Black Older Adults' Perception of Using Voice Assistants to Enact a Medical Recovery Curriculum

TL;DR

The paper investigates how Black older adults perceive using interactive voice assistants to enact a medical recovery curriculum after serious illness. It uses participatory design with concept videos and storyboards across five focus groups and speed-dating sessions (N=26, n=15) to elicit attitudes toward cultural representation, privacy, consent, and AI-enabled personalization. Key findings show a strong demand for Black cultural representation, concerns about stigma and accountability, and the potential of foundation models to tailor content, while highlighting infrastructure and access barriers. The work translates into design recommendations for inclusive, privacy-aware, context-sensitive home health IVAs and outlines a path toward integrating healthcare providers and community networks. This has practical implications for equitable deployment of AI-driven recovery support in the home.

Abstract

The use of interactive voice assistants (IVAs) in healthcare provides an avenue to address diverse health needs, such as gaps in the medical recovery period for older adult patients who have recently experienced serious illness. By using a voice-assisted medical recovery curriculum, discharged patients can receive ongoing support as they recover. However, there exist significant medical and technology disparities among older adults, particularly among Black older adults. We recruited 26 Black older adults to participate in the design process of an IVA-enacted medical recovery curriculum by providing feedback during the early stages of design. Lack of cultural relevancy, accountability, privacy concerns, and stigmas associated with aging and disability made participants reluctant to engage with the technology unless in a position of extreme need. This study underscored the need for Black cultural representation, whether it regarded the IVA's accent, the types of media featured, or race-specific medical advice, and the need for strategies to address participants' concerns and stigmas. Participants saw the value in the curriculum for those who did not have caregivers and deliberated about the trade-offs the technology presented. We discuss tensions surrounding inclusion and representation and conclude by showing how we enacted the lessons from this study in future design plans.

Figures (7)

• Figure 1: Screenshots from each concept video: Physical Activity Coach, Digital Garden, and Workout Buddy. Note, that the IVA in the videos is called Alexa for participants to make the connection to a mainstream IVA. The IVA in the storyboard is called Carol, due to its role of "caring" for others and to further convey that it is an imaginary idea.
• Figure 2: Storyboard called Positive Reminiscing.
• Figure 3: Medical provider-facing interface. All names are fictional.
• Figure 4: Patient interface, controllable by both voice and touch.
• Figure 5: Recipe sketch.