What helps, what hinders?-Focus group findings on barriers and facilitators for mobile service robot use in a psychosocial group therapy for people with dementia.

Introduction: Many countries are facing a shortage of healthcare workers. Furthermore, healthcare workers are experiencing many stressors, resulting in psychological issues, impaired health, and increased intentions to leave the workplace. In recent years, different technologies have been implemented to lighten workload on healthcare workers, such as electronic patient files. Robotic solutions are still rather uncommon. To help with acceptance and actual use of robots their functionalities should correspond to the users' needs. Method: In the pilot study Care4All-Initial, we developed and field-tested applications for a mobile service robot in a psychosocial, multimodal group therapy for people with dementia. To guide the process and assess possible facilitators and barriers, we conducted a reoccurring focus group including people with dementia, therapists, professional caregivers as well as researchers from different disciplines with a user-centered design approach. The focus group suggested and reviewed applications and discussed ethical implications. We recorded the focus group discussions in writing and used content analysis. Results: The focus group discussed 15 different topics regarding ethical concerns that we used as a framework for the research project: Ethical facilitators were respect for the autonomy of the people with dementia and their proxies regarding participating and data sharing. Furthermore, the robot had to be useful for the therapists and attendees. Ethical barriers were the deception and possible harm of the people with dementia or therapists. The focus group suggested 32 different applications. We implemented 13 applications that centered on the robot interacting with the people with dementia and lightening the workload off the therapists. The implemented applications were facilitated through utilizing existing hard- and software and building on applications. Barriers to implementation were due to hardware, software, or applications not fitting the scope of the project. Discussion: To prevent barriers of robot employment in a group therapy for people with dementia, the robot's applications have to be developed sufficiently for a flawless and safe use, the use of the robot should not cause irritation or agitation, but rather be meaningful and useful to its users. To facilitate the development sufficient time, money, expertise and planning is essential.