Information and Informed Consent Form for Participant to Participate in Online Questionnaire

TITLE: Understanding the attitudes and preferences of current and future older adults in the use of robots to facilitate occupational performance

Charmaine Chiang and Caiwei (Michelle) Li
Master of Occupational Therapy Candidates
University of Toronto
Phone: 416-946-8573

Dr. Alex Mihailidis, PhD
Professor, Department of Occupational Science and Occupational Therapy
University of Toronto
Phone: 416-946-8565
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You are being asked to participate in a research study. Please read the information about the study presented in this form. The form includes details on study’s risks and benefits that you should know before you decide if you would like to take part. You should ask the study team to explain anything that you do not understand and make sure that all of your questions have been answered before signing this consent form. Before you make your decision, feel free to talk about this study with anyone you wish. Participation in this study is voluntary.

Background and Purpose
Service robots assist people with their daily activities to allow for independence while living at home. These robots can help older adults remain at home while aging, but there is not much known about how they should be designed, what activities they can assist with, or how they should be used.

The purpose of this study is to gain a more in-depth understanding of how service robots can be incorporated into the daily lives of current (aged 65+) and future (aged 35-64) older adults. We hope the knowledge gained from the study will help in identifying the acceptability and preferences regarding the use and design of service robots in the daily lives of community-dwelling older adults.

You are being asked to participate in the study because you are a current older adult at 65 years and older or because you are a future older adult between 35 and 64 years old. We will be recruiting sixty participants to participate in the study.

You are eligible to take part in this study if you:
  • Are 35 years of age or older
  • Are living within the community (i.e. living at home, in a retirement home)
  • Can read, speak, and understand the English language
  • Have the capacity to consent
If you agree to participate, you will be provided with a questionnaire with questions organized into the following categories: demographic information, experience with technology, acceptability of robots, preferences of robots, and ranking of preferences. You will also indicate on your questionnaires at the end if you are interested in participating in the interview portion of the study. The questionnaire will take about 15 to 20 minutes to complete.
Potential Risks and Benefits
Potential Risks
You may have feelings of discomfort and anxiety while answering questions in the questionnaire. You may experience frustration, confusion, anger, sadness, or embarrassment when acknowledging the fact about aging. Should you become distressed during the study, you may skip the questions you may not wish to answer. You may also withdraw from the study at any time.

Potential Benefits
Participation in this study does not guarantee any direct benefits. It is hoped that your resulting preferences will be taken into consideration for the user-centred design of future service robots. You may also have the opportunity to learn about new robotic systems that you were otherwise unfamiliar with before the study.

Voluntary Participation
Your participation is entirely voluntary. You may decide not to be in this study, or to be in this study now and then change your mind later. You may leave the study at any time and refuse to answer any question that you do not want to answer. In no way does signing this consent form waive your legal rights nor does it relieve the investigators, or involved institutions from their legal and professional responsibilities.

Withdrawal from study
Your participation in this study is voluntary, and you may decline to participate or withdraw from the study at any time for any reason. You may choose to end your participation at any time by closing your browser. If you withdraw from the study and wish to share your experience, you are encouraged to contact the student investigators, Charmaine and Michelle at (416) 946-8573 or and Because the online survey is anonymous, we will not be able to delete your survey responses after they have been submitted as it will be impossible for us to identify them.

All information obtained during the study will be held in strict confidence. Each participant will be assigned a unique code number to preserve anonymity. This code number, instead of your name, will be used for all data collection and analysis. No names or identifying information (e.g. phone number, email) will be recorded on any response forms, nor used in any publications or presentations. All paper data will be stored securely in the laboratory of Supervisor (Alex Mihailidis). All electronic data will be securely stored on the UofT server. Only those on the research team will have access to the data. All data will be stored for five years and then destroyed from the date of study completion.

Quality Assurance
The research study you are participating in may be reviewed for quality assurance to make sure that the required laws and guidelines are followed. If chosen, (a) representative(s) of the Human Research Ethics Program (HREP) may access study-related data and/or consent materials as part of the review. All information accessed by the HREP will be upheld to the same level of confidentiality that has been stated by the research team.

Conflict of Interest
There are no conflicts of interest for participants participating in the study.
Contact Information
If you have any questions or concerns, please contact the student investigators Charmaine Chiang at or Caiwei (Michelle) Li at or 416-946-8573. You may also contact the study supervisor, Dr. Alex Mihailidis at or 416-946-8565.

If you have questions about your rights as a research participant, or about any ethical issues relating to this study, you can contact the University of Toronto Office of Research Ethics at or 416-946-3273. The Office of Research Ethics is a group of people who oversee the ethical conduct of research studies. They are not part of the study team. Everything that you discuss will be kept confidential.

You have the right to receive a copy of this consent form before participating in this study. If you would like a copy, please contact Charmaine Chiang or Caiwei (Michelle) Li using the contact information above.

* 1. By checking the “I Agree” button below, I confirm that:

This study has been explained to me and any questions I had have been answered.
I know that I may leave the study at any time. I agree to the use of my information as described in this form. I agree to take part in this study.