By 2030, the Government of Canada predicts that over 9.5 million (23%) Canadians will be 65 years of age or older. For this growing demographic of older adults, intelligent home health technologies have been proposed as one beneficial avenue to support and maintain health and wellness as they begin experiencing ageing-related health effects. However, many ethical concerns have been raised regarding the design and deployment of these technologies in ageing-in-place settings such as long-term care and nursing homes. This thesis aims to better understand the ethical concerns that long-term care stakeholders have with a subset of intelligent home health technologies known as Ambient Assistive Living (AAL) technology. To obtain this understanding, a Systematic Literature Review (SLR) was conducted to gather the different ethical concerns that long-term care stakeholders have with AAL technology and to observe the various ethical design and engineering frameworks used to develop AAL technology for aging-in-place settings. 41 publications were analyzed to identify various ethical concerns held by ageing-in-place stakeholders and the different ethical design and engineering frameworks used to address these concerns. The findings from the SLR identified 17 ethical concerns that influenced how the research was conducted with long-term care facility stakeholders. Following the SLR, a Participatory Design methodology in the form of workshops and interviews was developed and implemented with 30 long-term care facility stakeholders to understand their ethical concerns with two AAL devices: the Hexoskin ProShirtTM - a wearable device used to monitor and collect vital signs, and the AWS DeepLensTM camera - a machine-learning enabled video camera used to make predictions. Through data analysis, 35 topics were identified and grouped into 12 main ethical concerns for both devices. Once a better understanding of long-term care stakeholders' ethical concerns with the two devices was gained, a prototype of an ethical design tool - the Ethical DataSheet - was proposed. An Ethical DataSheet is meant to support researchers, engineers, designers, and others in developing a better understanding of the ethical concerns they must consider when designing and developing AAL technology for ageing-in-place applications. To create the Ethical DataSheet prototype, a snowball sampling literature review was conducted. By conducting the second literature review, inspiration from different ethical design tools was used to develop the prototype. The Ethical DataSheet prototype was then used to create Ethical DataSheets for the Hexoskin ProShirt™ and AWS DeepLens™, which present the top ethical concerns that were identified through the workshops and interviews with long-term care facility stakeholders. The findings of this research will be shared with the PATH research community, who are dedicated to providing nationwide testing and services for home health technologies that will accelerate the availability of appropriate smart systems (i.e. AAL technologies) for seniors' and patients' home healthcare.

This thesis reports from a telecare evaluation in a Norwegian municipality (2012-2016). The project was established to provide domestic results from a hitherto new field in the country to underpin future policy. This evaluation includes pre- and post-implementation data collection, which has been scarce in telecare. The methodological approach was realist evaluation that seeks to explore how telecare works, for whom, why and in which circumstances – or why it does not work. The research aimed to explore the hypothesis elicited from national policy documents: ‘If telecare is used, then people are enabled to remain safe in their own home for longer’. Various methods were used to gather data from multiple stakeholders as they have different knowledge about how the implementation developed. The methods in this evaluation included literature reviews, observations, and sequential interviews with users and relatives in addition to sequential focus groups with frontline staff. Realist evaluation was particularly suitable in demonstrating how and why telecare is useful to some users but not to others. Telecare had to match users’ abilities and needs for them to benefit from it. Telecare operates in a dynamic context, and therefore requires adjustment according to the user’s current situation, taking into account changes as they occur. This appears to have been often underestimated. Telecare holds a different position from other devices and technologies in people’s everyday life, which also needs to be acknowledged. Correct assessment is significant for users to obtain the intended effect from telecare. When telecare is correctly adjusted to users, it increases safety, which is essential for enabling older people to remain living at home. Several challenges in establishing telecare projects are identified and alternative ways to understand multi-disciplinary partnerships are suggested. By using realist evaluation the findings are nuanced and point to elements that are significant for achieving the intended outcomes.

The heterogeneity of the environments as well as the diversity of patients' needs and profiles are major constraints that challenge the spread of ambient assistive living (AAL) systems. AAL environments are usually evolving by the introduction or the disappearance of sensors, devices and assistive services to respond to the evolution of patients' conditions and human needs. Therefore, a generic framework that is able to adapt to such dynamic environments and to integrate new sensors, devices and assistive services at runtime is required. Implementing such a dynamic aspect may produce an uncertainty derived from technical problems related to sensors reliability or network problems. Therefore, a notion of uncertain should be introduced in context representation and decision making in order to deal with this problem. During this thesis, I have developed a dynamic and extendible framework able to adapt to different environments and patients' needs. This was achieved based on my proposed approach of semantic Plug&Play mechanism. In order to handle the problem of uncertain information related to technical problems, I have proposed an approach for uncertainty measurement based on intrinsic characteristics of the sensors and their functional behaviors, then I have provided a model of semantic representation and reasoning under uncertainty coupled with the Dempster-Shafer Theory of evidence (DST) for decision making

L’hétérogénéité des environnements ainsi que la diversité des profils et des besoins des patients représentent des contraintes majeures qui remettent en question l’utilisation à grande échelle des systèmes d’assistance à l’autonomie à domicile (AAL). En effet, afin de répondre à l’évolution de l’état des patients et de leurs besoins humains, les environnements AAL sont en évolution continue par l’introduction ou la disparition de capteurs, de dispositifs d’interaction et de services d’assistance. Par conséquent, une plateforme générique et dynamique capable de s’adapter à différents environnements et d’intégrer de nouveaux capteurs, dispositifs d’interaction et services d’assistance est requise. La mise en œuvre d’un tel aspect dynamique peut produire une situation d’incertitude dérivée des problèmes techniques liés à la fiabilité des capteurs ou à des problèmes de réseau. Par conséquent, la notion d’incertitude doit être introduite dans la représentation de contexte et la prise de décision afin de faire face à ce problème. Au cours de cette thèse, j’ai développé une plateforme dynamique et extensible capable de s’adapter à différents environnements et aux besoins des patients. Ceci a été réalisé sur la base de l’approche Plug&Play sémantique que j’ai proposé. Afin de traiter le problème d’incertitude de l’information lié à des problèmes techniques, j’ai proposé une approche de mesure d’incertitude en utilisant les caractéristiques intrinsèques des capteurs et leurs comportements fonctionnels. J’ai aussi fourni un modèle de représentation sémantique et de raisonnement avec incertitude associé avec la théorie de Dempster-Shafer (DST) pour la prise de décision / The heterogeneity of the environments as well as the diversity of patients’ needs and profiles are major constraints that challenge the spread of ambient assistive living (AAL) systems. AAL environments are usually evolving by the introduction or the disappearance of sensors, devices and assistive services to respond to the evolution of patients’ conditions and human needs. Therefore, a generic framework that is able to adapt to such dynamic environments and to integrate new sensors, devices and assistive services at runtime is required. Implementing such a dynamic aspect may produce an uncertainty derived from technical problems related to sensors reliability or network problems. Therefore, a notion of uncertain should be introduced in context representation and decision making in order to deal with this problem. During this thesis, I have developed a dynamic and extendible framework able to adapt to different environments and patients’ needs. This was achieved based on my proposed approach of semantic Plug&Play mechanism. In order to handle the problem of uncertain information related to technical problems, I have proposed an approach for uncertainty measurement based on intrinsic characteristics of the sensors and their functional behaviors, then I have provided a model of semantic representation and reasoning under uncertainty coupled with the Dempster-Shafer Theory of evidence (DST) for decision making