Calls of Care: Materializing Posthuman Personhood with Conversational Agents in Dementia Care

Paper Title

Calls of Care: Materializing Posthuman Personhood with Conversational Agents in Dementia Care

Publication Info

• Topic area: Posthumanist approaches to conversational agent design for dementia care.
• Keywords: Dementia care, personhood, posthumanism, conversational agents, participatory design, socio-material assemblages, ethics, human-computer interaction (HCI), care technologies, qualitative analysis.

Background and Problem

• Problem / challenge: Person-centered care (PCC) in dementia focuses predominantly on human interactions, neglecting the roles of nonhuman actors, such as technologies, in sustaining personhood. Existing conversational agent (CA) designs for dementia often treat these systems as passive tools rather than active participants in care assemblages.
• Significance: Addressing this gap can enhance the quality of dementia care by leveraging technologies to support meaningful experiences of personhood, particularly as dementia prevalence rises globally.
• Motivation and related work: Prior work in HCI has explored how artefacts can support personhood but has not fully theorized the agency of nonhuman actors. Posthumanist perspectives suggest that personhood is co-constituted through socio-material relations, offering a new lens for designing technologies like CAs in dementia care.

Solution

• Proposed approach: A theory–method package combining Kitwood’s concept of personhood with posthumanist theories to design and evaluate a conversational agent, Calls of Care, for people living with dementia (PlwD).
• Novelty:
  1. Integration of posthumanist perspectives with person-centered care to conceptualize personhood as socio-materially enacted.
  2. Participatory design (PD) process involving PlwD, relatives, and care workers to iteratively develop a CA prototype.
  3. Empirical insights into how CAs can support personhood through relational acts like recognition, validation, holding, and facilitation.
  4. A reoriented design space for CAs in dementia care, focusing on configuring relations of care rather than anthropomorphism or deception.
• Procedure and key techniques:
  • Conducted a six-month participatory design process in a long-term care home with four PlwD, relatives, and three social care workers.
  • Developed Calls of Care, a CA integrated into a retrofitted push-button telephone, leveraging familiar materiality.
  • Iteratively refined the system’s prompts, hardware, and interaction mechanisms based on feedback and observations.
  • Analyzed conversations using Kitwood’s Positive Person Work framework and situational analysis to trace socio-material enactments of personhood.

Results

• Concrete findings:
  • Moments of personhood were enacted through relational acts such as recognition (e.g., addressing participants by name), validation (e.g., affirming subjective realities), holding (e.g., sustaining emotional topics like grief), and facilitation (e.g., enabling participants to initiate or end conversations).
  • The CA supported meaningful conversations, allowing participants to reflect on personal themes like family and loss.
• Advantage over baselines:
  • Unlike traditional CAs that focus on symptom management or cognitive stimulation, Calls of Care fostered relational experiences and supported socio-material enactments of personhood.
• Experiments / evaluation:
  • Conducted iterative prototyping workshops with PlwD, involving bi-weekly sessions and feedback from care workers.
  • Evaluated interactions qualitatively using audio recordings, transcripts, and care worker reflections.
• Limitations and future work:
  • Limited to short-term interactions with one primary participant (Mrs. A), constraining generalizability.
  • Future work should explore diverse participants, longer-term use, and nonverbal forms of personhood.

Summary

This study introduces a posthumanist approach to designing conversational agents for dementia care, exemplified by the Calls of Care prototype. By integrating Kitwood’s concept of personhood with socio-material perspectives, the system supported relational acts like recognition, validation, holding, and facilitation, fostering meaningful conversations with PlwD. The findings highlight opportunities for CAs to sustain personhood while addressing ethical challenges like anthropomorphism and conversational breakdowns. Future research should expand on these insights to explore diverse contexts and nonverbal enactments of personhood in dementia care.