Caring robots are here to help

Nurse researchers and scientists developing culturally sensitive care robots say there is nothing to fear, and much to be gained, from this sophisticated technology.

Nurse researchers and scientists developing culturally sensitive care robots say there is nothing to fear, and much to be gained, from this sophisticated technology

Robots provide social assistance through interactions using speech,
movements and gestures. Picture: Science Photo Library

Robots, along with sensors and telemedicine, have been identified as technologies that can assist and prolong independent living for older people, with robots especially being used to help prevent social isolation and depression.

Socially assistive robots provide assistance through interactions using speech, movements and gestures, and are already used in many settings including healthcare. But attitudes to the use of robots vary, especially in the care of older people. 

A Europe-wide survey in 2015 found that 51% of respondents did not approve of the use of robots in the care of older adults or as companions (Special Eurobarometer 2015). There is also debate among healthcare professionals.

Brain activity

Recent experiments with a robot pet seal named Paro have been shown to improve older adults’ brain activity and lower their stress levels, but there is still concern that robots could replace or limit human interaction with older adults.

Research suggests that older adults who perceive a need for an assisting device in order to maintain their independence are more likely to accept the technology, but matching the robot’s capabilities to the user’s needs is very important (Frennert et al 2017).

A review of the literature related to the acceptance of healthcare robots among older adults (Broadbent et al 2009) found influential factors included age, education, gender, experience with technology and culture. Americans generally appear to be more accepting of robots.

Social norms

A number of studies exploring differences in the acceptance of robots across different cultures have found that people prefer robots that comply with the social norms of their own culture, in verbal behaviour (Andrist et al 2015Rau et al 2009Wang et al 2010), non-verbal behaviour (Trovato et al 2016) and interpersonal distance (Eresha et al 2013Joosse et al  2014).

This preference does not merely affect the likeability of the robot. In a series of experiments on the influence of culture on human interaction with robots, participants from the US and China were asked to solve a task with the possibility of relying on the suggestions of a robot assistant (Evers et al 2008).

Future robots must take account of the cultural identity of the assisted person
and healthcare team. Picture: Getty Images

Researchers analysed the level of trust, comfort, compliance and sense of control inspired by the robots, as well as the attribution to them of human characteristics, and found that each group had more trust and a more effective interaction with the robot that complied with the norms of their culture (Wang et al 2010). 

Cultural identity

The importance of culture and the need for cultural competence in healthcare has been widely investigated in the nursing literature. Nurses acknowledge that culture has a significant impact on healthcare decisions and advocate that patient care should be culturally appropriate and competent.

If service robots are to be accepted in the real world by real people, they must be designed to take account of the cultural identity and diversity of the assisted person and those of the healthcare team.

Designers of personal robots for healthcare are faced with questions such as how should the robot greet a person, should the robot ask direct questions or not, what physical distance should the robot keep from a person, should it avoid or encourage physical contact, and is there any area of the person's home that it should consider off-limits. The answer to all these questions is ‘it depends’ –  on the person’s values, beliefs, customs and lifestyle (Sgorbissa et al 2017).

Aware, sensitive

The CARESSES (Culturally Aware Robots and Environmental Sensor Systems for Elderly Support) project, is a three-year European-Japanese collaboration funded by the EU HORIZON 2020 programme and the Japanese Ministry of Internal Affairs and Communications.

A collaboration of nurses, computer scientists, psychologists and artificial intelligence scientists, we started work in January 2017 with the aim of creating culturally competent and intelligent assistive robots.  

We define a culturally competent robot as one that knows general cultural characteristics but is aware that these take different forms in different individuals, and is sensitive to cultural differences while perceiving, reasoning and acting.

What and how

Today it is technically conceivable to build robots operating in a 'smart' environment populated with smart sensors and devices that reliably accomplish basic assistive services. However, state-of-the-art robots consider only the problem of ‘what to do’ in order to provide a service: they produce rigid responses which do not adapt to the place, person and culture. It is now time for the technology to address the question ‘how to do’ (Sgorbissa et al 2017).

The CARESSES team believes that cultural competence would make assistive robots more acceptable to users by being more sensitive to their needs, customs and lifestyle. This would increase the robots’ impact on the quality of life of users and their carers, reducing the burden on caregivers and improving the system’s efficiency and effectiveness.

Pepper is a culturally aware robot that can entertain, read aloud
and play music and games. Picture: Getty Images

CARESSES' culturally aware solutions are meant to expand the capabilities of any assistive or companion robot. They will be demonstrated on the Pepper robot, which is designed and marketed by Softbank Robotics, a partner of the project.

Help from Pepper

The new culturally aware capabilities of the Pepper robot will include:

  • Communication through culturally appropriate speech and gestures.
  • Independent movement.
  • Assistance for individuals in performing everyday tasks, such as reminding them to make a shopping list, suggesting menus and receiving visitors.
  • Health-related assistance, such as reminding the person to take their medication or encouraging them to engage in physical activity.
  • Easing access to technology, such as the internet, video calls and smart appliances for home automation.
  • Provision of entertainment such as reading aloud and playing music and games.
  • Safety promotion through information and raising the alarm when needed. 

During the final year of the project, the culturally aware robots will be tested with older people in the UK and Japan.

In the CARESSES project, nurse researchers have the critical task of developing guidelines for transcultural robotic nursing, paving the way for future research in this field. The continuing debate among health and social care professionals about the acceptability of robots in healthcare may lead to the appropriate use of smart technologies among different populations and for different healthcare problems.

We believe it is important for nurses to be involved and play a role in the development of future healthcare assistive robotic innovations. Nurses should accept the challenge of increasing need and reduced human workforce and ensure that old and very old people in society continue to receive the care and support they need. Culturally competent assistive robots should be used ethically – they are useful tools for human carers, who they will never replace but can complement.

Irena Papadopoulos is professor of transcultural health and nursing at Middlesex University. Antonio Sgorbissa is associate professor, department of Informatics, bioengineering, Robotics and Systems Engineering, Universita Degli Stidu Di Genova. Christina Koulouglioti is senior research fellow, Research and Innovation Department, Western Sussex Hospitals NHS foundation Trust and Research Center for Transcultural Studies in Health at Middlesex University. 

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