Table 1.

Study characteristics (qualitative studies)

Study ID	Country	Study description	Participants	Setting (nursing home/care home)	Study aim and context of robopet exposure	Data collection	Analysis (tools used)
Birks 2016	Australia	Qualitative exploratory study	3 recreational therapists	125‐bed aged care facility	To explore the experience of therapists using PARO (baby seal) as a therapeutic tool with a diverse group of residents. Paro was employed daily as a diversional therapy with selected residents in either an individual or group activity. Each session was 30/40 min. Residents encouraged to interactively engage with Paro including stroking, cuddling and speaking. This occurred over 4 months	Semi‐structured interviews for 1 hr each. Each therapist also asked to maintain a journal	Inductive thematic analysis from the verbatim interview scripts and therapists journals
Chang 2013	USA	Observational study	10 residents displaying mild to severe cognitive impairment, 2 therapists	1 nursing home	To explore how using Paro as a multimodal sensory stimulus in a group activity affected the residents’ interactions with Paro itself, other people, the environment, and how the group used Paro; and to understand therapists’ perceptions and reflections on Paro's use in therapy. Paro was introduced to a small group of 4–7 residents as an activity for 8 weeks. The therapist led the activity, showing Paro to the residents and encouraging them to interact with Paro. The activity was open and flexible and residents did not attend all therapy sessions	Interviews before and after with 2 therapists	No details given
Chang 2015	USA	Observational study	Residents with dementia, staff and visitors	1 nursing home	To understand the social shaping process of the PARO seal human–robot interaction Paro was brought into the nursing home 2–3 times a week, for 1 hr per visit. 35 visits were made over a period of 13 weeks. PARO was placed at the centre of the table in specific areas. People were free to interact with PARO as they liked without guidance from the researchers	Informal interviews Observations Semi‐structured interviews with 8 staff	Field notes and interviews coded. Anthropological approach taken for the qualitative analysis to identify patterns
Giusti 2006	Italy	Ethnography	Residents with dementia	1 nursing home	To understand the interpretative dynamics in human–robot interaction by observing nursing home residents interacting with Paro. Paro was introduced in a group activity with 5 residents from 2 different areas of the nursing home twice weekly for 4 weeks. Paro was placed on the table, and the therapist left the residents alone to interact for 20 min. The activity was only partially structured, and residents were free to leave the session at any time	Video recording of 4 activity sessions with Paro	Qualitative speech behavioural analysis
Gustaffson 2015	Sweden	Qualitative interview study	11 professional caregivers (RNs, ANs, OTs)	1 dementia care home	To explore professional caregivers’ experiences of an interactive robotic cat (JustoCat) regarding usability, function and effects. Cat introduced as an activity for 7 weeks. Staff were trained by an OT in how to use JustoCat and encouraged staff to talk about JustoCat with the residents and were shown how to stroke it and make it purr. Early sessions were supervised, and the importance of staying with cat was emphasised	Qualitative interviews (used an interview guide to collect narratives relating to the impact/meaning and use of JustoCat in daily/working life, and its functionality)	Analysed using a qualitative descriptive approach, in which patterns were formulated into categories to present the variations in experiences
Iacono 2016	Italy	Narrative therapy study	6 residents with dementia	1 care home	To explore the potential of Paro as a tool for counteracting cognitive deterioration in residents with dementia through non‐pharmacological treatment based on narrative activity. Paro and Sugar (stuffed toy which looks like a seal pup) were introduced to 2 groups of residents (three residents in each group). Each group had 6 sessions with Paro and 6 with Sugar. 3 weekly sessions of 30 min each were conducted over 4 weeks (a total of 12 sessions). The goal of each session was for residents to create stories collaboratively	Video recording of sessions and writing of stories at end of sessions	Narrative analysis–calculate the number of words in each individual story; analyse the story on the basis of the model used in its construction—characters, setting and plot; analyse the settings, how they were described and the plot (which is the story itself and how it evolves over the course of the narration)
Jung 2017	Netherlands	Mixed methods	5 healthcare providers with experience of using Paro	1 care facility	To focus on how people with dementia could benefit from interaction with an animal‐like robot companion that is able to understand and respond to different types of touch. Paro had been available to the healthcare providers for 1 year. Their amount of experience with Paro differed because they cared for different patients with different needs	Semi‐structured interviews	Inductive approach
Moyle 2016	Australia	Pilot feasibility study	5 residents with dementia	107‐bed nursing home	To determine how feasible, effective and tolerable the CUDDLER bear robot was for people with dementia in a nursing home setting. Participants were offered 3 x 30 min sessions per week, for 5 weeks, with CUDDLER in a quiet closed room. Each session there was a facilitator (Registered Nurse with dementia care experience) whose aim was to encourage interaction with CUDDLER using a series of questions	Semi‐structured interviews (series of six questions), conducted by the intervention facilitator	Audio data from interviews/questions analysed with thematic analysis, concentrating on feasibility, tolerability, effectiveness and reliability
Moyle 2019a	Australia	Qualitative	5 participants from a cluster RCT	28 LTC facilities were enrolled in the RCT in South East Queensland	To provide critical reflection and commentary on the potential heterogeneity in responses to Paro during a 10‐week trial. Paro was given to the participant by the Research Assistant and left to interact with it as they wished, wherever they happened to be at the time, unless in the bathroom	Video recordings of participants for 30 min, immediately before (15 min) and during (15 min) sessions at weeks 1, 5 and 10	Coded in Noldus Observer XT using the Video Coding Incorporating Observed Emotion Scheme (Jones, Sung & Moyle, 2015)
Moyle 2017aa	Australia	Qualitative study nested within a larger RCT	20 family members, 10 from Paro and 10 from Plush Toy study conditions	9 LTC facilities	To explore the perceptions of family members about the use of Paro and Plush Toy with their older relative with dementia in LTC. Paro was compared with a look‐alike Plush Toy and usual care. Participants received individual, non‐facilitated, 15‐min sessions three afternoons per week (Monday, Wednesday and Friday between 1.00 p.m. and 5.00 p.m.) for 10 weeks with either Paro or a Plush Toy	Semi‐structured interviews (seven areas of questioning)	Inductive thematic analysis (Braun & Clarke, 2006)
Moyle 2018aa	Australia	Qualitative interview study as part of Cluster RCT	20 staff (Facility manager, clinical nurse consultants, RNs, EENs, Activity coordinators, NAs)	Nine long‐term care facilities across SE Queensland	To explore care staff perceptions of PARO baby seal (version 9) versus a comparative look‐alike non‐robotic animal as regards to the benefits and limitations in dementia care Participants received 3 x 15 min non‐facilitated sessions per week, for 10 weeks, with PARO. A trained RA left the resident with PARO using a prescribed script. Residents could interact with PARO as they liked. The care home staff were not involved in facilitating these sessions, but had opportunities to observe the sessions	Semi‐structured interviews that focussed on seven main areas, additional specific questioning was possible in response to interview responses.	Inductive thematic analyses were used to converge and compare themes. Themes were clustered according to views and experiences and linked to primary outcomes of interest
Niemela 2016 (PC)	Finland	Qualitative interviews study	1 Director Nurse (decision‐maker for municipality nursing homes) 10 professional carers (nurses)	3 Nursing Homes	To explore the process and criteria of adopting robots in elderly care in Finland and experiences of their use All three nursing homes had access to Paro for at least 1 year. Paro circulated between departments so the caregivers in one department typically used Paro 1–2 months at a time and could have periods of several months of non‐use	Semi‐structured interview for Director Nurse and Focus Group interviews for nurses.	NA
Pfadenhauer 2015	Germany	Ethnography		1 residential care centre for the elderly (with dementia)	To explore how people incorporate social robotics into their social interactions, and thereby changing these interactions. Paro was used by two care workers; three sessions per month, all but one session was in a group session	Participant observations and videographic documentation	“Quasi‐Socratic interpretation technique”—researcher gives his peers an exhaustive account of his/her (ad‐hoc) interpretation of a text or a video sequence. Ensuing discourse prompts reflection and revision of interpretation
Robinson 2013a	New Zealand	Qualitative interview study with intervention arm of an RCT	16 residents with dementia and 21 staff (manager, activity coordinator, nurses and caregivers)	1 retirement home with both hospital and home areas	To understand how residents and staff interact with PARO (baby seal) especially within the group format. Two sessions a week over 12 weeks: semi‐structured and resident directed. Topics for discussion available if residents not engaged in their own conversations. Passing round of PARO encouraged	Interviews with residents. Written questions for staff Observation notes during group sessions	Codes from previous robot—human research used and added to. Authors reported “data analysed and common themes noted.”

^aQualitative study encased within RCT (see Table 2 for RCT detail).