JMIR Publications

ABSTRACT

Background:

Older adults living alone in low-income housing face heightened risks of social isolation and loneliness due to limited social networks, transportation barriers, chronic health conditions, and inadequate access to information and communication technology. Voice-operated smart speakers offer potential for enhancing social connectedness in this underserved population, yet technology interventions are rarely designed with meaningful input from low-income older adults themselves. User-centered design (UCD) approaches can address this gap by engaging end-users throughout the development process to ensure technology solutions align with their unique needs and living contexts.

Objective:

This study aimed to engage low-income older adults in an iterative UCD process to develop prototype scenarios for smart speaker-based applications that promote social connectedness while addressing safety, community-building, and wellness needs.

Methods:

We conducted a three-stage UCD study with 29 older adults (mean age 70±6.8 years, 79% African American, 69% high school education or less) living alone in subsidized housing between April 2021 and April 2022. Stage 1 included five focus groups (n=25) combining needs assessment discussions with rapid brainstorming activities using the 6-8-5 design method and pictorial sheets. Stage 2 involved research team synthesis of focus group transcripts and brainstorming data to create a Design Strategies Map, development of initial prototype scenarios, five evaluation focus groups (n=18) to gather feedback, and iterative scenario refinement. Stage 3 comprised four validation focus groups (n=17) to assess refined scenarios and identify implementation recommendations. Participants included both smart speaker users (n=13) and non-users (n=16). Data were analyzed using thematic analysis for needs assessment, content analysis for brainstorming ideas and feedback, and matrix analysis for systematic comparison across scenarios.

Results:

Participants generated 153 ideas for smart speaker use, with Health and Safety (n=34, 22.2%) and Daily Assistance (n=41, 26.8%) being most frequent categories. Analysis revealed that social connection needs were inseparable from safety concerns related to living alone. Through iterative co-design, we developed seven prototype scenarios across four functional categories: Checking-In (peer and management wellness verification with privacy controls), Social Companion (conversational AI providing companionship and emotional support), Community Involvement (virtual bulletin boards and activity coordination), and Wellness Check (health monitoring with user-controlled interventions). Participants emphasized requirements for personalization, opt-in/opt-out controls, "Do Not Disturb" features, and safeguards preventing replacement of human connection.

Conclusions:

Low-income older adults can meaningfully engage in technology design and provide valuable insights that challenge assumptions about their needs and preferences. The prototype scenarios address the dual imperatives of social connection and safety while living alone, offering a foundation for developing smart speaker applications tailored to underserved populations. Implementation should prioritize user control, privacy protection, and careful consideration of user characteristics to build trust and ensure effective, sustained use of an intended technology platform. Clinical Trial: Not applicable