client software. In the trial, users employed Nokia 3220 and Nokia 5140i mobile
phones equipped with an NFC reader shell. In the trial, a reader shell made it
possible to read tag information and transfer this information from the tag to the
reader as the reading range is but a few centimetres. After a mobile phone is
identified, information concerning the meal selection can be transferred
through a GPRS connection to a middleware server and onwards to the back-end
system. Figure1 represents the architecture of the Nokia Field Force Solution.
On the left, there are the mobile phones which are used for selecting a tag.
After selection, information about the selection is transferred through the
operator network to the Service Manager and then via the Internet to the
back-end system.Figure 1
Nokia FFS architecture [23].


## 3.2.2. User Interface

The user interface utilised
was implemented by VTT  (Oulu, Finland),
a research partner, and ToP Tunniste  (Tampere, Finland), a company developing
NFC-based products. The application concept and the user interface were
developed in collaboration with the regional elderly care centre of Oulu, the
meal provider and the meal delivery service.The primary design drivers in
the user interface design were the physical and cognitive changes introduced by
growing old with differing capabilities. For example, the use of a keypad of a
mobile phone was avoided completely as the elderly might have problems with
small keys (as a result of impaired motor skills) and reading small fonts on a
screen (as a result of impaired eyesight). Navigating menus and selecting
objects from the screen were also completely avoided. The activity steps
required for ordering a meal were designed so that no task sequences needed to
be remembered. Meal ordering could be done with a single touch. The application
did not require the user to remember whether the order had already been placed
or not as it allowed repeated selections. If the user was unsure whether or not
the order had already been placed, it could be placed again. The aim was to
avoid causing an excessive memory load on users. If no order was received by the meal
service, the user would be given a phone call to double-check.The tag symbols were designed
to be simple and large. A large and clear font was also used in the mobile
application. Only the most necessary information for use was displayed on a
screen. After every successfully completed order, feedback was given both by
displaying a confirmation message on the screen (visual feedback) and by the
phone vibrating (tactile feedback). The aim was to keep feedback unobtrusive
and immediate.The UI was created in a
development environment implemented at VTT. Many alternative application
versions were developed rapidly in order to receive feedback from all parties.
Based on iterations, the required activity steps for meal ordering decreased
notably during the development process. The demonstration environment was built
to examine the functionality of the application and the user interface. This
environment was used to illustrate how the meal orders were processed and how
they were transferred between parties. Furthermore, the environment visualised
the user interfaces which were designed for each party. The functionality of
the system was demonstrated several times to all parties and they had the
possibility to give feedback based on their own viewpoints. The feedback was
used for iterating the application concept and related user interfaces.The final version of the UI consisted
of the following parts:(i)
an NFC tag stand (shown in Figure2) where the following items were
attached:
(a)
a tag representing the meal option ‘‘A’’;(b)
a tag representing the meal option ‘‘B’’; and(c)
a tag labelled ‘‘C’’ to indicate that there was no need for a meal,(ii)
a paper-based meal menu (illustrated in Figure3) which was changed
weekly by meal delivery personnel, and(iii)
a mobile phone equipped with an NFC reader shell.Figure 2
An NFC-enhanced plastic stand.Figure 3
An example of a menu (translated from Finnish).


## 4. Field Study Results

Here, the main findings from
the user experience analysis are presented. The findings are grouped into (a)
findings related to the user interface and touch-based interaction and (b)
findings related to the new service. The findings related to the service
continue with the discussion of the socioeconomic analysis of the service. At
the end of the chapter, findings related to user experience evaluation methods
are presented for validation purposes.


### 4.1. Experiences from the User Interface

Here, the main findings
related to the use of the touch-based interaction paradigm are presented. The
results include(i)
analysis of the effects of the physical and cognitive skills and capabilities
of elderly users,(ii)
analysis of effects of the users’ prior experience with mobile phones,
and(iii)
analysis of the design of the components of the system, including(a)
the mobile phone, and(b)
the menu stand.


#### 4.1.1. Effects of Physical and Cognitive Capabilities as to the Use of the Touch-Based User Interface

It is known that impaired motor skills can make the use of a mobile phone
keypad difficult. This fact was also noted in the trial. During the training
session, the participants tried to make a phone call with the test phone. Those
with trembling hands had considerable problems in pressing the right buttons.
Most of the trial users also had difficulties in switching off the phone due to
the small size of the ON/OFF button. The interview findings supported the
assumption that the keypad of a mobile phone was difficult to use. Some
participants commented directly that the buttons of a mobile phone were too
small for them. Furthermore, during one support visit one participant mentioned
that the advantage of a touch-based user interface was that one did not need to
press buttons.Besides the use of a keypad, impaired motor skills affected the capacity of
the participants to write with a pen. Many participants had trembling hands
which prevented them from writing clear text. One of the users was entirely
unable to write readable text with a pen. This probably had an effect on the
poor success of the diary (see Section4.6).In the training session, all the participants adopted the touch interaction
method easily regardless of their motor skills. Those elderly persons who had great difficulty in
the use of a mobile phone keypad or were unable to write clearly because of
impaired motor skills were able to order their meals by touching a tag with a
mobile phone. Regardless of the impaired motor skills, all participants were
able to adopt the interaction technique quickly and easily. In Figure4, meal
option ‘‘A’’ is selected by an elderly user.Figure 4
The meal order is placed by touching a tag with the mobile phone.As placing a meal order
required only a single activity step, that is, touching the tag with a mobile
phone, none of the participants had any problems in learning and adopting the
new procedure for ordering meals, even though all of them had memory problems
of some degree. The touch-based user interface made it possible to implement
the application so that it would not require any sequential operations. This
was observed to be a significant benefit for the trial users. For example, one
of the users said that he could not have participated if he would have needed
to remember sequences of buttons to be pushed.The interviews indicated that
the users normally remembered to place their meal orders. Only one person said
that he knew he had forgotten to make an order once. One person had sometimes
placed many orders because he was not sure if he had already placed an order
for the next day. Many participants had established a routine to place an order
at a certain time of day. That made it easy for them to remember the daily
order. An analysis of log files supports these conclusions. There were some
occasions where the orders were not received correctly, but it was impossible
to separate the possibility of technical failure from the users forgetting to
place their orders.Although all the participants
stated that they had remembered to place orders, they also said that
remembering to place the daily meal order caused them worry. They were aware of
their memory problems and it provoked a certain amount of uncertainty among
them. The implementation employed allowed the user to repeat placing orders
unlimited times. Another alternative would be to provide a checking system
which would clearly show the user if necessary actions had already been
completed.


#### 4.1.2. Effects of Earlier Mobile Phone Experience

Even though prior use of a
mobile phone strongly correlated with the willingness to adopt the application
(see further discussion in Section4.2), it did not have any effect on the ability to learn
and use this application. Users, who had not used a mobile phone previously,
were able to learn, adopt, and use the user interface as fluently as the more
experienced of mobile phone users. In the final interview, all participants
stated that the user interface was easy to use. The touch-based interaction
technique was easily adopted by all users. This finding is in line with the results
of Rukzio et al. [1]. They suggested that touching with a mobile phone is an
intuitive and natural way to select objects. Therefore, it is well suited for
tasks which need to be integrated in the everyday life of the users. The
participants were also able to receive and interpret the feedback given with
the mobile phone regardless of their earlier experience with mobile phones.However, even though their
earlier experiences of using a mobile phone had no effect on the fluency to use
the application, it had an impact on how the users were able to use the phone.
The users with no prior experience of mobile phones had some difficulty with
the very basic functionalities of the phone, that is, loading a battery and
switching the phone on and off. To overcome these problems, they requested the
help of the delivery personnel.Furthermore, when the users
were recruited for the study, many refused when they heard that the pilot scheme
test would require the use of a mobile phone. This observation indicates that a
mobile phone can evoke negative expectations in some elderly persons.


#### 4.1.3. Mobile Phone Equipped with an NFC Reader Shell

An NFC reader, which makes it
possible to read tags, was placed in the changeable shell of a mobile phone.
Finding the right point for touch required a little bit of training when the
users learned to use the application. However, with some training all users
were able to place orders fluently during the training session. Most users
placed the reader directly on the tag. However, one user preferred to slide the
phone up and down in order to ensure that the reader would touch the tag.
Training observation also showed that finding the correct reading distance
required some training. With some repetition, users were able to find the most
comfortable reading distance—some preferred to
place the reader some centimetres (which is the maximum reading range) above
the tag and some preferred actually touching the tag. All this required physical
contact with the actual user interface devices and some repetition. The trial
users would not have been able to use the application correctly without
hands-on training and personal guidance.


#### 4.1.4. Mobile Phone Feedback

After touching a tag, feedback
was given in text format in four different views following each other
automatically and without any user intervention. These views are presented in
chronological order in Figure5 (texts here have been translated from Finnish).
The third screen confirms a successful order and is accompanied with tactile
feedback in the form of the phone vibrating. During training, the users reacted
in different ways to the feedback given. Most of them would hold the phone for
an unnecessary long time close to the tag as they were not able to clearly
identify whether the action was successfully completed or not. Most users held
the phone over the tag until they received tactile feedback and the
confirmation message, even though they could have removed the phone when the ‘‘Opening
application…’’ text was displayed.Figure 5
Feedback texts of a mobile phone after touching a tag.‘‘Meal A ordered’’ and ‘‘No meal’’
feedback integrated with a tactile feedback (vibrating alert) were understood
as the sign of a successful order. An immediate auditory feedback after the
successful tag read could give a clearer sign to a user when the mobile phone
would be moved away from the proximity of a tag.Eight out of nine participants
said they were sure that their orders always reached the back-end system. They
presumed that their order was transferred to the system of the meal provider
when they received ‘‘Meal A ordered’’ or ‘‘No meal’’ feedback. One person was a
little unsure because she had experienced technical problems during the trial.More direct feedback about the
selected meal was sought for by some of the users during the training session.
One user said that he would like to have seen the description of the meal given
in a menu, not just the tag title ‘‘A’’ or ‘‘B’’ referring to the actual menu item.
Therefore, if the user wanted to check that the confirmed meal really was what
was wanted, he/she had to check from the menu table what the meal really was.
Sharing attention between the screen of the mobile phone and the menu table
appeared to be troublesome for some elderly users. However, providing the
complete information about the meal would have required so much screen space
that it would have required a smaller font to be used, thus decreasing the
usability for those with impaired eyesight.During support visits, it came
out that some participants had not noticed problems in orders, although—due to technical
problems—they had not
received a confirmation indicating a successful order Thus, they assumed
incorrectly that their selection was transferred to the back-end system. This
suggests that even though visual and tactile feedbacks were combined to indicate a successful
placing of order, this did not indicate unsuccessful orders clearly enough when
the order was not processed correctly, for example, due to technical problems.


#### 4.1.5. Menu Table

Interpretation of the menu
table caused problems for some participants at the beginning of the training
session. Difficulties to read and interpret the menu table were the primary
reason for rejecting the adoption of the system for those two persons who
decided not to participate in the pilot scheme test after the introduction of
the application. These persons succeeded easily in touching the tag, but
linking the tags to certain meals was too complex for them. The menu tables
included two challenges. First, the user had to match the tag labels ‘‘A’’ and ‘‘B’’ with
the corresponding menu column to find out which tag related to which meal.
Secondly, the user had to read the row which showed the meal for the next day, that
is, when placing an order on Tuesday, the users would need to read the menu row
for ‘‘Wednesday’’ in order to find out what meal items were offered for the next
day. However, all persons who attended the trial reported no problems in the
interpretation of the menu table in the final interview.The menu table also had an
effect on the intuitiveness of the user interface. Before using the touch-based
interface, the user had to check which meal he/she wanted to order for the
following day from the menu table. Thus, the interaction was not as direct as
it could have been and made the selection of a meal more complex decreasing the
intuitiveness of the UI. In the training session, two users tried to touch the
name of a meal printed in a paper menu. After short training, they also
assimilated the principle of placing an order by touching a tag instead of a menu
item. As the pilot scheme test period continued, the problems with the menu
table clearly decreased. However, one of these users still touched the name of
a meal even at the end of the test period. He touched the name of the meal
after he had touched a tag. This problem is caused by the fixed size and form
of the tag. If the tags could be freely formatted to fit the logical selection
area (in a similar way in which links on web pages adapt to the length of the
word or the size of the picture), the user interface solution could have been
more intuitive (see Figure6) as the users would have been able to touch the
meal name directly instead of the tag placed on the top of the column.Figure 6
Meal menu with free-format tags (tags outlined with dashed lines).Aesthetic issues were also
observed to play a substantial role in the pilot scheme test. One of the
persons, who refused to take part in the trial, was clearly appalled by the
appearance of the plastic menu stand. At the beginning of the training session,
she spontaneously shouted “how awful!” Another user, who after participating in
the pilot scheme trial preferred the older meal order practice, wanted to place
the plastic stand flat on the kitchen table in order to prevent the neighbours
seeing the stand through the window. However, most of the participants said
they were satisfied with the appearance of the plastic menu.


### 4.2. Experiences from the Application

At the beginning of the trial,
that is, when recruiting the users and conducting the first interview and
training the users, most users required lots of encouragement and mental
support. In the training session, many participants did not trust their
abilities to place meal orders successfully independently.All the clients, except for
one, were satisfied or very satisfied with the previous catering service
practice. The opinion of one person was that the food was not always healthy
enough.Two elderly clients refused to
participate in the trial after the first interview, when they first saw the
components of the application. They seemed to make the decision on the basis of
the looks of the user interface components. They had first volunteered based on
the discussion, but then refused when they actually saw the meal menu and the
phone used for interaction. Both users refused even to try to use the
application. In addition, two other clients were very doubtful about their
participation in the pilot scheme test. They both thought long and hard before
they decided to take part in the test. They both doubted their ability to use
the application because they had memory problems. In addition, one participant
did not see how the new service would give him any added value, as he was happy
with the meals he received before the trial. However, these participants
finally decided to participate in the trial. All were given an opportunity to
leave the pilot scheme test if they wanted. All users continued as long as the
trial period lasted, except for any hospitalisation and rehabilitation periods.The remaining seven
participants were not as doubtful as the participants described above. They
were more confident and positive towards using the application and many said
that the solution seemed interesting. One person would have wanted the trial
period to be longer. In general, the attitude towards the new solution was
observed to be slightly positive among the participants before the trial
period.The final interviews revealed
that attitudes towards the new catering service varied greatly among the
participants. Five of the nine participants preferred the new catering service
over the earlier practice. A primary reason for this was that they saw added
value in the possibility to select the meal for the next day of two options.
Four of the nine participants preferred the earlier catering service practice.
They did not find the possibility to select their meal between two options to
be useful or valuable. They also experienced that the new catering service
caused them worry because they had to remember to place the order daily. All
these findings were confirmed by the follow-up study, that is, no change in
attitudes was observed.The willingness to adopt the
new practice was influenced strongly by whether or not the user owned a mobile
phone before the study. All five participants who preferred the new catering
service owned a mobile phone before the study. Three participants out of four
who preferred the older catering service practice did not own a mobile phone.
Table1 represents preferences for the meal ordering practices.Table 1
Preferences for the methods.
UserAgeOwned a mobile phonePreferable meal ordering practiceU1<60NoConventionalU269YesTouch-basedU372YesTouch-basedU480NoConventionalU580YesConventionalU680YesTouch-basedU781YesTouch-basedU884YesTouch-basedU988NoConventional


### 4.3. Changes in Attitudes

As we collected information about attitudes and expectations of the
participants in different phases of the experiment, we were able to observe
possible changes caused by the experiment. The following were monitored:(i)
attitudes towards technology in general,(ii)
attitudes towards the application used in
this experiment, and(iii)
attitudes towards meal delivery service
in general.
Our findings indicate that the attitudes of the trial users towards
technology did not change during or immediately after the experiment. The users
who had the most positive attitudes towards technology were most willing to use
and adopt the service, and continued to use the technology after the experiment
the same way they did before the experiment.No change in the willingness to adopt the enhanced meal-ordering service
was observed when compared the situation evaluated in the after-use and
follow-up evaluation. The trial users who would have been willing to adopt the
service right after the experiment still thought that the service would bring them
value in a follow-up study. Also, no indication of increased willingness to
adopt the service was observed in the follow-up study. However, it must be
noted that the users who could be reached for the follow-up study almost solely
(with the exception of one user) represented the group who were willing to
adopt the service. There were substantially more health-related reasons which
prevented follow-up interviews in the group which was not willing to adopt the
service after the trial.No changes in the attitudes towards the meal delivery service and meals
were observed. However, that would have been highly difficult to achieve, as
the satisfaction towards the meal service and the meals was extremely high
already at the beginning of the experiment. However, this observation is based
solely on the interviews and the stated subjective satisfaction of the users.
More reliable results could be derived, for example, by collecting information
daily and observing the actual consumption of the meals.


### 4.4. Experiences of the Delivery Personnel

As the trial covered the whole
service chain, to fully understand the potentials and challenges of the system, it was
important to evaluate the system from the viewpoint of all service chain
members. In this paper, the focus is primarily on the experiences of the
elderly users. However, the delivery personnel also actively used the
touch-based user interface and were involved on a daily basis with the
application and the elderly users.The delivery personnel
experienced the touch-based user interface as very easy to learn, adopt, and
use. It was also quick and did not require time-consuming tasks to be performed
or remembered. Therefore, the application was not experienced as a burden by
the delivery personnel. However, not much benefit could be seen from the
viewpoint of the delivery person. The touch-based user interface was very
effective and efficient, but the delivery personnel did not get any direct
benefits from using it. Perhaps the greatest benefit was on the better
monitoring of the meal delivery process.However, as the delivery
personnel visited the elderly users daily, they got to solve technical problems
faced by the users. For example, they were asked for help in loading the
batteries and turning on the mobile phone. As the number of trial users was
small, this did not cause significant delays during trial use. However, if all
customers of the meal delivery service were to require similar assistance,
technical problems might cause delays and problems in meal delivery, especially
when one must consider that the users who participated in this trial were
selected because they represented the most capable users of the meal delivery
service.


### 4.5. Socioeconomic Analysis

Value net and flows of the meal ordering and delivery are depicted in
Figure7.Figure 7
Value net of meal ordering and delivery.Material flow (illustrated with blue dashed line) of the meal ordering
and delivery service chain is very simple. Meals are prepared by the meal
provider, which are then distributed for the elderly clients by the logistics service
provider. All monetary flows (illustrated with solid red lines) are linked to the
elderly care service provider who coordinates the whole service chain. Elderly
clients pay their share of the meals to the elderly care service provider who
pays to the meal and logistics service providers. Because the average income
(pension) of elderly clients is quite low and the cost of the meal home
delivery is relatively high (minimum fee on the private sector is about€ 5 per client per
delivery), subsidisation from the municipality was needed to keep the service
affordable for elderly clients.The elderly care service provider acts also as a junction of the
information exchange in this service chain, however, information flows are not
depicted in the figure in order to keep it as simple and descriptive as
possible. Naturally, the information from the elderly client to the elderly
care service provider is most important in considering this pilot scheme. Other
important information flows in the service chain are the elderly care service
provider informing meal provider and logistics service provider about changes
in customers, their diets and delivery destinations.Measuring the socioeconomic impacts from the investments in information
and communication technology (ICT) is very challenging and multifaceted.
Although many costs, such as the investment on NFC-enabled mobile phones and
tags or man hours spent on system development, can quite often be directly
calculated, there are several difficulties in measuring the benefits of new
technologies. First and foremost, benefits are mostly indirect, such as
improved quality or customer satisfaction, which makes it very difficult to
measure the impact on the profitability of the company. Secondly, benefits may
not necessarily be visible in small-scale experiments, as redesign and
implementation of whole business processes may be needed in order to gain
noticeable benefits. Lastly, benefits in the elderly care sector should not be
only measured from the level of individual companies. Instead, focus should be
on the changes in aggregate benefits of the elderly care sector, which should
then be compared with the ICT investment to find out real profitability. For
example, if technology could be used to support independent living of the elderly,
the cost savings in the area of institutional care service for the elderly
should also be taken into account when the benefits of the technology are
assessed.The main findings of the socioeconomic benefits and costs are summarised
in Table2. The costs of the provided services are mostly associated with the
increased use of employee time. Both elderly care and logistics service
providers noticed an increased need for hands-on assistance and support with their
elderly clients. From the meal provider viewpoint, the production of an alternative
meal was found to be time-consuming, which therefore increased costs for the
meal provider. Although the pilot scheme showed that NFC-enabled meal ordering
and delivery services can be implemented with a relatively light technological
infrastructure, the costs of providing and maintaining the back-end system and
additional costs of NFC-enabled mobile phones and tags had to be taken into
account.Table 2
Socioeconomic benefits and costs.
Actor+/−Benefit/cost typeDescriptionElderly care+Improved
service qualityOpportunity to choose meals and the
delivery of weekly menus to customers+Improved
service qualityDelivery follow-up through web
pages+Indirect
cost savings (employee time)No need to manually receive
cancellations−Indirect
cost (employee time)Additional time spent on teaching
and supporting elderly clients−Indirect
cost (employee time)Persuation of elderly clients to
participate into the pilot scheme was noticed to be a difficult and time-consuming
task−Infrastructure
and maintenance costCost of providing and maintaining
meal service back-end system (and possibly tags and mobile phones)Meal provider+Improved
service qualityNew meal alternative for the
clients−Indirect
cost (employee time)Producing several meals takes more
time and therefore increases total costsLogistics service provider+Improved service qualityQuality of the service can be
improved with delivery tracking, because it provides a way to prove that
meals are delivered in time+Increased
efficiencyOptimisation of delivery routes
through delivery time monitoring+Increased
efficiencyReporting of problems with the
mobile phone−Indirect
cost (employee time)Time spent on supporting elderly
clientsImproved service quality was considered the most important benefit from
the viewpoints of the elderly care and meal providers. They both had the
impression that elderly clients would appreciate the opportunity to select
meals, especially in the future when elderly clients get used to their mobile
phones. The elderly care service provider also estimated that considerable
indirect cost savings might be achieved in large-scale use, because there would
be no need to manually receive any meal cancellations which normally would take
a couple of hours per day of one employee’s work time.All five drivers of the logistics service provider who participated in
this small-scale pilot scheme reported that the pilot scheme did not have a
noticeable impact to their work efficiency. However, the persons interviewed from
management level expected that the increase in efficiency of the delivery could
be clearly noticed if service would be taken into large-scale use. They
predicted that the data from delivery time monitoring could be used to
significantly increase the efficiency of the delivery. An increase in
efficiency would be obtained mainly by the optimisation of delivery routes. As
a result, the logistics service provider was highly interested in taking the
delivery monitoring in large-scale use.As a conclusion to the assessment of the benefits and costs, all
business actors expressed that this kind of service would need a significantly
larger customer base to be economically profitable. It was also pointed out
that the service provided should be tightly integrated into existing
information systems, which might reduce some manual paper work and thus provide
additional benefits to the stakeholders.


### 4.6. Experiences from the Evaluation Methods

The first interview combined
with observations during the training proved to be an excellent source for
collecting data about the attitudes and expectations of the users towards the
application before use. Most users required lots of encouragement and support
in the interview situation and this was very challenging for our researcher.
Sometimes it was difficult to draw a line between pressuring and encouraging
the user.Observing the training
situation revealed facts about how easy it was to adopt the application and what
kind of problems
the users had with it. It was essential that the elderly users used the
application themselves during the training. If they had just seen the
researcher showing them how to use the application, they probably would not
have been able to use it for themselves. The actual physical contact with the
application and the interface removed lots of doubts related to the application
and gave the users confidence towards their ability in coping with it. With
just a little repetition, the users were able to take in the idea of the
interface and were then able to use it fluently.The pen- and paper-based diary
was not a successful method for collecting information on user experience
related to the adopted technology. First and foremost, some users had trembling
hands and were not able to write easily. This probably affected their
willingness to use a diary for data collection. One user was unable to write
with a pen and paper at all, so the diary was not offered to him.However, a bigger problem was
that the users did not correctly understand the role of the diary. Although the
role of the diary was explained in the first interview and also explained in
writing on the first page of the diary, the users failed to fully understand
it, probably due to the mental workload of the interview and training. Five
users used the diary for reporting their satisfaction with the meals, and not
for reporting their experience with the new technology. One of these five users
had realised during the trial that the focus of the diary writings should be on
the technology and not on the meals. That user then started to write about
experiences with the technology.Four users did not use the
diary at all. One of them stated in the postinterview that the application did
not evoke any specific emotions. When taking into account the nature of the
application, this was understandable. After all, the use of the application did
only take about 15 seconds and it was designed to be an integrated part of the
everyday routines of the users. This was not an application which was designed
to move its user emotionally or intended to entertain or provide flow
experiences. Instead, this is an application which, when working correctly,
should be as ‘‘invisible’’ and work as effortlessly as possible. Therefore, it
was understandable that describing one's feelings towards the application might
be felt to be difficult.The actual value of the
application was not to provide satisfaction for the user in using the
technology, but to provide the users with greater satisfaction with the meals
they received. From this perspective, the evaluation of the meals received
would be even more appropriate than evaluating the technology used for ordering
the meals. This would allow us to determine whether or not the application was
able to increase the satisfaction with the meals and the meal service. However,
in our field study, we did not use the diary to collect information on how
satisfied the users were with their meals before the trial, so we cannot use
the data gathered with diaries to compare if improvement was achieved.Unfortunately, as the diary
method did not provide information expected, it did not provide direct data
about fleeting user experiences which emerged during use. Therefore, the role
of storytelling in the after-use interview, where the user had to rely on
memory, was stronger in collecting data on user experiences than first planned.
This might have had an effect on the results.As it was highly ethical to
ensure that the new application would not leave any users without food, the
system status was monitored during the trial and all abnormalities were checked
manually (usually by calling the user). The users were also able to call the
researchers at any time for help. They used this opportunity when they had
technical problems. This kind of support activity provided lots of information
about the operation of the application and problems encountered by the user and,
also, it maintained the feeling of involvement. Assistive technology targeted at
the elderly is often criticised for increasing loneliness and decreasing the
social encounters of its user. In this trial, the application might have
actually done the opposite by increasing the social contacts of its users, as
the researcher and other people involved in the trial were actively involved
with the users during the trial. However, it must be noted that if similar
applications were to become more common, this level of personal involvement
might not be as feasible in everyday life.The experiences from the follow-up study show that as time had passed
after the experiment, it was very difficult for the users to concentrate on the
technology under evaluation. The discussion very often directed itself towards
the meal service in general, and not the technology used in the trial.
Therefore, the follow-up study mostly provided information about the attitudes
of the users at the point of the interview. However, the role of the follow-up
study can be seen also as a method for ensuring that the experiment did not
cause negative effects in the lives of the users (as described in [22]). This can be used for evaluating the ethical issues
related to the experiment. From the research point of view, it can be
problematic to balance between avoiding negative impacts of the pilot scheme and
creating high-impact concepts. If the concept is found extremely valuable by
the users and is able to considerably contribute towards a higher quality of
life for the pilot scheme users, losing the possibility to use technology after
the pilot scheme may have strong negative effect on the well-being of the pilot
scheme users (as described in [22]). The negative psychological effect of loss can be
much stronger than the positive effect achieved through the pilot scheme.
However, the goal of concept design is to create high-impact concepts which
would be appreciated and valued by the users. Methods and examples for
balancing between these two contradictory goals would be welcome.


## 4.1. Experiences from the User Interface

Here, the main findings
related to the use of the touch-based interaction paradigm are presented. The
results include(i)
analysis of the effects of the physical and cognitive skills and capabilities
of elderly users,(ii)
analysis of effects of the users’ prior experience with mobile phones,
and(iii)
analysis of the design of the components of the system, including(a)
the mobile phone, and(b)
the menu stand.


### 4.1.1. Effects of Physical and Cognitive Capabilities as to the Use of the Touch-Based User Interface

It is known that impaired motor skills can make the use of a mobile phone
keypad difficult. This fact was also noted in the trial. During the training
session, the participants tried to make a phone call with the test phone. Those
with trembling hands had considerable problems in pressing the right buttons.
Most of the trial users also had difficulties in switching off the phone due to
the small size of the ON/OFF button. The interview findings supported the
assumption that the keypad of a mobile phone was difficult to use. Some
participants commented directly that the buttons of a mobile phone were too
small for them. Furthermore, during one support visit one participant mentioned
that the advantage of a touch-based user interface was that one did not need to
press buttons.Besides the use of a keypad, impaired motor skills affected the capacity of
the participants to write with a pen. Many participants had trembling hands
which prevented them from writing clear text. One of the users was entirely
unable to write readable text with a pen. This probably had an effect on the
poor success of the diary (see Section4.6).In the training session, all the participants adopted the touch interaction
method easily regardless of their motor skills. Those elderly persons who had great difficulty in
the use of a mobile phone keypad or were unable to write clearly because of
impaired motor skills were able to order their meals by touching a tag with a
mobile phone. Regardless of the impaired motor skills, all participants were
able to adopt the interaction technique quickly and easily. In Figure4, meal
option ‘‘A’’ is selected by an elderly user.Figure 4
The meal order is placed by touching a tag with the mobile phone.As placing a meal order
required only a single activity step, that is, touching the tag with a mobile
phone, none of the participants had any problems in learning and adopting the
new procedure for ordering meals, even though all of them had memory problems
of some degree. The touch-based user interface made it possible to implement
the application so that it would not require any sequential operations. This
was observed to be a significant benefit for the trial users. For example, one
of the users said that he could not have participated if he would have needed
to remember sequences of buttons to be pushed.The interviews indicated that
the users normally remembered to place their meal orders. Only one person said
that he knew he had forgotten to make an order once. One person had sometimes
placed many orders because he was not sure if he had already placed an order
for the next day. Many participants had established a routine to place an order
at a certain time of day. That made it easy for them to remember the daily
order. An analysis of log files supports these conclusions. There were some
occasions where the orders were not received correctly, but it was impossible
to separate the possibility of technical failure from the users forgetting to
place their orders.Although all the participants
stated that they had remembered to place orders, they also said that
remembering to place the daily meal order caused them worry. They were aware of
their memory problems and it provoked a certain amount of uncertainty among
them. The implementation employed allowed the user to repeat placing orders
unlimited times. Another alternative would be to provide a checking system
which would clearly show the user if necessary actions had already been
completed.


### 4.1.2. Effects of Earlier Mobile Phone Experience

Even though prior use of a
mobile phone strongly correlated with the willingness to adopt the application
(see further discussion in Section4.2), it did not have any effect on the ability to learn
and use this application. Users, who had not used a mobile phone previously,
were able to learn, adopt, and use the user interface as fluently as the more
experienced of mobile phone users. In the final interview, all participants
stated that the user interface was easy to use. The touch-based interaction
technique was easily adopted by all users. This finding is in line with the results
of Rukzio et al. [1]. They suggested that touching with a mobile phone is an
intuitive and natural way to select objects. Therefore, it is well suited for
tasks which need to be integrated in the everyday life of the users. The
participants were also able to receive and interpret the feedback given with
the mobile phone regardless of their earlier experience with mobile phones.However, even though their
earlier experiences of using a mobile phone had no effect on the fluency to use
the application, it had an impact on how the users were able to use the phone.
The users with no prior experience of mobile phones had some difficulty with
the very basic functionalities of the phone, that is, loading a battery and
switching the phone on and off. To overcome these problems, they requested the
help of the delivery personnel.Furthermore, when the users
were recruited for the study, many refused when they heard that the pilot scheme
test would require the use of a mobile phone. This observation indicates that a
mobile phone can evoke negative expectations in some elderly persons.


### 4.1.3. Mobile Phone Equipped with an NFC Reader Shell

An NFC reader, which makes it
possible to read tags, was placed in the changeable shell of a mobile phone.
Finding the right point for touch required a little bit of training when the
users learned to use the application. However, with some training all users
were able to place orders fluently during the training session. Most users
placed the reader directly on the tag. However, one user preferred to slide the
phone up and down in order to ensure that the reader would touch the tag.
Training observation also showed that finding the correct reading distance
required some training. With some repetition, users were able to find the most
comfortable reading distance—some preferred to
place the reader some centimetres (which is the maximum reading range) above
the tag and some preferred actually touching the tag. All this required physical
contact with the actual user interface devices and some repetition. The trial
users would not have been able to use the application correctly without
hands-on training and personal guidance.


### 4.1.4. Mobile Phone Feedback

After touching a tag, feedback
was given in text format in four different views following each other
automatically and without any user intervention. These views are presented in
chronological order in Figure5 (texts here have been translated from Finnish).
The third screen confirms a successful order and is accompanied with tactile
feedback in the form of the phone vibrating. During training, the users reacted
in different ways to the feedback given. Most of them would hold the phone for
an unnecessary long time close to the tag as they were not able to clearly
identify whether the action was successfully completed or not. Most users held
the phone over the tag until they received tactile feedback and the
confirmation message, even though they could have removed the phone when the ‘‘Opening
application…’’ text was displayed.Figure 5
Feedback texts of a mobile phone after touching a tag.‘‘Meal A ordered’’ and ‘‘No meal’’
feedback integrated with a tactile feedback (vibrating alert) were understood
as the sign of a successful order. An immediate auditory feedback after the
successful tag read could give a clearer sign to a user when the mobile phone
would be moved away from the proximity of a tag.Eight out of nine participants
said they were sure that their orders always reached the back-end system. They
presumed that their order was transferred to the system of the meal provider
when they received ‘‘Meal A ordered’’ or ‘‘No meal’’ feedback. One person was a
little unsure because she had experienced technical problems during the trial.More direct feedback about the
selected meal was sought for by some of the users during the training session.
One user said that he would like to have seen the description of the meal given
in a menu, not just the tag title ‘‘A’’ or ‘‘B’’ referring to the actual menu item.
Therefore, if the user wanted to check that the confirmed meal really was what
was wanted, he/she had to check from the menu table what the meal really was.
Sharing attention between the screen of the mobile phone and the menu table
appeared to be troublesome for some elderly users. However, providing the
complete information about the meal would have required so much screen space
that it would have required a smaller font to be used, thus decreasing the
usability for those with impaired eyesight.During support visits, it came
out that some participants had not noticed problems in orders, although—due to technical
problems—they had not
received a confirmation indicating a successful order Thus, they assumed
incorrectly that their selection was transferred to the back-end system. This
suggests that even though visual and tactile feedbacks were combined to indicate a successful
placing of order, this did not indicate unsuccessful orders clearly enough when
the order was not processed correctly, for example, due to technical problems.


### 4.1.5. Menu Table

Interpretation of the menu
table caused problems for some participants at the beginning of the training
session. Difficulties to read and interpret the menu table were the primary
reason for rejecting the adoption of the system for those two persons who
decided not to participate in the pilot scheme test after the introduction of
the application. These persons succeeded easily in touching the tag, but
linking the tags to certain meals was too complex for them. The menu tables
included two challenges. First, the user had to match the tag labels ‘‘A’’ and ‘‘B’’ with
the corresponding menu column to find out which tag related to which meal.
Secondly, the user had to read the row which showed the meal for the next day, that
is, when placing an order on Tuesday, the users would need to read the menu row
for ‘‘Wednesday’’ in order to find out what meal items were offered for the next
day. However, all persons who attended the trial reported no problems in the
interpretation of the menu table in the final interview.The menu table also had an
effect on the intuitiveness of the user interface. Before using the touch-based
interface, the user had to check which meal he/she wanted to order for the
following day from the menu table. Thus, the interaction was not as direct as
it could have been and made the selection of a meal more complex decreasing the
intuitiveness of the UI. In the training session, two users tried to touch the
name of a meal printed in a paper menu. After short training, they also
assimilated the principle of placing an order by touching a tag instead of a menu
item. As the pilot scheme test period continued, the problems with the menu
table clearly decreased. However, one of these users still touched the name of
a meal even at the end of the test period. He touched the name of the meal
after he had touched a tag. This problem is caused by the fixed size and form
of the tag. If the tags could be freely formatted to fit the logical selection
area (in a similar way in which links on web pages adapt to the length of the
word or the size of the picture), the user interface solution could have been
more intuitive (see Figure6) as the users would have been able to touch the
meal name directly instead of the tag placed on the top of the column.Figure 6
Meal menu with free-format tags (tags outlined with dashed lines).Aesthetic issues were also
observed to play a substantial role in the pilot scheme test. One of the
persons, who refused to take part in the trial, was clearly appalled by the
appearance of the plastic menu stand. At the beginning of the training session,
she spontaneously shouted “how awful!” Another user, who after participating in
the pilot scheme trial preferred the older meal order practice, wanted to place
the plastic stand flat on the kitchen table in order to prevent the neighbours
seeing the stand through the window. However, most of the participants said
they were satisfied with the appearance of the plastic menu.


## 4.1.1. Effects of Physical and Cognitive Capabilities as to the Use of the Touch-Based User Interface

It is known that impaired motor skills can make the use of a mobile phone
keypad difficult. This fact was also noted in the trial. During the training
session, the participants tried to make a phone call with the test phone. Those
with trembling hands had considerable problems in pressing the right buttons.
Most of the trial users also had difficulties in switching off the phone due to
the small size of the ON/OFF button. The interview findings supported the
assumption that the keypad of a mobile phone was difficult to use. Some
participants commented directly that the buttons of a mobile phone were too
small for them. Furthermore, during one support visit one participant mentioned
that the advantage of a touch-based user interface was that one did not need to
press buttons.Besides the use of a keypad, impaired motor skills affected the capacity of
the participants to write with a pen. Many participants had trembling hands
which prevented them from writing clear text. One of the users was entirely
unable to write readable text with a pen. This probably had an effect on the
poor success of the diary (see Section4.6).In the training session, all the participants adopted the touch interaction
method easily regardless of their motor skills. Those elderly persons who had great difficulty in
the use of a mobile phone keypad or were unable to write clearly because of
impaired motor skills were able to order their meals by touching a tag with a
mobile phone. Regardless of the impaired motor skills, all participants were
able to adopt the interaction technique quickly and easily. In Figure4, meal
option ‘‘A’’ is selected by an elderly user.Figure 4
The meal order is placed by touching a tag with the mobile phone.As placing a meal order
required only a single activity step, that is, touching the tag with a mobile
phone, none of the participants had any problems in learning and adopting the
new procedure for ordering meals, even though all of them had memory problems
of some degree. The touch-based user interface made it possible to implement
the application so that it would not require any sequential operations. This
was observed to be a significant benefit for the trial users. For example, one
of the users said that he could not have participated if he would have needed
to remember sequences of buttons to be pushed.The interviews indicated that
the users normally remembered to place their meal orders. Only one person said
that he knew he had forgotten to make an order once. One person had sometimes
placed many orders because he was not sure if he had already placed an order
for the next day. Many participants had established a routine to place an order
at a certain time of day. That made it easy for them to remember the daily
order. An analysis of log files supports these conclusions. There were some
occasions where the orders were not received correctly, but it was impossible
to separate the possibility of technical failure from the users forgetting to
place their orders.Although all the participants
stated that they had remembered to place orders, they also said that
remembering to place the daily meal order caused them worry. They were aware of
their memory problems and it provoked a certain amount of uncertainty among
them. The implementation employed allowed the user to repeat placing orders
unlimited times. Another alternative would be to provide a checking system
which would clearly show the user if necessary actions had already been
completed.


## 4.1.2. Effects of Earlier Mobile Phone Experience

Even though prior use of a
mobile phone strongly correlated with the willingness to adopt the application
(see further discussion in Section4.2), it did not have any effect on the ability to learn
and use this application. Users, who had not used a mobile phone previously,
were able to learn, adopt, and use the user interface as fluently as the more
experienced of mobile phone users. In the final interview, all participants
stated that the user interface was easy to use. The touch-based interaction
technique was easily adopted by all users. This finding is in line with the results
of Rukzio et al. [1]. They suggested that touching with a mobile phone is an
intuitive and natural way to select objects. Therefore, it is well suited for
tasks which need to be integrated in the everyday life of the users. The
participants were also able to receive and interpret the feedback given with
the mobile phone regardless of their earlier experience with mobile phones.However, even though their
earlier experiences of using a mobile phone had no effect on the fluency to use
the application, it had an impact on how the users were able to use the phone.
The users with no prior experience of mobile phones had some difficulty with
the very basic functionalities of the phone, that is, loading a battery and
switching the phone on and off. To overcome these problems, they requested the
help of the delivery personnel.Furthermore, when the users
were recruited for the study, many refused when they heard that the pilot scheme
test would require the use of a mobile phone. This observation indicates that a
mobile phone can evoke negative expectations in some elderly persons.


## 4.1.3. Mobile Phone Equipped with an NFC Reader Shell

An NFC reader, which makes it
possible to read tags, was placed in the changeable shell of a mobile phone.
Finding the right point for touch required a little bit of training when the
users learned to use the application. However, with some training all users
were able to place orders fluently during the training session. Most users
placed the reader directly on the tag. However, one user preferred to slide the
phone up and down in order to ensure that the reader would touch the tag.
Training observation also showed that finding the correct reading distance
required some training. With some repetition, users were able to find the most
comfortable reading distance—some preferred to
place the reader some centimetres (which is the maximum reading range) above
the tag and some preferred actually touching the tag. All this required physical
contact with the actual user interface devices and some repetition. The trial
users would not have been able to use the application correctly without
hands-on training and personal guidance.


## 4.1.4. Mobile Phone Feedback

After touching a tag, feedback
was given in text format in four different views following each other
automatically and without any user intervention. These views are presented in
chronological order in Figure5 (texts here have been translated from Finnish).
The third screen confirms a successful order and is accompanied with tactile
feedback in the form of the phone vibrating. During training, the users reacted
in different ways to the feedback given. Most of them would hold the phone for
an unnecessary long time close to the tag as they were not able to clearly
identify whether the action was successfully completed or not. Most users held
the phone over the tag until they received tactile feedback and the
confirmation message, even though they could have removed the phone when the ‘‘Opening
application…’’ text was displayed.Figure 5
Feedback texts of a mobile phone after touching a tag.‘‘Meal A ordered’’ and ‘‘No meal’’
feedback integrated with a tactile feedback (vibrating alert) were understood
as the sign of a successful order. An immediate auditory feedback after the
successful tag read could give a clearer sign to a user when the mobile phone
would be moved away from the proximity of a tag.Eight out of nine participants
said they were sure that their orders always reached the back-end system. They
presumed that their order was transferred to the system of the meal provider
when they received ‘‘Meal A ordered’’ or ‘‘No meal’’ feedback. One person was a
little unsure because she had experienced technical problems during the trial.More direct feedback about the
selected meal was sought for by some of the users during the training session.
One user said that he would like to have seen the description of the meal given
in a menu, not just the tag title ‘‘A’’ or ‘‘B’’ referring to the actual menu item.
Therefore, if the user wanted to check that the confirmed meal really was what
was wanted, he/she had to check from the menu table what the meal really was.
Sharing attention between the screen of the mobile phone and the menu table
appeared to be troublesome for some elderly users. However, providing the
complete information about the meal would have required so much screen space
that it would have required a smaller font to be used, thus decreasing the
usability for those with impaired eyesight.During support visits, it came
out that some participants had not noticed problems in orders, although—due to technical
problems—they had not
received a confirmation indicating a successful order Thus, they assumed
incorrectly that their selection was transferred to the back-end system. This
suggests that even though visual and tactile feedbacks were combined to indicate a successful
placing of order, this did not indicate unsuccessful orders clearly enough when
the order was not processed correctly, for example, due to technical problems.


## 4.1.5. Menu Table

Interpretation of the menu
table caused problems for some participants at the beginning of the training
session. Difficulties to read and interpret the menu table were the primary
reason for rejecting the adoption of the system for those two persons who
decided not to participate in the pilot scheme test after the introduction of
the application. These persons succeeded easily in touching the tag, but
linking the tags to certain meals was too complex for them. The menu tables
included two challenges. First, the user had to match the tag labels ‘‘A’’ and ‘‘B’’ with
the corresponding menu column to find out which tag related to which meal.
Secondly, the user had to read the row which showed the meal for the next day, that
is, when placing an order on Tuesday, the users would need to read the menu row
for ‘‘Wednesday’’ in order to find out what meal items were offered for the next
day. However, all persons who attended the trial reported no problems in the
interpretation of the menu table in the final interview.The menu table also had an
effect on the intuitiveness of the user interface. Before using the touch-based
interface, the user had to check which meal he/she wanted to order for the
following day from the menu table. Thus, the interaction was not as direct as
it could have been and made the selection of a meal more complex decreasing the
intuitiveness of the UI. In the training session, two users tried to touch the
name of a meal printed in a paper menu. After short training, they also
assimilated the principle of placing an order by touching a tag instead of a menu
item. As the pilot scheme test period continued, the problems with the menu
table clearly decreased. However, one of these users still touched the name of
a meal even at the end of the test period. He touched the name of the meal
after he had touched a tag. This problem is caused by the fixed size and form
of the tag. If the tags could be freely formatted to fit the logical selection
area (in a similar way in which links on web pages adapt to the length of the
word or the size of the picture), the user interface solution could have been
more intuitive (see Figure6) as the users would have been able to touch the
meal name directly instead of the tag placed on the top of the column.Figure 6
Meal menu with free-format tags (tags outlined with dashed lines).Aesthetic issues were also
observed to play a substantial role in the pilot scheme test. One of the
persons, who refused to take part in the trial, was clearly appalled by the
appearance of the plastic menu stand. At the beginning of the training session,
she spontaneously shouted “how awful!” Another user, who after participating in
the pilot scheme trial preferred the older meal order practice, wanted to place
the plastic stand flat on the kitchen table in order to prevent the neighbours
seeing the stand through the window. However, most of the participants said
they were satisfied with the appearance of the plastic menu.


## 4.2. Experiences from the Application

At the beginning of the trial,
that is, when recruiting the users and conducting the first interview and
training the users, most users required lots of encouragement and mental
support. In the training session, many participants did not trust their
abilities to place meal orders successfully independently.All the clients, except for
one, were satisfied or very satisfied with the previous catering service
practice. The opinion of one person was that the food was not always healthy
enough.Two elderly clients refused to
participate in the trial after the first interview, when they first saw the
components of the application. They seemed to make the decision on the basis of
the looks of the user interface components. They had first volunteered based on
the discussion, but then refused when they actually saw the meal menu and the
phone used for interaction. Both users refused even to try to use the
application. In addition, two other clients were very doubtful about their
participation in the pilot scheme test. They both thought long and hard before
they decided to take part in the test. They both doubted their ability to use
the application because they had memory problems. In addition, one participant
did not see how the new service would give him any added value, as he was happy
with the meals he received before the trial. However, these participants
finally decided to participate in the trial. All were given an opportunity to
leave the pilot scheme test if they wanted. All users continued as long as the
trial period lasted, except for any hospitalisation and rehabilitation periods.The remaining seven
participants were not as doubtful as the participants described above. They
were more confident and positive towards using the application and many said
that the solution seemed interesting. One person would have wanted the trial
period to be longer. In general, the attitude towards the new solution was
observed to be slightly positive among the participants before the trial
period.The final interviews revealed
that attitudes towards the new catering service varied greatly among the
participants. Five of the nine participants preferred the new catering service
over the earlier practice. A primary reason for this was that they saw added
value in the possibility to select the meal for the next day of two options.
Four of the nine participants preferred the earlier catering service practice.
They did not find the possibility to select their meal between two options to
be useful or valuable. They also experienced that the new catering service
caused them worry because they had to remember to place the order daily. All
these findings were confirmed by the follow-up study, that is, no change in
attitudes was observed.The willingness to adopt the
new practice was influenced strongly by whether or not the user owned a mobile
phone before the study. All five participants who preferred the new catering
service owned a mobile phone before the study. Three participants out of four
who preferred the older catering service practice did not own a mobile phone.
Table1 represents preferences for the meal ordering practices.Table 1
Preferences for the methods.
UserAgeOwned a mobile phonePreferable meal ordering practiceU1<60NoConventionalU269YesTouch-basedU372YesTouch-basedU480NoConventionalU580YesConventionalU680YesTouch-basedU781YesTouch-basedU884YesTouch-basedU988NoConventional


## 4.3. Changes in Attitudes

As we collected information about attitudes and expectations of the
participants in different phases of the experiment, we were able to observe
possible changes caused by the experiment. The following were monitored:(i)
attitudes towards technology in general,(ii)
attitudes towards the application used in
this experiment, and(iii)
attitudes towards meal delivery service
in general.
Our findings indicate that the attitudes of the trial users towards
technology did not change during or immediately after the experiment. The users
who had the most positive attitudes towards technology were most willing to use
and adopt the service, and continued to use the technology after the experiment
the same way they did before the experiment.No change in the willingness to adopt the enhanced meal-ordering service
was observed when compared the situation evaluated in the after-use and
follow-up evaluation. The trial users who would have been willing to adopt the
service right after the experiment still thought that the service would bring them
value in a follow-up study. Also, no indication of increased willingness to
adopt the service was observed in the follow-up study. However, it must be
noted that the users who could be reached for the follow-up study almost solely
(with the exception of one user) represented the group who were willing to
adopt the service. There were substantially more health-related reasons which
prevented follow-up interviews in the group which was not willing to adopt the
service after the trial.No changes in the attitudes towards the meal delivery service and meals
were observed. However, that would have been highly difficult to achieve, as
the satisfaction towards the meal service and the meals was extremely high
already at the beginning of the experiment. However, this observation is based
solely on the interviews and the stated subjective satisfaction of the users.
More reliable results could be derived, for example, by collecting information
daily and observing the actual consumption of the meals.


## 4.4. Experiences of the Delivery Personnel

As the trial covered the whole
service chain, to fully understand the potentials and challenges of the system, it was
important to evaluate the system from the viewpoint of all service chain
members. In this paper, the focus is primarily on the experiences of the
elderly users. However, the delivery personnel also actively used the
touch-based user interface and were involved on a daily basis with the
application and the elderly users.The delivery personnel
experienced the touch-based user interface as very easy to learn, adopt, and
use. It was also quick and did not require time-consuming tasks to be performed
or remembered. Therefore, the application was not experienced as a burden by
the delivery personnel. However, not much benefit could be seen from the
viewpoint of the delivery person. The touch-based user interface was very
effective and efficient, but the delivery personnel did not get any direct
benefits from using it. Perhaps the greatest benefit was on the better
monitoring of the meal delivery process.However, as the delivery
personnel visited the elderly users daily, they got to solve technical problems
faced by the users. For example, they were asked for help in loading the
batteries and turning on the mobile phone. As the number of trial users was
small, this did not cause significant delays during trial use. However, if all
customers of the meal delivery service were to require similar assistance,
technical problems might cause delays and problems in meal delivery, especially
when one must consider that the users who participated in this trial were
selected because they represented the most capable users of the meal delivery
service.


## 4.5. Socioeconomic Analysis

Value net and flows of the meal ordering and delivery are depicted in
Figure7.Figure 7
Value net of meal ordering and delivery.Material flow (illustrated with blue dashed line) of the meal ordering
and delivery service chain is very simple. Meals are prepared by the meal
provider, which are then distributed for the elderly clients by the logistics service
provider. All monetary flows (illustrated with solid red lines) are linked to the
elderly care service provider who coordinates the whole service chain. Elderly
clients pay their share of the meals to the elderly care service provider who
pays to the meal and logistics service providers. Because the average income
(pension) of elderly clients is quite low and the cost of the meal home
delivery is relatively high (minimum fee on the private sector is about€ 5 per client per
delivery), subsidisation from the municipality was needed to keep the service
affordable for elderly clients.The elderly care service provider acts also as a junction of the
information exchange in this service chain, however, information flows are not
depicted in the figure in order to keep it as simple and descriptive as
possible. Naturally, the information from the elderly client to the elderly
care service provider is most important in considering this pilot scheme. Other
important information flows in the service chain are the elderly care service
provider informing meal provider and logistics service provider about changes
in customers, their diets and delivery destinations.Measuring the socioeconomic impacts from the investments in information
and communication technology (ICT) is very challenging and multifaceted.
Although many costs, such as the investment on NFC-enabled mobile phones and
tags or man hours spent on system development, can quite often be directly
calculated, there are several difficulties in measuring the benefits of new
technologies. First and foremost, benefits are mostly indirect, such as
improved quality or customer satisfaction, which makes it very difficult to
measure the impact on the profitability of the company. Secondly, benefits may
not necessarily be visible in small-scale experiments, as redesign and
implementation of whole business processes may be needed in order to gain
noticeable benefits. Lastly, benefits in the elderly care sector should not be
only measured from the level of individual companies. Instead, focus should be
on the changes in aggregate benefits of the elderly care sector, which should
then be compared with the ICT investment to find out real profitability. For
example, if technology could be used to support independent living of the elderly,
the cost savings in the area of institutional care service for the elderly
should also be taken into account when the benefits of the technology are
assessed.The main findings of the socioeconomic benefits and costs are summarised
in Table2. The costs of the provided services are mostly associated with the
increased use of employee time. Both elderly care and logistics service
providers noticed an increased need for hands-on assistance and support with their
elderly clients. From the meal provider viewpoint, the production of an alternative
meal was found to be time-consuming, which therefore increased costs for the
meal provider. Although the pilot scheme showed that NFC-enabled meal ordering
and delivery services can be implemented with a relatively light technological
infrastructure, the costs of providing and maintaining the back-end system and
additional costs of NFC-enabled mobile phones and tags had to be taken into
account.Table 2
Socioeconomic benefits and costs.
Actor+/−Benefit/cost typeDescriptionElderly care+Improved
service qualityOpportunity to choose meals and the
delivery of weekly menus to customers+Improved
service qualityDelivery follow-up through web
pages+Indirect
cost savings (employee time)No need to manually receive
cancellations−Indirect
cost (employee time)Additional time spent on teaching
and supporting elderly clients−Indirect
cost (employee time)Persuation of elderly clients to
participate into the pilot scheme was noticed to be a difficult and time-consuming
task−Infrastructure
and maintenance costCost of providing and maintaining
meal service back-end system (and possibly tags and mobile phones)Meal provider+Improved
service qualityNew meal alternative for the
clients−Indirect
cost (employee time)Producing several meals takes more
time and therefore increases total costsLogistics service provider+Improved service qualityQuality of the service can be
improved with delivery tracking, because it provides a way to prove that
meals are delivered in time+Increased
efficiencyOptimisation of delivery routes
through delivery time monitoring+Increased
efficiencyReporting of problems with the
mobile phone−Indirect
cost (employee time)Time spent on supporting elderly
clientsImproved service quality was considered the most important benefit from
the viewpoints of the elderly care and meal providers. They both had the
impression that elderly clients would appreciate the opportunity to select
meals, especially in the future when elderly clients get used to their mobile
phones. The elderly care service provider also estimated that considerable
indirect cost savings might be achieved in large-scale use, because there would
be no need to manually receive any meal cancellations which normally would take
a couple of hours per day of one employee’s work time.All five drivers of the logistics service provider who participated in
this small-scale pilot scheme reported that the pilot scheme did not have a
noticeable impact to their work efficiency. However, the persons interviewed from
management level expected that the increase in efficiency of the delivery could
be clearly noticed if service would be taken into large-scale use. They
predicted that the data from delivery time monitoring could be used to
significantly increase the efficiency of the delivery. An increase in
efficiency would be obtained mainly by the optimisation of delivery routes. As
a result, the logistics service provider was highly interested in taking the
delivery monitoring in large-scale use.As a conclusion to the assessment of the benefits and costs, all
business actors expressed that this kind of service would need a significantly
larger customer base to be economically profitable. It was also pointed out
that the service provided should be tightly integrated into existing
information systems, which might reduce some manual paper work and thus provide
additional benefits to the stakeholders.


## 4.6. Experiences from the Evaluation Methods

The first interview combined
with observations during the training proved to be an excellent source for
collecting data about the attitudes and expectations of the users towards the
application before use. Most users required lots of encouragement and support
in the interview situation and this was very challenging for our researcher.
Sometimes it was difficult to draw a line between pressuring and encouraging
the user.Observing the training
situation revealed facts about how easy it was to adopt the application and what
kind of problems
the users had with it. It was essential that the elderly users used the
application themselves during the training. If they had just seen the
researcher showing them how to use the application, they probably would not
have been able to use it for themselves. The actual physical contact with the
application and the interface removed lots of doubts related to the application
and gave the users confidence towards their ability in coping with it. With
just a little repetition, the users were able to take in the idea of the
interface and were then able to use it fluently.The pen- and paper-based diary
was not a successful method for collecting information on user experience
related to the adopted technology. First and foremost, some users had trembling
hands and were not able to write easily. This probably affected their
willingness to use a diary for data collection. One user was unable to write
with a pen and paper at all, so the diary was not offered to him.However, a bigger problem was
that the users did not correctly understand the role of the diary. Although the
role of the diary was explained in the first interview and also explained in
writing on the first page of the diary, the users failed to fully understand
it, probably due to the mental workload of the interview and training. Five
users used the diary for reporting their satisfaction with the meals, and not
for reporting their experience with the new technology. One of these five users
had realised during the trial that the focus of the diary writings should be on
the technology and not on the meals. That user then started to write about
experiences with the technology.Four users did not use the
diary at all. One of them stated in the postinterview that the application did
not evoke any specific emotions. When taking into account the nature of the
application, this was understandable. After all, the use of the application did
only take about 15 seconds and it was designed to be an integrated part of the
everyday routines of the users. This was not an application which was designed
to move its user emotionally or intended to entertain or provide flow
experiences. Instead, this is an application which, when working correctly,
should be as ‘‘invisible’’ and work as effortlessly as possible. Therefore, it
was understandable that describing one's feelings towards the application might
be felt to be difficult.The actual value of the
application was not to provide satisfaction for the user in using the
technology, but to provide the users with greater satisfaction with the meals
they received. From this perspective, the evaluation of the meals received
would be even more appropriate than evaluating the technology used for ordering
the meals. This would allow us to determine whether or not the application was
able to increase the satisfaction with the meals and the meal service. However,
in our field study, we did not use the diary to collect information on how
satisfied the users were with their meals before the trial, so we cannot use
the data gathered with diaries to compare if improvement was achieved.Unfortunately, as the diary
method did not provide information expected, it did not provide direct data
about fleeting user experiences which emerged during use. Therefore, the role
of storytelling in the after-use interview, where the user had to rely on
memory, was stronger in collecting data on user experiences than first planned.
This might have had an effect on the results.As it was highly ethical to
ensure that the new application would not leave any users without food, the
system status was monitored during the trial and all abnormalities were checked
manually (usually by calling the user). The users were also able to call the
researchers at any time for help. They used this opportunity when they had
technical problems. This kind of support activity provided lots of information
about the operation of the application and problems encountered by the user and,
also, it maintained the feeling of involvement. Assistive technology targeted at
the elderly is often criticised for increasing loneliness and decreasing the
social encounters of its user. In this trial, the application might have
actually done the opposite by increasing the social contacts of its users, as
the researcher and other people involved in the trial were actively involved
with the users during the trial. However, it must be noted that if similar
applications were to become more common, this level of personal involvement
might not be as feasible in everyday life.The experiences from the follow-up study show that as time had passed
after the experiment, it was very difficult for the users to concentrate on the
technology under evaluation. The discussion very often directed itself towards
the meal service in general, and not the technology used in the trial.
Therefore, the follow-up study mostly provided information about the attitudes
of the users at the point of the interview. However, the role of the follow-up
study can be seen also as a method for ensuring that the experiment did not
cause negative effects in the lives of the users (as described in [22]). This can be used for evaluating the ethical issues
related to the experiment. From the research point of view, it can be
problematic to balance between avoiding negative impacts of the pilot scheme and
creating high-impact concepts. If the concept is found extremely valuable by
the users and is able to considerably contribute towards a higher quality of
life for the pilot scheme users, losing the possibility to use technology after
the pilot scheme may have strong negative effect on the well-being of the pilot
scheme users (as described in [22]). The negative psychological effect of loss can be
much stronger than the positive effect achieved through the pilot scheme.
However, the goal of concept design is to create high-impact concepts which
would be appreciated and valued by the users. Methods and examples for
balancing between these two contradictory goals would be welcome.


## 5. Discussion

Diversity among the elderly
people [25] means that it can be very challenging to design and
implement services and user interfaces which could be widely adopted by the
elderly users. In addition to differences in skills among the elderly users,
there are other challenges, such as a low confidence towards one's own
abilities in using computer technologies [26] and a short or nonexistent experience in using novel
applications.Based on the evaluation of the
home care employee, a notable part of the elderly clients would not be able to
order their meals by touching a tag with an NFC-enabled mobile phone because of
their decreased cognitive and physical capabilities. In addition, many elderly
clients refused to participate in the trial when they heard that they should
use a mobile phone in order to receive their daily meals. When developing new
services for the elderly, it is essential to remember that the elderly are
often unfamiliar with and unwilling to adopt new technologies [27].Two clients, who were initially
willing to participate in the trial based on a phone discussion, withdrew from
the trial when they first saw the application interface and had the application
demonstrated to them. Both used a mobile phone regularly. The user interface
clearly did not live up to their expectations. None of trial users decided to
stop using the application in the middle of the experiment period. The home
care employee assessed that the participants of the NFC catering service trial
were very eager to prove that they could cope with the test application.The field experiment showed
that a touch-based user interface can provide an easy-to-learn and adoptive
user interface paradigm for the elderly to be used in applications integrated
with the everyday life of its elderly users. Adopting the user interface does
not require specific prior knowledge or experience of technology. Impaired
motor skills do not prevent its use or make the use of the touch-based user
interface difficult. The touch-based user interface also allows a direct and
natural interaction which can reduce the cognitive load by decreasing the
memory load of the users.The success of the application
evaluated was not that evident. Four out of nine participants preferred the
older catering practice and did not think that the application would provide
them with added value. This indicates that user experiences related to the
usefulness of a solution are significant factors in introducing new
technological solutions. This observation is not surprising as the application
described in this paper was primarily implemented for examining the aspects
related to the touch-based user interface and the application itself was not
the main focus of the study. Therefore, the application was not based on a thorough
analysis of the needs of the elderly users, which has been found to be
essential for designing successful applications for the elderly [28, 29].The trial revealed some issues
which could have been implemented better. For example, remembering to place a
meal order daily introduced worry and stress to the user. Adding a reminder to
the application or implementing an intuitive check system which could be used
for checking if the order had already been placed could resolve this issue. In
addition, by changing the feedback of a mobile phone in a way in which it would
give auditory feedback in addition to tactile and visual feedback after a
successful reading could possibly improve the usability of the solution.
However, it would be unlikely that acceptance towards the NFC-based meal
ordering service would change substantially, because all participants did not
perceive the basic idea of meal selection as valuable.However, a majority of the
users would have been willing to continue to use the application after the
experiment, and saw added value in the enhanced service. This finding is in line with the previous study of Zimmer
and Chappell [30] which suggested that life-quality-enhancing new
technologies are welcomed by many elderly people.Three out of four users, who
preferred the older catering practice over the new one, did not own a mobile
phone. All the participants who preferred the new catering solution over the
older practice had their own mobile phone. It is possible that the participants
who owned a phone experienced the new catering service as a new additional feature
of a mobile phone, which they already experienced to be such a useful device
that they had gone and purchased it. However, the participants who did not own
a mobile phone were forced to use it now, even though they had not thought it
to be important enough that they would like to get one. Many elderly clients of
the meal service refused to participate in the trial because they did not want
to use a mobile phone. More generally, this might also indicate that the
attitude towards new technology is a strong contributor to the willingness to
adopt services similar to the one used in the trial.The follow-up study revealed
that the quality of meals and the reliability of the catering service are the
most valuable things for the elderly clients of the catering service. Secondary
issues are the possibility to select meals between several meal alternatives
and the possibility to cancel the meal flexibly.Although the pilot scheme proved
that all pilot scheme participants were able to order their own meals with NFC-enabled
phones, the business potential of this service in this customer segment is
somewhat questionable. The main reason for the weak business potential is that
the clients chosen in this pilot scheme group were those who were evaluated to
most probably succeed in the pilot scheme. Furthermore, the interviewed
personnel of the elderly care found it very unlikely that the majority of the
home care clients could either succeed or be willing to use this service.
Doubts about succeeding were based on the estimation that a large proportion of
their overall 200 customers have functional capabilities which are simply too
low for this kind of service, for example, severe memory disorders. However, the
customer base could be expanded by offering the service also to other interested
parties. For example, in the city of Oulu, there are currently over 15,800 elderly persons, that is, over 65 years, and
home-care clients, about 1.3%, are only a very small proportion of that segment.



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*Source: 931701-2008-07-17.xml*