Demographic change involves higher proportions of older people and people in need of care, bringing the care sector to its knees due to personnel, economic, and organizational shortcomings [1,2]. Geriatric care, nursing care, and—as a comparatively new development [3]—care institutions for (older) disabled people suffer badly from a lack of care personnel in combination with raising needs of care for older (geriatric care), chronically ill (curative care), and disabled (care of the disabled) people [4,5].

The development of technical innovations is proceeding constantly to relieve care staff, complement care supply, enhance safety in emergencies, and enable a largely autonomous life for people in need of care [6]. Within these developments, diverse Ambient Assisted Living (AAL) technologies and systems [7,8] enable monitoring of vital parameters, detecting falls and emergencies, and a longer stay at home using smart home technologies [9,10].

Such technologies and systems are rarely used in both real-life and professional working environments [11]. Beyond availability and technical possibilities, users’ acceptance and the broad willingness to use these systems are decisive for a sustainable integration of AAL technologies in everyday life [12]. As recently reported [13], there are considerable differences in AAL acceptance between people in need of care and professional caregivers, indicating a more critical and restraint attitude of care staff compared with people in need of care and their relatives.

The professional caregivers’ perspectives on specific AAL technologies and on the data gathered in line with perceptions regarding benefits of and barriers to such systems are not known. This study, therefore, takes professional caregivers’ perspectives on AAL technologies into account, comparing different care contexts—geriatric care, medical care, and disabled people’s care.

In the following sections, we have presented the theoretical background starting with examples of current AAL technologies and systems, followed by AAL acceptance studies in professional care contexts.

Due to abovementioned reasons, it was necessary to use a qualitative approach first; interviews were conducted with professional caregivers working in diverse care areas (n=6) to identify challenges in care and the perceived benefits of as well as barriers to AAL technology usage from a care staff’s perspective. The differentiated look on professional caregivers allowed us to investigate what assistive technology should and should not do. Based on the qualitative results of this preceding study, the Web-based questionnaire for this study was conceptualized.

Therefore, this study aimed to quantitatively investigate the professional caregivers’ acceptance of assistive technologies in professional care contexts, differentiating between geriatric care, medical care, and disabled people’s care. This investigation was driven by the following research questions:

In order to reach a larger sample of care professionals, a Web-based survey was developed and specifically tailored to professional caregivers working in diverse care contexts. A preceding interview study focused on professional caregivers’ daily routines, their perceptions of different assistive technologies, and their wishes and needs. These qualitative results enabled the development of a scenario- and Web-based survey that addresses professional caregivers in a realistic and comprehensible way.

As an independent variable, we explored the care context contrasting 3 areas: (1) geriatric care; (2) nursing care; and (3) disabled people’s care and support. Naturally, these are not distinct categories as sometimes, there are overlaps across these care areas in real-life care settings. However, the responding caregivers had to assess themselves in terms of their main professional area. Thus, we took their self-assessment as an expert classification.

As dependent variables, we analyzed different acceptance ratings. First, participants answered items with respect to AAL technology acceptance, differentiating among data storage, access, and collection, as well as perceived benefits and barriers respecting AAL technologies. The items for these areas were taken from a preceding qualitative interview study with professional caregivers of different care areas. Furthermore, the next dependent variable relates to different types of gathered data and different types of technologies used for AAL assistance. All constructs, the respective items, and their evaluations have been presented in Multimedia Appendix 1.

Overall, the survey contained 14 questions pictured on 9 pages (including the starting page, final page, and scenario introduction). Measuring was operationalized by 6 forced-choice questions, open comment fields, and 82 items departed in 8 thematic blocks. These items were block wise randomized and had to be evaluated on 6-point Likert scales (1=min: “I strongly disagree” to 6=max: “I strongly agree”). Thereby, values <3.5 indicated rejection, whereas values >3.5 indicated approval. During the Web-based survey, participants had the opportunity to review and change their answers if desired.

Demographic characteristics (age, gender, education, and duration of professional experience) and the care sector of respondents (ie, geriatric care, nursing care, and disabled people’s care and support) represented the questionnaire’s first part of the survey. In the second part, participants’ attitudes toward technical self-efficacy (4 items, alpha=.884; based on [38]), their needs for privacy (6 items, alpha=.833; based on [39,40]), and their interpersonal trust (3 items, alpha=.793; based on [41]) were assessed.

To ensure that all participants refer to the same baseline concerning the evaluation of AAL technology, a scenario approach was adopted; the participants should imagine the integration of an AAL system into their professional working environment. Room sensors, microphones, video cameras, and ultrasonic sensors were introduced as part of the AAL system, and their functions within the AAL system were detailed (eg, automatic opening and closing of doors and windows, reminders, and alarms [emergencies, falls]).

Subsequently, participants were asked to evaluate perceived potential benefits (14 items, alpha=.923) and potential barriers (17 items; alpha=.861) referring to the described AAL system. Both benefits and barriers of the described AAL system were obtained from the interview study. Furthermore, participants indicated whether they would accept gathering different types of data (14 items, alpha=.856; based on the information needed to realize technical functions). Afterward, participants assessed different technologies to gather data (using 12 items, alpha=.892; based on technical configurations of the AAL system). Additionally, participants assessed data access (alpha=.802) and data storage (alpha=.760) issues, each using 3 items referring to diverse types of data (video data, audio data, position data, and room data).

The acceptance of AAL system was evaluated using 6 statements (alpha=.932; eg, “I find the described AAL system useful”). Finally, participants could reason their opinions and their feedback concerning the study on an optional basis.

Before the study was started, the Web-based survey was pretested by communication scientists concerning comprehensibility and technical functionality. Additionally, pretests with “laypeople” were conducted to ensure comprehensibility and to enable the estimation of the length of time participants would need to fulfill the survey.

We have reported descriptive findings as well as inference statistics differentiating between care professionals working in different care contexts (group differences are reported based on post hoc tests [Tukey honestly significant difference]). Looking at the results for the constructs of AAL technology perception (Figure 1), significant differences for the 3 care contexts were revealed (F_14,220=2.514, P=.002). Multimedia Appendix 1 presents means and SDs of all items for the whole sample and the 3 care contexts.

Participants working in the area of disabled people’s care indicated a significantly lower acceptance of AAL technologies (F_2,118=4.570; P=.01) than those working in geriatric and medical care. Furthermore, regarding the data that are allowed to be gathered, the perception was significantly different (F_2,118=4.073; P=.02); participants working not only in medical care but also in geriatric care showed more positive evaluations compared with participants working in disabled people’s care. Regarding technologies that can be used to gather data, the same result was found (F_2,118=11.727; P<.001); participants working in medical and geriatric care differed significantly from those working in disabled people’s care, who indicated a more negative attitude toward specific technologies. In contrast, potential benefits of (F_2,118=0.350; P=.71) and barriers to (F_2,118=1.853; P=.16) AAL technology usage were not found to be significantly different across the care contexts (disabled people’s care: mean 4.5 [SD 0.7]; medical care: mean 4.2 [SD 0.7]; and geriatric care: mean 4.3 [SD 0.9]). Issues of data access (F_2,118=.340; P=.71) and data storage (F_2,118=2.235; P=.11) were not found to be significantly different as well, showing a homogenous evaluation independent of the care context.

In this section, we present the significant differences within the evaluation of AAL technology acceptance, applied technologies, and data collection in more detail.

In contrast to previous research results reporting mostly positive evaluations of ICT and assistive technologies in care [24,32,33], professional care staff has reportedly been more critical concerning the integration of AAL technologies into their professional routine [13,34].

The evaluations of which data can be gathered and which specific technologies should be used revealed yet underexplored insights into the perceptions of care professionals; the only accepted data collection was regarding emergencies, whereas the collection of other data types was, at the utmost, tolerated if not rejected. The negative assessment had been confirmed by open comments in the questionnaire and was also voiced in the preceding interviews. Apparently, care staff evaluations contradict the reasons why AAL systems can be useful at all: those systems can only be efficiently used if data about the patient and his or her location, health status, and care situation are recorded and, if necessary, interpreted by remote medical services. The evaluation of specific technologies showed similar findings; participants indicated to only accept quite static technologies (eg, emergency buttons), which record static, binary data (eg, door open or closed). In line with previous research [42], more complex AAL technologies (eg, cameras, microphones, and life-logging) were—owing to their still higher potential of violation of privacy—broadly rejected in the care context. Participants’ feedback suggests that the major concern is regarding the sneaking suspicion that the collected data will be not only stored for long term but also accessible to others. Here, a general distrust toward illegal data access and abuse by third parties becomes obvious.

The negative attitude might also be attributed to the applied scenario-based approach. Previous research has shown that the methodology used to capture acceptance reactions modulates outcomes considerably; acceptance after hands-on experience with AAL technologies has been much more positive [26] compared with assessing the acceptance through scenario analyses, in which participants should envision the usage of assistive home technologies. Possibly, professional care staff would have evaluated AAL technologies more positively if they had the chance to test these technologies in their everyday professional life and rely their perceptions on own experiences.

In addition to personal characteristics, for example, experience with technology, which is known to impact AAL technology acceptance [32,34], the interview findings revealed that the working conditions in care context are decisive for AAL technology acceptance in the sensible field of care. This study confirms the influence of the care context. While medical and geriatric care professionals are generally more positive toward AAL technologies, the professionals working in disabled people’s care are more reluctant toward the usefulness of AAL systems and perceive higher concerns regarding data collection in the care situation.

We assume that the differences especially in evaluations of data and technology configurations are caused by disparate internal perspectives of the care institutions. Geriatric and especially medical care are concentrated on the short-term and temporary care of old and chronically ill patients and, therefore, focus on patients’ safety as well as substantial improvement in health. Additionally, geriatric and medical caregivers are involved in high numbers of emergencies, in which monitoring technologies are widely used. On those grounds, geriatric and medical caregivers might have a more positive attitude toward assistive technologies. In contrast, care institutions for disabled people have a completely different disputation. They represent a long-term stationary home and, besides safety issues, focus especially on the protection of human dignity, rights, and privacy of their residents. Therefore, caregivers of disabled people probably have a more restraint attitude toward assistive technology and are specifically critical toward the collection of personal data.

Overall, care does not equal care; the diversity of care needs to be considered in the development process of assistive technologies and especially in the way those technologies are introduced and implemented in daily care routines of care institutions.

There are some limitations to be considered in future research. While we revealed a basically negative attitude toward (data collection in) AAL systems, stakeholder-specific reasons underlying participants’ reluctance are not known. Possible reasons against using AAL systems might include concerns that (1) employers could control the quality of care (staff); (2) responsibility claims could be pleaded by family members (staff); (3) a low usability of technology might overcharge the technology competence (staff); (4) personal data could appear in public (patient); (5) emergency help would contradict life-end decisions (patient); and (6) a lower supply quality by insurances (family members) or extra financial burden due to costly technology (family members). Future research should clarify which of these reasons should be addressed by adequate information and communication strategies.

A further limitation is related to the applied method and sample issues. Due to our scenario-based approach, the evaluations based on a fictional, and not real, AAL system could have led to an overestimation of potential barriers especially fears concerning data security [26] as well as a general discomfort of being monitored in intimate (care) situations [42]. We, therefore, aim for hands-on evaluations of AAL technologies in diverse professional care environments (ie, in institutions for geriatric, medical, or disabled people’s care).

Moreover, there are sample-related aspects to be considered. Most of our participants were women. Even though this is consistent with higher proportions of women working in care institutions [43], research should aim at exploring more male caregivers to analyze whether acceptance positions are impacted by gender roles.

Furthermore, as we only included participants from one country, outcomes are limited to the German health care system and perspectives on AAL. Future research should extend the perspectives to enable a direct comparison of AAL acceptance as well as data and technology perceptions in different countries and cultures [37].

Findings can be used for the development, design, and configuration of AAL technologies as well as for health care and nursing management issues. As data are not needed to be stored for a long-term (only direct processing) and can be processed by the system for nearly all functions, targeted communication strategies could inform the handling of data (eg, only processing not storage). The transparency and the honesty of communication strategies are essential to inform caregivers about the usefulness of AAL systems for them (support in care routine), for the institution (efficiency), and also for patients and family members (patient safety). In addition, the policy of an institution regarding how data are handled should be explicitly made. Likewise, communication strategies could be tailored to diverse care contexts and their particularities in a more detailed and satisfying way. This is especially important as the feedback from our participants during the preceding interview study and also in comment fields during the Web-based survey (“they don’t care about us”) showed that care personnel often do not feel their needs to be heard and appreciated by the care institution’s management, policy, and society. If care personnel are considered as a valuable part in the process of integration of assistive technologies, all stakeholders—caregivers, caretakers, and patients—will benefit alike.