Agora: Red Deer Polytechnic Undergraduate Journal
Volume 16:1 2025 Agora Conference Proceedings

Exploring the Co-design Process in the
Creation of a Sensory Stimulation
Assistive Technology
Ashley Mast
The most recent report from the Canadian Institute for
Health Information (2021a) estimated that in Canada there were
2,076 long-term care (LTC) facilities with 198,220 beds, and an
average of twenty-nine beds per 100,000 individuals over the
age of sixty-five. According to Statistics Canada (2016),
approximately half of those residing in long term care have a
diagnosis of dementia, the prevalence of which increases with
age. As of 2024, 7.8 million individuals over the age of sixtyfive live in Canada (Statistics Canada, 2024), and the
Alzheimer’s Society of Canada (2024) predicts that by 2030
there will be nearly one million individuals living with dementia.
These projections raise serious concerns about the potential for
dramatic increases in the number of individuals living in longterm care (LTC). In conjunction with these increases, there are
the concerns that the COVID-19 pandemic brought to light.
Within the first six months of the pandemic, residents in LTC
accounted for 80% of the deaths that occurred, and by December
2021, residents accounted for 43% of the total deaths in Canada

118

from the illness (Canadian Institute for Health Information,
2021b; Canadian Institute for Health Information, 2021c). The
high rates of infection placed considerable strain on the staff in
facilities

with

dramatically

increased

absenteeism,

accompanying understaffing, and demand for overtime hours.
Unsurprisingly, the number of mental health issues reported by
staff in LTC facilities rose considerably (Clarke, 2021) and
residents reported they lacked choice in their lives and the care
they received which contributed to increased distress and
confusion (Davison, 2019). These concerns highlight the need
for urgent action within LTC facilities, with assistive technology,
defined as technology that helps improve functioning and
enables health, well-being, inclusion, and participation in care
(World Health Organization, 2024), often portrayed as a
solution.
Non-pharmacological interventions, such as sensory
therapy, are recognized as the optimal first line of intervention
for LTC residents. Sensory therapies come in a variety of forms,
and have been found to improve the physical, behavioral, and
emotional functioning of individuals with cognitive impairment
and dementia (Friedmann et al.,2014). The most common form
of sensory therapy involves tapping and brushing which
increases proprioception, the ability to perform daily functions,
and enhances one’s overall quality of life (Lancaster et al.,

119

2016). However, this form of therapy is usually therapistdirected based on protocol which does not take the individual
needs and input from residents into account, and which involves
direct physical contact between therapists and residents. To
increase the autonomy of residents it is suggested that assistive
technology (AT) might be implemented in the use of sensory
therapies. AT, in the form of smart gadgets installed in home care
settings, allows caregivers to monitor the recipient's actions,
increasing their peace of mind and assisting in the completion of
daily tasks while still ensuring the safety of their loved one
(Arthanat et al., 2022). The use of this smart home automation
also contributed to an increase in engagement in their care and
increased autonomy for the care recipient (Arthanat et al., 2022).
Just as AT can be implemented in private homes, it can also play
a role in LTC, contributing to a reduction in workload and
providing a sense of safety for residents and staff (Dorsten et
al.,2009). These benefits allow for autonomy for residents and
reduced burnout for staff which is a critical outcome of a personcentered approach to care.
The World Health Organization (Bennett et al., 2015)
recommends that best practice for care includes a focus on
delivering care to individuals while accounting for the needs
identified by the residents, their families, and trusted others. A
person-centered care plan (PCC) allows staff to focus on the

120

needs of the individual, promoting care that reflects the values,
preferences, and functionality of residents which fosters shared
decision-making between residents and staff (Howard et al.,
2021; Kim, D & Kim, M, 2023). PCC models such as enhanced
care plans increase communication between residents and staff
and increase the residents’ perceptions of thriving while living
in LTC (Guney and Kardag, 2023; Baxter et al., 2020). The
impact on resident well-being shows the benefits of a more
person-centered approach to resident care. While the personcentered approach cannot be implemented for every resident
every time, this research lends weight to the argument that when
it can be implemented it should be.
With the benefits of a PCC model of care being evident,
it is beneficial to the process of designing new assistive
technology, that all involved in its use provide input on how best
to implement it. As Such, the co-design process is intended to
create an understanding of the experiences and needs of all users
in the development of technology, from direct end-users, to
upper management, to front-line staff (Chinaleong-Brooks,
2020). In the context of sensory therapy, Lima (2024) found that
naturalistic observation and casual conversation with individuals
with cognitive impairment allowed for a natural flow of
information that contributed to designing sensory and cognitive
stimulation games that suited individual needs. Likewise,

121

Wright et al., (2023) used the co-design process in an acute
psychiatric unit to engage with care workers, nurses, and doctors
to identify important impacts on the use of sensory therapy,
facilitating preparation for a change in sensory practice. These
two studies show the usefulness of the co-design process and the
varying stakeholder groups that can be identified to participate
in the implementation of designs.
The Present Study
To increase the autonomy of residents it may be desirable
to enhance person-centered care in the context of sensory
therapy through the co-design of AT solutions. As a potential
solution, an occupational therapist in Alberta is designing a selfadministered sensory stimulation tool. This technology will
prompt residents using a visual cue from a projector to engage
in sensory therapy with a sensory tool of their choosing. This
visual cue indicates which area of the arms or legs to begin
with,and moves through the body areas until the completion of
the therapy session. This investigation engaged in a
comprehensive co-design process to further the design and
implementation of this new sensory stimulation assistive
technology. By exploring the perspectives of varied stakeholder
groups and collecting shared and unique perspectives this study
will engage in an early-stage co-design process to contribute to

122

the iterative process of co-design, which will allow for progress
toward the development and implementation of a field-ready
prototype of this AT.
Method
This study used a convenience sample of participants (N
= 14), including administrative and managerial staff at Bethany
CollegeSide (n = 5), residents at Bethany CollegeSide (n = 6),
an occupational therapist (n = 1), and two occupational and
physiotherapy assistant students from Red Deer Polytechnic (n
= 2). Recruitment for all participants included posters and
communication with the coordinator at Bethany CollegeSide,
and the occupational and physiotherapy assistant instructor at
Red Deer Polytechnic. No incentive was offered for
participation in this study. The inclusion criteria were the same
for all staff in that they must hold a paid position with Bethany
CollegeSide. The occupational therapist was required to be
working

within

the

field

as

an

occupational

therapistOccupational Therapy students were required to be
enrolled in the occupational therapy program at Red Deer
Polytechnic as either first- or second-year students. Finally,
residents must reside at Bethany CollegeSide full time. This
study received approval and followed the ethical guidelines of
the Red Deer Polytechnic Research Ethics Board.

123

Materials
The materials in this study included a demographic
questionnaire that outlined their gender, and years working/
living in LTC,a set of four pre-recorded demonstration videos
(the product pitch, a sensory education video,the user interface
for therapists and rehab staff, the resident user journey). Two
digital recording devices were used to record the data. An openended focus group moderator guide was used to ensure the flow
of the focus groups was maintained. Questions included in the
sessions for staff, students, and occupational therapists were as
follows: 1. What do you see as the biggest challenge to effective
care in LTC? 2. What role, if any does technology play in helping
to address these challenges? 3. How would you describe the pros
and cons of assistive technology? After watching the
demonstration videos the participants were asked: 4. Having
seen the demonstration, what are your general impressions of
this particular technology?; 5. What are your views on the
potential usefulness of this technology?; 6. What problems do
you see with this technology?; 7. What advice/ suggestions do
you have for the developer of this technology?; 8. Do you have
any final thoughts or anything else to add? These questions were
modified slightly for enhanced readability with resident
participants.

124

Procedure
Due

to

scheduling

conflicts,

only

the

administrative/managerial group and the resident group were
completed using focus groups. The occupational therapist and
the two occupational and physiotherapy assistant students took
part in individual interviews with the student researcher using
the same procedure. Participants provided written or verbal
informed consent. All participants were asked the first three
questions for their specified group and viewed a selection of
demonstration videos. The administrative/managerial group and
the occupational and physiotherapy assistant students viewed
videos, 1,2, & 4, the Occupational therapist, viewed videos
1,2,3, & 4, and the residents viewed only video 4. The selections
of the videos were based on the scope of the participant's
employment or education as well as relevance to residents. Each
group was asked five follow-up questions regarding the
technology discussed in the videos. All interviews and focus
groups lasted between twenty and forty-five minutes. This study
used thematic analysis, a qualitative method used for
identifying, analyzing, and reporting themes within the data
allowing for the organization and description of rich data,
placing data from all participants into similar themes (Braun &
Clarke, 2006). In this study, once all interviews were completed
the data was manually transcribed, anonymized, coded, and
125

themed by the student researcher and then coded by a second
independent coder.
Results
The demographic questionnaires were reviewed the
participants self-identified as female (n = 7) and male (n = 7).
Resident participants stated they have lived in long-term care for
between 1.5 – 12 years. Administrative and managerial staff and
the occupational therapist worked within the long-term care for
9-25 years. Finally, the student participants were both first-year
students.

After coding, three key themes were identified

reflecting both shared and unique experiences/perceptions. The
first theme, Capacity Concerns and the Ambivalent Advantage
of Technology occurred in four of the five sessions and
encompassed the capacity issue in long-term care. The use of
technology can contribute to solving the capacity issue however,
implementation of such technology comes with the need for
more financial resources, and staffing resources “Current
technology resource supports to implement and identify
appropriate technology creates more problems in LTC, as we
adopt technology when it doesn’t have a broader technological
solution to address the issue in the workforce.” Cross et al.,
(2024) found that without the appropriate training and funding,
staff were hesitant to engage in the use of AT even if it was a

126

benefit to the residents. One participant’s main concern revolved
around the space required for this specific technology. “You
can’t have this in patient rooms, so you would need a separate
room, and they might not have the rooms available. They’d have
to get rid of something and then they’ll need something else.”
While there is concern regarding workforce capacity and space,
care that is facilitated using technology helps residents to be able
to go about their daily activities. “If we don’t get the care, we’re
not able to go on with our day”. Of particular interest in this
theme is that the staff group and the occupational therapist were
concerned about financial and workforce capacity whereas, the
students were concerned about the physical space available to
support the implementation of new technologies. This theme
accentuates the need for a balance of staff workload and funding
as well as space that facilitates new opportunities without taking
away from another necessary activity.
While capacity issues are a major focus within LTC,
another vital concern involves the quality of resident care. The
second theme identified was the Impact on Quality Care. This
theme encompasses the importance of high quality of life for
residents, and the sorts of staff-resident interactions that best
facilitate this. This theme occurred in four of the five sessions.
Of importance is ensuring that any new technology is actively
contributing in a meaningful way to effective care. In one case a

127

participant explained the concern that arises when introduced
technological changes do not integrate effectively with existing
equipment/practices “I spent two hours yesterday trying to find
a personal directive for a guy who needed a bed on Monday, but
I can’t get it, because I’m not on that platform. I called placement
and they didn’t have it either, so to me that is a technological
issue that’s really interrupting service.” In this case, the use of
technology interrupted the participant's ability to provide needed
care to other residents and could have delayed the intake of the
resident needing a bed. One of the student participants explained
the concern of loss of valuable skills for staff “…you could have
a chance of getting less experienced personnel right, people are
going to be using the equipment more, so they lose that skill that
they have.” One group difference regarding this theme was that
while staff mentioned the potential added burden to staff of new
technology students were more concerned about how the eased
burden resulting from new technologies could adversely impact
skill development/maintenance. This theme illustrates the varied
ways ways new technology could impact the quality of care that
residents receive and highlights the challenge of balancing
advantages and limitations.
When implementing new technology within any work or
home setting finding the right fit for the right population is key.
In a LTC setting the technology working for the right population

128

is even more important as the population for which this
technology is being implemented are in many ways vulnerable.
As such the third and final theme identified was PersonEnvironment Fit. This theme was identified in every session
conducted and was a concern for all participants. The original
intent of the developer of this technology was for this technology
to be used by residents with dementia. According to one
participant, however, “When I look at the residents that we have
in our dementia units, I don’t think that they would be able to
figure this out. We would be spending more time assisting them
and helping to explain how it works than we would put into a
regular therapy program for them.” The concern in this theme
revolves around the requirements of using and benefitting from
the technology relative to resident interest and capability. There
was concern among several participants that this technology,
though promising, was not a good fit with the target population.
One participant from the staff group expressed that changing the
resident population would be beneficial “I feel like more for a
young adult population maybe would be cool.”

The

occupational therapist suggested that if the developer wanted to
use it for those with cognitive impairment it might be best
implemented with, “someone who has super mild cognitive
impairment or brain injury”. The staff group further suggested
that“if it (the sensory intervention) could be done as a group that

129

supports their time (it) may be more effective. Then it might
increase cueing from other people and more opportunities for
sensory.” This opportunity for interaction between residents
encompasses the overall feeling regarding this technology, it can
be useful, in the right context, with the right staff training, and
the right resident population.
Discussion
The benefits of assistive technology range from reducing
staff workload to increasing the feeling of autonomy for
residents. The results of this study show the barriers and benefits
associated with not only the use of technology within LTC but
also the specific benefits and barriers that can be found using
this assistive technology. The first theme identified was centered
largely around the capacity issues within LTC, with the staffing
crisis and funding for new technologies to help residents and
lessen staff workload being a highly recognized issue. The
evident risk for care homes is loss of funding, which impacts
staff, residents and their family members. Brassolotto et al.,
(2020) emphasize that in Alberta the long-term care homes most
affected by funding cuts are the ones within rural areas. As such
providing therapies and protocols that are easily accessible to all
facilities and family members could allow for the safeguarding
of forms of therapy. Financial restraints and lack of

130

accountability for care leave the staff feeling constrained and
powerless against the limitations that occur (Brassolotto et al.,
2020). These constraints felt by the staff will then compound on
top of the already overwhelming work overload leading to more
staff turnover and increasing the capacity issue within the
facility.
The use of technology is meant to assist individuals with
conducting certain aspects of their care independently. Thus,
residents’ perception of their ability to use the technology is
integral to its function in LTC. Of particular interest to this study
is healthcare technology self-efficacy, an individual's perception
of their ability to use healthcare technology effectively, which
includes their emotional state regarding their healthcare and
their perception of these technologies (Rahman et al., 2016).
Concerning using healthcare technologies, Graat et al., (2025)
found that confidence in the ability to use technology plays a
vital role in participant engagement suggesting that when
individuals lack the necessary self-efficacy, they have more
difficulty engaging. Specifically, in the case of residents with
more severe cognitive impairment, it would be vital to ensure
they felt strong self-efficacy regarding their ability to use
technology.

131

Conclusion
This study explored the use of the co-design model in the
creation of a sensory stimulation assistive technology tool.
While there were concerns regarding the target population, the
overall attitude towards this technology was positive. A vital
outcome of this study was the input provided by the multiple
stakeholders involved. While co-design typically involves input
from developers and end users (Chinaleong-Brooks, 2020) this
study emphasizes that input from other key stakeholder groups
also has considerable value. This study accentuated the need to
gain input from various perspectives to ensure that the needs of
all those impacted, from organizational staff to end users, have
a say in the design of important technology.
There were some limitations within this study. Sample
size was smaller than anticipated. The original intent was to have
multiple members of each stakeholder group participate in focus
groups. This was not possible, for front line staff and student
groups, however, a reflection of staffing capacity issues within
long-term care, and student workloads and time constraints.
Nevertheless,

there

was

representation

from

multiple

stakeholder groups.. providing valuable information to the
developer as they move toward a prototype ready technology.

132

References
Alzheimer Society of Canada. (2024). Dementia numbers in
Canada. Alzheimer Society of Canada.
https://alzheimer.ca/en/about-dementia/whatdementia/dementia-numbers-canada.
Arthanat, S., Wilcox, J., & LaRoche, D. (2022). Smart Home
Automation technology to support caring of individuals
with Alzheimer’s disease and related dementia: An
early intervention framework. Disability and
Rehabilitation: Assistive Technology, 19(3), 779–789.
https://doi.org/10.1080/17483107.2022.2125088.
Bennett, S., Fancourt, N., Peters, D., & Wu, A. (2015). WHO
global strategy on people-centered and integrated
health services. World Health Organization.
www.who.int.
Brassolotto, J., Caspar, S., Spenceley, S., & Haney, C.-A.
(2020). Long-Term Care in rural Alberta: Exploring
autonomy and capacity for action. Journal of Long
Term Care, 80–90. https://doi.org/10.31389/jltc.31.
Braun, V., & Clarke, V. (2006). Using thematic analysis in
psychology. Qualitative Research in Psychology, 3(2),
77–101. https://doi.org/10.1191/1478088706qp063oa.
Canadian Institute for Health Information . (2021a). Long-Term
Care Homes in canada: How many and who owns
133

them?. Canadian Institute for Health Information .
https://www.cihi.ca/en/long-term-care-homes-incanada-how-many-and-who-owns-them
Canadian Institute for Health Information . (2021b). Covid-19’s
impact on long-term care. CIHI.
https://www.cihi.ca/en/covid-19-resources/impact-ofcovid-19-on-canadas-health-care-systems/long-termcare
Canadian Institute for Health Information . (2021c). The impact
of COVID-19 on long-term care in Canada: Focus on
the first 6 months . CIHI.
Chinaleong-Brooks, K., Jennings, J., Mccutcheon, J., & Singh,
S. (2020). Understanding co-design. Alberta Health
Services.
Clarke, J. (2021, June 10). Impacts of the COVID-19 pandemic
in nursing and residential care facilities in Canada.
Government of Canada, Statistics Canada.
https://www150.statcan.gc.ca/n1/pub/45-280001/2021001/article/00025-eng.htm.
Cross, H., Armitage, C. J., Dawes, P., Leroi, I., & Millman, R.
E. (2023). Capabilities, opportunities and motivations
of staff to provide hearing support to long-term care
home residents with dementia. International Journal of

134

Audiology, 63(7), 519–526.
https://doi.org/10.1080/14992027.2023.2227764.
Davison, T. E., Camões-Costa, V., & Clark, A. (2019).
Adjusting to life in a residential aged care facility:
Perspectives of people with dementia, family members
and Facility Care Staff. Journal of Clinical Nursing,
28(21–22), 3901–3913.
https://doi.org/10.1111/jocn.14978.
Friedmann, E., Galik, E., Thomas, S. A., Hall, P. S., Chung, S.
Y., & McCune, S. (2014). Evaluation of a pet-assisted
living intervention for improving functional status in
assisted living residents with mild to moderate
cognitive impairment. American Journal of Alzheimer’s
Disease & Other Dementias, 30(3), 276–289.
https://doi.org/10.1177/1533317514545477.
Government of Canada. (2024, October 31). Older adults and
population aging statistics. Government of Canada,
Statistics Canada.
https://www.statcan.gc.ca/en/subjectsstart/older_adults_and_population_aging.
Graat, M., Prior, P. L., Hartley, T., Unsworth, K., McKelvie, R.
S., Huitema, A. A., Bijji, M. K., & Suskin, N. G.
(2025). “is this thing on?: Measuring technology selfefficacy influence on cardiac rehabilitation patients’

135

adoption of a virtual care platform. CJC Open.
https://doi.org/10.1016/j.cjco.2025.02.003.
Güney, A., & Karadağ, a. (2023). Impact of enriched dementia
care planning on individualized care approaches and
psychological well-being of residents. Turkish Journal
of Geriatrics, 26(4), 424–434.
https://doi.org/10.29400/tjgeri.2023.370.
Howard, E. P., Martin, L., Heckman, G. A., & Morris, J. N.
(2021). Does the person-centered care model support
the needs of long-term care residents with serious
mental illness and intellectual and developmental
disabilities? Frontiers in Psychiatry, 12.
https://doi.org/10.3389/fpsyt.2021.704764.
Kim, D. E., & Kim, M. J. (2023). Factors influencing shared
decision-making in long-term care facilities. BMC
Geriatrics, 23(1). https://doi.org/10.1186/s12877-02304301-6.
Lancaster, S., Zachry, A., Duck, A., Harris, A., Page, E., &
Sanders, J. (2016). Delivery of the wilbarger protocol:
A survey of pediatric occupational therapy
practitioners. Journal of Occupational Therapy,
Schools, & Early Intervention, 9(3), 281–289.
https://doi.org/10.1080/19411243.2016.1169243.

136

Lima, C. (2024). Designing sensory and cognitive stimulation
activities with and for people living with moderate to
late-stage dementia. Design for Health, 8(2), 206–224.
https://doi.org/10.1080/24735132.2024.2434376.
Rahman, M. S., Ko, M., Warren, J., & Carpenter, D. (2016).
Healthcare technology self-efficacy (HTSE) and its
influence on individual attitude: An empirical study.
Computers in Human Behavior, 58, 12–24.
https://doi.org/10.1016/j.chb.2015.12.016
Statistics Canada. (2016). Health reports: Alzheimer’s disease
and other dementias in Canada.
https://www150.statcan.gc.ca/n1/pub/82-003x/2016005/article/14613-eng.htm
Wright, L., Bennett, S., Meredith, P., & Doig, E. (2023).
Planning for change: Co-designing implementation
strategies to improve the use of sensory approaches in
an acute psychiatric unit. Issues in Mental Health
Nursing, 44(10), 960–973.
https://doi.org/10.1080/01612840.2023.2236712.
World Health Organization. (2024). Assistive technology.
World Health Organization. https://www.who.int/newsroom/fact-sheets/detail/assistive-technology.

137