10.6092/issn.2038-3460/17479
The participation of older people in technology development is an ambivalent field: while promising a better fit between users and technology, it still is challenging for both the project and for older users. This is particularly the case when older people with cognitive or physical impairments are to be involved. The article examines the configuration of older people as users in the design of a digital memory training for older people with mild cognitive impairment (MCI). Referring to (feminist) STS, this configuration is conceptualised as a matter of care. Based on an ethnographic field study the article unfolds the spatial, affective, discursive and material practices of user configuration and describes ambivalences and asymmetries in the configuration process that determine the configuration of older people as users in user-centred design.
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Cordula Endter
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Tecnoscienza – Italian Journal of Science & Technology Studies
feminist STS
User Participation as a Matter of Care. The Configuration of Older Users in the Design of Assistive Technologies
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2021-03-09
2023-06-27
2021-03-09
2023-10-16
93-116
TS
Cordula Endter
2020
10.6092/issn.2038-3460/17479
93
German Centre of Gerontology, Berlin
2038-3460
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feminist STS
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User Participation as a Matter of Care. The Configuration of Older Users in the Design of Assistive Technologies
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                                                                                Essay
                                                                                       93




User Participation as a Matter of Care
The Configuration of Older Users in the Design of
Assistive Technologies

Cordula Endter
German Centre of Gerontology, Berlin, DE


     Abstract: The participation of older people in technology development is
     an ambivalent field: while promising a better fit between users and technol-
     ogy, it still is challenging for both the project and for older users. This is
     particularly the case when older people with cognitive or physical impair-
     ments are to be involved. The article examines the configuration of older
     people as users in the design of a digital memory training for older people
     with mild cognitive impairment (MCI). Referring to (feminist) STS, this con-
     figuration is conceptualised as a matter of care. Based on an ethnographic
     field study the article unfolds the spatial, affective, discursive and material
     practices of user configuration and describes ambivalences and asymmetries
     in the configuration process that determine the configuration of older peo-
     ple as users in user-centred design.

     Keywords: age; technology; configuration; user-centred design; feminist
     STS.

     Submitted: April 30, 2020 – Accepted: October 15, 2020

     Corresponding author: Cordula Endter, German Centre of
     Gerontology, Manfred-von-Richthofen-Strasse 2, 12101, Berlin, Germany.
     Email: cordula.endter@dza.de




1. Introduction

   Against the background of demographic change and active ageing
policies, older people are assigned many tasks: for example, they are sup-
posed to play an active role in society, engage in community service and
volunteer work, all while staying healthy and fit. In doing so, they should
make their own valuable contribution to master the social and economic
challenges of demographic change. Participating in technology develop-
ment is a relatively new topic in this arena of activities. Parallel to the rise

TECNOSCIENZA
Italian Journal of Science and Technology Studies
11 (2) pp. 93-116 - ISSN 2038-3460
www.tecnoscienza.net                                2020
94                                                           Tecnoscienza – 11 (2)

of assistive technologies, which should enable older people to age in place
autonomously and independently, they are perceived as a promising tar-
get group, but also as important participants in the development process.
Their participation should increase the fit between the requirements and
needs of older users and the design of the technical artefact. In the course
of this redefinition of older people as key agents in the development pro-
cess, various approaches have been developed to involve them. They
range from user-centred design, to design for all, to co-design and co-
creation. Irrespective of these different approaches, from the perspective
of age(ing) studies, the question arises as what older people participate
and how they participate. Mackay et al. (2000), for example, point out
that the practice of user participation has little in common with the hu-
manistic, democratic and utopian ideal of participatory design. Rather,
users are considered as a “good thing” (2000, 738) because their partici-
pation would lead to an improvement of the technical artefact. Hagen et
al. (2018) speak of an “acceptance bias” of user-centred approaches that
pursue acceptance by means of participation – a bias that also affects the
role of researchers accompanying the design process such as cultural an-
thropologists or social scientists (Beimborn et al. 2016; Lassen et al.
2015). Peine and Neven (2019) identify a tendency in which participatory
methods become the sine qua nons of gerontechnology, in which user
needs are seen primarily as input for design and development (see also
Peine et al. 2014). Compagna and Kohlbacher (2015) emphasize that the
integration of users primarily functions as a guarantee for being consid-
ered in the competition for funding, which does, however, not necessarily
mean that users are successfully integrated.
    This is where the article begins. It is based on my ethnographic re-
search I undertook for my dissertation about the development and use of
assistive technologies for older people1. The article describes the partici-
pation of older people in technology development from the perspective of
feminist Science and Technology Studies (STS) using the example of us-
er-centred design in state-funded technology development projects in
Germany that design assistive technologies for older people. The article
points out how older people become older users in the process of partici-
pating in the design process. Therefore, the article describes this process
as a socio-material configuration and illustrates the different spatial, affec-
tive, discursive and material practices in which this configuration of older
people as users takes place. From a feminist perspective, this implies ask-
ing about the power relations and the potential for intervention.
    In the following I will briefly outline the context of user-centred de-
sign in information and computer sciences and theorise it from within
(feminist) STS. Then I describe the spatial, affective, discursive and mate-
rial enrolment of older people in the usability test of MemoPlay, a tech-
nology development project funded by the German Federal Ministry of
Education and Research (BMBF), from an ethnographic perspective. The
aim of this project was to develop an interactive online platform contain-
Endter                                                                   95
ing a memory training for older people with mild cognitive impairment
(MCI)2. I will then discuss how these practices of configuration can be
understood as a matter of care in the sense of Puig de la Bellacasa (2011)
and reflect my research in the context of feminist STS. The article points
out that the participation of older people in technology development pro-
jects is a practice that must be carried out with care so that participation
can be arranged in an attentive, responsible, professional and reciprocal
manner.


2. Theorising User-Centred Design from a (feminist) STS
   Perspective

2.1 User-centred design in gerontechnology

    In the design process of a technical artefact various methods are used
to test the prototype and to ensure that the requirements placed on it are
met. Therein, user-centred design (UCD) has become the main design
approach. It aims at achieving a high degree of fit between the needs and
requirements of the later users and the technical artefact by involving per-
sons who represent the target group as well as possible.
    UCD goes back to the psychologist Donald A. Norman, who in his
work at the University of California San Diego dealt with design princi-
ples for user interfaces in the late 1980s. He first presented his concept
together with Stephen W. Draper in the book User-Centred System De-
sign: New Perspectives on Human-Computer Interaction (1986). It is fol-
lowed by The Psychology of Everyday Things (1988), in which Norman
further elaborates his approach with regard to basic design principles.3
    In the last years UCD has become an umbrella term for a broad set of
methods and agendas linked to the participation of users in different
fields of innovation (Karlsson et al. 2012; Marcus 2015; Oudshoorn and
Pinch 2003a). Especially in European and national funding programmes
on assistive technologies for older people – like for example active and
ambient assisted living (AAL) – UCD has become one of the main ap-
proaches to enable older people to participate in the design process
(Fischer et al. 2020; Merkel and Kucharski 2019; Ogonowski et al. 2018).
In these contexts, UCD goes beyond Norman’s classical conception by
shifting the focus towards user-driven technology development. Here, the
participation of older people in the design process pursues different ob-
jectives. First of all UCD – as it is for example mandatory in the German
funding programme on AAL (BMBF 2010) – is a reaction to the lack of
market success of the developed technologies (Fachinger 2018; Green-
halgh et al. 2016). To overcome the missing market penetration UCD
should guarantee that needs and requirements of older users are met and
the products’ acceptance increases (Compagna 2012). Furthermore the
participation of older people should avoid negative age-related stereo-
96                                                           Tecnoscienza – 11 (2)

types and ageism and foster the empowerment of older people as users of
digital technologies (Beimborn et al. 2016; Endter 2016; Peine et al. 2014;
Wanka and Gallistl 2018).
    In contrast to this political agenda, the practical implementation of
UCD reveals that these objectives cannot be achieved that easily. Rather,
it becomes clear how tricky the application of UCD is. In most cases the
project members like developers, designers or technicians are unfamiliar
with older people as target group, but in the context of state-funded de-
velopment of AAL they have to get familiar with them. Furthermore, they
have to involve them and ensure their stable and long-term participation
in the design process in general and the usability testing in particular,
whereby the testing may be physically and/or cognitively demanding and
emotionally stressful for the test persons. At the same time, the project
members should ensure that the participation of the test persons does not
jeopardise the success of the project, since this would also call into ques-
tion the proof of success vis-à-vis the funding agency. At the same time,
these challenges limit the scope for user participation as a democratic-
humanistic form of participation and practice of knowledge production –
as I will show in the following with the configuration of users.
    Against this background critical gerontologists argue that UCD fails to
involve older people adequately (Lassen et al. 2015; Merkel and Ku-
charski 2019). It is criticised for instance that their participation primarily
functions to legitimize technological development or should foster the
market success by improving the fit of prototypes with user requirements
(Endter 2016; Neven 2010; Peine et al. 2014). Moreover, it is stressed that
certain age groups are often underrepresented in UCD, such as socially
deprived or educationally disadvantaged older people (Biniok et al. 2016;
Künemund and Tanschus 2013; Compagna 2012).

2.2 Turning to the user: the perspective of (feminist) science and
   technology studies

    At the beginning of the 1980s there was a growing interest in users
beyond technical sciences (Joyce and Mamo 2006; Oudshoorn and Pinch
2003b). According to Mackay et al. (2000), this increased interest is based
on an emerging scientific debate on technology in social sciences, which
negotiates the question of the social construction of technology. The
works of Trevor Pinch and Wiebe Bijker (1984) on the social construc-
tion of technology (SCOT) are linked to this turn to the user in early STS
research. They assign a significant role to users in the stabilisation of a
technology. According to Pinch and Bijker, users are significantly in-
volved in the “closure” (1984) of the interpretative flexibility of a tech-
nology. They illustrate these closure processes with various examples,
such as the invention of the bicycle or Bakelite (Bijker 1995; Bijker et al.
1987; MacKenzie and Wajcman 1985; Pinch and Bijker 1984).
Endter                                                                     97
    Steve Woolgar (1991) also uses the idea of interpretative flexibility,
whereby, unlike Pinch and Bijker, he does not regard the closure as a ne-
gotiation of users, but rather as a practice of designers and developers,
whereby he makes use of the semiotic analogy of machines as text and us-
ers as readers. He defines this practice as a configuration of users, in
which “the user’s character and capacity, her possible future actions are
structured and defined in relation to the machine” (Woolgar 1991, 89).
He interprets this work of defining, enabling and limiting as “boundary
work” (Woolgar 1991, 90). The result of this boundary work is a user-
technology relation that is configured by the designers, not by the users.
The latter are only given access to the use of the technology. Therein, the
interpretative flexibility of the machine as text is limited. With his semiot-
ic approach Woolgar is able to reveal user representations and imagina-
tions of designers and developers. At the same time, the strongly semiotic
orientation limits the conception of users and thus the analysis of the us-
er-technology relation to its representative function and excludes other
actors involved in the configuration. In contrast, Mackay et al. (2000) ar-
gue for the opening up of Woolgar’s concept and taking more account of
the configuration of designers by users or institutions to which they are
connected. They suggest an understanding of configuration as a fluid, sit-
uated and constructive practice.
    In contrast to Woolgar, who emphasizes the encoding of users by de-
signers, Madeleine Akrich (1992) develops an approach that places the
inscription of user representations at the center of her analysis. She re-
veals how the developers, in the process of designing technology, inscribe
their ideas about its use, but also their preferences, competencies, morali-
ties and attitudes into technology. She refers to the material-semiotic or-
der that develops in the process as a “script”. Although the users can
modify the script, they are not involved in the scripting procedure.4
    Within these strongly semiotic approaches of Akrich or Woolgar, the
power dimension within the configuration of the technical artefact re-
mains largely undiscussed. Although Woolgar does refer to the powerful
practices that are needed to involve users in a way that is beneficial to the
success of the project, his semiotic orientation limits the conception of
users. Here feminist approaches provide a different perspective on tech-
nology development, in order to show the boundaries on which the con-
stitution of a technical artefact on the one hand and its users on the other
hand are based (Forsythe 2001; Moser and Law 2003; Rommes et al.
2012; Suchman 2007). For example, Lucy Suchman (1993; 2006; Such-
man et al. 2002) has explicitly gone beyond the academic debate and has
made feminist STS approaches productive for the work in the field of
Computer Supported Cooperative Work. In this context, thinking about
older users from a feminist STS perspective was also given a renewed im-
pulse in the field of Aging Studies (Endter 2020; Höppner and Urban
2018; Joyce and Mamo 2006; Latimer 2018; Mort et al. 2013). Here a key
aspect of this research is the consideration of users and technology as mu-
98                                                        Tecnoscienza – 11 (2)

tually co-constituting phenomena (Aceros et al. 2015; Endter 2018; 2020;
Östlund et al. 2015; Peine and Neven 2019; Wanka and Gallistl 2018).

2.3 User participation as a matter of care

    Theorising user participation from a feminist STS perspective shifts
the focus towards the politics of user participation. Therefore, I draw my
attention to the “intra-active open-ended performative processes of be-
coming that reconfigures connectivity, constraints and exclusions”
(Suchman et al. 2002, 163) in the alignment of age and technology. Fol-
lowing Suchman (2007), when theorising the configuration of older per-
sons as users, the matters of fact about age and technology in the rou-
tinised work of user integration has to be scrutinised. This means that it
has to be examined what this work of assembling and reassembling older
people as users means for the configuration of age in technology devel-
opment.
    This focus on users-in-the-making opens up the opportunity to “inves-
tigate the imaginative and practical activities through which socio-
material relations are reproduced and transformed” (Thygesen and Moser
2010, 131). Thereby the goal is not to unmask the developers as ignorant
towards the diversity and complexity of age and older users’ needs, but
“to move beyond critique” (Pols 2018, 2) by contesting the images taken
for granted about age and assistive technologies in such an emergent con-
text like elderly care technologies (Asdal and Moser 2012). On the one
hand we find a manifest imagination of age as decline and loss, especially
when thinking about old age cultural images are determined by notions of
frailty or vulnerability (Gilleard and Higgs 2011; Katz 2015). On the oth-
er hand we have a contradictory imagination of assistive technology, tel-
ecare or robotics as innovative and helpful (Hergesell 2019; López
Gómez 2015; Neven 2015). This juxtaposition of age as imagined as in
need for technical care and technology as being able to provide this kind
of care determines the age-technology-relation in the context of assistive
technologies.
    For feminist STS research this can be understood as a call to “stay
with the trouble” (Haraway 2016) when doing research on age and tech-
nology. This means, for example, asking who sets “the conditions for
practices and for what kind of realities that are made possible” (Thygesen
and Moser 2010, 131) or pointing out how participation could have been
undertaken in a different manner or how alternative configurations of us-
ers were excluded in the design process. Therefore, to think of user-
centred design as a “matter of care” (Puig de la Bellacasa 2011) is a prom-
ising approach to make these entanglements and power relations visible.
In her consideration of technology, Puig de la Bellacasa expands Latour’s
conception of technology as a “matter of concern” (Latour 2004) by re-
ferring to the affective dimension that accompanies things of concern.
She states: “We must take care of things in order to remain responsible
Endter                                                                    99
for their becoming” (Puig de la Bellacasa 2011, 90). For Puig de la Bel-
lacasa this responsibility is also an “ethico-political obligation”. For her,
as a feminist scholar in the study of technology, this means that “we need
to count all the concerns attached to [technology], all those who care for
it” (2011, 90). In contrast to Latour, for Puig de la Bellacasa this also
means taking a stronger stand for a position that takes into account the
persistent forms of power, exclusion and inequality when dealing with
matters of concern.
    Following Puig de la Bellacasa, I consider the development of tech-
nology in general and the involvement of users in user-centred design in
particular as a “matter of care”. This conceptualisation throws light on
the question of power and hierarchy that undermine the participation
process. Caring in this sense is not understood as a work dedicated to the
development and functionality of the artefact, as Treusch (2015), for ex-
ample, clearly shows in her research on robotics, but as a reflexive prac-
tice that asks how the project members involved in the constitution of the
technical artefact evaluate their actions of user involvement and to what
extent they see themselves as responsible for the involvement of older
people as users in the design of the technology.
    From a feminist perspective, it matters whose interests are represented
in technological development, whose work is rendered invisible, who is
considered important enough to be included in the socio-material assem-
blage and who is excluded (Puig de la Bellacasa 2011; Suchman 2007;
Moser and Law 2003). This goes along with Mol, Pols and Moser’s notion
of care in practice as “a persistent tinkering in a world full of complex
ambivalences and shifting tensions” (Mol et al. 2010, 14). They under-
stand these practices of tinkering as a form of doing good care, whereby
“[t]he good is not something to pass a judgement on, in general terms
and from the outside, but something to do, in practice, as care goes on”
(2010, 13). With regard to user-centred design this means asking to what
extent the agents involved in the process consider their own actions as
good. It also means questioning the postulated ideology of user participa-
tion as a “good thing” (Mackay et al. 2000) for older people.
    To question this goodness of user participation I refer to Joan Tron-
to’s (1993) criteria of good care. Although Tronto does not take an STS
perspective her conceptualisation of good care is fruitful for thinking
about the relation of age and technology and linking STS and Aging
Studies. According to Tronto, good care is characterised by attentiveness,
responsibility, competence and reciprocity. Tronto argues that these re-
quirements must be fulfilled for carers to be able to recognise the needs
of others (caring about), to carry them out (care taking) and to serve them
(care giving), thus building a mutual relationship between carers and
those who are cared for (care receiving) and thus providing good care.
Tronto’s criteria can function as a heuristic for examining the extent to
which user-centred design actually empowers users to participate in the
design process and fosters a fit between technology and user needs.
100                                                         Tecnoscienza – 11 (2)

Therefore, I apply Tronto’s criteria of good care to user-centred design
and analyse how the different spatial, affective, discursive and material
practices of configuring older users are attentive, competent, responsible
and reciprocal and thus representing a “specific modality of handling
questions to do with the good” (Mol et al. 2010, 13).


3. Configuring Dementia
     With the focus on dementia, ageing is no longer stigmatised as an age-
specific loss of physical capabilities and competences, it is also configured
as cognitive decline and the loss of personhood (Alzheimer’s Disease In-
ternational 2018). These scientific depictions of dementia in neuroscien-
tific and cognitive psychological studies are echoed in public discourses
about dementia as a threat or burden either to society or to the welfare
state, but these cultural assumptions and normative expectations are en-
tangled with material figurations of dementia for example in scientific la-
boratories (Åsberg and Lum 2010), clinical memory consultations (Moser
2008), care practices and environments (Spindler 2018) or in technology.
     Sociologists working critically on this double stigmatisation decon-
struct the fear of dementia as expression of our “cognitive culture” and
modern individualism (Katz 2012). For example Latimer shows in her
study on biomedical research how dementia is constructed as “the worst
of what ageing does to people” (Latimer 2018, 839; see also Latimer and
Puig de la Bellacasa 2011) and coincidently this construction legitimates
medical research and intervention. Also Moser outlines Alzheimer’s Dis-
ease (AD) as a powerful material-semiotic assemblage that mobilises dif-
ferent actors like for example scientists responsible for putting AD
squarely on the public discourse and policy agenda as a significant topic
(Moser 2008). Åsberg and Lum (2010, 329) critique the decontextualiza-
tion and objectification of AD in biomedical imagination and scientific
practice and highlight “the subject positions thus rendered available” in
the object-subject-positionings of biomedical practices. Against the pow-
erful instrumentalisation of dementia in the public health and scientific
discourses, researchers such as Twigg and Buse (Twigg 2010; Buse and
Twigg 2014, 2016) emphasise the role of materiality to reconfigure the
ageing-dementia-relation. In their research they point out how the mun-
dane practices of everyday clothing enable people with dementia to re-
claim their status as autonomous subjects. Similarly, Kontos (2004; 2005;
2015) is broadening the empowering scope of embodiment in describing
the bodily practices of remembering for example in dancing or singing.
And Swinnen (2016; Swinnen and de Medeiros 2017; Swinnen and
Schweda 2015) shows how people diagnosed with AD express themselves
in poetry slams in a New Yorker day-care hospital. These research find-
ings contradict the normative image of dementia as a loss of cognitive
abilities and personhood, instead they reveal the mundane acts of per-
Endter                                                                     101
formatively reconfiguring identity as an ongoing discursive articulation
and material formation (Endter 2020).


4. Methodological Approach
    The following ethnographic description of the configuration of older
people as users in user-centred technology development is based on my
fieldwork in the state-funded research project MemoPlay.5 From March
2014 to November 2014 I conducted fieldwork in the project, which in-
cluded accompanying the project members in their work, conducting in-
terviews and actively participating in the tests as study personnel of the
project. Furthermore, I conducted interviews with the older usability test
participants and took part in their trainings at home as a participating ob-
server. The fieldwork in MemoPlay was part of a larger field study in the
context of my dissertation, in which I ethnographically examined differ-
ent state-funded research projects on the development of assistive tech-
nologies for older people from 2014 to 2016. Most of them were part of
the BMBF research agenda of Active and Ambient Assisted Living
(AAL).
    The empirical analyses presented here is based on my field notes, pro-
tocols, interview transcripts and minutes of conversations, as well as the
field documents I have collected during my participation in the project.
All interviews were transcribed and coded with MAXQDA. The coding
procedure of my ethnographic material and its analysis is based on
Grounded Theory in its reflexive (Breuer et al. 2010) and situational
(Clarke 2012) modification. Furthermore, I have triangulated the ethno-
graphic material with a document analysis of the BMBF research program
on active and ambient assisted living from 2008 until 2016.
    As ethnography always focuses on the single case – here the state-
funded technology development project MemoPlay – the interpretation
of the practices, meanings and structures is always situational and contin-
gent (Rabinow 2008; Marcus 1995). Concentrating on a single project al-
lows me to go into greater depth to describe the different groups of actors
in their heterogeneity and relativity. At the same time, the analysis reveals
problem areas and solution strategies that go beyond the individual pro-
ject, allowing conclusions to be drawn about the field beyond the single
case. The empirical analysis given here highlights the final usability test by
describing the first meeting of the older participants with the project
members Stefanie Müller and Thomas Beyer. Müller and Beyer are staff
members of the gerontological research institute and responsible for the
user involvement in the user-centred design of the project. In the empiri-
cal analysis given here I will ethnographically describe the first visit of the
older usability test participants in the final usability test of the project.
102                                                         Tecnoscienza – 11 (2)

5. Case Study
    MemoPlay is the name of a German state-funded technology devel-
opment project. From 2012 until 2014 it developed an interactive online
platform. This platform contains three different components: a memory
training – its central component – a communication tool to chat or for
videotelephony and an information section for users with short films and
texts about age-specific topics such as healthy living, nutrition, mobility
and security. It should enable older people suffering mild cognitive im-
pairment (MCI) to train their cognitive abilities by conducting the
memory training. As a stand-alone application that can be installed both
on a standard tablet or on a personal computer, it is intended for individ-
ual use at home without the need for assistance from care givers or medi-
cal staff.
    The memory training consists of six different exercises in which, for
example, the older user has to sort words to colours, mentally rotate ge-
ometric objects or compare numerical values. Five of these six tasks must
be completed per training unit. The selection of the tasks as well as their
degree of difficulty is determined by the programme’s algorithm. After
each unit a chart appears on the screen that reports the test results back
to the user and compares them with the points already reached. With the
help of the training, the cognitive performance of the users should im-
prove over the course of the training.
    The interdisciplinary research project team consists of three academic
project partners – a gerontological research institute, a geriatric hospital,
and a research institute for artificial intelligence (AI) – and two non-
academic partners – an IT service provider and a provider of medical de-
vices. The non-academic partners and the research institute for AI were
mainly responsible for hard- and software development. The gerontologi-
cal research institute and the geriatric hospital carried out the user in-
volvement following a user-centred design approach.
    In the user-centred design of the project people aged sixty years and
older were involved as interview partners or test users in three different
stages of the technology development: the requirements analysis, the
formative evaluation and the summative evaluation of the prototype.
    In the requirements analysis twelve participants – half of them diag-
nosed with MCI – had to fill in two standardised questionnaires to evalu-
ate their technical competence and technology acceptance. Afterwards, a
standardized interview was conducted with them. The interviews were
analysed in-depth to derive requirements that should lead the iterative
design process.
    During the formative evaluation brief surveys were conducted in the
day clinic of the geriatric hospital. For example, paper prototypes were
tested in small samples up to five older people. They were shown differ-
ent designs of pictures, icons or logos and asked which one they thought
would better meet their needs or be more intuitive. More complex ques-
Endter                                                                    103
tions, such as the design of the menu navigation or the user interface,
were tested with a larger group of patients of the day clinic using
mockups to illustrate the design more adequately. All participants in the
formative evaluation were diagnosed with MCI.
     In addition to the formative tests in the day clinic a laboratory testing
was carried out by the gerontological research institute after 18 months of
the project’s running time. Sixty people had to test one of the later six ex-
ercises of the memory training as well as various other functions, such as
receiving and carrying out a video call. During their tests eye movements
and facial expressions were tracked, logging data was collected and the
behaviour of the persons was recorded. In this sample, too, half of the
participants were diagnosed with MCI.
     The final usability test of the summative evaluation started after com-
pletion of the development of the prototype in spring 2014. A total of
eighty people – half of them diagnosed with MCI – was selected and di-
vided into four groups of twenty people each. One test group carried out
the memory training on a tablet, another on their home PC. The other
forty people were divided equally between an active control group testing
a video game and a passive control group not receiving any intervention.
Participants were found through a senior university, advertisements on
the Internet and the gerontological research institute’s network.
     While the previous tests were mainly concerned with aspects of usa-
bility and technology acceptance, the final usability test pursued a further
scientific question. The gerontological institute and the geriatric hospital
also wanted to find out whether regular memory training has a measura-
ble effect on cognitive performance and neural structure. To assess cogni-
tive performance of all participants, the test persons had to complete var-
ious psychological tests measuring their cognitive abilities at the begin-
ning, in the middle and at the end of the usability test. From the persons
assigned to the active test groups doing the memory training on tablet or
PC, twenty were randomly selected to undergo magnetic resonance imag-
ing (MRI) at the beginning and end of the eight-week test. The aim of the
MRI examination was the visual detection of structural changes in the
cortex due to training. If abnormalities were found during this examina-
tion, the person was informed and advised to consult a specialist to clarify
the findings. This scientific evaluation of the training was a strong motiva-
tion for test users to participate in the study, as they repeatedly empha-
sised during interviews. Many hoped to obtain more precise and, above
all, scientifically proven information about their cognitive performance.
For most of the participants, cognitive fitness was proof that they were
not yet old and did not show any signs of dementia.
104                                                            Tecnoscienza – 11 (2)

6. Empirical Analysis
    On a sunny Monday morning in May 2014, twenty older people arrive
at the gerontological research institute for the first time. In the study
room the tables have been already arranged in a closed rectangle. Each
place has been prepared with a nameplate and a folder with information
about the project, the agenda of the day and further information about
the study. The people in the room have been invited to take part in the
usability test of the project. As a test person, it is their task to test the pro-
totype at home for eight weeks, to undergo psychological tests to deter-
mine their cognitive performance, and – if randomly chosen – to take part
in the MRI examination at the beginning and the end of the usability test
period. In addition to the participants, the two project members Stefanie
Müller and Thomas Beyer, who both work at the gerontological research
institute, and myself are present.

6.1 Spatial and affective user configuration

    After all participants have arrived Müller and Beyer start their presen-
tation. Müller informs the participants what will happen over the course
of the next weeks and explains the study. She repeatedly emphasises how
important it is that older people are involved in the development of tech-
nology that they will later use, hence why it is so important that the par-
ticipants are here today and have agreed to participate in the study. She
also appeals to their individual ambition and sense of responsibility when
she describes the user test. No questions are asked during her presenta-
tion, everyone is listening carefully. Some take notes, but most of them
follow Müller’s explanations and wait and see how things will unfold.
    In the further course of the test, they also only react when asked, they
keep quiet, they complete the questionnaires without asking questions
and they agree to the tests Müller and Beyer are doing with them, even if
some mention later in a subordinate clause that they felt uncomfortable in
the test situation they had to undergo during their visit. They want to ap-
pear competent and informed and, as if their participation would be put
to the test, they want to prove themselves as suitable candidates.
    In this test situation Müller and Beyer create a social situation, which
addresses participants as users and encourages them to take on this role.
For this purpose, the participants are placed in a spatial setting that is
largely foreign to them, such as the things (questionnaires, psychological
tests) and persons (study personnel) with whom they interact within this
setting.
    In addition, the older participants have to prove their cognitive abili-
ties in front of two strangers who not only lead the study and thus seem
to have a specific social status qua professional position, but also distin-
guish themselves from them as “scientists”. Thus, they not only assign a
specific role to the participants, but also assume one themselves. Within
Endter                                                                     105
this setting, emotions such as shame and social norms, such as respect for
authority, play a crucial role in understanding why the participants be-
have passively. Furthermore, the presence of the other participants rein-
forces the assumption of the role as test users. This also explains why no
exchange between the participants develops in the further course of the
event. When social communication takes place, it occurs on a hierarchical
level in exchange with the coordinators of the study.
     Müller and Beyer thus not only create a social, but also a normative
space that promotes the assumption of the role of test users. In contrast
to Müller and Beyer, who – as study coordinators and staff members of
the gerontological research institute – can be assigned to the scientific
field, the older participants are configured as a homogeneous group – the
test users. The participants only know each other’s names, but they do
not have any information about age, profession or personal attitudes. This
liminality enables Müller and Beyer to assign a new role to the partici-
pants and to spatially, affectively, discursively and materially code them
according to this role. The spatial setting (a conference room in a scien-
tific research institution), the materialities at hand (information material,
presentation techniques, test sheets) and their own role as scientists help
them to do this.

6.2 Discursive and material user configuration

    In addition to the spatial setting, the dichotomous construction of
study coordinators and test users along with the resulting asymmetrical
positioning of the older participants, it is Stefanie Müller’s lecture that
convinces participants to take on the role of test users.
    She is the welcoming project member, the professional scientist, the
sovereign study coordinator. But she is also the test supervisor who pro-
vides the participants with questionnaires and test procedures to measure
and classify their cognitive performance. What is striking here is the re-
peated reference to how important it is that those present take part in the
study and thus make a central contribution not only to the MemoPlay
project but also to the development of gerontechnologies as a whole.
    Stefanie Müller does, however, not mention that the participation of
older people is also highly relevant for the project team in order to meet
the requirements of the funding authorities. Instead, she appeals to the
sense of responsibility of the participants and stresses how important
their feedback and test results are for the development of the prototype.
Neither does she mention that its development has already been complet-
ed at the time the usability tests are carried out. At the end of the usabil-
ity test, none of the eighty participants will have terminated prematurely,
all will have undertaken their exercises twice a day and completed the test
tasks as well as the medical examinations.
    In repeatedly referring to the value of the training for the scientific in-
vestigation of cognitive performance, Müller does not only appeal to the
106                                                         Tecnoscienza – 11 (2)

participants’ sense of responsibility, but also to their ambition to achieve
good results and to prove that they are cognitively capable, on the one
hand, and on the other hand, to their fear of getting Alzheimer’s Disease,
thus indirectly referring to the discourse on dementia. In her speech,
Müller refers to the dementia discourse uncritically and places the users
in the asymmetrical dementia-technology relation in which older people
are regarded as potentially affected by cognitive impairments due to their
age.
     However, it is not only the study coordinators Stefanie Müller and
Thomas Beyer, the spatial setting, the study situation and the circulating
scientific knowledge that configure the older participants as users, but al-
so the psychological test procedures and questionnaires used in the test to
assess cognitive performance. In their materiality they witness the scien-
tific authority of the study coordinators and contribute to their scientific
performance. The test procedures not only generate different numerical
values, but also rank the participants according to their performance and
classify them into those without MCI and those affected by MCI. There-
in, psychological tests tame older persons to fit into their assigned roles as
users (Pols 2012, 144).
     Of course, the participants are by no means passive puppets, they also
participate in the configuration as users. Nonetheless, there are gradual
differences between their own commitment and agency as users and the
discursive and material practices of the study coordinators that configure
them as users and situate them in the asymmetrical user-technology rela-
tion of the user-centred design (Endter 2018; López Gómez 2015; Neven
2010).


7. Discussion

7.1 User configuration as a matter of care

    In the analysis of the different practices of configuration it has become
clear that the usability test represents a critical situation in the develop-
ment process. It is Müller and Beyer’s task to handle this critical situation
by integrating the older participants into the role of test users so that they
“most likely act like users” (Woolgar 1991, 82). But the participants are
“complex, fragmented in nature, and are attributed with varying signifi-
cance“ (Mackay et al. 2000, 738). To handle this complexity, Müller and
Beyer employ different powerful practices that configure the participants
as users spatially and affectively as well as discursively and materially. In
this, user configuration becomes a powerful practice that distinguishes
between those who assign positions (project workers) and those who are
placed in those positions (older people). The asymmetrical relationship
between project members responsible for conducting the usability tests
and older test users who performed the tests guarantees that the test users
Endter                                                                    107
behave in accordance to their role, develop a high level of compliance
with the test procedure and ensure that the prototype evaluation is car-
ried out. At the same time, this hierarchy ensures that the uncertainty in-
troduced by the participation of older people is brought under control.
     With regard to the question, if these practices of configuration can be
regarded as practices of care, I return to Tronto (1993). She stresses that
care is characterized by attentiveness, responsibility, competence and rec-
iprocity. Considering the practices of Müller and Beyer, the empirical
analysis shows that they meet the criteria mentioned by Tronto to a cer-
tain extent: they are attentive to the participants, ensure that they feel
comfortable in the test situation, emphasize the importance of their par-
ticipation and show how useful they are as users for the development of
technology. In doing so, they signify the decision of the participants to
take part in the usability test as a practice of good care – in the sense that
they contribute to research and innovation as well as a better life for other
older people when using assistive technologies. Furthermore, they them-
selves take on responsibility for the participants and prove their scientific
competence in conducting lectures and test procedures. At the same time,
it becomes clear that these practices are always aimed at involving the
participants in such a way that they neither delay nor hinder the devel-
opment of the technology, that their results do not endanger the success
of the project and that they correspond to the user representations of the
project and thus of the artefact. Müller and Beyer’s actions are, however,
not reciprocal – the last of Tronto’s criteria. The test users only get in-
volved when it is useful and helpful for the project. More participatory
formats or participations that go beyond testing prototypes or being in-
terviewed to evaluate technical features are not applied.
     It becomes clear that the project members do indeed make an effort
to involve older people in a good way. They do act to a certain extent at-
tentively, responsibly and competently. However, they are basically not
oriented towards the good of the users, but towards the success of the
project and thus the development of a new technology – in this case the
interactive online platform for memory training. However, this orienta-
tion contradicts the actual orientation of user participation as democratic
and emancipative, and cannot be reconciled with Tronto’s criterion of be-
ing a reciprocal interaction. This clearly shows that the project members’
concern for the users cannot be described as good care in the sense of
Tronto. Rather, it becomes apparent that good care is not addressed to
the users, but to the technology. What follows from this if user participa-
tion is considered a matter of care from a feminist perspective? First of
all, it shows that user involvement is ambiguous, situational and contin-
gent. Beyond this, it also calls into question what can be regarded as user
participation in technology development in general and user-centred de-
sign in particular. In this it can be seen an opportunity to show how the
participation of older people in technology development is a practice that
needs to be taken care of. On the one hand, UCD represents the oppor-
108                                                         Tecnoscienza – 11 (2)

tunity for older people to be involved in the development of technologies
that are important for them. User participation offers the possibility to
counteract stereotyping and deficient images of age and raise developers’,
software engineers’ or designers’ awareness to the heterogeneity and mul-
tiplicity of age. On the other hand, it has been emphasised at various
times that older people often do not participate as participants in the hu-
manistic, democratic sense of participatory design but as preconfigured
test users. Here it becomes clear that both the question of when participa-
tion takes place and the question of how it takes place is an expression of
a specific power relation in which older people are involved but do not
participate. Herein, UCD is a relational, situated practice with shifting
powers and moving targets. It cannot be judged as enabling or paternal-
istic, instead it is ontologically multiple (Mol 2002). Latimer calls such
heterogeneity “a multiple inhabited by a multitude” (Latimer 2019, 277).
In this multiplicity the older participants are configured in the spatial, af-
fective, material and discursive practices of the project members in order
to witness a user-centred design of the prototype without participating in
the development of the prototype.
    Against this background Neven (2010; 2015) asks why more and more
older people should be involved in technology development and suggests
that the outcomes of participation should be scientifically evaluated ra-
ther than continuing current practice. Künemund (2018) argues similarly
with regard to the German AAL funding programme and calls for a prob-
lem-oriented scientific evaluation as starting point of technology devel-
opment that should be carried out independently of the involvement of
older people. Wanka and Gallistl (2020) also demand a revision of the
funding programmes which envision other participation formats of older
people. This article adds a feminist perspective to these calls with the aim
of intervening against established practices and views of older users and
power relations in UCD as explained in the following.

7.2 Being reflexive: the politics of doing research on technology

    Participating as a feminist STS scholar in the user-centred design im-
plies “reclaim[ing] and reinvent[ing] the politics of relation” (Latimer
and López Gómez 2019, 251). This means critically asking how one’s own
research stabilises the normative potential of user participation as good.
While Puig de la Bellacasa emphasises “the ethico-political obligations”
(2011, 90) that shape our research, reassembling the often-neglected “re-
al” users and what they imagine technocare to be like, this implies “stay-
ing accountable to the politics, power and privilege involved in such
work” (Martin et al. 2015, 630). This can be a form of care. This suggests
understanding research as an open-ended and “response-able” (Barad
2007) process of “being alongside” (Latimer 2019) or as Martin et al.
have claimed it: “As the contexts in which we work become seemingly
more urgent, that is, more critical, we must become even more cautious
Endter                                                                   109
about how we enact our care. Likewise, the greater success we STS schol-
ars have in world-making, the more we have to be accountable to and
take responsibility for those whose lives we touch” (Martin et al. 2015,
635-636). In the context of assistive technologies this means taking on ac-
countability for the world-making effects of one’s own research and the
intimate entanglements in the research process including participation in
the configurational practices of user participation. Thinking about the
technology-age-relation in UCD from a feminist STS perspective broad-
ens this reflexivity to the question of intervention. By re-contextualizing
the powerful practices of Müller and Beyer as care that is contradictory,
multiple and relational instead of objective, quantifiable and per se good,
is an attempt to intervene into the politics of age and technology as it is
powerfully enacted in the policy agendas of active and assisted living. Ex-
plicating the boundaries, differences and contradictions that constitute
technocare, scatters the normative power of user participation as a “good
thing” and opens up the multiple ontologies of the age-technology-
relation.


8. Conclusion

    The ethnographic description showed how older people are config-
ured as users in user-centred design in state-funded research projects on
the development of AAL technologies in Germany. It pointed out that
the involvement of older people in the design process is a critical situation
for technology projects and their outcomes. By ethnographically describ-
ing the practices of configuring users in the state-funded AAL project
MemoPlay, it could be illustrated how participation is limited to passivity
and control. In this, UCD can be understood as a powerful practice “that
includes particular objects of attention and concern and inseparable
knowing subjects” (Suchman 2011, 134) and at the same time excludes
and makes invisible other practices and subjects. The result of this
boundary work is the constitution of older people as users of assistive
technologies in the design process that do not question the design pro-
cess. Against this background it becomes clear that user participation is
less a manifestation of the participation process of older people than of
the powerful practices of establishing controllable users. If UCD should
lead to an involvement of older users it must become a matter of care for
those responsible for the user involvement. Tronto’s criteria can lead here
as a taxonomy that can guide the participation process and lead to a more
participative involvement of older people as users in the development of
technologies that should fit their needs and not in reverse.
110                                                            Tecnoscienza – 11 (2)

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    1
       The dissertation “Assistiert Altern. Die Entwicklung und Nutzung technischer
Assistenzsysteme für ältere Menschen aus kulturanthropologischer Perspektive” is
published in spring 2021.
     2
        MCI can occur at an older age and cause impairments of memory, attention and
thinking. These may be significantly below the performance usual for the respective age and
educational level without significant everyday restrictions (Etgen et al. 2011). However, it is
assumed that MCI is associated with a highly increased risk of dementia, especially with
regard to the occurrence of Alzheimer's dementia (Pantel and Schröder 2007).
     3
       In addition to the more narrowly defined user-centred design, there are a number of
approaches that address a broad group of users, such as human-centred design, design for
all or universal design. They all have the common objective of designing human-technology
interfaces for all users, regardless of previous knowledge and experience, age or gender.
These design approaches have their origin in early trade union efforts to improve the
computer workstations of employees in Scandinavia (Ehn 1989; Bødker and Pekkola 2010).
     4
       Akrich (1992; 1995) uses the terms “subscription” and “de-inscription” to describe
precisely those processes of appropriation that run counter to the action programmes. De
Laet and Mol (2000) later expand the idea of re-scription with their concept of fluid
technology to point out the creative and unpredictable practices of use and modification.
     5
        The project name, places and persons mentioned in the following have been
anonymised by the author.
