Designing Virtual Reality Experiences for Elderly Degree Project

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Designing Virtual Reality Experiences for Elderly

A qualitative study focusing on VR suppliers operating within the elder care sector.

Degree Project

Author: Elin Bohlin & Linn Müller Supervisor: John Jeansson

Examiner: Clarinda Rodrigues

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Abstract

This thesis provides an in-depth research of five VR suppliers working with creating VR experiences targeted to elderly within the elder care sector in Sweden. Furthermore, a technological knowledge gap between elderly and VR technology are researched. The focus of this thesis is therefore how VR suppliers, as early adopters, design VR experiences to elderly, as digital immigrants. To investigate the chosen topics, two research questions was formulated; RQ1. How do VR suppliers design a VR experience targeted to digital

immigrants within the elderly care sector? RQ2. How do VR suppliers, as early adopters, bridge the digital gap between VR-technology and digital immigrants?

This thesis constitutes of a qualitative research where the empirical findings are based on interviews with the VR suppliers. The research took an inductive approach in order to get close to the respondents and interpret their realities. Theories about Customer experience, Value, Value Co-creation, Digital immigrants and Early and Late adopters, have thereafter helped to connect the empirical findings with aspects within these theories, to further understand important aspects for the VR suppliers when they design their VR experiences.

The results of the study present the aspects that are important to take under consideration when VR suppliers design their VR experiences towards elderly within the elder care sector. A model showing the steps when designing the VR experience has been provided and constitutes of identifying needs, customize the service, create trust and security, set the environment, inform and educate personnel, handling impairments and bridging the gap.

Furthermore, the participants confirmed a knowledge gap within technology amongst elderly and that there is a need to bridge the gap in order for the VR service to be successfully implemented.

Acknowledgements

The authors would like to express their deepest gratitude to their supervisor John Jeansson for his dedication and effort, which has brought much value for the authors in the process.

Further, the authors would like to thank the VR suppliers Kemppi at AktiVRa, Stenbenke at Atea, Ahlin at Kultur365, Holm at PlaymÄkers and Perlesi at Virotea for participating in this study and sharing their valuable insights, knowledge and experiences. Finally, the authors would like to thank the examiner Clarinda Rodrigues and fellow students for their opinions and suggestions that they have provided during the course, as that hav contributed to the ongoing improvement of this thesis.

Keywords

Virtual reality, Technology, Customer Experience, Customer value, Digital immigrants, Early and Late adopters, Digital divide, Elderly, Designing for elderly, Design process.

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1 Introduction

The introduction chapter will give an insight to the main research field of this study and the problematization within the chosen topic. Moreover, it identifies a theoretical gap within the research field and proposes what the research will contribute with. The definition of the purpose and research questions will give further insight and

understanding of the upcoming chapters. Lastly, the delimitations of the study will be presented.

1.1 Background

“Now, more than ever, people could really do with an escape from reality,”

(Cussell, 2020 cited in Roose, 2020.)

Recent technological developments are contributing to changing the way people experience both physical and virtual environments. Virtual Reality (VR) is a cutting- edge technology likely to play an important role in several industries (Flavián et al., 2019). VR is a computer-generated environment where the user has the possibility to interact and navigate in a VR-world whilst real-time senses are being triggered (Guttentag, 2010). When using VR, several of the users’ senses are covered by

technology, such as a visual screen and headphones that create the experience of being in another reality, the real physical environment have been replaced with a digital one that provides a sensory immersive experience for the user (Brigham, 2017). According to Hired (2019) demand growth for engineering roles in 2019 trended with VR

engineering at the top with a 1400 % increase. Often, VR is associated with the gaming and entertainment industry and with younger generations (Gilbert, 2020). Although, according to Burch (2016), interest among older generations is also present and according to Lin (2017) VR is being suggested as a promising tool to use within the eldercare sector.

The population of elderly increases each year, due to good health and evolved healthcare, the average life expectancy today in Sweden is 81 years for men and 84 years for women. In 2060 the average life expectancy is calculated to be around 87 years for men 89 years for women (Socialstyrelsen, 2019). According to Lin (2017), when people are ageing, there is a likelihood of a decrease in social activities, limitations in cognitive capabilities and symptoms that can indicate depression.

Amongst elderly living in long-term care facilities, more than a quarter develop some form of dementia or depression. Technology has shown potential to improve the quality of life among older adults and VR is believed to be a beneficial tool to use for its immersive interaction capabilities (ibid). Recently, VR companies around the world

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have started working with designing VR experiences that could potentially improve the life for elderly (Rogers, 2019). For example, by helping elderly in end-of-life care to travel, performing activities and look back at old memories. Others are designing VR experiences for senior communities, to promote health and create fun activities and some companies customize their experiences by creating their own material. There are also companies focusing on decreasing loneliness, isolation and depression through VR experiences, for example by letting the elderly travel and thereby help them to check off their bucket list of places they want to see. One company also uses Virtual Exercise as a way to create a fun and exciting experience on the exercise bike, to motivate the elderly to exercise (Rogers, 2019).

Arguably, possibilities with VR can be important to share light on, in regard to the ongoing pandemic in the world. Measures taken to prevent the spread of COVID-19 are for instance that people should stay at home in attempts to stop the spread of the virus (Rogers, 2020). Due to this, isolation and loneliness is increasing, and the social recession hits some groups harder, such as elderly people living alone and people with disabilities (Klein, 2020). VR can, for example, be a way to counter isolation within the elder care sector as the elderly have the possibility to enter virtual representations of new environments, which then creates new topics for them to discuss (Johansson, 2020).

1.2 Problem discussion

1.2.1 Managerial problematization

As mentioned in the background, there are companies that, in the last couple of years, have started to look at elderly within the healthcare sector as a target group and how elderly can derive value from technologies such as VR (Omsorgsakademin, 2018).

Some companies that work within the field focus on bringing VR to elderly to help reduce loneliness and make it possible to see places, without the need to travel (Rogers, 2019). Amongst companies working with VR within the elder care sector in Sweden today, focus is for example to bring joy and happiness to elderly that, due to sickness or to their high age, normally are not able to spend so much time outside (Stjernstedt, 2019). The Swedish health- and eldercare express an openness for technical solutions.

In the population of elderly 80 year or older, 36 % are today receiving some form of eldercare from the Swedish government. The development of digital operation methods within the welfare is seen as a way to increase the efficiency and quality and should help the elderly care to maintain or increase the sense of participation, activity, security and independence of the person in need of help (Socialstyrelsen, 2019). To help the elderly to a healthy aging, health-promoting activities are required that are meaningful,

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individualized and targeted. These can be activities that create community participation, human interaction and belonging by creating meeting places with the right conditions.

This can help against isolation and loneliness as well as creating meaning by inviting the elderly to be an initiator or by acquiring new knowledge and skills (Borell and Iwarsson, 2013).

VR has proved to be a promising tool, but like any other technology, it comes with limitations. Concerns regarding usability, privacy, ethical and security issues are parts of artificial reality that still need to be further developed. When it comes to usability, motion sickness and independence, i.e. manoeuvring of VR without help, are two important development points (Brigham, 2017). Other concerns with VR technology are that it comes with costs, both in terms of hardware but also the customized and designed software (Famakinwa, 2019). Some elderly people oppose technology, which can result in the elder care service choosing not to use it. Also, there is nothing to guarantee that the elderly will not get tired of VR technology, which can make the solution short-term (Rosa, 2019). Moreover, there are questions regarding the service, how well catered it is for the elderly today. Øvstegård (2019) argues that whilst the VR-industry and

technology is maturing, design and usability will gain more interest among both

practitioners and researchers. That could evolve in more efforts being made to improve the usability of VR-applications and new available methods for practitioners working with them. Moreover, Haddon et al. (2012) list several reasons why designers should include elderly when designing products and services. This list includes reasons such as elderly being a large and growing group, that the elderly wants useful and usable

technology and lastly, designing for elderly helps everyone, as age is something that will affect us all. Haddon et al. (2012) further explain that designers need to consider age related issues. Most technology is designed by young people, few of them have experienced impairments such as decreased vision, memory loss, difficulties staying focused and less mobility. Everyone who lives long enough, will experience age related impairments and therefore, the older users’ limitations are important to take under consideration when designing.

1.2.2 Theoretical problematization

Regarding technology, users can be seen as ‘Early adopters’ and ‘late adopters’

(Escobar-Rodríguez and Romero-Alonso, 2014). This can be referred to the willingness of the user to adopt technology into their life. The willingness can depend on the

customers set of needs, product criteria and reactions to new innovations (Meade and Rabelo, 2004). Early adopters are often those people who are starting up innovations and transmit them to others, whereas late adopters are more sceptical and reserved

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towards adopting new innovations and technology (Escobar-Rodríguez and Romero- Alonso, 2014). Technology is mainly developed by younger people and new things are first used by them (Hagberg et al., 2007). This could leave the elderly people to deal with technological challenges in society as they look at technology usage differently, with other attitudes, beliefs and intentions than younger people do (Niehaves and Plattfaut, 2014). As an example, mobile phones have for a long time been difficult to use for older people due to small buttons and unclear displays on the phones. The issue of old people lagging behind with technology then becomes a question of information, education and persuasion (Hagberg et al., 2007). Nonetheless, Haddon et al. (2012) underline that stereotyping older adults to limitations and disabilities would be unfortunate. Not all age-related problems affect everyone. They mean that designers should consider age relative issues but also a universal usability need.

Research suggest that there is a so-called digital divide or a digital gap. Prensky (2001) identifies a new language “The digital language” which has arisen with the new

technology of computers, videogames and the internet. He defines the differences between two generations: the digital natives and the digital immigrants. Digital natives are those who are born into the digital world and digital immigrants are those who later in their lives come to understand and learn digital technologies. The digital immigrants are learning a new language, which later in life can be harder to learn and therefor, the digital immigrants turn to their old ways of doing things before trying the internet or the digital technologies. Prensky (2001) means that because of the new language there is a gap between the digital natives and the digital immigrants when communicating with each other and how they go about learning new things. Prensky (2001) further explain that because of the new language there is a gap between the digital natives and the digital immigrants when communicating with each other and how they go about when learning new things.

Zhao et al. (2014) studied the capability and possible barriers for digital immigrants.

The findings that they highlighted to overcome the barriers, was to improve usability, user experience, social interaction and educational possibilities. The importance of usability when interacting with a product is that it should be easy to learn and to understand, especially for elderly that do not have the same skills as younger people.

Identified difficulties were the layout, navigation and labelling. The solution could be to present a design that is easy to follow and in line with the users habits, interests and specific needs of elderly. Famakinwa (2019) suggests that to be successful within an elderly market, the aim should be designing products and services for, and in co- creation, with seniors focusing on user experience. Focusing on collaborative and individualized offerings is important, but being aware of the limitations of the elderly,

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such as impaired vision, hearing, mobility and dexterity, which comes as a result of aging, is even more value-creating in a design process and analysis of customer needs (Rosa, 2019).

Another aspect is that many elderly people have troubles seeing the value and use of the technology, often because of their lack of willingness, interest and experience of digital technology (Nymberg et al., 2019). When a product or a service has a perceived value for the customers, they are willing to give up something in order to receive it, to be able to fulfil their need (Worduff, 1997: Zeithaml, 1988). The customers are creating the value for themselves by integrating and using the product or service, but the supplier has the role of producing the product or service that the customer could see as valuable (Grönroos and Ravald, 2011). Therefore, it could be of importance that the supplier gives the customer skills and knowledge on how to use their products and services, in order for the customer to better be able to create value and satisfy their needs (Payne, Storbacka and Frow, 2008). Often, the experience that the service or product provides is more satisfying than the product itself (Abbott, 1955). Therefore, focusing on a

customized and personalised customer experience can be necessary for companies to have in mind as customers search for opportunities to create value (Zine et al., 2014).

This thesis explores how VR suppliers, as early adopters, design and target their VR experiences for the digital immigrants, the elderly within the elder care sector. This is a qualitative study with an inductive approach where five VR suppliers are interviewed.

Further, to help the reader some clarifications and definitions of concepts will be made.

Companies and organisations that are suppliers of VR experiences to the elderly will be defined as VR suppliers. When referring to the elderly the definitions of Late adopters and Digital Immigrants will be used interchangeably.

1.3 Research gap

Previous research on VR has focused on fields within the health care sector, such as how it is being used for patients and caregivers. However, there is a lack of scientific research regarding how VR suppliers work within the elder care sector and how VR suppliers design VR experiences targeted towards elderly. Previous research has shown that there is a gap between technology and elderly. Although, there are limited research regarding if and how VR-suppliers work to bridge the technological gap.

1.4 Research question

RQ1. How do VR suppliers design a VR experience targeted to digital immigrants within the elderly care sector?

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RQ2. How do VR suppliers, as early adopters, bridge the digital gap between VR- technology and digital immigrants?

1.5 Research purpose

The purpose of this research is to analyse VR suppliers that operate within the elderly care sector. This is done in order to understand how they design VR experiences for elderly and to create knowledge of how VR suppliers could bridge the technological gap between this new cutting-edge technology and the elderly. This enables a possibility to find recommendations for VR suppliers when planning to design VR experiences for elderly within the elderly care sector.

1.6 Delimitations

The empirical research is limited to VR suppliers, working with the elderly care within the Swedish market. Due to the small market within this field, there was a limitation regarding available participants for this study. Because of the small number of VR suppliers participating, a rather narrow view does not speak for the entire market. The Coronavirus COVID19 made it unfavourable to have face-to-face interviews which made the interviews limited to online interviews. This thesis do not explore the problem from the elderly’s or the caregiver’s point of view, although this was the intention with this thesis from the beginning. This was not possible due to the COVID19 virus, whereas focus lies towards the VR suppliers. There is a large group of older people in society that could benefit from a VR-service, however, this thesis is limited to older people living within elderly care homes. The interviews are executed in Swedish, the findings used in the thesis are translated to English. The awareness of the variations that can occur are dealt with caution and care.

2 Literature review

The literature chapter will give an insight to conducted research within the field. It will give the reader a deeper understanding on the topics.

2.1 Customer Experience

“One key element of understanding and managing customer experience is the ability to measure and monitor customer reactions to firm offerings, especially customer attitudes and perceptions” (Lemon and Verhoef, 2016, p.71). There are multiple definitions of

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customer experience that can be found throughout the literature. Early on, Abbott (1955) discussed a broad notion that people are desiring satisfying experiences and not the product itself. However, later research includes definitions of customer experience more in depth. Pine and Gilmore (1998) addressed the importance of experiences in today’s society and that companies can benefit from creating strong and lasting

experiences. Meyer and Schwager (2007, p.118) argue that “Customer experience is the internal and subjective response customers have to any direct or indirect contact with a company”. Further, Verhoef et al. (2009), Lemon and Verhoef (2016) and Bolton et al.

(2018) describe customer experience as a holistic approach that takes the customers whole journey under consideration. The customer journey includes all the customers interactions with the product or the service and the company, before, during and after the purchase, also called touch points. Verhoef et al. (2009) continue, the evaluation includes the customer’s cognitive, affective, emotional, social and physical responses that were experienced during the customer journey. Lemon and Verhoef (2016) explain that the whole experience of the customer journey is evaluated by the customer which results in a degree of satisfaction and future expectations of the company. Customer satisfaction is defined as the customer’s expectations compared with the delivered experience. The ability to measure customers attitudes and perceptions of a company and its offerings is an important element in assessing customer satisfaction (ibid).

Customized and personalized customer experience is of importance for companies as customers search for opportunities to create value (Zine et al., 2014). Regarding VR technology and customer experience Flavián, Ibáñez-Sánchez and Orús (2019) argue that VR technologies can have a key role to enhance the different touch points in the customer journey which will add value to the customer experience. Customer

experience managers must focus on satisfying the customers’ needs but also focus on the core experience. This can be done by defining the core experience and then add the supporting and empowered experiences when designing technology-enhanced

experiences. The Core Experience is the basic offering with the absence of- or limited technology, it is the base from where enhanced experiences can be built (ibid).

Customer experience within health care is of importance as services have impact on life quality. Healthcare service solutions often focuses more on the wants of the customer instead of the need of the customer. By changing the focus both the customer and the supplier can benefit (Berry, 2019).

2.2 Value

Zeithaml (1988), Woodruff (1997) and Oh (1999) concludes that there are several definitions and meanings of customer value but Woodruff (1997, p.140) defines

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customer value as:

“High-value customers quantifies the monetary worth of individual customers to the organization, whereas Value of an organization quantifies an organization’s worth to owners. Customer Value, on the other hand, takes the perspective of an organization's customers, considering what they want and believe that they get from buying and using a seller's product”

Zeithaml (1988, p.14) defines it as ‘‘perceived value is the consumer’s overall

assessment of the utility of a product based on perceptions of what is received and what is given’’. Kumar and Reinartz (2016, p.37) argue that “In various definitions of

“value,” there is a reasonable variety in the spirit of describing the trade-off between

“give” elements and “get” elements”.

Worduff (1997) and Zeithaml (1988) discuss customer value as something perceived by the customer and this perception is influenced by what the customer has to give up or sacrifice, for example the price which could be the amount of money, energy, effort or time, in order to receive the predicted or preferred attributes. This can take the form of benefits, convenience, utility, quality, and worth of a service or a product. Zeithaml (1988) means that the received value varies across customers, as they all seek different types of value as it is something that is individualistic and personal. Woodruff (1997) argues that a customer’s value can differ depending on the context, the situation, the product or the service. The value can be considered and re-considered by the customer at different times, such as before and after the purchase. The customer evaluates the experience of the product or service which creates opinions and feelings about the received value.

In order for an organization to gain competitive advantage, they need to understand that customer value is important, however, what is more important is to figure out how the organization is to compete when delivering value (Woodruff, 1997). By learning about the customer and the market a company can answer the questions about what customers actually value and which values to focus on. This can be accomplished by getting feedback on how well their value are delivered and understand how the value might change in the future (ibid). Kumar and Reinartz (2016) talks about value from

customers. One of their key insights is that customers contribute to businesses directly by purchases but also indirectly through actions in form of referrals, feedback and recommendations to others which can occur through different platforms. It is essential for the businesses to put the focus on the customer instead of the product, in order to be able to understand their current customers but also new prospects to get measures and

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insights of future value. Woodruff (1997) means that to get a competitive advantage, the organization needs to discover and meet the customers desired value. This can be done by being innovative, but also starting by building an in-depth understanding of the customer to be able to create customer value that is based on the customers desired usage and consequence situations (ibid). Kumar and Reinartz (2016) also have key insights when talking about bringing value to consumers. Businesses can create

perceived value for their customers by using their strengths and abilities as leverage and adapt their customers perceptions about value to their offerings and also take an

advantage by differentiating themselves from their competition.

2.2.1 Value creation and Value Co- Creation

Value and value creation are the core of a service and essential for businesses to understand the dynamics of a service system (Vargo, Maglio and Akaka, 2008).

Defining the value creation process Payne, Storbacka and Frow (2008, p.86) argue that:

“The customer’s value creation process can be defined as a series of activities performed by the customer to achieve a particular goal. One key aspect of the

customer’s ability to create value is the amount of information, knowledge, skills and other operant resources that they can access and use.”

Grönroos and Ravald (2011) discuss value creation as a dynamic process that emerges from the customer usage and integration processes of the resources, and not from the suppliers. The customers are creating value for themselves. The supplier’s role in the value creation process is to produce the resources. Although, suppliers need to help their customers with the value creation process in a way so that it is also profitable for the supplier (Payne, Storbacka and Frow, 2008). Grönroos and Ravald (2011) mean that suppliers can, to some extent, during interactions with the customer get opportunities to influence the customers value creation process and can thereby be a co-creator of value.

Payne, Storbacka and Frow (2008) argue that a supplier can influence the customers value process by giving them more skills and knowledge to be able to use the resources in an effective and relevant way, to facilitate to the customers mission and values. By doing this the supplier also acquires competitiveness and can also build a more valuable role in the customer’s activities.

When co-creating value, a beneficial relationship is established between the customer and the supplier. The supplier is using their capabilities when producing a resource such as product or a service and customers use their capabilities to apply the resource in the context of their own lives. This in exchange for the customers resources which can

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come in form of money, which the supplier values (Vargo, Maglio and Akaka, 2008).

Payne, Storbacka and Frow (2008) argue that value co-creation needs interactions between the supplier and the customer to be able to see and understand the value co- creation opportunities that can be used strategically. Interaction is a mutual action between two or several parties that in some ways influence one anothers’ processes.

These processes merge into a joint value creation process enabling the customer and supplier to create value together (Grönroos and Ravald, 2011).

2.3 Elderly and technology

2.3.1 Designing for the elderly

The use of digital technologies is increasingly proposed as a tool in the health and social care sector to cater for the growing ageing population. However, in practice, the

designers working with these technologies are ill equipped to design for elderly (Lindsey et al., 2012). Joyce et al. (2007) propose that a significant contributing factor is ageism. Ageism is leading to poorly designed and produced artefacts for older people, caused by neglecting elderly experiences, needs and desires. To be able to discuss designing for an older age group, defining the group of older people will be done first.

There is not only one way to classify what variables to take into consideration when defining an age group (ibid). Fisk and Rogers (2010) explain that individual differences occur but in general there are traits that older people have in common. Those are

biological, psychological and social characteristics. Fisk and Rogers (2010) further suggest grouping older people into two groups; the younger adult ranging from 60-75 years and the older, aged over 75 years. Caprani (2012) argues that being aware of the capabilities and limitations of an older person as a user, designers can use that

information and let it be guide lining in the design process. When people grow older, decline in vision and hearing is common, some traits as those can have implications on how elderly people interact with technology. Designers of technology systems should have these things in mind and use appropriately sized text, high contrast colors and include adjustable audio (Fisk et al., 2010). Other age-related changes can be cognitive changes that will influence the user. These can be working memory, ability to store and retrieve information together with a decline in information processing speed. These all affect how the older person interact with devices (Caprani, 2012). Regarding what can be thought of when designing for elderly, Hickman et al. (2007) describe three

objectives when a new technology is being designed for older adults: a need to be adapted to the end users physical impairments, the degree of satisfaction and familiarity regarding the device itself and the appreciation of the benefits during use with the interface. A golden rule to interact naturally with a virtual environment is a user

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interface that is easy to use immediately, without the need for any previous training or experience (Steinberg, 2012). Other aspects that should be taken into account are any changes regarding cognitive abilities due to ageing such as perception, memory,

attention and other functions that are involved in everyday life, to ensure the usability of a given interface (Gamberini et al., 2006).

2.3.2 Technology for the elderly

One barrier when designing technological services for the elderly could potentially be them mastering the technology. Technology is increasingly present in everyday life, and older people usually face usability problems, such as the graphic interface design and input devices choice, that can be allocated to unsuitable design of central features (Czaja, 2005). Castilla et al. (2013) argue that information computer technologies have standards that are primary appropriate for young and middle-aged people. The effort older people have to make in order to incorporate the media is, for some, so high that many choose not to even try. According to Golant (2017) there is an ever- increasing number of technology-focused business start-ups around the world that are hoping to convince older consumers how their technology can assist in ageing successfully.

However, not many older consumers are either using these services today or are aware of these new possibilities. Golant (2017) further argues that if the developers expect to reach the elderly consumer groups, they need to understand what the factors are that will influence the smart technology adoption decision making. Czaja & Lee (2007) mean that the elderly can benefit from the usage of internet and technologies in the way that it offers the elderly to stay independent for a longer time and increase their quality of life. It helps the elderly to gain information, perform tasks and activities such as shopping, banking and take a more active role in their own healthcare. As well as it creates opportunities for the elderly to get education or employment. The elderly can also stay in touch with their friends and family preventing social isolation (ibid).

2.3.3 Early and late adopters

Meade and Rabelo (2004, p.667) states “The technology adoption life cycle is a means for classifying the market and its reaction to a high-tech product”. Meade and Rabelo (2004) means that the consumers can fall into the classifications of innovators, early adopters, early majority, late majority or laggards which are concepts coming from Rogers (2003). Escobar-Rodríguez and Romero-Alonso (2014) discuss the phrases

‘early adopters’ to include the classes of innovators, early adopters and early majority, and the phrase ‘later adopters’ to the remaining classes of late majority and laggards (see figure 2.1).

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Figure 2.1 Adopter categorization on the basis of innovativeness (Escobar-Rodríguez and Romero-Alonso, 2014, p.1232)

Depending on how willing the customer is to adopt to the new technologies, they fall into the different classes (Escobar-Rodríguez and Romero-Alonso, 2014). The

willingness can depend on the customers set of needs, product criteria and reactions to new innovations (Meade and Rabelo, 2004). The definitions of the divide mentioned in figure 2.1 can define early adopters as those who are open to change and who seek out and embrace innovations. They are often those who are starting up innovations and transmit them to others, which is important for evolvement. Whereas late adopters are more sceptical and reserved towards adopting new innovations and technology, sometimes even resisting it because they are afraid of the risks of failure. However, early adopters’ enthusiasm and attitudes can help reduce the late adopters’ resistance (Escobar-Rodríguez and Romero-Alonso, 2014). Early adopters are often widely respected in their social circle and have the abilities to persuade others to adapt innovation, this is why early adopters often serve as opinion leaders (Agarwal et al., 1998). Renaud and Van Biljon (2008) mean that there is a distinction between

acceptance and adoption of technology. Acceptance is an attitude towards technology whereas adoption is a process where the user starts by being aware to later embrace and make use of the technology as a part of one’s life. Although, to fully adopt a

technology, acceptance must occur.

Niehaves and Plattfaut (2014) discuss that many of the elderly people over the age of 65 are not adopting new technologies, IT and the internet in the same extent as younger people do, or at all. Nymberg et al. (2019) describe a generation gap defined by some of the elderly themselves, between the elderly and the younger generations. The elderly concluded that the younger generations are adapted and accustomed to the new

technology, while they themselves are not. Niehaves and Plattfaut (2014) mean that this

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leaves the elderly people to deal with technological challenges in the society. The reasons could be that elderly look at technology usage differently, with other attitudes, beliefs, and intentions than younger people do. Nymberg et al. (2019) conclude in their findings that issues that some elderly people in the ages 65 - 80 have with new

technology, is that they have troubles seeing the advantages of the technology, that can depend on their lack of willingness, interest and experience of digital technology. Also, the difficulty level of learning, using and keeping up with a technology plays a role, where mistrust in their own capabilities and the fear of doing something wrong are influencing factors. Other barriers detected were impaired movement, vision and

hearing. Although, there was also a curiosity and acceptance as many of the elderly also understood that there is no going back when it comes to the development of new

technology.

2.3.4 Digital Natives vs. Digital immigrants

As Prensky (2001) defined ‘digital natives’ as individuals who have always used a computer and a mobile phone and the ‘digital immigrants’ as the ones who have, at a later point in life, migrated and learned to use digital technologies. Digital immigrants are assumed to resist new technology or at least have some difficulty accepting it (Vodanovich et al., 2010). Over the years Prensky's proposition has been widely discussed and there are several indications about when the era of the digital natives begins in a range from 1974 to 1990, although age is not necessarily the only factor (Lugano and Peltonen, 2012). Wang et al. (2013) also conclude the two common characteristics that are used to define digital natives and digital immigrants; age and accessibility. A distinction of an exact year span does not exist, but the cut-off date is suggested to be somewhere between the end of 1970 to the end of 1990. However, this view has been met with criticism (Brown and Czerniewicz, 2010). Loos (2012) means that instead of talking about the digital divide between digital immigrants and digital natives focusing on age, it would be more correct to refer to the digital spectrum, as there in every generation are people having trouble with new technology. Technology can be available to different degrees depending on one's background, education, life experience, life stage and age-related functional limitations, which will affect the degree of the technology competence and preferences. Prensky (2001) argues that digital literacy is a factor that differentiates between generations. Digital literacy is defined by Gilster (1997) as the ability to understand and use technologically mediated information and how this can differentiate between generations and various groups of people in how they manage their everyday lives.

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Zhao et al. (2014) identify digital immigrants based on characteristics such as doing things the old way, not being open to the new technologies. The digital immigrants are using the new technologies as a second source and not as the first source. Their

communication occurs through traditional channels and they are focusing on one task at a time when doing or learning things. Zur and Zur (2011) stresses the fact that not all digital natives and not all digital immigrants are created equal in terms of attitudes and skills in the matter of digital technologies. They divide the immigrants into three different groups; Avoiders, Reluctant adopters and Enthusiastic adopters. Avoiders are those who don’t interact or interact as little as possible with technology, otherwise they are using only old media. Reluctant adopters are those who accepts the new technology as a part of the world, with caution, they are trying to interact with it, but have trouble understanding and using the technology to its fullest. Enthusiastic adopters are those constantly learning, they are interested in technology and have the capacity to keep up with the speed of the new technology development, using it to their advantage.

2.4 VR in the research field

Technological advances such as VR have become increasingly common in today’s society and are being used in numerous fields (Lin, Chen and Cheng, 2018). Within the health sector VR is being used for different purposes. In a study by from 2016 treadmill training was combined with non-immersive VR, to test the hypothesis that combining those two factors could target cognitive aspects and safe ambulation to see if it would lead to less falls than treadmill training alone. The results showed that after six months of training, the test group of older adults with a high fall risk, treadmill training in combination with VR led to reduced fall rates, compared to using treadmill training alone (Mirelman et al., 2016). Multiple studies have also been carried out using VR when treating burn injured patients. A fairly recent study from 2014 compared the effect of VR as a distraction method on 30 adolescents aged 10 to 17 at a burn clinic compared to standard care on burn treatment and found that less pain was reported when VR was used during wound care compared to passive distraction or standard care (Jeffs et al., 2014).

2.4.1 VR as a tool for patients

VR has, in several therapy and rehabilitation contexts, shown to be a promising and effective tool. The technology has recently received attention from researchers and clinicians working with elderly people with Alzheimer’s disease and related disorders.

Many promising disease- modifying treatments for Alzheimer's and related disorders have the last decades been researched and proposed. However, despite clinical trials conducted on treatments’ efficiency, no important breakthroughs have been made, and

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therefore resulted in an increasing interest regarding non- pharmacological treatment research (O’Neil, et al., 2011). Engaging in stimulating mental activities at an older age may prevent cognitive decline and possibly reduce the risk of developing dementia (Gates et al., 2011). There are nowadays different games and digital applications that specializes in informing, educating and enhancing cognitive functions. Some

applications that have been developed, have shown to be successful in the treatment of stress, phobias, anxiety, post-stroke rehabilitation and pain mitigation (Manera et al., 2016). Another study researched the possibility of using VR as a tool for cognitive training for elderly suffering from Alzheimer’s disease. That study concluded that VR- based cognitive rehabilitation systems support procedures for alleviating psychological symptoms and behaviours of early stage Alzheimer’s disease (Garcia- Betances et al., 2015). Regarding VR and elder care, some literature has shown that technologies can help the elderly to live better lives by improving physical health and mental health, decreasing loneliness, and creating more social interactions (Lin et al., 2018).

2.4.2 VR as a tool for caregivers

VR has not only been researched as a tool to help patients but also for caregivers.

According to Hirt and Beer (2020) some key aspects when it comes to the care of people suffering from dementia or Alzheimer, is the communication and empathy from caregivers. VR could be an effective method to train informal and professional

caregivers, in order to improve their communication and empathy skills. The study by Hirt and Beer (2020) researched the use and the impact of VR simulation in dementia care education. The study concluded that little is known about the use and impact of VR in dementia-related education. Hirt and Beer (2020) argues that there are few studies on the subject, and they do not address effectiveness in the field. Garcia-Betances et al.

(2015) argues that there is a growing demand to significantly improve the efficiency in the care sector and of social support services. They mean that computer technology- based health care applications that are designed for elderly patients can contribute and help. Research, development and implementation of new computer-based applications for needs that is not yet covered in the rehabilitation and cognitive impairment

mitigation field can contribute to address the problem. They argue that information computer-based technology applications based on VR environments, can become an important game changer (ibid). The evolving technology enables healthcare through Virtual platforms which have a lot of benefits. However, the need of human touch should be a factor to consider when developing technical solutions (Berry, 2019)

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3 Conceptual framework

The conceptual framework will be used for the analysis and discussion of the results from the empirical findings.

As presented in the literature review, there are concepts that can be included and taken under consideration when looking at factors that can influence the VR experiences for a digital immigrant. The concepts form the basis for the conceptual framework (see figure 3.1.) When the VR suppliers (early adopters) offer VR experiences to elderly (digital immigrants) within the context of elderly care sector, the technological gap need to be bridged in order for the elderly to see what value the VR service can provide. The literature review show that the perceived value of the service is an aspect that will affect the customer experience and whether the VR technology will be adopted or not by the digital immigrant. The experience needs to be valuable for the user in order to be adopted and used. Further, the literature review suggests, that the interactions between the digital immigrant and the VR experience will result in a customer experience based on the digital immigrants’ feelings, attitudes and perceptions of the whole experience.

These are evaluated and compared by the consumers earlier perceptions and

expectations which form the consumers level of satisfaction. The evaluations can result in feedback that help the VR suppliers to improve and further customize the VR

experiences based on wants and needs.

Figure 3.1: Conceptual framework (authors own contribution).

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4 Methodology

The methodology chapter present and give insight to the approaches, strategies and methods used in this thesis to answer the research questions. The choices made are discussed and motivated. A presentation of the operationalization and the VR suppliers are provided as well as the research quality, ethical and sustainable considerations.

4.1 Research approach

This thesis has an interpretivist view and an inductive approach. Bryman and Bell (2011) describe interpretivism as a view that lets the researcher get close to the subjects, which creates a deeper understanding of the differences between people and objects in the social world, to understand the meaning of a social action. The inductive approach seeks to understand the deeper meaning of a context and allows the researcher to go into depth of the explored subject (Saunders et al., 2009). When comparing the deductive and inductive approach, the deductive approach starts from gathering theory and concepts from what is known today, creating a hypothesis or research question. The next step is testing the hypothesis by collecting data and see whether the findings confirm or reject the hypothesis, the deductive approach is mostly associated with quantitative research. The inductive approach is associated with qualitative research and starts the other way around. With a general research question, starting from the

observations or findings made during the data collection, to generate theory from the findings (Bryman and Bell, 2011). Even though the inductive approach originates from empirical findings, Saunders et al. (2012) stress that the inductive approach does not mean disregarding theories when formulating objectives and research questions. The collected data helps to identify patterns to build theories, however this does not exclude using existing theory to help explore and formulate research questions. Furthermore, when using an inductive approach, the emphasis is to get a deeper understanding of a certain context rather than generalizing the findings (Saunders et al., 2009). In

conclusion, the deductive approach originates from logic whereas the inductive approach originates from the empirical findings (Alvesson and Sköldberg, 2009). The abductive approach is a mix between the two, and the researcher moves back and forth between both approaches (Gray, 2004).

In regard to the lack of research and knowledge on how VR suppliers work to create valuable experiences for elderly within the elder care sector, the authors of this thesis mean that the answers to the research questions lay in the results of the empirical findings. This study does not test hypotheses or theories, but has open and general research questions, asking how VR suppliers work. However, the theory helps to create

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a basis for understanding the topics presented in the literature review of this thesis.

Moreover, by looking for patterns and categories in the results it enables the authors to explain the findings and connect and compare to theories. By analysing empirical findings, a deeper understanding of the research area can generate in more knowledge to the chosen research topic. From this analysis a set of recommendations can emerge for VR suppliers. To do this,the researchers of this thesis need to get close to the subjects and interpret their social worlds. Their social worlds can in this case be described as the VR suppliers’ operations in the context of the elderly care sector. Therefore, the

inductive approach was chosen.

4.2 Research method

Quantitative and qualitative research are two research strategies with different

orientations. When looking at qualitative and quantitative research, the main differences are that qualitative research is often inductive, generating theory and focusing on words, meaning and contextual understanding. The quantitative strategy is most often

deductive where the focus is testing of theories and quantification which rather includes numbers, behaviour and generalization. Another difference between quantitative and qualitative research is the methods used when collecting the data (Bryman and Bell, 2011). In other words, qualitative research is a more open-ended research strategy, able to in depth examine a subject by, for example, using participant observations, in-depth, semi-structured or unstructured interviews. Researchers should begin by considering the nature of their research questions when deciding on which research strategy to use (ibid). In a qualitative research, one of the main interests is to find understanding of reality as a social construct, which are managed through social and cultural meaning (Eriksson and Kovalainen, 2016). Through qualitative research strategy, a deeper understanding of a phenomenon can be obtained as the research aim to create

knowledge and understanding how peoples’ experiences are being interpreted, valued and how they characterize their social world (Merriam and Tisdell, 2016).

Through a qualitative research strategy, the authors of this thesis are able to go into depth to gain a deeper understanding of how VR suppliers work in the context of the elderly care sector. It gives the authors the opportunity and flexibility to dive deep into the subject and enables them to gain an insight and interpret VR suppliers constructed worlds. In addition, it provides knowledge in how they see, feel and value their

surroundings. Thus, this thesis takes an interpretive view and a qualitative open-ended strategy, which is most suitable to answer the nature of the research questions.

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4.3 Research design

The research design is explained as a framework of how to collect and analyse retrieved data, and it further reflects on how decisions have been made and prioritized in the research process. There are five research design approaches; case study, comparative design, longitudinal design, cross-sectional and experimental design (Bryman and Bell, 2011). The research design selected for this thesis, as the most appropriate one, is case study design. A case study design is popular and widely used in business research. Case studies can focus on a singular case which can be a single organization, a single

location, a single event or a person and provides the researcher with an in-depth

understanding of the case (Bryman & Bell, 2011). However, multiple case study designs are becoming increasingly common as they are an extension to case study design. This research design encourages the researcher to see what is unique but also to find

commonalities between the cases and further to connect theoretical reflections on the findings (ibid). Furthermore, this design method is suitable to use in this study as the case study design functions well when the research aim is to answer questions of “how”

and “why” (Yin, 2018).

4.4 Sample selection

The sample for this thesis is a non-probability sample which according to

Krishnaswamy and Satyaprasad (2010) is a non-random sampling, with the merits of simplicity and convenience. When using a non-probability sample, it is not

representative for the whole population, in relation to probability sample. A probability sample is a random sampling with a chance of every population being selected, which is essential in order to be able to draw general conclusions of a whole population. The reason why the sample is a non-probability sample is because of the purposive sampling method made by the researcher’s judgement of relevant criteria of the sample (Bryman and Bell, 2011). The purposive sampling method enables the authors of this thesis to target a specific sample of VR suppliers which have the attributes and criteria requested.

This, in order to be relevant for the purpose of this thesis and to help answering the research questions. The criteria of the VR suppliers were met and consistent with the research topic, purpose and research questions.

The criteria of the selection or VR suppliers:

1. They are working within Sweden

2. They are working with VR experiences within the eldercare sector.

The criteria of the participant:

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1. The participants need a deep understanding of how the organization works with VR

2. They also need to have a deep understanding of how the VR is being targeted towards the elder care sector.

During the research, four private companies was found that matched the criteria, one of the companies was no longer active, meaning three of the companies was accessible and reached out to. During the search, a public organisation, a municipality, in Sweden working with VR in elderly care was also found, within the same municipality another public actor was also found and contacted. In total, five interviews were conducted. As mentioned, the participants will be referred to as VR suppliers. They were all contacted by phone where the purpose and research questions were presented. All of the contacted VR suppliers accepted to participate in an interview, conducted through a video call with Zoom or Skype, a measure taken, necessary due to the situation with the Coronavirus COVID-19. Table 4.1 provides an overview of the VR suppliers participating in the study.

4.4.1 VR supplier profiles

Table 4.1: VR Supplier profiles (Authors own contribution)

VR supplier

Respondents

Work position of respondent

Sector

Kultur 365

Ahlin Culture broker Public

PlaymÄkers

Holm PlaymÄker/Culture assistent Public AktiVRa

Kemppi VR educator Private

Virotea Perlesi VD & Founder Private

Atea

Stenbenke XD specialist Private

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Kultur 365

Within the municipality of Södertälje, an initiative called Kultur 365 is focusing on providing cultural activities for elderly. This started in 2007 with a variety of activities with the goal to enhance elderlys’ social lives and implement more culture to their lives.

PlayStation 2 was introduced and implemented in the elderly care facilities and later, tablets where also implemented. In December 2016 a collaboration with Film

Stockholm started and they introduced and implemented the VR technology into the elderly care facilities. The VR technology have been used to stimulate and create meaningful experiences that engages the elderly and evoke memories (Södertälje, 2020, A). Ahlin is a culture broker developing and managing Kultur 365 with the mission to create new perspectives and activities for elderly people to provide more social presence (Ahlin, 2020)

PlaymÄkers

Is an initiative within Kultur 365 where young people visit the elderly within the municipality's different instances, such as elderly care facilities. PlaymÄkers role is primarily to be out in the field, working with elderly and introducing them to

technology and culture in various ways. This creates a meeting between the elderly and the young people where they can exchange knowledge and with technology and culture as tools, the young people can activate the elderly’s minds and awaken memories. VR is such a tool used when PlaymÄkers is out in the elderly care facilities (Södertälje, 2020, B). Holm works as a PlaymÄker, also called culture assistant, where he is out in the field working with and implementing VR within the elder care sector. He has also been involved in creating several VR experiences made in 360 cameras. As being a part of Kultur 365, movies in 180 degrees and 360 degrees is material that they create and use for their VR-service. Except from making their own material, PlaymÄkers also use material from 3^rd party companies (Holm, 2020).

AktiVRa

Is a VR company working with VR technology in various areas such as healthcare (allabolag, 2020). AktiVRa is using VR as a way to activate and stimulate humans as well as exploring how VR can benefit people in different ways. They are also providers of courses, lectures and trainings within the subject (Lucidvr, 2020). Kemppi is a VR educator and consultant that have been working with VR in the field at elder care facilities and childrens’ hospital. Due to interest and higher demand, Kemppis main work is now to travel around in Sweden and share his knowledge, to inspire and to help organizations and different elder care facilities to understand and use the VR-

technology (Kemppi, 2020)

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Virotea

Is a VR company focusing on the elder care sector and people with disabilities (LSS) to provide a service where they can experience meaningful activities and get improved quality of life. They are marketing their solution as easy-to-use and with solutions tailored for the needs of the business (Virotea, 2020). Virotea have their own

application and the offering includes the license to use their program. The app includes pictures and movies that 3^rdparty companies develop together with photographers that travel around the world and take pictures of different sceneries. The company hope that VR can help elderly people within the elder care sector and LSS-patients to feel less isolated, under stimulated and depressed. Perlesi is the founder and CEO of Atea, he works with sales and implementation of VR (Perlesi, 2020).

Atea

Is a large IT-company who is a supplier of infrastructure solutions. Amongst other technologies, they offer VR solutions for the elderly by providing a package solution with their own application adapted to the elder care sector. They are marketing their solutions as easy and safe to use and sees VR technology as a way to create community and improved quality of life (Atea, 2020). Stenbenke is working as an XD specialist within Atea. Since these technologies are new, the work task involves informing, inspire, listen and discuss with the customers, municipalities and counties, what their challenges are and then come with suggestions for how these technologies can further help them. Stenbenke is also involved during the implementation of the VR service, if the customer needs some training or help getting started with the new technology (Stenbenke, 2020).

4.5 Data collection

4.5.1 Type of data

Throughout the thesis primary data is used. Primary data is first-hand information collected though original sources during for example, an interview or an observation made directly by the researcher (Krishnaswamy and Satyaprasad, 2010). Secondary data are sources of data that others already collected, for example books, peer-reviewed articles, reports from governments or statistical statements regarding organizations and corporates. The secondary sources can be used by the researcher in reference purposes, comparison purposes or as the sole source of information in a study (ibid).

For the purpose of this thesis, primary data was collected through semi-structured interviews held on Zoom and Skype, where VR suppliers working within the elderly

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care sector was interviewed. Interviews were conducted with the purpose to get a deep knowledge on how VR suppliers work with VR, due to the lack of knowledge and research on how VR suppliers work in this field. No secondary data has been used in this thesis. The secondary sources in this thesis is collected from peer-reviewed articles, books and online sources. The majority of the sources used are peer-reviewed articles, to attain credibility. The secondary sources have been used throughout the thesis. They have been used to create understanding for the topics, to argue for choices made in the method as well as to find connections between empirical findings and theory.

4.5.2 Interviews

“A research method is simply a technique for collecting data” (Bryman and Bell, 2011, p.41) Considering the method to collect data, the semi-structured interview is most suitable for this thesis to be able get a deeper understanding of the context. The Semi- Structured interview is a mix between the structured- and the unstructured interview.

The structured interview has strict guidelines to follow and are mostly used in the quantitative research, whereas the unstructured interview is flexible with almost no guidelines at all (Bryman and Bell, 2011). Semi-structured interviews provide structure at the same time as it allows digression and flexibility. This opens up for the researcher to use pre-formulated questions but also for questions that may arise during the

interview (Myers, 2013). By using open-ended and descriptive questions it allows the participants in their own words to describe their way of thinking and their subjective perspectives, attitudes and meaning of things and situations which will provide the authors with a deeper understanding (Taylor, Bogdan and DeVault, 2015). According to Bryman and Bell (2011) a synchronous online interview mediated through technology i.e. a webcam is similar to a phone interview but also an in-person interview as both the respondent and the interviewer can see and hear each other, even if they are located in different places. The positive effects of the both methods when conducting an interview is combined, it is time and cost saving but still a personal meeting as visual contact can be made.

A semi-structured interview was to prefer over an unstructured one in this thesis. This is because of the possibilities to have both a structure but with the flexibility to ask open- ended questions as well as it provides an opportunity to ask follow-up questions when respondents mention something with a potential value for the study. Moreover, as there are two authors of this thesis, a semi-structured interview can ensure comparability which can give a better result.

The interviews were conducted with the help of an interview guide (see Appendix A and B). Most of the questions was open-ended, encouraging the participant to speak

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freely about the topic. A pilot study was conducted to make sure that the guide and the questions had a good order, that the questions was relevant for the study and that the questions was clear and intelligible. Before the interviews the ethical aspects were dealt with. The information was sent by email several days prior to the interview so that the participant had time to read through the information and sign a consent. In the same email, to prepare the online interview, the link and instructions to the online meeting was sent, and if there was any problem a phone number was provided for them to call so that the interview could be done by phone instead. Although, there were no such issues.

In the beginning of the interview the ethical aspects were brought up to make sure that the participants had understood their rights and they were asked to give consent to the interview being recorded. The interviews were executed in Swedish and were held on Zoom and Skype. Both of the researchers were present during all interviews where one had the leading role, and the other one was taking notes and helped the interviewer to stay on track or fill in when necessary. The roles were switched for each interview.

During the interview notes and recordings was made. The interviews lasted around 60 minutes. The interviews were thereafter transcripted based on the recordings, and the results are presented in the empirical findings. Furthermore, since this thesis has two authors, the description of the distribution of work can be found in Appendix C.

4.5.3 Operationalisation

In order to answer the research questions in our qualitative research and to fulfil the purpose of the thesis an interview guide and an operationalisation table was made (see table 4.2). The interview guide contains topics and formulated questions connecting to the concepts and theory presented in the literature review. 23 questions were prepared.

The guide was used during the interview with the VR suppliers.

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Table 4.2: Operationalisation (authors own contribution).

Concepts or dimension Interview questions

Reasoning

Business operations

1-4

To get an understanding about the respondent, the VR supplier, and the market, questions was asked that allowed the respondents to briefly introduce each topic.

Customer experience, Value and Co-creation

5-9

Questions was asked to the respondent regarding the experience they provide, to get a deeper understanding how the suppliers create a VR experience, how they create value and how the VR experience affect the elderly. Questions about co-creation was asked. This part gave the researchers further insight in how the suppliers engage and offer the elderly a memorable experience.

Implementation

10-12

To fully understand the VR suppliers’ ways to go about the implementation in the elderly care facilities and how they are communicating with the elderly and personnel during the implementation.

Creating the Experience

13-15

To get insight in how the VR suppliers work when creating the experience for elderly and what their greatest lessons and key areas are when designing an experience. Also, to explore if they are designing experiences for age-related impairments such as vision, hearing and mobility in mind.

Digital Natives & Digital Immigrants

16-19

Exploring the VR suppliers view of the target group and the technological gap and how they go about to bridging the gap.

Other questions

20-23

Questions about the respondent to help the authors interpret the results and to compare opinions and

attitudes. The last question opened up for the respondent to speak freely and add something if they wanted to.

Designing Virtual Reality Experiences for Elderly Degree Project