HHS Public Access

Author manuscript
OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
Author Manuscript

Published in final edited form as:

OTJR (Thorofare N J). 2019 October ; 39(4): 247–256. doi:10.1177/1539449218813906.

Profiles and Predictors of Smart Home Technology Adoption by

Older Adults
Sajay Arthanat1, John Wilcox1, Mackenzie Macuch1
1University of New Hampshire, Durham, USA

Abstract
Author Manuscript

The commercial popularity of smart home (SH) technology has broadened the scope of aging-in-
place and home health occupational therapy. The objective of this article is to examine ownership
of SH technology by older adults, their readiness to adopt SH technology, and identify the client
factors relating to the adoption. A survey of older adults aged 60 and above living in the
community was conducted. Respondents (N = 445) who were women; in the age group of 60 to 70
years; living in a two-level home, with a body function impairment; with a fall history; and
experienced in information and communication technology (ICT) were significantly likely to be
“brisk adopters” of SH (p < .05). Stepwise regression model identified marital status, home
security, and overall ICT ownership as the predictors of SH ownership, whereas being female,
concern over home security, and perceived independence contributed to SH readiness (p < .05).
Consideration of the identified client profiles, health, and personal factors will strengthen SH
integration for aging-in-place.
Author Manuscript

Keywords
aging-in-place; smart home technology; home automation; information and communication
technology; gerontechnology

Introduction
Smart home (SH) technology can facilitate aging-in-place for seniors by promoting safety
and security, emergency response, health management, and independence in occupational
routines. An increasing aging population combined with the alarming cost of long-term care
relocation make SH technologies significant for older adults today. Recent advancements in
Author Manuscript

information and communication technology (ICT) to support home automation and

monitoring have brought SH intervention to the forefront. Although availability and
affordability have significantly improved, the acceptance of SH technologies by older adults
has historically been low. This article reports on a survey research to investigate the extent of
older adults’ adoption of various home automation technologies as well as the factors
predicting their affinity to SH.

Corresponding Author: Sajay Arthanat, Associate Professor, Department of Occupational Therapy, College of Health and Human
Services, University of New Hampshire, 4 Library Way, Hewitt Hall, Durham, NH 03824, USA. [email protected].
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
 Arthanat et al. Page 2

Background
Author Manuscript

SH technology is now a popular product commodity in the consumer electronics industry.

The technology’s popularity has been spurred by the integration of wireless networking,
connectivity to interlink and control gadgets and appliances (termed as Internet of things), as
well as to remotely monitor one’s home. The SH concept is defined as having three core
characteristics: (a) sensor networks to monitor and gather information about the state of the
home and its residents, (b) mechanisms that allow communication between devices to enable
automation and remote access, and (c) user interfaces such as home displays, personal
computers, tablets, and smart phones to enable consumers to set preferences/goals as well as
to receive information and feedback (Cook, 2012; Hargreaves & Wilson, 2013). In addition,
the introduction of wearable interface technologies such as smart watches and health
monitors have added a new dimension to SH technology. Although home owners in general
may value the comfort, convenience, and home energy management with automation
Author Manuscript

(Wilson, Hargreaves, & Hauxwell-Baldwin, 2017), SH technologies have far greater

implications for the aging.

A great majority of people prefer to age in their home and community (American
Association of Retired Persons, 2014). Aging-in-place is now also being promoted
worldwide by policy makers and health providers to save costs on institutional care (Peek et
al., 2014; World Health Organization, 2007). With the impending risks of institutionalization
including functional declines, physical and cognitive impairments, chronic diseases,
declining social network, and low levels of physical activity (Stuck et al., 1999), the value of
SH technology becomes significant with aging. Reliance on SH in the home health setting
has grown as technologies continue to be widely recommended for monitoring physiological
and functional outcomes, safety, social interactions, emergency detection, and cognitive and
Author Manuscript

sensory assistance (Demiris et al., 2004; Liu, Stroulia, Nikolaidis, Miguel-Cruz, & Rios
Rincon, 2016). More recent developments with wireless connectivity and Internet of things
highlight SH technology’s capability to promote independence, telehealth, and health
monitoring (Majumder et al., 2017). Chung, Demiris, and Thompson (2016) concluded that
when SH technology is implemented appropriately and ethically, it has the potential to
strengthen older adults’ quality of life, safety, and prospects for aging-inplace. Although the
potential is noteworthy, home health professionals need to be cognizant of older adult’s
context and personal factors leading to successful adoption of SH interventions.

Although valid prevalence data on ownership and usage of SH technology by older adults
are yet to emerge, studies have historically highlighted a consistent level of resistance and
attitudinal barriers among older adults toward SH technology (Coughlin, D’Ambrosio,
Author Manuscript

Reimer, & Pratt, 2007; Demiris et al., 2004). Another precursor to technology adoption by
older adults to consider is their level of readiness, defined as “the propensity to embrace and
use new technologies for accomplishing goals in home life and at work” (Parasuraman,
2000, p. 308). As most older adults spend the bulk of their years in the pre–digital Internet
era, their readiness to explore and use ICT is often called into question. In adoption
literature, early adopters are characterized as having relatively higher awareness of
innovation, wealth, information-seeking skills, and above all, the perception of the benefits
of adoption (Rogers, 2003). In fact, these characteristics were evident in early adopters of

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 3

SH (Wilson et al., 2017). At the other end, initial barriers to SH technology adoption by
Author Manuscript

older adults are noted to be lack of awareness, limited knowledge of availability, and funding
constraints (Morris et al., 2013). Concerns pertaining to usability, reliability, trust, privacy,
accessibility, and affordability that were reported a decade ago (Coughlin et al., 2007) still
seem to persist (Garg & Kim, 2018). There is an overwhelming perception among
consumers in general that SH will increase dependence on technology, are nonessential
luxuries, are intrusive, and undermine privacy (Wilson et al., 2017). In a systematic review
on acceptance of SH, Peek et al. (2014) enumerated six qualitative themes associated with
preimplementation of SH by older adults with a major corpus of the literature outlining the
theme of concerns with technology. Along with concerns, the researchers concluded that
adoption is dictated by perceived benefits and need for technology, consideration of
alternatives, social influence, and personal characteristics of older adults.

As aging-in-place proponents continually elucidate the promise of SH, the assertions are yet
Author Manuscript

to be supported by research on their real-world effectiveness. Evidence to support SH

intervention is still emerging. Currently, most studies have small and heterogeneous samples
and involve qualitative approaches (Liu et al., 2016). Although empirical evidence to support
the use of SH for aging is needed to promote its role in health care (Layton, 2015),
investigations into older adults’ current levels of usage and readiness for adoption are
equally paramount for occupational therapists and technology providers in a home health
setting. Building on the research to examine older adults’ key demographic and health
determinants for adoption of ICT (Elliot, Mooney, Douthit, & Lynch, 2014; Macedo, 2017;
Vroman, Arthanat, & Lysack, 2015), a parallel emphasis must be given specifically to SH
technology. This study aimed at addressing two broad research questions:

Research Question 1: To what extent has SH technology been adopted by older

Author Manuscript

adults? What types of SH devices have high rates of adoption, potential for adoption,
and rejection among the population?

Research Question 2: What are the demographic and health-related factors related to
the overall adoption profiles of SH technology by older adults and to what extent do
the factors contribute to their SH ownership and readiness?

Health-related factors of focus were medical diagnosis; chronic disability attributed to

mobility, vision, hearing, or cognitive impairments; history of falls or accidents; and
perceived independence in daily routines.

Method
This descriptive study was conducted through a survey of older adults residing in the New
Author Manuscript

England region of the United States. The overarching goal was to examine the status and
potential as well as facilitators and barriers for them to age in place. The research protocol
was reviewed and approved by the institutional review board for human participant
protection at the University of New Hampshire. The data segments on home automation and
the associated variables were the focus of this study.

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 4

Participants
Author Manuscript

A convenience sample of individuals 60 years and older was employed in the study. With
our focus on aging-in-place, they were eligible to participate if they lived in the community
alone or with family. Conceivably, older adults who lived in long-term care facilities such as
assisted living and nursing homes were not considered. The chosen sample size was above
400, which is the recommended number for generalizability of findings for any population
above 10,000 people for surveys that involve any categorical data and estimated margin of
error of 0.05 (Bartlett, Kotrlik, & Higgins, 2001). The sample was also adequate for the
multiple regression analysis employed in this study considering the recommended ratio of 10
respondents for each predictor variable (Bartlett et al., 2001).

Survey Questionnaire
A draft of the survey questionnaire was initially developed from literature on aging-in-place,
Author Manuscript

and second through interviews with 10 older adults in the community. The interview
participants were sampled purposively based on unique demographic characteristics, living
situation, and health status. To ensure that we captured wide-ranging aging-in-place
perspectives, the sample included individuals in high and low income (below the median),
living alone or with family, and those with and without a chronic disability. The interview
questions centered on facilitators and barriers to aging in the community including
perspectives on SH technology. The interview data were analyzed by three members of the
research team independently. Although the perspectives varied, data saturation was
noticeable during our triangulation through common indicators and converging themes
among the participants. Measurable indicators from the content analysis were added as
questions on the survey. These were compiled in the areas of participation and independence
in home and community activities, access and safety, use of ICT including home automation,
Author Manuscript

community resources, and social support. The survey was then pilot tested with 12 older
adults who first completed the questionnaire and then provided feedback and suggestions
through a 2-hr focus group. Specific to this study, participants stated their needs with home
automation, preferences, and dislikes; sought clarifications; and provided input on the
technologies to be included in the survey. Thirteen SH commercially available devices (see
Figure 1 in “Results” section) were discussed and listed in the survey and respondents
needed to report on each whether they (a) “already have,” (b) “do not have but wish to
have,” or (c) “do not have and do not wish to have” the device. Although the device listing
was not exhaustive, the list was deemed as an adequate representation of the current SH
technology market. The final survey was created following analysis of the audio-recorded
data.
Author Manuscript

Data Collection
The survey was primarily administered online through Qualtrics® survey platform.
Participants were recruited through Qualtrics® Panel, a large sample pool organized by the
company in various demographic and customer profiles. Potential respondents register into
the panels and provide their personal and demographic information. The company then
invites them to participate in surveys that match their profile and interests.

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 5

Older adults in the New England region of the United States were stratified from the sample
Author Manuscript

pool. Respondents were screened out automatically if they reported their age to be below 60
years or residing in long-term care facilities. To ensure response quality, a coordinator at
Qualtrics® carefully reviewed the first 50 responses for reliability and any missing sections
of data. Once reliability of the panel was established, the survey was launched. A student
research assistant monitored all individual responses thereafter. To check for duplication,
responses were reviewed for distinct geographical location as generated from the
respondent’s IP address. Comments at the end of each survey section also attested to the
response validity. In addition, questions with quality filters were included at random points
in the survey, in which participants were expected to respond to a question using a certain
choice on the given Likert-type scale. The filters indicated that participants were paying
attention to the questions and any response that deviated from the assigned choice was
screened out for review and possible exclusion. Recent studies have compared the merit of
Author Manuscript

online survey panels and surveys that employ traditional methods of respondent recruitment
(Heen, Lieberman, & Miethe, 2014; Weinberg, Freese, & McElhattan, 2014). Although
demographic variations were seen among the respondents, the quality of the data sets and
findings was not significantly different in both methods.

In addition to the online version, students in our occupational therapy program administered
the survey to a cohort of older adults in the community as part of a service learning
assignment on aging-in-place. The survey remained active for a 2-month period from March
to May 2018, and the average time for response completion on the online and hard copy
versions were about 15 min and 25 min, respectively. No incentives were offered to the
survey respondents through the research project, and participation was invited only based on
their interest with the research topic. However, Qualtrics respondents may have received a
small incentive based on the length of the survey, their specific panelist profile, and survey
Author Manuscript

completion difficulty. Incentives may have included cash, airline miles, gift cards,
redeemable points, sweepstake entries, and vouchers.

Data Analysis
Data relevant to this study were extracted and organized from the survey data set for analysis
in IBM SPSS software. Descriptive statistics were first conducted to analyze demographics,
SH technology ownership, and consumer profiles. Profiles were created based on the
responses to the 13 SH devices on a 3-point ordinal scale ranging from 2 = already have, 1 =
wish to have, and 0 = do not wish to have. Therefore, the total adoption score for
participants ranged from 26 (for those who owned all 13 devices) to 0 (who owned no
devices). Participants were then profiled into three proportionate groups—brisk adopters,
emerging adopters, and slow adopters—using 33.3 percentile distribution in the score. Cross
Author Manuscript

tabulations along with chi-square analysis of the three adopter profiles were conducted
against key variables of demographics, living situation, ICT, and health. Studies in the past
have used a similar analytical framework to examine profiles of older adults who adopted
ICT (Vroman et al., 2015).

To examine the key predictors to SH adoption, the outcomes of ownership and overall
readiness were computed in continuous scale for each respondent. The ownership score was

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 6

the total number of devices owned from 0 to 13, and overall readiness score was calculated
Author Manuscript

by adding the devices owned and wished to have, and deducting the number of devices that
they did not wish to have from the sum. The readiness score, therefore, ranged from +13 to
−13. Doing so negated any bias or relative importance to the devices in the analysis and
accounted current ownership and interest, as well as reluctance to SH technology. For the
prediction analysis, bivariate correlation coefficients were first calculated individually
between key predictor variables and the outcome variables of ownership and overall
readiness. The predictor variables were chosen based on their relevance as well as
association with SH adoption as examined in the cross tabulations. We then conducted a
stepwise multiple regression analysis from the bivariate analysis with predictors with p value
less than .1 to generate the model that best contributed to the ownership of, and readiness
for, SH technology. Multicollinearity was verified and any predictor variable with tolerance
less than .1 and variance inflation factor above 5 was removed from the model.
Author Manuscript

Results
In all, 445 older adults completed the survey—416 respondents from the online Qualtrics
panel and 29 interviewed by students. The average age of the sample was 70.7 years (SD =
5.3 years, range = 60–95 years) with the majority (68%) being females. Participant
demographics including residential information are displayed in Table 1. Fifty-four percent
were married and about 80% had some college education and higher. The majority (78%)
were retired and the household income was well distributed with about 20% reporting
income more than US$60,000, around the national median household income. About 55%
lived with a spouse or partner, whereas 35% resided alone. The geographical locations were
evenly distributed with participants reporting their residence in cities, suburbs, towns, and
rural small towns. Sixty-one percent lived in a two-level home. On the question of home
Author Manuscript

security (please rate how you feel about the security of your home) on a 5-point Likert-type
scale, the majority felt their home to be safe (30%) to very safe (64%).

Seventy-three percent of the respondents reported having a medical condition, many of

which were chronic, yet manageable, such as hypertension and diabetes. Fifty-three percent
reported at least one body function impairment—23% in mobility, 22.7% in postural
balance, 29% in vision, 19% in hearing, and 10.4% in cognition. A small, yet notable,
proportion (14%) of older adults had experienced at least one injurious fall or accident at
home. When asked to rate their independence in managing daily personal routines on a 5-
point Likert-type scale, 93% reported being independent to very independent. With respect
to ownership of ICT, a very high proportion of older adults had a computer (98.4%), and had
access to Internet (98.9%), cell phone (94.6%), and cable television (90.1%). Looking at
Author Manuscript

devices to facilitate SH wireless connectivity and remote monitoring, majority of

respondents used a smart phone (81%) and tablet (74.5%), whereas about half (53%)
reported that they owned a smart watch.

Profiles of SH Technology Adoption

Table 2 highlights the percentage of older adult respondents (N = 445) in rank order of SH
device ownership along with wish for ownership, and reluctance for ownership. For this

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 7

preliminary analysis, respondents were classified accordingly as current adopters, potential

Author Manuscript

adopters and nonadopters for each of the 13 devices. The devices with high rates of
ownership were carbon monoxide alarms, thermostats, motion sensing lights, and backup
power generator. Interest for the top five devices ranked from water leak detectors, auto
shutoff on stoves, backup generator, and motion-sensing lights, whereas the least desired
devices were remote home monitoring, control of lights and appliances via smart phone,
motion-activated camera, voice-activated assistant, and emergency alerting system.
Examining the median distribution, respondents, on average, owned three of the listed 13
devices (M = 3.2, SD = 2.01), wished for an additional three (M = 3.3, SD = 3.11), and
expressed no interest in six devices (M = 6.3, SD = 3.3). The median for the total adoption
score was 10 (M = 9.8, SD = 4.46) with a range of 0 to 23. Using 33.3 percentile ranges,
three proportionate groups were derived. Slow adopters (30%) had a total adoption score
ranging from 0 to 8. Emerging adopters’ (33%) score ranged from 9 to 12 and brisk adopters
Author Manuscript

(37%) scored at 13 or higher. Note that the groups could not be derived in three exact
proportions due to the lack of decimal points in the overall adoption score.

Cross tabulations and Pearson chi-square analysis of the adopters in two age categories (see
Figure 2) show that individuals 60 to 70 years old are significantly more likely (χ2(1, N =
443) = 5.6, p < .05) to be brisk SH adopters (41.6%) than those 71 years and above (30.6%).
In terms of gender, more women were brisk adopters (39.1%) with a significant association
as opposed to men who were comparatively slow adopters (40.4%; χ2(1, N = 443) = 10.8, p
< .05). There were no patterns or significant associations seen with the older adults’ marital
status, education, income, or place of living. However, with the design of the home, older
adults living in two-level homes were significantly more likely to be brisk adopters (40.7%)
than those in one-level homes (30.8%; χ2(1, N = 443) = 6.4, p < .05).
Author Manuscript

With respect to associations with health, individuals with and without medical diagnosis
have an almost equal likelihood to be brisk (38% and 34.2%), emerging (32.1% and 35.8%),
and slow adopters (29.9% and 30%, respectively). However, there were a significantly
higher number of older adults with body function impairments including problems with
mobility (χ2(1, N = 443) = 6.3, p < .05), balance (χ2(1, N = 442) = 7.6, p < .05), and
hearing (χ2(1, N = 441) = 4.1, p < .05) who were more likely to be brisk and emerging
adopters than slow adopters, as seen in Figure 3. No similar patterns were evident in those
with sensory and cognitive impairments. Also, older adults who experienced an injurious fall
or accident (14%) tended be brisk adopters (42.6%) than slow adopters (19.7%) of SH
technology although the association was not statistically significant (χ2(1, N = 443) = 3.46,
p = .17). Figure 4 shows the link that older adults who owned ICT devices that provide
portability, wireless connectivity, and remote monitoring are significantly likely to be SH
Author Manuscript

adopters. Majority of individuals who owned smart phone, 40%, were brisk adopters
compared with the 23.8% who did not own one (χ2(1, N = 444) = 7.8, p < .05). The same
pattern with brisk adopters was noticeable with those who used a tablet, 42.6% and 20.4%
(χ2(1, N = 444) = 18.4, p < .05), or a smart watch, 44.3% and 28.7% (χ2(1, N = 444) =
11.5, p < .05).

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 8

Predictors of SH Adoption
Author Manuscript

Tables 3 and 4 list findings from the bivariate and stepwise regression analysis for the
outcomes of SH ownership and readiness, respectively. For ownership, the significant
predictors were being married; income above US$60,000; living with a spouse or partner;
home’s perceived security; any body function impairment with mobility, balance, vision,
hearing, or cognition; and total ownership of ICT. Stepwise regression from the bivariate list
(p < .1) indicated being married, home security, and ICT ownership as the significant
predictors in the model (F(3, 434) = 5, p < .05, R2 = .08).

The average readiness score for SH technology was 0.3 (SD = 6.6) with a median of 1 and
range from 13 to −13. Increasing age, higher perceived independence in daily occupational
routines, and home security were negative predictors (p < .05) of readiness. At the same
time, being female, number of falls, and overall ownership of ICT contributed to readiness
Author Manuscript

for SH technology (p < .05). Stepwise regression pointed out being female, independence in
routines, and overall ICT ownership to be the significant predictors contributing to the model
(F(3, 437) = 9.4, p < .05, R2 = .06).

Discussion
The study findings reveal the extent of SH technology adoption among older adults, their
ownership and affinity toward specific types of SH devices, their consumer profile, and
factors attributed to current and future adoption. Overall, the adoption rate of some of the
popular SH devices was considerably low as reflected in past findings (Liu et al., 2016).
However, certain devices had comparatively higher rates of adoption such as the carbon
monoxide alarm, programmable and autoset thermostat. Safety seemed to be the clear
priority in older adults’ preference for SH, with a major portion of the sample indicating
Author Manuscript

interest in devices such as the water leak detector, auto shutoff for stove, and backup
generator. Interestingly, the survey findings reflected the diffusion of innovation theory
(Rogers, 2003) and supported the prevailing notion of older adults being late adopters of SH
technology (Wilson et al., 2017). Adoption seemed chronological in the list, with most of the
recent innovations such as voice-activated assistants, motion-activated camera, smart light
control, and remote home monitoring being the least preferred by the older adults in our
sample. It will be interesting to examine how the adoption pattern shifts with future
innovations in SH technology.

Demographic Factors With SH Adoption

Our data indicate women in their baby boomer age of 60 to 70 years (more than men) to be
emerging consumers of SH. Although ownership of SH technology was not predicted by age
Author Manuscript

and gender, increasing age and being male significantly lessened the readiness to adopt it in
the future. This finding was unanticipated as women have traditionally been slow to adopt
ICT in general compared with men (Hargittai, 2010). Nevertheless, gender differences in
adoption of specific types of ICT are not uncommon and that may be the case with SH
technology. For example, whereas men have predisposition toward entertainment-based
ICTs, women have been found have a relative preference for social interaction–based ICTs
than men (Büchi, Just, & Latzer, 2016). Contrary to our expectation, older adults at all levels

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 9

of education and income have an equal likelihood of adopting SH technology. A plausible

Author Manuscript

explanation to this finding may be that most of the SH devices that were owned were
commercially well known and affordable across all demographics of older adults. Although
the subsequent regression analysis did show income more than US$60,000 as a significant
predictor of ownership, the overall readiness for SH was not predicted by income. Being
married and living with a spouse or partner contributed significantly to current ownership of
SH as indicated in previous studies on adoption of ICT (Vroman et al., 2015). A novel
finding from the study was that older adults residing in two-level homes were far more likely
to realize the need and adopt SH technology sooner than those living in a one-level home
with space possibly being an influencing factor.

Health and SH Adoption

As theorized by Davis (1989) and later highlighted in studies, the realization of technology’s
Author Manuscript

benefit and usefulness serves as a vital catalyst to its adoption by older adults (Lee &
Coughlin, 2015; Yusif, Soar, & Hafeez-Baig, 2016). Older adults with a body function
impairment and those with a history of a major fall or accident were potential adopters of
SH technology possibly due to their evolving concern for safety, security, and independence.
Analysis of our data reveals the benefits of SH technology in promoting a sense of security.
There was a positive correlation between SH ownership and perceived home security,
although concern for security significantly increased readiness to adopt newer SH devices.
To highlight another predictor, the potential of SH technology to support participation
became evident in the study findings. Higher perceived independence in managing daily
routines was negatively associated with readiness, and we may deduce inversely that
declining independence may prompt the need for SH technology.

Role of ICT
Author Manuscript

Our study sample had a notably higher degree of ICT ownership (including computer and
Internet) compared with the figures reported in nationwide survey studies (Pew Research
Center, 2017). The findings confirm that older adults with exposure and access to the more
recent and advanced ICTs such as tablets, smart phones, and activity tracking watches are
significantly more likely to seek out and adopt SH technology. As a common thread, all
respondents who used remote home monitoring, the 92% who owned a voice-activated
assistant, and the 74% who had installed a motion-activated camera, all owned a smart
phone. Overall, ICT ownership (especially with the devices that were designed around
portability, connectivity, and network integration within the home) paved way for SH
adoption. The finding is in sync with product design literature that technology experience
and domain knowledge positively influence consumer skill and comfort levels with newer
Author Manuscript

technologies (Jordan, 1998). Also, as per innovation diffusion theory (Rogers, 2003), ICT
may be serving as the social channel for older adults to facilitate preimplementation
knowledge of SH.

Clinical Implications
Occupational therapy has been at the forefront for fostering participation for older adults in
the context of home and community. The profession has pioneered advances and contributed
to a deep knowledge base in home assessments and environmental modifications. SH

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 10

intervention is an evolving subdomain, and it is important for the profession to keep pace
Author Manuscript

with rapid advancements in home automation, to ensure interventions are delivered using
core practice principles and evidence-based best practices. The challenge for now is that
quantity and quality of evidence are low (Liu et al., 2016). Formal approaches are necessary
to examine the client factors that may lead to successful adoption or abandonment of the
technology. Preintervention evaluations need to elaborately gather the client’s demographic
factors and health history including body structure and functions, home safety, and
independence. These premorbid factors may be an inherent advantage for some older clients.
However, it is also important to acknowledge that the predictors identified in our models
only contributed to 8% and 6% of the variance (R2) with SH ownership and overall
readiness, respectively. Regardless of the client factors, a major goal of the intervention must
also be in reducing technology anxiety and facilitating motivation, perceived benefit, and
trust of older clients to embrace SH technology. For instance, a recent end user study found
Author Manuscript

that the behavioral traits of performance expectancy, effort expectancy, expert advice, and
trust together contributed about 81% of the variance in an older adult’s intent to use SH
technology for meeting health care needs (Pal, Funilkul, Charoenkitkarn, & Kanthamanon,
2018).

Study Limitations
The study sample was limited to the New England region of the United States and had
unique demographic characteristics such as income and ethnicity. Therefore, the findings in
entirety may not generalize nationally or globally to the aging population. The study used
two distinct data sources, with the vast portion of data collected through the online panel.
Nonetheless, similar to past research that compared the merit of the two sources (Heen et al.,
2014; Weinberg et al., 2014), there were no noticeable differences found in key measures of
Author Manuscript

SH ownership, readiness, and overall adoption between the two sample cohorts. The
analytical framework used to define the profiles and outcomes of ownership and readiness
were arbitrary to the study, and future research on SH adoption may need to examine
whether the findings are consistent.

Conclusion
Innovations in home automation technology are surging. However, adoption and interest in
SH technology are relatively low among older adults. Current levels of ownership and
readiness vary vastly by the type of technology, demographic segments, functional status,
and home safety. The findings from this study are expected to contribute to the better
integration of SH interventions in occupational therapy home health setting. Future research
may examine the explored factors in an intervention context with smaller cohorts of clients
Author Manuscript

to further elucidate barriers and best practices for practitioners to promote SH technology
adoption.

Acknowledgments
Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of
this article: This research was funded by the England Faculty Fund at the College of Health and Human Services at

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 11

the University of New Hampshire. The project described was also supported by the Tufts National Center for
Advancing Translational Sciences, National Institutes of Health, award number UL1TR002544. The content is
Author Manuscript

solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

References
American Association of Retired Persons. (2014, April). Survey: What makes a community livable?
AARP PPI. Retrieved from https://www.aarp.org/livable-communities/info-2014/aarp-ppi-survey-
what-makes-a-community-livable.html
Bartlett JE, Kotrlik JW, & Higgins CC (2001). Organizational research: Determining appropriate
sample size in survey research. Information Technology, Learning, and Performance Journal, 19,
43–50.
Büchi M, Just N, & Latzer M (2016). Modeling the second-level digital divide: A five-country study of
social differences in Internet use. New Media & Society, 18, 2703–2722.
Chung J, Demiris G, & Thompson HJ (2016). Ethical considerations regarding the use of smart home
technologies for older adults: An integrative review. Annual Review of Nursing Research, 34, 155–
181. doi:10.1891/0739-6686.34.155
Author Manuscript

Cook DJ (2012). How smart is your home? Science, 335, 1579–1581. doi:10.1126/science.1217640
[PubMed: 22461596]
Coughlin JD, D’Ambrosio LA, Reimer B, & Pratt MR (2007). Older adult perceptions of smart home
technologies: Implications for research, policy & market innovations in healthcare. IEEE Service
Center. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=cmedm&AN=18002331&site=ehost-live
Davis FD (1989). Perceived usefulness, perceived ease of use, and user acceptance of information
technology. MIS Quarterly, 13, 319–340.
Demiris G, Rantz MJ, Aud MA, Marek KD, Tyrer HW, Skubic M, & Hussam AA (2004). Older
adults’ attitudes towards and perceptions of “smart home” technologies: A pilot study. Medical
Informatics and the Internet in Medicine, 29, 87–94. doi:10.1080/14639230410001684387
[PubMed: 15370989]
Elliot AJ, Mooney CJ, Douthit KZ, & Lynch MF (2014). Predictors of older adults’ technology use
and its relationship to depressive symptoms and well-being. Journals of Gerontology, Series B:
Author Manuscript

Psychological Sciences & Social Sciences, 69, 667–677. Retrieved from http://
search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=97548126&site=ehost-live
Garg R, & Kim J (2018, 4). An exploratory study for understanding reasons of (Not-) using internet of
things. In Extended Abstracts of the 2018 CHI Conference on Human Factors in Computing
Systems (p. LBW024) Montreal, Canada. Association for Computing Machinery. Retrieved from
https://dl.acm.org/citation.cfm?id=3170427.3188466
Hargittai E (2010). Digital na(t)ives? Variation in internet skills and uses among members of the “net
generation.” Sociological Inquiry, 80, 92–113.
Hargreaves T, & Wilson C (2013). Who uses smart home technologies? Representations of users by
the smart home industry? Eceee Summer Study Proceedings. Retrieved from https://
www.eceee.org/library/conference_proceedings/eceee_Summer_Studies/2013/6-appliances-
product-policy-and-ict/who-uses-smart-home-technologies-representations-of-users-by-the-smart-
home-industry/2013/6-241-13_Hargreaves.pdf/
Heen MS, Lieberman JD, & Miethe TD (2014). A comparison of different online sampling approaches
for generating national samples. Center for Crime and Justice Policy, 1, 1–8.
Author Manuscript

Jordan PW (1998). Introduction to usability. Philadelphia, PA: Taylor & Francis.

Layton N (2015). Problems, policies and politics: Making the case for better assistive technology
provision in Australia. Disability and Rehabilitation: Assistive Technology, 10, 240–244.
doi:10.3109/17483107.2014.889229 [PubMed: 24524441]
Lee C, & Coughlin JF (2015). PERSPECTIVE: Older adults’ adoption of technology: An integrated
approach to identifying determinants and barriers. Journal of Product Innovation Management, 32,
747–759. doi:10.1111/jpim.12176

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 12

Liu L, Stroulia E, Nikolaidis I, Miguel-Cruz A, & Rios Rincon A (2016). Smart homes and home
health monitoring technologies for older adults: A systematic review. International Journal of
Author Manuscript

Medical Informatics, 91, 44–59. doi:10.1016/j.ijmedinf.2016.04.007 [PubMed: 27185508]

Macedo IM (2017). Predicting the acceptance and use of information and communication technology
by older adults: An empirical examination of the revised UTAUT2. Computers in Human
Behavior, 75, 935–948. doi:10.1016/j.chb.2017.06.013
Majumder S, Aghayi E, Noferesti M, Memarzadeh-Tehran H, Mondal T, Pang Z, & Deen M (2017).
Smart homes for elderly healthcare—Recent advances and research challenges. Sensors, 17(11),
2496. doi:10.3390/s17112496
Morris ME, Adair B, Miller K, Ozanne E, Hansen R, Pearce AJ, … Said CM (2013). Smart-home
technologies to assist older people to live well at home. Journal of Aging Science, 1, 1–9.
doi:10.4172/jasc.1000101
Pal D, Funilkul S, Charoenkitkarn N, & Kanthamanon P (2018). Internet-of-things and smart homes
for elderly healthcare: An end user perspective. IEEE Access, 6, 10483–10496.
Parasuraman A (2000). Technology Readiness Index (TRI) a multiple-item scale to measure readiness
to embrace new technologies. Journal of Service Research, 2, 307–320.
Author Manuscript

Peek SM, Wouters EM, van Hoof J, Luijkx KG, Boeije HR, & Vrijhoef HM (2014). Factors
influencing acceptance of technology for aging in place: A systematic review. International Journal
of Medical Informatics, 83, 235–248. doi:10.1016/j.ijmedinf.2014.01.004 [PubMed: 24529817]
Pew Research Center. (2017). Tech adoption climbs among older adults. Retrieved from http://
assets.pewresearch.org/wp-content/uploads/sites/14/2017/05/16170850/PI_2017.05.17_Older-
Americans-Tech_FINAL.pdf
Rogers EM (2003). Diffusion of innovations. New York, NY: Free Press.
Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, & Beck JC (1999). Risk factors for
functional status decline in community-living elderly people: A systematic literature review. Social
Science & Medicine, 48, 445–469. [PubMed: 10075171]
Vroman KG, Arthanat S, & Lysack C (2015). “Who over 65 is online?” Older adults’ dispositions
toward information communication technology. Computers in Human Behavior, 43, 156–166.
doi:10.1016/j.chb.2014.10.018
Weinberg JD, Freese J, & McElhattan D (2014). Comparing data characteristics and results of an
Author Manuscript

online factorial survey between a population-based and a crowdsource-recruited sample.

Sociological Science, 1, 292–310.
Wilson C, Hargreaves T, & Hauxwell-Baldwin R (2017). Benefits and risks of smart home
technologies. Energy Policy, 103, 72–83. doi:10.1016/j.enpol.2016.12.047
World Health Organization. (2007). Global age-friendly cities: A guide. France. Retrieved from http://
www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf
Yusif S, Soar J, & Hafeez-Baig A (2016). Older people, assistive technologies, and the barriers to
adoption: A systematic review. International Journal of Medical Informatics, 94, 112–116.
doi:10.1016/j.ijmedinf.2016.07.004 [PubMed: 27573318]
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 13
Author Manuscript
Author Manuscript

Figure 1.
Adopters of SH technology by demographics.
Note. SH = smart home.
Author Manuscript
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 14
Author Manuscript
Author Manuscript

Figure 2.
Adopters of SH technology by home design.
Note. SH = smart home.
Author Manuscript
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 15
Author Manuscript
Author Manuscript

Figure 3.
Adopters of SH technology by functional impairments and safety.
Note. SH = smart home.
Author Manuscript
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 16
Author Manuscript
Author Manuscript

Figure 4.
Adopters of SH technology by ICT ownership.
Note. SH = smart home; ICT = information and communication technology.
Author Manuscript
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 17

Table 1.

Participant Demographics.
Author Manuscript

Characteristics % Frequency
Gender (N = 444)
Males 31.7 141
Females 68.1 303
Marital status (N = 442)
Single 18.7 83
Married 53.9 240
Divorced 20.9 93
Separated 1.6 7
With partner 4.3 19
Education (N = 441)
Author Manuscript

Below high school 0.4 2

Completed high school 18.4 82
Some college 22.2 99
Associate degree/diploma 10.3 46
Bachelor’s degree 25.2 112
Master’s degree or higher 22.5 100
Income (N = 438)
Below US$15,000 5.6 25
US$15,000–US$30,000 17.1 76
US$30,000–US$45,000 16.9 75
US$45,000–US$60,000 16.6 74
US$60,000–US$75,000 10.6 47
Author Manuscript

US$75,000–US$90,000 9.9 44
Above US$90,000 21.8 97
Employment (N = 440)
Full time 7.6 34
Part time 8.1 36
Self-employed 4.7 21
Unemployed and seeking job 1.6 7
Retired 76.9 342
Ethnicity (N = 444)
White (Caucasian) 95.7 425
African American 1.1 5
Hispanic or Latino 0.7 3
Author Manuscript

Asian 0.9 4
Native Indian 0.4 2
Other 1.1 5
Place of living (N = 444)
City 20.7 92

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 18

Characteristics % Frequency
Town 23.6 105
Author Manuscript

Suburb 28.3 126

Rural or small town 27.2 121
Living situation (N = 444)
With spouse or partner 54.8 244
Alone 35.3 157
With family 9.7 43
Home design (N = 443)
One level 38.9 173
Two or more levels 60.7 270
Author Manuscript
Author Manuscript
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Arthanat et al. Page 19

Table 2.

Ownership and Interest in Common SH Devices (N = 445) with top five devices in each category in bold.
Author Manuscript

SH devices Current adopters (%) Potential adopters (%) Nonadopters (%)

Carbon monoxide alarm 81.5 12.2 6.3
Manually programmable thermostat 47.5 20.8 31.7
Autoset thermostat 43.8 17.7 38.5
Motion sensor lights 35.8 27.3 36.9
Backup generator 27.9 36.5 35.6
Home security system 19.5 23.8 56.8
Voice-activated assistant 19.3 17.2 63.5
Emergency alert system 17.2 23.4 59.4
Water leak detector 9.9 41.8 47.4
Motion-activated camera 7.7 25.2 67.0
Author Manuscript

Auto shutoff stove 7.2 38.0 54.8

SH control 5.4 25.4 69.2
Remote monitoring 5.0 23.8 71.3

Note. SH = smart home.

Author Manuscript
Author Manuscript

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
 Author Manuscript Author Manuscript Author Manuscript Author Manuscript

Table 3.

Predictors of SH Ownership (with significant predictors (p<0.05) highlighted).

Bivariate model Stepwise regression model

Variables B SE B ß T p B SE B ß t p
Arthanat et al.

Age 0.00 0.02 0.01 0.23 .82

Gender—female 0.31 0.21 0.07 1.49 .14
Married 0.71 0.19 0.18 3.73 .00 0.6 0.19 0.15 3.1 .002
College education and above −0.39 0.24 −0.08 −1.62 .11
Income > 60k 0.47 0.19 0.12 2.46 .01
Living with spouse/partner 0.52 0.19 0.13 2.71 .01
Home security 0.54 0.14 0.18 3.94 .00 0.42 0.13 0.15 3.16 .002
Medical diagnosis 0.38 0.21 0.08 1.77 .08
Body function impairment −0.54 0.19 −0.13 −2.85 .00
Number of falls 0.00 0.08 0.00 −0.04 .97
Independence in daily routines −0.02 0.14 −0.01 −0.17 .87
ICT ownership 0.18 0.05 0.18 3.87 .00 0.14 .045 0.14 3.02 .003

Note. SH = smart home; ICT = information and communication technology.

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
Page 20
 Author Manuscript Author Manuscript Author Manuscript Author Manuscript

Table 4.

Predictors of SH Readiness (with significant predictors (p<0.05) highlighted).

Bivariate model Stepwise regression model

Variables B SE B ß T p B SE B ß t p
Arthanat et al.

Age −0.12 0.06 −0.10 −2.08 .04

Gender—female 1.83 0.67 0.13 2.73 .01 1.25 0.45 0.13 2.8 .05
Married −0.08 0.63 −0.01 −0.12 .90
College education and above 0.72 0.79 0.04 0.92 .36
Income −0.27 0.64 −0.02 −0.42 .67
Living with spouse/partner −0.03 0.63 0.00 −0.05 .96
Home security −1.21 0.46 −0.13 −2.64 .01
Medical diagnosis −0.31 0.71 −0.02 −0.44 .66
Body function impairment 1.14 0.63 0.09 1.81 .07
Number of falls 0.53 0.26 0.10 2.04 .04
Independence in routines −1.15 0.46 −0.12 −2.51 .01 −0.63 0.30 −0.096 −2.06 .04
ICT ownership 0.47 0.15 0.14 3.04 .00 0.45 0.10 0.19 4.25 .00

Note. SH = smart home; ICT = information and communication technology.

OTJR (Thorofare N J). Author manuscript; available in PMC 2020 October 01.
Page 21