Abstract
Abstract. Technology acceptance of conventional Information and Communication technologies (ICT) devices is extensively researched within the last twenty years. However, comparably small knowledge is prevalent with respect to ubiquitous ICT in the living environment. Furthermore, there is nearly no data about user acceptance's dependency of integrated technologies on varying domestic spaces and how acceptance varies regarding user diversity. This study explores the acceptance of home-integrated ICT (hands-free equipment, camera, positioning system). In different domestic spaces (living room, bedroom, bathroom) acceptance for integrated technology was assessed, using qualitative as well as quantitative methods. Results show that users' acceptance differs considerably depending on the room type (acceptance is the highest in the living and the lowest in the bathroom). Moreover, the most disliked technology for home monitoring are camera-based systems, followed by the positioning system and the microphone. Also, there was a significant interacting effect of room type and technology: While none of these technologies is accepted for the bathroom, the living room is less sensitive to their presence with the microphone as the most accepted technology. User diversity does not play a major role hinting at generic acceptance patterns regarding ICT integrated in home environments.
Introduction
Due to a strong attention of research, policy and media, it is meanwhile broadly known that in many countries of the world population characteristics change dramatically, with considerable consequences for social, organizational and political processes and procedures. The consequences of the demographic change are especially visible in the health care sector: Increased life expectancy, improved medical healthcare in combination with a higher living standard as well as reduced fertility rates lead to a growing number of frail older persons, who will need medical treatments and long term care provided by health care systems [1] . It is a central question how these challenges can be mastered sufficiently [2, 3, 4] .
Today about 15% of the European population reports difficulties in performing daily activities without professional help due to some form of physical, mental or cognitive disability [5] . Also, the prevalence of chronic diseases is expected to further increase in an aging society (diabetes, cardio vascular diseases and dementia as the age-related diseases with the highest incidence rates world wide). As such, the number of patients suffering from e.g. diabetes is expected to increase by 40 % in the next decennia, and those suffering from cardiovascular diseases by even 50% [6] . Thus, increasingly more seniors are expected to require personal care in the coming years. Due to the shortcomings in the medical supply chain and the care sector, thirdparty's assistance seems to be unavoidable in many cases [7] .
The maturity of information and communication technologies, their ubiquity and easy access in combination with electronic health technology may compensate these shortcomings and will thus play an important role in the near future [8, 9] . In contrast to the advanced technical development and the innovation in technologies to be implantable in the home, still, the knowledge about the human factor is considerably underdeveloped. Aspects of humans' technology acceptance, the detailed study and the willingness to accept technology within living spaces as well as the individual usage motives and barriers are mostly disregarded, or even underestimated so far.
As any successful rollout of such sensitive technologies requires first and foremost users' acceptance and their openness, research should focus not only on the technical part, but it should also consider the way these technologies meet users' needs and wants with respect to privacy, dignity, and their requirements for as useful perceived smart home technologies [7, 10, 11, 12, 13 ].
Information and Communication Technologies in the Home Environment
Within the last five to ten years a variety of new healthcare concepts for supporting and assisting users in technology-enhanced environments emerged ( [14, 7] for an overview of state-of-the-art applications). These Ambient-Assisted-Living (AAL) applications are characterized by a combined use of ICT and health monitoring devices [15, 16] . They enable autonomous and unobtrusive collection of clinical data and support the continuous transmission of physiological information between patients and remote healthcare providers. By providing a wide variety of services, including assistance to carry out daily activities, health and activity monitoring, getting access to social, medical and emergency systems, and by this facilitating social contacts, smart healthcare applications are expected to bring medical, social and economical benefits to different stakeholders [17, 18, 19] . Applications and systems mainly focus on four different goals: (1) the detection of emergency situations, (2) long-term treatment of chronic diseases and rehabilitation, (3) early detection of and a timely care for illness, and (4) maintaining health and well-being.
Especially, the first goal, the detection and prevention of emergency is of primary interest, as smart technologies monitor the activities at home and focus on falls and congestive heart failures as their main application areas.
More than 30% of seniors 65 years and about 50% of the people over 80 years fall at least once a year [20] . In 20% to 30% of the cases, people suffer serious injuries with sustaining effects on mobility and independence [21] . As many of these falls happen when people are alone at home, mobile emergency systems and devices had been developed enabling users to call for help in an emergency situation. Such mobile devices worn either at the hip or around the wrist are problematic, though. Empirical evidence shows that patients often do not carry those devices or are simply not able to operate them when medical problems occur. As a consequence, people lie on the floor for hours, sometimes even days, unnoticed. Not unusually, these accidents have lethal consequences.
In order to overcome the shortcomings of mobile emergency transmitters, other systems had been developed. Technological approaches range from wearable sensors, like accelerometers and pressure sensors [22, 23] , contact free methods using acoustic (microphone) [24] or visual (video camera) [9, 25, 26] sensors. There are even solutions available, which measure the contact forces that are applied to the ground by the users feet [27, 28] . Each approach offers advantages but also drawbacks in certain scenarios. Wearable sensors are mobile and can be used in various locations, however they are not invisible and require a high amount of care and maintenance of the users. Acoustic and visual sensors provide very reliable information but require visible obtrusive technology that may bring up privacy and intimacy concerns.
Technologies at Home
Even though no one would really deny the usefulness and the necessity of home care technologies for emergency situations, AAL technologies in the own home are though connected with plenty of emotions: acceptance barriers and restraints on the one hand, as well as the wish to be independent and able to live at home for a longer time in spite of illness on the other hand. Thus, the consideration of users' acceptance and the understanding of the nature of barriers and needs and wants is of major importance. Yet there is increased research awareness that acceptance for medical technology differs in some aspect from the traditional technology acceptance concept [29] . In contrast to traditional ICT, medical assistance devices address mostly older, frail and diseased people, who have very specific and wide-ranged needs [2, 30, 31, 32, 33] . For instance, there is another need regarding the communication with the system for a mobility-impaired person in comparison to a user with hearing deficiencies but otherwise unlimited mobility. The same problem applies to the cognitive skills and their decline over the life span, the technical self-confidence and the willingness to use such modern technology. Hence, there is a great necessity for a comprehensive and sensible identification of factors that influence acceptance of smart home technologies [34, 35] .
In addition, some cautionary notes regard to the smart home approach itself. The omnipresence of information may be perceived as a violation of personal intimacy limits, raising concerns about privacy, and loss of control [36, 10] . So far, we have only limited knowledge about the fragile limits between the different poles: on the one hand the wish to live independently at home feeling safe and secure, and on the other hand the feeling of loss of control and the disliking of intrusion in private spheres [36, 37] . For most people there is no other place, which is more intimate and confiding than "the own four walls". The investigation of functional requirements but also emotional barriers in the domestic home environment is for all persons, but especially for frail seniors of utterly importance [8, 19, 38, 37, 39] .
Yet, accommodation is extremely important in human's life for reasons of perceived safety, and it belongs to the basic human needs to feel protected, stable and secure. Moreover, health is the greatest wealth and therefore a very sensitive and delicate topic -there is no higher good than this and everyone tries to protect it as long as somehow possible. Thus, the involvement of end users, their perspectives, whishes and needs, into every step of the development process plays a great role for a successful rollout.
Research Approach
As there is only little knowledge about users' acceptance of ubiquitous technologies integrated in their homes the aim of this study was to gain insights in the acceptance of smart home technologies. A two-step procedure was applied, using exploratory (qualitative) methods (focus groups) in a first step, followed by a questionnaire study for verification. The question whether there are any factors influencing the acceptance of these new technologies and if so, which these are should be discussed primarily by older users who would be the first users when shipping the products.
Regarding to the improved technology acceptance model (TAM) by Venkatesh and Davis [29] technology acceptance is influenced by two main factors: perceived usefulness and perceived ease of use, which again are influenced by external social and cognitive factors. The contribution of the latter factors though is controversially discussed by acceptance researchers [38] with respect to the number of factors and their relative contribution to acceptance outcomes.
In this paper we laid focus on analyzing the factors:
-Age -Gender -Health status -Attitudes towards technology -Frequency of technology usage
In the following we will report if and how these factors are influencing the acceptance of upcoming integrated technologies for home-monitoring technologies.
Methodology
The empirical approach entailed a two-step procedure. In a first step, five focus groups were run in order to learn users' perceived concerns with regard to smart home technologies and the individual needs and wants. On the basis of individual argumentations, we identified the crucial factors, which were then taken as a basis for the development of the questionnaire instrument. In a second step, the quantitative survey was applied, in order to validate the findings within a broader sample.
(Semi-) Qualitative Data Collection -Pre-study Focus Groups
The focus groups (FG) were conducted in order to identify the acceptance of different ICT by (potential) users. Qualitative data from 42 mainly older adults were used in the focus groups. The participants were recruited using the authors' social network. The focus laid on elderly people (FG 1-4, Table 2 ), however in order to check in how far the discussions and arguments raised are age specific, we also had a focus control group with younger adults (FG 5). Snapshots of the focus groups are given in Figure 1 . The educational level of participants was above average: 79% of participants had a university degree. Depending on the individual argumentation lines and the different discussion needs, the duration of the focus groups varied from 1:00 to 1:45h. All focus groups were guided and encouraged by the same moderator.
Three focus groups (FG 1-3) followed a free and open discussion forum, identifying generic attitudes. We collected discussions about 1) Technical devices and technologies participants possess and use at home, 2) Attitudes about a different sensibility of rooms, but also an evaluation which rooms seem to be appropriate for medical home monitoring 3) Privacy, security and trust issues touched by the respective monitoring technology
The purpose of the free approach was to give participants a feeling for the ubiquity of technical devices they are surrounded by at home and how much information of their personal life they gain -or could gain, assumed they were equipped with data collecting memory-chips or transmission technology. The other two focus groups (FG 4 and 5) followed a scenario-based approach. They started with two short futuristic example-movies showing integrated ubiquitous technologies, one positive ("Ambient Assisted Living" (beginning), Fraunhofer IESE, 2009, (00:00:00-00:04:30h) and one negative example ("The Island" (Scene), Michael Bay, 2005, (00:02:30-00:04:10h).
In all focus groups participants were requested to fill out a "technology-roomacceptance-matrix" (Table 2) , which showed the acceptance of technologies in different rooms at home under specific conditions, e.g. "when ill". Each participant had to fill out the technique-room-matrix and to note conditional acceptance criteria, if applicable. Results were discussed afterwards. The whole group had -beyond the individual matrices -to find a consensus about one common group matrix. This was done to learn which arguments were commonly agreed on. 
Quantitative Data Collection -Questionnaire
In a next step a questionnaire instrument was designed to validate and supplement the results of the pre-study. 100 adults between 28 -93 years of age participated. The questionnaire's structure followed five-W-Questions: "Who" accepts "when" "what" (home-integrated technologies), "where" under "which conditions"? "Who": The "Who"-part of the questionnaire was arranged in five sections.
• The first part included demographic data with respect to participants' age, gender, educational level and profession.
• The second section applied to person's health status (e.g. present chronicle diseases, dependency on medical devices).
• The third section should figure out person's general attitude towards technique. Five questions addressed interest, stress, trust, fun and distrust on a four-point Likert scale from 1 = "no agreement" to 4 = "full agreement".
• The fourth section focused on the participants' experience with technology in general (usage frequency of popular information and communication devices (PC, mobile phone, video/digital camera, GPS).
• The fifth section should gain information about person's social context (e.g.
number of persons at home, dependency on long-term care).
"When": The "When"-item determined, if acceptance of integrated technologies is affected by health-status. Therefore all following questions were asked for two scenarios: • being healthy compared to • being ill.
Due to space limitations, we report on the results for the ill setting only.
"When": The "What"-query determined the kind of integrated informationcommunication and medical technologies. The three technologies were
• microphone • camera • positioning-system. "Where": In this section, three rooms had to be evaluated regarding their sensitivity to technology monitoring
• living room
The questions for the participants' acceptance of technologies in rooms were formulated in personal statements one had to confirm on a four-point scale from "no" = 0 to "yes" = 3.
"Which conditions": The conditional acceptance situations, "which" had to be fulfilled to generally accept integrated technologies, were determined in the last section of the questionnaire (privacy concerns, financial burden etc.).
Participants of the Questionnaire Study
100 younger, adult and elderly persons volunteered to take part in the questionnaire study. Participants were collected mainly by the authors' social network and by announcements in local newspapers. Most questionnaires were distributed in paperform (partly in senior homes), some online. Three age groups were formed (Table 3) . The mean age of the sample was M = 61 years (SD=15,4.) Three age groups were formed: (1) The younger/middle aged persons (aged 20 to 40), (2) adult persons (41 to 65 years of age) and (3) elderly/retired adults (older than 65 years, Figure 3 ). The latter group referred to the fact that with 65 years the retirement phase starts [39] . As can be seen From Figure 3 , the majority of participants belonged to the "adult group", as they are assumed to be the potential users of upcoming new integrated, ubiquitous supporting technologies. Gender (57% female participants) is considered in the analyses due to some substantial differences regarding technology usage [42, 36] . The classification of health status into healthy and ill participants was determined by four questions: (1) Do you have of any chronic diseases? (2) Do you need regularly health check-ups? (3) Are you dependent on any medical devices? (4) Are you dependent on medical care? (5) All people answering positively to at least one of these questions were classified as "ill", in our study 51%.
Results
Qualitative data from the focus group study were reported descriptively. Then, quantitative results were analyzed by (M)ANOVA-procedures, referring to effects of room type (contrasting living-, bed-, bathroom), of technology type (contrasting microphone, camera, positioning) as well as interaction effects. For all analyses we also focused on effects of user diversity. The level of significance was set at 5%. Outcomes on the less restrictive significance level of 10% were referred to as marginally significant.
Qualitative Data: Key Findings from the Focus Groups
The qualitative results of the focus groups were analyzed descriptively. Overall, participants showed a vivid interest in the topic and participated with enthusiasm and high openness. In order to illustrate the individual attitudes, some of the comments of participants are detailed. Answers are categorized by technologies regarding the acceptance in different domestic spaces.
Microphone: The integration of hands-free equipment was mostly accepted in the living room, but was highly controversially discussed for the bed-and bathroom.
"From my perspective it is important to have microphones everywhere as you are moving around in your house" (male, FG2) "And if I'm ill it could be really helpful when somebody could hear me and knows: This guy is still breathing"(male, FG2) "But I don't want a microphone there and somebody hears me up or down there. That is kind of eavesdropping. Imagine that I have guests and somebody listens to us" (female, FG1)
Camera: In none of the focus groups, the integration of a camera was accepted for bed-and bathroom, both are perceived as highly intimate. The negative aspects of being watched were frequently compared to future visions of Orwell's "1984, Big Brother is watching you".
"Being monitored by camera feels like surveillance" (female, FG2) "I regard eye contact with camera as highly inappropriate, even when I'm ill" (male, FG2) "I do not want anybody watching me" (male, FG2) "I really don't like it. You never know, if there is somebody watching you or not" (male, FG2) "Recently, I was in the hospital and monitored all the time. I couldn't get over it the whole week. I always felt unpleasant" (male, FG2) (…) "Well, when was in ICU I felt very guarded and I knew all stand behind me" (male, FG2) "When I think of communicating with friends and family using the Internet, then they may see me in the living-, or dining room, but they are not able to see me in the bath-or bedroom" (female, FG1)
Positioning system: The positioning was only conditionally accepted in case of falls. When somebody has fallen and keeps lying on the floor, this system was highly accepted in case of being ill or at fall risk.
"When I slip and fall, I would say "yes" to position finding in the bathroom" (female, FG1) "When you are ill and in need of help, then I would accept the positioning in any place" (female, FG3)
Beyond the different acceptance patterns depending on technology types it was also obvious that personality of participants and general attitudes towards life played a large role within the evaluations of smart home technologies. Overall, two different attitudes were identified: the "Skeptics" and the "Resigned".
The skeptics rather declined everything-independently of health state or needs:
"Well, I don't want anything at all" (male, FG2) "For me, one negative aspect is the too high reliance on technologies and the lack of respecting persons' personality. (…) That is most important for me when being old and communicating with humans instead of technologies. The real person (contact) is important for me" (female, FG4)
The resigned on the other hand rather accepted all technologies, in case of illness and dependence of care. They seek for the possibility to stay independently at home:
"If you tell me that being monitored at home is a real alternative to a retirement home, I would accept it. Then, you don't have to live with the old dodderers" (female, FG2) "If it is necessary and I really need it, when I'm ill, then I would accept any technology anywhere at home" (female, FG3)

Quantitative Results of the Questionnaire Survey
Effects of domestic spaces A first analysis regards the main effect of the type of domestic space, thus addressing the question whether the three rooms under study -living room, bedroom or bathroom -show a different sensitivity towards monitoring through home medical monitoring. It should be noted that for all scenarios the participants had to evaluate they should imagine to be chronically ill. The ANOVA for multivariate measurements revealed a significant omnibus effect of domestic space (F(2,94) = 30.2; p < 0.05). The descriptive outcomes are visualized in Figure 4 (left side). Apparently, the living room is the one for which participants would accept home monitoring (M = 2.2 out of 3 points max), followed by the bedroom (though considerably lower with M = 1.8) and last ranked is the bathroom (M = 1.6) which reveals to be most sensitive towards medical monitoring.
Fig. 4. Left: Main effect of do (means). High values represen

Effects of technology type
A second analysis addresse more concerns than others seen there, there was a sign < 0.05). From all technolo technology (M=2.2/3 point camera is-unequivocally an
Interacting effects of domes
The ANOVA for repeate domestic space x technolog acceptance for a technolo While for the auditory mon (living room most and ba acceptance for camera and p
Effects of user diversity
As users might differ in a n the cartography of rooms a (contrasting the young, the females), health states (con well as technical experienc conventional information a low familiarity with device
In order to come to the impacting the acceptance d monitoring when being ill main effects of user dive answers, showing that "ho When Your Living Space Knows What You Do omestic spaces (Means); Right: Main effect of technology ty nt high levels of acceptance.
ed the question whether some of the technologies prov . In Figure 4 (right), outcomes are illustrated. As can nificant main effect of technology type (F(2,94) = 29.4.2 ogies, the microphone (plus speaker) is the most accep ts max), followed by the positioning system (M=1.9). T nd in a relatively clear distance -ranked last (M = 1.4).
stic spaces and technology type ed measurements revealed a significant interaction gy type ( Figure 5 ). The interaction says that the exten gy also depends on the respective room characterist nitoring (microphone and speaker) there is a clear rank athroom least accepted), the users show an equally l positioning system in bathroom and bedroom.
number of characteristics that should be considered wit and technology types, we analyzed effects of age gro e adult and the older users), gender (contrasting males ntrasting the chronically ill vs. the healthy participants) ce (contrasting people with a high experience when us and communication technologies and persons who show handling). e point: user diversity did not reveal to be a major fac decision which technology type should be used for ho and which rooms of the house are especially sensitive ersity). Obviously, there were unequivocal attitudes ome", "intimacy" and "privacy" are generic categor 
cts the evaluation of technology types in domestic space
d a marginally significant three-way interaction eff between age, and the evaluation of the technology type Figure 6 ). As can be seen there, the adult group shows age groups especially regarding the camera monitoring nt three-way interaction of age, technology type in diffe h values represent high levels of acceptance. Analyses showed a margina 0.1) between gender and t outcomes are illustrated in accept the microphone mon strongly than do men.
Fig. 7. Marginally significan room type (Means). High valu

Interacting effect: Health st
In addition (Figure 8 , left status and the evaluation of (F(1,93) = 4.21; p < 0.05).
While the microphone i the use of the camera and th the healthy in contrast to th ill persons would more e chronically ill the type of te tates and the evaluation of technology types side) a significant interacting effect of individuals' hea f the usefulness of the respective technologies were fou s equally accepted (M = 2.1) 'for ill and healthy perso he positioning system would be more strongly accepted he chronically ill persons, contradicting the expectation t easily accept edward84@example.com. Conversely, for echnology is decisive for acceptance.
al expertise and the evaluation of technology types gorized into a group, which reported to be highly fami ntional information and communication technologies an be quite unfamiliar. As found, the extent of techn lly significant interacting effect with the evaluation of udy (F(2,93) = 2.9; p < 0.1). The interaction is depicted can be seen there, both expertise groups are not differ ce for the camera as a monitoring technology at ho t differences in the acceptance of the positioning syst 
Discussion
In this research, we focus technologies. As the "hom respecting emotional and persons would accept moni to understand both, univers we examined 100 users of been found to severely im domestic spaces [38] . sed on the technology acceptance for home monitor me" is a highly private space, with a specific mean social living, we examined if and if so to which ext toring technologies there, when they would be ill. In or sal patterns as well as diversity-prone acceptance answ a wide age range (25-93 years of age). Especially age mpact the sensitivity of technology implementation wit also gender was of interest within acceptance of ho 6, 42]: About one half of the participants were males, e, it was a plausible assumption that chronically ill peo ptance patterns than healthy persons, as diseased peo essity of medical care and also quick care in case could be derived that chronically ill persons would m hnologies in comparison to healthy people. On the ot ced person handles illness in a much more versed way ing on, possibly much better than any home technology. approach all participants had to envisage that they would They were asked to rate the acceptance for three technolo ogy using the auditory system only, a visual and audit ation with auditory information) and a positioning syst s in the room. In order to understand different sensibili rooms had to be compared respecting the acceptability Even though falls are known to happen in all rooms of the house, the most likely places to fall are the bedroom and the bathroom [42] . As many of these falls happen, when people are alone at home, mobile emergency systems should call for immediate help, compensating for long-term consequences of the fall. Unfortunately, bathroom and bedroom are exactly the rooms for which the users would not accept technologies.
Apparently, the feeling of nondisclosure and confidentiality, the emotional and personal activities in these rooms do not tolerate any medical monitoring and need concealment and privacy, independently of the scenario (ill or not), and, independently of health state of participants. The same applies to other user characteristics. Neither gender, nor age was found to seriously impact the acceptance patterns, showing one more the universality of the acceptance outcomes here.
From the technologies under study, the microphone (using only the auditory channel) was the most accepted (especially in combination with the living room). The camera was mostly declined. Here two important motives came into fore. One is that the feeling of being watched provokes feelings of discomfort (rather than feeling of security and safety, what is astonishing especially for the chronically ill persons). The other is that technology still-is regarded as "cold" and "impersonal", and this is highly disliked by participants. If there would be a human being, which would watch that nothing happens, even though this person needs not to be very close to the monitored person, people would prefer this over any technology. Obviously, technology is -at least in this cultural space-not regarded as "helpful", as a "personal safeguard", as "friend", even though this factually is the case. In this context, many more studies have to be carried out, in which the role of technologies at home is carefully studied, and the characteristics technology must have in order to be accepted.
Limitations and Future Research Duties
Even though the study provided interesting insights into acceptance of home technologies, this research represents only a first step into a lot bigger room cartography with much more possibly integrated technologies as we singled out just three technologies in three domestic spaces. This regards both, more rooms, and more technologies. Beyond the possibility to integrate more technologies within different rooms one could add portable devices as well as integrating sensors and techniques into furniture, carpets, etc. Possibly, the feeling of mobile technology as monitoring systems would be more easily accepted and not evaluated as "big eye is watching you" as mobility always implies flexibility and While we regarded all use of technologies and acceptance from the viewpoint of one user, the everyday life with partner and family at home means, more than one person could use the technologies at the same time. Therefore it will be really interesting to research acceptance for multiuser purposes.
Also, the investigation of the impact of different using roles on acceptance for medical assistive home technologies is a serious research duty. So far participants had to evaluate that they themselves would have been monitored for the case of emergency rescue. As found, the emergency situation was not taken as equally serious as the fear of violation of own privacy as the most valuable goods. This attitude could change whenever participants would be requested to evaluate the same technologies in the same home environment, but not for themselves, but for the check of the wellbeing of a close family member or relative, which could live not in the same town or geographical region, but abroad. In this context, we should also focus on more culturally diverse contexts. This demand not only touches different conceptualizations of "home" and "privacy" as well as of the ability to tolerate closeness and sharing of won lives with others. This demands also touches the unawareness of a society, which shows a quite sophisticated customization on a high richness of the care system, an elaborated medical standard, as well as a high density of medical institutions as well as care systems is very high. Acceptance of supporting technologies could be completely different in countries with lower possibilities and economic standards. Also, in sparsely populated or uninhabited areas, as e.g. in the North of Europe, in which people live in remote areas with a long distance to others, acceptance for home monitoring technologies could be evaluated quite differentially.

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