Wecare:
Care for Elderly Mental Well-being at a Distance

By

Violet Yujiao Zhang
Supervisor: Dr. Garnet Hertz

MASTER OF DESIGN - INTERACTION DESIGN 2024

A CRITICAL AND PROCESS DOCUMENTATION THESIS PAPER SUBMITTED IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF DESIGN

EMILY CARR UNIVERSITY OF ART + DESIGN

© Violet Yujiao Zhang, 2024

Abstract
The global population is rapidly aging, leading to an increase in the number of elderly
individuals requiring care and support. Meanwhile, the birth rates in many countries are
declining, which means a relative decrease in the number of young caregivers while the demand
increases. The One-Child Policy limited many Chinese families to single-child households from
1980 to 2016, creating a shortage of caregiving for the elderly. The elderly in need of care have
fewer children to ‘guard against old age,’ as per a Chinese proverb. Consequently, the One-Child
Policy burdened adult children who cared for their aging parents and grandparents. This research
addresses common mental illness care concerns impacting elderly individuals in families facing
these circumstances and explores ways to support their younger caregivers.
The COVID-19 pandemic has further exacerbated the issue of remote care, heightening the
sensitivity of the elderly and intensifying their sense of loss due to physical decline with age. As
a result, the demand for accessible and barrier-free design has become increasingly critical. To
address this complex issue, this research employs participatory and interview methods to
investigate the factors contributing to psychological changes in elderly individuals.
The scope of the research includes interviews with professionals and adult children as
caregivers, conducting autoethnographic research, journaling and observations to gain further
insights into the psychological challenges currently faced by the elderly. The project aims to
provide an in-depth understanding of the changes experienced by the elderly and clarify the
social and cultural factors associated with these changes. The ultimate goal of the research is to
support a digital mental health tool designed for distant caregivers who often find themselves
under immense pressure while caring for the elderly, addressing the critical need to proactively
understand and tackle potential mental well-being issues in elderly individuals. This digital
mental health tool is named “Wecare” - it is tailored to address the specific needs and challenges
with the aim of enhancing mental well-being, facilitating communication between caregivers and
the elderly, providing education to users, and preventing potential mental illness.

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Land Acknowledgement
I would like to acknowledge that this research has taken place on the unceded territories of the
Coast Salish peoples, including the Musqueam, Squamish and Tsleil-Waututh nations. Unceded
means that this land was never surrendered, relinquished or handed over in any way.
Today, most of BC remains unceded sovereign Native lands, over which neither the Canadian
or BC governments have the legal or moral authority to govern. I hope that our words and
actions today can help to foster a better understanding of how we can support Indigenous
sovereignty as settlers and uninvited guests on this land, and to work to create new relationships
with the Original Peoples of this land based in honour and respect.

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Acknowledgement
Looking back on my 16 years in Canada, from being an international student to a settled
immigrant, I vividly see the conflict between choosing my own lifestyle and returning to be with
my family, especially as an only-child living abroad. However, I am not alone; we are a
community, many of whom share similar concerns. As an interaction designer, I aim to use
research and professional skills to identify issues and propose viable design solutions to help
myself and others alleviate the remote caregiving challenge.
I want to thank my family and friends for their understanding and support, particularly their
assistance throughout my research journey.
I want to express my gratitude to my supervisor, Dr. Garnet Hertz, for his invaluable guidance,
constant supervision and encouragement throughout this journey. His responsibility and patience
were instrumental in the successful completion of this thesis.
I sincerely thank my internal reviewer, Keith Doyle, for his insightful feedback, which
significantly contributed to the refinement of this thesis.
Lastly, I am grateful to all the participants and experts who generously shared their experiences
and thoughts during the interviews and research process.

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Table of Contents
Abstract
Land Acknowledgement
Acknowledgement
Keyword
Motivation
Framing Research
Why
Literature Research: Previous Studies
Research Phase 1 - Background Investigation
Methodology
Data Collection and Analysis
Observations
Problems
Results

Research Phase 2 - User Behaviour Research
Methodology
Data Collection and Analysis
Observations
Problems
Results

Wecare

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3
4
6
6
8
10
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12
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14
17

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20
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Introduction
Design Goal
Definition of Audiences
Design Criteria
Design
Personas
User Journey
Features
User Flow
Wireframe
Design Mockup

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25
26
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27
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Discussion
Limitation and Reflection
Conclusion
References
Appendix A - Diagrams
Appendix B Wecare Walkthrough
Appendix C - Research Ethic

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34
36
40
43

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Keywords
aging, mental health, elder care, remote care, remote communication, remote connection, digital
mental health tool, user experience design, interaction design, service design, health design.

Motivation
The One-Child Policy was implemented nationwide by the Chinese government in 1980 and
ended in 2016.1 Over the 36 years, the policy caused many negative consequences. The birth and
fertility rates declined as sons were generally favoured over daughters; consequently, China’s
gender ratio tilted in favour of men. The relaxed policy from one child to two children resulted in
a statistically significant decline in the male over female gender ratio at birth (Tang et al., 2022).
Meanwhile, the second wave of Chinese emigration to the West started in the late 1970s (Figure
1).2 Many Chinese choose to study, work and live abroad. As a result, those only-child and their
parents live at a distance.
The One-Child Policy changed parenting in most Chinese families in two ways (Figure 2). In
the previous generations, parents could expect many children to support them in old age. For the
current generation, parents have no other option but to rely on one child for support. Children
have been brought up in circumstances very different from those relationships of filial piety in
which elders were the focus of the family (Chen et al., 2021). The contemporary only-child
caring for parents and grandparents is a relatively new 4-2-1 family structure (four grandparents,
two parents, and one child) (Jiang & Sánchez-Barricarte, 2011), placing a high emotional burden
on the only-child.

1

The One-Child Policy was a Chinese government initiative introduced in 1980, restricting most Chinese families to having only
one child. This nationwide program, aimed at curbing the rapid growth of the country’s population, remained in effect until its
discontinuation in 2016. The policy originated from the government’s concern that the rapid population growth could
compromise the nation’s development. The unique challenge arose from the sheer size of China’s population and its
predominantly youthful age structure, which was perceived as a potential obstacle to overall progress.
2

The Second Wave of Chinese Emigration refers to the movement of Chinese people from the mid-19th century to the early 20th
century, following the earlier phase known as the Coolie Trade or the First Wave of Chinese Emigration, which mainly occurred
during the 19th century. The second wave saw significant Chinese migration to various regions, including Southeast Asia, North
America, Australia, and other parts of the world.
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Figure 1: Immigration numbers surged during the period of The Second Wave of Chinese Emigration. (Source: China
Immigration Statistics from 1980-2017, data source: The World Bank,
https://www.macrotrends.net/countries/CHN/china/immigration-statistics) .

Figure 2: The way of parenting changes over time. (Source: Violet Zhang)

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The global impact of the COVID-19 pandemic has heightened awareness of remote care3,
particularly for elderly individuals residing in different countries or separated from their families.
This scenario encompasses elders living in long-term care homes or those who live alone,
emphasizing the need for an in-depth examination of their mental well-being during such times
(Gerritsen & Voshaar, 2020). Despite the increasing focus on remote care, there remains a
noticeable gap in attention regarding the mental health of the elderly. The predominant discourse
often centers on physical health, overshadowing the equally critical aspect of mental well-being.
Hence, there is a pressing need to pay more attention to the mental health needs of the elderly,
considering they endure social isolation for extended periods (Lee et al., 2020). This gap
underscores the importance of investigating and addressing the unique challenges that elderly
individuals face in maintaining their mental health while receiving remote care. Telemedicine, as
a cost-effective, convenient, and accessible healthcare delivery method that has been utilized for
several decades before the COVID-19 pandemic on a limited scale, mainly due to professional,
technological or legal barriers (Doraiswamy et al., 2021; Hassan et al., 2021). Yet, the
COVID-19 pandemic increased the need and growth of telehealth, bringing about a notable shift
in how it is viewed and its role within healthcare systems (Smolić et al., 2022).
However, the existing resources and tools predominantly target physical care, leaving a
significant void in comprehensive support systems that consider the mental and emotional needs
of both the elderly and their caregivers. The lack of specialized products for mental health care in
the remote caregiving context necessitates research to identify gaps in available resources and
explore potential avenues for developing tailored solutions. By understanding these dynamics,
the research aims to enhance remote care practices, promoting holistic well-being for elderly
individuals and those responsible for their care.

Framing Research
Adult children living overseas with aging parents residing in their home country face unique
challenges in providing remote care. In households where individuals reside in close proximity,
the feeling of togetherness often arises naturally as they sense each other’s presence within their
3

Remote care refers to the delivery of healthcare services, monitoring, and support from a distance, usually facilitated by
information and communication technologies. In the context of this research, remote care specifically involves individual
families with the only-child as the main caregiver who lives apart from the elderly in different countries.
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shared surroundings. Nevertheless, this sense of togetherness shifts when individuals no longer
reside in the same place, prompting different ways of experiencing this connection (Shakeri et
al., 2023, p. 1). After discussing with family and friends, I observed that when they live far away
from their parents, it is challenging to balance personal preferences and familial obligations, and
they may hesitate to invite their parents to live with them in a new country due to concerns about
their parents’ ability to adapt to a different environment. Moreover, they usually have a sense of
guilt that they cannot provide care for their parents and are pressured to balance their own needs
and responsibilities with their parent’s well-being. The problem of remote care has become more
serious since the pandemic, and the elderly have become more sensitive with a prominent sense
of loss as their physical abilities decline with age (Aging Changes in the Senses, n.d.; Pitt, 1998;
Charles & Carstensen, 2010 ). As a result, the need for accessibility and barrier-free design
(which aims to create inclusive environments for people of all abilities) is growing, leading to the
creation of numerous products that cater to the care of aging parents. However, as the result of
my previous desk research, I observed that these products on the market primarily focus on the
physical health and accessibility of the elderly while neglecting the importance of their mental
health.
The goal is to significantly enhance the comprehension of mental health concerns among the
elderly population, both within their own awareness and that of their caregivers. By emphasizing
the importance of open communication between caregivers and the elderly, I aim to facilitate
stronger connections and prompt identification of potential mental health issues. Through early
recognition and proactive measures, I aspire to prevent these problems from arising.
How can we design a solution that addresses the factors influencing the mental health of
the elderly, particularly in the context of remote caregiving?
This question takes into consideration the unique challenges faced by only-child caregivers in
Canada and the elderly in China for Chinese families. By examining this particular demographic
as a case study, the research goal is to comprehend challenges and develop a reference
framework for supporting families, potentially inspiring families in other cultures with the same
only-child family pattern.
This project conducted field research on Chinese families in China and Canada as case studies
to explore the daily caregiving challenges, thereby inspiring help for the wider population. It will
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not involve professional mental health diagnostic tests for use in professional clinics but rather
integrate issues found in research to design a comprehensive tool to help caregivers care for the
elderly, especially on being aware of mental health care.

Why
Numerous individuals living apart from their families perpetually grapple with the challenges of
remotely tending to their aging parents, a situation particularly pronounced within Chinese
households characterized by an only-child dynamic. Predominantly, the focal points for many
such individuals involve augmenting communication frequency with their parents and ensuring
their physical well-being and safety. However, a conspicuous oversight lies in acknowledging the
paramount significance of mental well-being as parents advance in age and comprehending the
intricate strategies for managing the stress associated with distant caregiving for the elderly.
This study is primarily tailored to address adult offspring who have assumed the role of remote
caregivers while dwelling abroad, specifically targeting those residing in Canada. In addition, the
secondary audience encompasses elderly parents residing in their country of origin, China.

Literature Research: Previous Studies
In the journal Mental Health and Wellbeing of Older People: Opportunities and Challenges, it is
noted that over 20% of individuals aged 55 or older may experience some form of mental health
issues. Biological changes can affect brain function, social changes may lead to isolation or
feelings of worthlessness, and physical illnesses are often significant contributing factors. Mental
health issues seriously impact elders’ ability to perform basic daily activities, reducing their
independence, autonomy, and quality of life. The first step in mitigating these negative
consequences is diagnosis. Unfortunately, mental health problems often go undiagnosed and
untreated, leaving many elders struggling without appropriate assistance or any assistance at all.
Few mental health providers receive specialized training in caring for elders, and many harbour a
range of societal biases. This therapeutic pessimism among healthcare professionals suggests a
belief that elders cannot change, making psychiatric care seem futile at their advanced age. Thus,
there is minimal investment in developing policies, strategies, programs, and services for elders
with mental health issues (de Mendonça Lima & Ivbijaro, 2013).
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During the literature research, several studies focused on various aspects of mental health
among elders for remote care. These topics include ageism and psychological well-being among
elders (Kang & Kim, 2022), potential digital solutions for remote monitoring of mental health for
elders (Ianculescu et al., 2023), remote social contact to protect mental health among elders
(Hawkley et al., 2021), remote healthcare for elders during Covid-19 Pandemic (Smolić et al.,
2022) and more. Although there are various studies from the perspectives of sociology (Clarke et
al., 2011), economics (The Silver Economy, 2017), and healthcare systems (Prince et al., 2007),
more studies are needed that consider research findings as user pain points to inspire the design
solution from the field of interaction design.

Research Phase 1 - Background Investigation
Methodology
I conducted autoethnography, journaling, observation, and interview methods to address the
research question. I also attended online conferences and processed literature reviews during the
summer field research. Emily Carr University’s Research Ethics Board (REB) approved this
study on July 5, 2023. See Appendix B: Research Ethics for a detailed overview of the REB
process used.
The research undertaken for this thesis involved an extensive review of relevant literature to
establish a comprehensive foundation for the study. A total of 20 scholarly articles,
peer-reviewed journals, and authoritative books were examined to understand the current state of
knowledge in caring for elderly mental well-being at a distance from different aspects. The
literature review aimed to clarify the background and identify key theories, methodologies, and
gaps in existing research, providing a nuanced context for the subsequent investigations. The
analysis involved categorizing the literature into thematic clusters, highlighting recurring trends,
and synthesizing findings to summarize and highlight each agreement and disagreement in the
literature.
I had many conversations with my grandparents and other family members during the
autoethnographic study. I observed and journaled what happened when I took my grandparents to
the community clinic for physical examinations, experienced the current healthcare system, and
learned about government policies in Jiaxing, Zhejiang, China. Moreover, I interviewed one
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counsellor, one professional caregiver, and five adult caregivers who are only-children in their
families in Vancouver, BC, Canada.
I designed two sets of open-ended questions for interviews with two experts and five caregivers
to understand their feelings and difficulties during the caring time.
Data Collection and Analysis
All interviews were audio recorded, and notes were taken during each session. All audio files
were transcribed; I transcribed part of the audio, and Otthor.AI transcribed some of it. I analyzed
and summarized the collected data. All data collection processes for this research followed
ethical standards and received formal approval from the Research Ethics Board. A few leading
questions are below, and these questions also helped during the script analysis:
● What is caregiving, and who provides it?
● What are some common mental health problems among the elderly?
● What causes mental health problems?
● How do caregivers and elders know about mental well-being?
● What are some concerns that caregivers had during remote care?
● How do caregivers and the elderly usually communicate? What device and communication
tools do they usually use?
Observations
People commonly perceive the elderly as a vulnerable group. However, according to research,
elders had a higher likelihood of associating emotional events with knowledge-acquisition goals
than younger adults. Additionally, elders demonstrated a stronger preference for recording
positive events related to knowledge acquisition, indicating a positive effect in the context of
social goals (Ji et al., 2017, p. 7). The bias can stem from stereotypes and assumptions about
their physical and cognitive abilities and societal perceptions of aging. However, it is crucial to
recognize that the elderly population is diverse, and individuals within this group have unique
strengths, experiences, and capabilities.
In the observations, elderly individuals often seemed less concerned about living independently
away from their children. Still, they tend to conceal their difficulties to avoid burdening their
offspring. What is interesting is that many elders have confidence in their ability to care for
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themselves and often favour their own approaches over scientifically tailored ones, particularly
in areas like diet. For example, one interviewee responded as follows:
“Recognize that as an only-child, you will have to make many decisions on your own to help and
care for your parents. At the same time, you will want to respect their wishes.” - Interviewee A

One interesting fact that emerged from a story while interviewing a caregiver is that major
medical procedures like heart surgery can lead to depression and cognitive problems, and few
people knew this fact until it happened. For example, other individuals described this dynamic in
the following way:
“Grandma doesn’t want to live with us, she needs her own space. However, she recently had heart
surgery, and at first she didn’t notice that she was physically declining after the surgery. Later, she
felt emotional changes and was very agitated at night. We took her to the hospital for tests and
examinations and she was diagnosed with depression. We realized that there is a high probability of
depression after heart surgery.” - Interviewee B

The common mental illnesses4 among the elderly are anxiety, depression, and dementia,
confirmed during the expert interview by Sonia Mirani, who has been nursing in a senior care
home in Vancouver, BC, Canada, for 13 years. Mental well-being is an essential aspect of
end-of-life care that is often neglected:
“I think being mentioned that the mental well-being part and then the end of life part is like not only
kind of plan ahead and then the physical pain but also like mentally how the whole family can go
ahead and go through with this process.” - Sonia Marani

Moreover, according to an interview with the Counsellor Ying Ma from Beijing, China, she
mentioned a small number (about 5%) of visitors were elderly, a few of whom came to the
counselling on their initiative. Most of them were coming because their children booked the
appointment for them. However, the elderly are used to solving problems independently instead
of asking for help, and most elderly visitors want counsel on managing their relationships with

4

Common mental illnesses refer to mental health conditions that are prevalent and frequently encountered in the general
population. These disorders affect individuals’ thoughts, emotions, behaviour, and overall well-being. In this research, the
common mental illness among the elderly includes anxiety, dementia, and depression.
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their children and family. Very little is self-centred and involves self-awareness (Y. Ma, Expert
Interview, July 20th, 2023).
On the other hand, caregivers, especially those who are solely responsible for their parent’s
well-being, find themselves in a challenging role and notice that sometimes caring for the elderly
is a stressful experience, especially after major medical procedures. Caregivers expressed a
positive impact of digital mental health tools: mobile apps provide skill building for caregivers,
while web-based services provide skill training or skills exercising and education on their
well-being. Therefore, combining the format of digital tools can lead to creating a useful mixed
tool for addressing the caregiver’s mental health, burden, and stress at the more general level.
Key aspects such as coping skills, emotion regulation, skill development, and education were
highlighted as crucial elements of these tools. However, it was observed that there is a shortage
of digital mental health tools explicitly designed for the caregivers of elders (Petrovic &
Gaggioli, 2023).
Problems
The issues highlighted in this research cover various aspects of elderly care, including but not
limited to challenges related to facility management, incongruent government policies and
community services, caregiver pressure, communication issues, cognitive conflicts between
caregivers and elders, elders’ social connections, and living environments.
Firstly, the community clinic presents challenges such as less seating, accessibility issues, and
limited parking, making it a less-than-ideal environment for elderly patients seeking medical
attention. Additionally, there needs to be more focus on health and wellness initiatives. The
community clinic’s health and wellness bulletin board publicity includes emergency care
knowledge, infectious disease prevention and control, and lung health knowledge. In addition, in
the National Standards for Basic Public Services in China, there is only one report or service
related to mental health: the management of patients with severe mental disorders (National
Development and Reform Commission (国家发展改革委). (2023, August). National Standards
for Basic Public Services (国家基本公共服务标准) https://www.ndrc.gov.cn/xwdt/tzgg/202308/

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P020230810405141147781.pdf). It does not include general counselling and examination or
provide counselling or a service hotline. However, a simple search on the internet will reveal a
national free counselling hotline. Whether the hotline truly exists or works – or if anybody can
use it is debatable. Or do the state services need to be better linked to the region’s health care
system?
Secondly, government policies and community services for the elderly appear mixed. While
some policies and benefits are appreciated, there is inconsistency in the quality and
standardization of facilities and services across different communities. This lack of uniformity
can lead to disparities in the care and support received by elderly individuals.
The senior activity center in Jiaxing, Zhejiang, China, where my grandparents live offers
several rooms and amenities like a dance room, ping pong room, daycare room, and meeting
room. Unfortunately, most of these rooms are locked and have limited access, and the centre
situated on the second floor with no elevator does not seem well-suited to the needs of the
elderly. These facilities were created more for appearances and to meet simple community
building standards rather than to cater to those in need. The responsibility for activities, including
cleaning and organizing, mainly falls on the elderly, as the community workers do not take much
initiative (Figure 3). This underscores the importance of aligning community services with the
actual requirements and capabilities of the elderly community members.
In addition, communication between caregivers and the elderly has also changed over time. The
expression of emotions varies due to the manner of expression, life experiences, and cognitive
differences. Research shows that emotions are not universal but deeply rooted in cultural and
linguistic contexts, and people may not notice the changes when they become bilingual after the
migration (Besemeres, 2004, p. 157). With the diversity of cultural approaches to emotional
behaviour, the nonverbal communication of feeling is as salient as emotional concepts, idioms,
or expressive forms (Ye, 2003). Moving into a new language makes us see that our feelings, once
thought to be personal, are partly shaped by culture. For those who speak two languages,
deciding how to express emotions can be a struggle, as each language comes with its own
cultural norms. In autobiographical texts, specific words, ways of talking, expressions, and even
deliberate silences in conversations highlight that different languages may express emotions
differently (Besemeres, 2004, p. 157).
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Figure 3: Images reveal a consistently locked daycare center, inaccessible steps to the elderly activity center, only display of
physical health instructions in the community clinic, and a complicated online booking system unsuitable for the elderly. (Source:
Violet Zhang, Jiaxing, Zhejiang, China, July 2023) (A full-size version is available in Appendix A)

Lastly, the research raises the importance of caregivers’ mental health during the caring
process. Caregiving embodies the characteristics of chronic stress: It induces both physical and
psychological strain over extended periods of time, comes with high levels of unpredictability
and controllability, generates secondary stress across various aspects of life, such as work and
family dynamics, and often demands heightened levels of vigilance (Schulz & Sherwood, 2008).
Caregivers often experience high levels of stress, anxiety, and depression, and digital mental
health tools can potentially provide much-needed support and resources (Petrovic & Gaggioli,
2023, p. 7).
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Results
Research and literature review show elders have a strong ability for self-care and a determination
to pursue social goals. Elders demonstrated significantly enhanced verbal fluency when faced
with decision-making tasks of high personal relevance (Jin et al., 2019, p. 7). This highlights the
importance of actively empowering them to maintain mental and emotional health.
Mental health cannot be considered in isolation, there is a sizable and robust relationship
between physical and psychiatric morbidity (Carstensen, 2012); it is linked to many factors, such
as physical changes, environmental shifts, language barriers, religious beliefs, personal
preferences, lack of trust in mental health, self-confidence, etc. However, the acceptance of
talking about mental health varies widely among individuals and families. The stigma associated
with mental health problems can contribute to this ignorance, making it essential to promote
open dialogue and understanding within communities and families to ensure timely support for
those in need.
In addition, safety is always the first concern in remote care; because of distance and time, there
are fewer ideas and topics to share with parents. It is often more about listening and helping. As
caregivers take on the responsibility of caring for elders, the increased stress affects their
immediate caregiving role. It causes them to think about their retirement and future well-being.
Caregivers face the dual challenge of protecting their mental health while providing essential
care to their elderly loved ones.
Finally, experts in the field emphasize the importance of mental health; sometimes, it should be
prioritized over physical health. However, practical mental health tools, digital mental health
tools and assessments remain limited.

Research Phase 2 - User Behaviour Research
Methodology
I conducted a secondary analysis of user behaviours to enhance the product’s inclusivity and
improve user experience. Initially, I engaged with various mental health related applications and
explored websites dedicated to educating elders about health issues. I conducted a thorough
product analysis on these platforms. Additionally, I conducted participatory research and
volunteered for four weeks in the “On the Digital to Go” workshop in November 2023 to teach
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digital literacy to elders. About 35 elders were in the workshop, alongside the instructor, I helped
groups of elderly individuals learn how to download, register, log in, and utilize applications.
Data Collection, Mapping and Analysis
For the secondary research phase, data collection involved capturing screenshots from several
applications and websites related to mental health and elders’ health education. These
screenshots served as the primary source material. A spreadsheet was utilized to analyze this data
effectively for mapping, categorization, and feature analysis. The spreadsheet enabled a
structured breakdown of the gathered information, allowing for a comprehensive evaluation of
the features and functionalities present in the applications and websites. During the participatory
research phase, observations were made by taking pictures and maintaining detailed notes. The
combination of visual documentation through note-taking allowed for a comprehensive and
firsthand exploration of the challenges of the elderly while navigating applications and learning
digital skills. All data collection processes for this research were conducted in accordance with
ethical standards and received formal approval from the Research Ethics Board at Emily Carr
University.
Observation
The Petrovis and Gaggioli article “Digital Mental Health Tools for Caregivers of Older Adults”
mentioned a noticeable absence of digital mental health tools designed to assist caregivers, with
a total of forty-four applications marketed for this purpose in their research. However, only eight
comprehensive apps addressed three or more categories beyond information and resources,
communication, and caregiver-recipient interaction. (Petrovic & Gaggioli, 2023). These eight
applications are Alzheimer’s Caregiver Buddy, Balance: for Alzheimer’s Caregiving, CareZapp,
Carezone, Care4Dementia, Dementia Caregiver Solutions, HABC, and Kinto: Care Better.
Although numerous applications offer features proven to ease caregiver burdens and enhance
health outcomes, only a limited number offer emotional support. (Grossman et al., 2018).
From secondary research, I noticed that most mental health-related applications emphasized
teaching methods for emotional relief or were directly instructed on meditation techniques and
offered various meditation courses, such as Headspace, Calm, Mindshifting, BetterMe: Mental
Health, etc (Figure 4). However, those websites for knowledge sharing with the elderly were
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text-heavy, despite categorizing the content, which made the information seem cluttered and
burdened readers during navigation. Moreover, these apps largely offer comparable services
focused on soothing emotions. However, they need to inform users about how these emotions
arise, how to identify them, and how to address them, and very few of them are for elders only.

Figure 4: Most mental well-being applications focus on relaxing, soothing the mood, and leading users to do
meditation. (BetterMe: Mental Health, Clam, Mindshifting. [Mobile app]. App Store.
https://www.apple.com/ca/app-store/)

Moreover, I observed from the “On the Digital to Go” workshop in November 2023, which
taught digital literacy to elders, that many elders were using phones and tablets as their primary
learning devices (Figure 5). The intricate registration processes were confusing and challenging
to complete. Additionally, they needed clarification and struggled with the actions requiring
secondary confirmation. This gave me a new understanding of the user experience for elders
using applications.

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Figure 5: Elderly individuals primarily use phones or tablets as their main learning devices, often with
larger font settings. (Source: Violet Zhang)

Problems
Throughout the research, I have identified varying degrees of lack of accessibility and complex
registration procedures for the products. Most of these products focus on delivering a solution to
the customer. Few serve as an assessment tool that aids in understanding the process. However,
in the complex realm of mental health, the process is a crucial component. Early identification
and a proper understanding of vulnerabilities hold significant meaning. Moreover, many products
and applications are designed for individual use, emphasizing self-relief and seeking help alone.
Yet, it is widely recognized that mental health, regardless of the stage, requires external support
in life’s journey.
Results
The research has systematically reconsidered the objectives, functionalities, and user experience
I aim to cultivate in product development. Drawing insights from the workshop experience, the
design approach will prioritize a simplified registration process, minimizing unnecessary clicks
and ensuring a seamless, transparent user journey.
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Wecare
An Introduction to Wecare
Wecare is a digital health tool designed to improve remote caregiving for the mental well-being
of our elders. It offers general online assessments, monitoring aids, caregiving tips, mental health
literacy blogs, and integrated public resources. Caregivers and elders can easily onboard Wecare
and access all features for free. Our mission is to advocate for the importance of mental health in
elderly care, facilitating better connections between caregivers and elders while addressing
potential psychological issues positively and effectively.
Wecare Design Goal
Bridge the gap in mental health literacy by raising awareness of several critical aspects:
a.) The correlation between the physical decline of the elderly and its potential impact on their
mental health.
b.) It Is important for caregivers to recognize and manage their mental health amidst their
responsibilities.
Wecare is ​a digital health tool for distant caregivers, who often find themselves under the
immense pressure of looking after the elderly. It addresses the critical need to proactively
understand and address potential mental well-being issues that can arise in elderly individuals.
The product will be presented as a responsive web application suitable for websites, tablets, and
phones.
Definition of Audience
Wecare’s primary audience encompasses includes adult children who identify as caregivers, a
diverse group that includes single-family members, adopted family members, and chosen family
members. Furthermore, primary and secondary users can include families who have lost a sibling
and now find themselves as the sole caregiver in their current circumstances (Figure 6). These
individuals are bound by their love and responsibility for their elderly parents or relatives.

21

Figure 6: The diagram shows the range of caregivers and elderly people involved in the project.
(Source: Violet Zhang)

Design Criteria
The research focuses explicitly on linear care patterns for distant family dynamics and the
experiences of newcomers to a country. The linear care pattern, or intergenerational caregiving,
refers to the caregiving arrangement where the younger generation, typically adult children, are
responsible for caring for their elderly parents or grandparents. This 4-2-1 pattern of care has
been a traditional and prevalent approach in many societies and families (Jiang &
Sánchez-Barricarte, 2011). This decision is rooted in the understanding that these scenarios often
present distinct challenges in providing care and maintaining the mental well-being of elderly
individuals. These caregivers may navigate the complexities of providing care from a distance,
potentially facing cultural and linguistic barriers when immigrating to a new country.
Design
The four factors — physical health, medications, social engagement, and lifestyles — are pivotal
elements impacting daily mental wellness and were derived from field research. Simultaneously,
22

this research revealed the influence of these factors on the relationship between elders and
caregivers. The four factors form the following four parameters - physical changes, emotional
changes, connection, and environmental changes - profoundly shape the content of Wecare as the
digital platform (Figure 7). The assessment questions will center around these parameters,
forming the cornerstone of the evaluation process. The assessment questionnaire will extensively
focus on the elements highlighted in blue on the left half of the square; only some basic
questions will be asked in the red area on the right half of the square. It is important to note that
responses indicating concerns in the red areas may raise a red flag, suggesting the need for
further advice and consultation. In such cases, seeking help from professional experts is strongly
advised.

Figure 7: The framework shows the four major factors that affect elderly mental health in daily life. This framework
consists of four parts. The left and right edges show the range of caregivers and the elderly respectively, indicating the
stakeholders in this framework. In the middle circle, there are four critical factors of mental illness. Surrounding the
circle outside are four important parameters of elder mental health care derived from the four factors.
(Source: Violet Zhang) (A full-size version is available in Appendix A)

Personas
I have identified six distinct personas in mapping through the spectrum of caregiving.
Recognizing the intricate nature of caregiving, I have expanded the spectrum to encompass many
potential stakeholders within this framework. Adult children, particularly the only-child, assume
primary caregiver roles due to their inherent responsibilities. Moreover, secondary, tertiary, or
even quaternary caregivers include relatives, professional caregivers, children’s friends, elderly
acquaintances, social workers, and volunteers (Figure 8).
23

To better understand the caregiving landscape, I have conducted an analysis that involves
scenario assessment, needs identification, and the highlighting of pain points. This approach has
enabled a comprehensive ranking of caregiving relevance, offering insights into the nuanced
needs and challenges experienced across these personas.

Figure 8: The role spectrum elucidates the connections between various caregivers, highlighting those who can provide
quick and efficient care for the elderly due to their close proximity in responsibilities and relationships.
(Source: Violet Zhang) (See full-size version in Appendix A)

Wecare User Journey
The journey map below illustrates the rationale behind users selecting the product, their expected
outcomes, and the tangible benefits they anticipate post-usage. Moreover, it serves as a mirror
reflecting the vision for the product, nurturing a positive rapport between the product and its
audience (Figure 9), emphasizing the importance of building trust. This map also serves as a
compass, steering the development of user flow and wireframes in the subsequent phases.

Figure 9: A user journey map that delineates the users’ expectations regarding their experience before, during,
and after using the product. (Source: Violet Zhang)

24

Wecare Features
All the preceding efforts prompted deep contemplation regarding the product’s core purpose and
the precise needs of the audience. Aligning with the established framework to ensure an
improved user journey, I distilled the product’s essence into four pivotal features. These features
encapsulate the product’s mission: fostering connections between the elderly and caregivers,
facilitating the monitoring of mental well-being for both caregivers and the elderly, and guiding
all users through self-reflection and knowledge-sharing. The details of each feature are listed as a
reference for future design and development. (Figure 10)

Figure 10: The diagram displaying the goal and primary features that will be incorporated into the product.
(Source: Violet Zhang)

Wecare User Flow
The user flow of Wecare showcases the underlying logic and lays the groundwork for subsequent
product development (Figure 11). Built on knowledge, connection, monitoring, and reflection
foundations, the product embodies specific functionalities such as assessment, self-assessment,
caregiving tips, mental health literacy, monitoring, and reminders. Assessment results will be
saved, allowing users to revisit and modify them while retaining previous test records as a new
log for reflection and self-awareness. The current user flow streamlines the sign-up process,
ensuring a quick and user-friendly adoption of the product for both caregivers and the elderly. It
now only showcases three common mental health issues among the elderly: anxiety, dementia,
25

and depression, and more features will be developed in the future. Moreover, the product
provides caregivers with a self-assessment tool, empowering them to assess their psychological
stress levels, understand the challenges they encounter while caregiving, and take proactive steps
to make necessary adjustments.

Figure 11: The user flow plans the Wecare platform’s logic and helps visualize the structure for further
development. (Source: Violet Zhang) (A full-size version is available in Appendix A)

Some features have been specially considered. For example, remote family caregivers can invite
professional caregivers or other family members who live closer to the elderly as secondary
caregivers, if applicable. Caregivers can invite elders to join and participate in the assessment,
facilitating their involvement in the process. Meanwhile, elders can take the initiative to become
members of Wecare and proactively focus on their mental health.
Wecare Wireframe
The wireframe outlines the structure of the web application, aiding in communication and
aligning expectations regarding the product’s layout and functionality early in the development
26

process. It also facilitates identifying current shortcomings, allowing for refinement during
development. Additionally, the wireframe is an excellent tool for early user testing, enabling me
to

conduct

tests

with

three

pairs

of

caregivers and the

elderly (Figure 12).

Figure 12: Wecare Wireframe examples (Source: Violet Zhang)

Design Mockups
As a result, the Wecare prototype has evolved to present a complete user flow, vividly narrating
the journey and functionality of the product after several iterations driven by self-refinement and
testing. Each iteration has been instrumental in enhancing user experience, streamlining
functionalities, and addressing identified shortcomings.

27

Figure 13: Wecare Mockup examples. In the upper right corner, the larger mockup is the home dashboard, where
users can clearly see an overview of the Wecare features. Below are three smaller mockups (from left to right),
which represent screens for Assessment and Resources and steps of taking an assessment in progress.
(Source: Violet Zhang)

Figure 14: Some details about the Wecare mockup. The two mockups above show the login and dashboard
screens. (Source: Violet Zhang)

28

Figure 15: Some details about the Wecare mockup. The two mockups above show the assessment summary page
and the assessment screening process. (Source: Violet Zhang)

Figure 16: Some details about the Wecare mockup. The two mockups above show the caring tips and the mental
health literacy blog screens. (Source: Violet Zhang)
29

Discussion
The overarching goal of this research was to explore a design solution for caregivers that
addresses the factors influencing the mental health of the elderly, particularly in remote
caregiving, considering the unique challenges faced by only-child caregivers in Canada and the
elderly in China. Examining this particular demographic as a case study aims to comprehend
challenges and develop a reference framework for supporting families, potentially inspiring
families in other cultures with the same only-child family pattern. While uncovering the factors,
the analysis forms parameters that build the foundation of the final Wecare digital health tool
design. These include physical changes, emotional changes, social engagement, and
environmental shifts. Moreover, behavioural research shows that simple user flow and
straightforward actions are more friendly for elderly users, and they prefer to use a smartphone
or tablet for searching and reading. These research findings were summarized, and four
parameters were used as starting points for design implications.
The final design solution, Wecare, is a digital health tool — a web application designed for
caregivers and elderly users. Wecare serves not only as a connection and health monitoring
platform but also offers assessment, enhances mental health literacy, and provides helpful
resources that enable caregivers and the elderly to pay attention to their mental wellness
throughout the remote caring process.
To intensify the current assessment tool into a more sophisticated, data-oriented one, the project
aspires to integrate robust data as backend support in the future. This evolution aims to elevate
the product into professional clinical diagnostic tools, empowering individuals and experts to
make precise and effective initial assessments. The system can also be developed and expanded
for policymakers, government, and social services.

Limitations and Reflection
Notably, a crucial learning point has been the intricate interplay between physical changes,
particularly post-surgery recovery, and mental health. For instance, research indicates that heart
surgery, such as coronary artery bypass grafting (CABG), is linked to an increased risk of
30

depression approximates between 30% and 40% of all cases, while major depression commonly
arises as a psychiatric complication following brain surgery after traumatic brain injury (TBI)
(McKhann et al., 1997; Jorge et al., 2004; Tully & Baker, 2012). These insights have surfaced
through data collection and field research. However, the vastness of the topic and the multitude
of perspectives explored by various research fields such as physiology, medicine, neurology, and
psychology make it challenging to cover all aspects comprehensively or focus on specific
categories. While providing valuable insights, this study is just one facet of a larger conversation
on the intricate relationship between physical and mental health in elderly individuals under
remote care.
Although the primary focus of the research and Wecare digital health tool is to alleviate the
burden for caregivers, understanding the perspectives of the elderly remains integral to the
overall effectiveness of the project.

Conclusion
After two years of research, the study reveals that the mental well-being of the elderly is a
significant concern, especially in remote care. The research initially addresses issues from
cultural backgrounds and policies, delving into specific demographic groups. Despite the
limitations of the sample size, meaningful stories and discoveries were unearthed. Organizing
and categorizing the research data, the researchers utilized skills in interactive design to create a
digital health tool for elder care - Wecare. This product is dedicated to assisting caregivers in
providing better remote care for the elderly, particularly emphasizing mental health.
The implications of the research and design practice are significant. Elder care should not only
focus on physical decline but also everyday mental well-being. Given the stressful and
competitive living environment, mental health initiatives should not be exclusive to the younger
generation. There should also be an emphasis on raising awareness of elders’ mental health and
educating individual family caregivers, professional caregivers, and elders about mental health’s
importance. The healthcare system should improve services and regulations, provide aid, and
encourage experts and social workers to use proper assessment tools to make consulting and
pre-examining easier.

31

In addition, this research project could take many paths in the future. There is great potential in
building the product into a care system. For instance, onboarding counsellors to the Wecare
platform that elders and caregivers can use to book consultations through the web application.
Counsellors can also follow up on the assessment report after connecting with patients.
Moreover, long-term care home experts can utilize Wecare to assess elders’ mental well-being
simultaneously with the physical checkup. This not only aids nurses in providing inclusive care
for the elderly but also helps identify and prevent potential mental illnesses before, during, and
after each stage of care. Wecare will support experts in comprehensively onboarding elders to the
care home. It will assist nurses in maintaining daily care routines by providing helpful tips and
contributing to the well-being of family members after hospice care.
The existing research serves as the foundation for Wecare, giving it a preliminary form. Future
studies and data-driven approaches hold immense potential to mature Wecare into a sophisticated
tool, making it a practical resource in various professional fields. We are excited about the future
opportunities through the Wecare project and its development.

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27. Shakeri, H., Geiskkovitch, D. Y., Garg, R., & Neustaedter, C. (2023). Sensing Their Presence: How Emerging
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28. Smolić, Š., Blaževski, N., & Fabijančić, M. (2022). Remote Healthcare During the COVID-19 Pandemic:
Findings for Older Adults in 27 European Countries and Israel. Frontiers in Public Health, 10.
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30. The silver economy. (2017, March 7). ISO.
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31. Tully, P. J., & Baker, R. A. (2012). Depression, anxiety, and cardiac morbidity outcomes after coronary artery
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34

Appendix A - Diagrams

Figure 3: Images reveal a consistently locked daycare center, inaccessible steps to the elderly activity center, only
display of physical health instructions in the community clinic, and a complicated online booking system unsuitable
for the elderly. (Source: Violet Zhang, Jiaxing, Zhejiang, China, July 2023)
35

36

37

38

Appendix B - Wecare Walkthrough

Figure 13: Wecare Mockup examples. In the upper right corner, the larger mockup is the home dashboard, where
users can clearly see an overview of the Wecare features. Below are three smaller mockups (from left to right),
which represent screens for Assessment and Resources and steps of taking an assessment in progress.
(Source: Violet Zhang)

First, simplify the login interface to make it easy for elders. Users also have the option to log in
by using third-party services such as Google and WeChat. The dashboard has comprehensive
functions such as caring reminders, monitoring capabilities, and showing current caring tasks.

39

Figure 14: Some details about the Wecare mockup. The two mockups above show the login and dashboard
screens. (Source: Violet Zhang)

First, users can view past records. If they find the information provided in previous assessments
needs to be more accurate, they can modify it based on the original input. However, previous
information will not be overwritten; it will be logged as versions for users to review. Users also
have the option to start a new assessment if they choose.
Caregivers can also conduct self-assessments to monitor their own mental health status.

40

Figure 15: Some details about the Wecare mockup. The two mockups above show the assessment summary page
and the assessment screening process. (Source: Violet Zhang)

Users can view past records. If they find the information provided in previous assessments needs
to be more accurate, they can modify it based on the original input. However, previous
information will not be overwritten; it will be logged as versions for users to review. Users also
have the option to start a new assessment if they choose. Caregivers can also conduct
self-assessments to monitor their own mental health status.
During the assessment, caregivers will be prompted to select their role, such as family caregiver,
professional in-home caregiver, or other family relatives. Primary caregivers can also add and
invite others as secondary caregivers to join the platform. To improve connections between
caregivers and elders, caregivers can invite elders to join during the assessments, allowing them
to address issues together.
41

Figure 16: Some details about the Wecare mockup. The two mockups above show the caring tips and the mental
health literacy blog screens. (Source: Violet Zhang)

After the assessment, intuitive caregiving tips will be generated, and caregivers will receive
suggestions. They can then add the tips to the calendar and edit or adjust tasks accordingly.
Lastly, mental health literacy blogs, social services helplines, and public resources are important
for caregivers and elders. These resources will be regularly updated to ensure users have access
to a wealth of information and fresh insights.

42

Appendix C - Research Ethics
Emily Carr University Research Ethics Board (ECU-REB)
Research + Industry Office
520 East 1st Avenue
Vancouver, BC V5T0H2
ethics@ecuad.ca
CERTIFICATE OF RESEARCH ETHICS APPROVAL

The Emily Carr University Research Ethics Board approves the following project:
File #
100550

Title
Care for Elderly Mental Well-Being at
a Distance

Principle Investigator:
Dr. G. Hertz

Other Investigators
Violet Zhang (MDes Student)

The current approval dates are:
Approval Date
July 5, 2023

Expiration Date
February 28, 2024

The nature of the approval is as follows:
Type of Event
New Approval Process

Type of Review
Delegated Review

Approved Documents
Email invitation (for experts), consent
form, recruitment script, ECU-REB
application

It is the researchers’ responsibility to meet all research ethics requirements in the jurisdictions in which the research takes place.
The procedures and protocols described in this certification must be followed closely. Note the following conditions associated
with this approval:
•

•

For multi-site or partnered research, researchers are required to comply with all research ethics requirements that
apply. Researchers are expected to share notice of this approval with partners, sites of research, or other research
ethics review boards, as applicable.
If changes to the approved application and documents are required by new partners, sites of research or other
research ethics boards, researchers are required to inform the ECU-REB of these changes.

Researchers are required to report anticipated changes, adverse incidents, and project completion for further research ethics
review. All reporting is managed through the research portal on the Research Management System Process Pathways Romeo https://ecuad.researchservicesoffice.com/. Login and complete “event” reports for changes, adverse conditions, renewals, and
the completion of this research ethics file.
This research ethics approval is in compliance with Tri-Council guidelines (TCSP2 2022) and Emily Carr University policies and
procedures.

Nick Conbere
Chair, Emily Carr University Research Ethics Board
Emily Carr University of Art + Design

ROMEO - Researcher Portal

Application for Human Research Ethics - REVISED 2017, 2022
Project Info.
File No: 100550
Project Title: Care for elderly mental well-being at a distance
Principal Investigator: Dr. Garnet Hertz (Faculty of Design + Dynamic Media)
Start Date: 2023/05/01
End Date: 2024/02/28
Keywords: Interaction design
Project Team Info.
Principal Investigator
Prefix: Dr.
Last Name: Hertz
First Name: Garnet
Affiliation: Faculty of Design + Dynamic Media
Position: Associate Professor
Email: ghertz@ecuad.ca
Phone1: 1-604-789-6582
Phone2:
Fax: 1-604-630-7427
Primary Address: Emily Carr University of Art + Design520 E 1st AvenueVancouver, BC V5T 0H2
Institution: Emily Carr University of Art and Design
Country: Canada
Comments:
Other Project Team Members
Prefix

Last Name

Zhang

Common Questions

First Name

Affiliation

Violet

Faculty of
Graduate
Studies

Role In
Project

CoInvestigator

Email

vzhang52147
@ecuad.ca

1. Project Ethics Details

#
1.1
1.2
1.3
1.4

1.5

1.6

1.7

1.8

1.9

Question
Answer
Anticipated date that work with participants
2023/05/01
will begin.
Anticipated date that work with participants
2024/02/28
will end.
Type of Project
Graduate Thesis Project or Dissertation
If you have chosen "Other" in the selection
above, please describe here
Does the research fall within the jurisdiction
of another research ethics board or body?
No
If so, all approvals need to be in place
before participant research can begin.
If you answer 'Yes' to question 1.5, please
list the names of all of the Research Ethics
Board(s) to which you have applied for this
project.Include the approval date(s). These
dates must match the dates in the
certification documents that you attach to
this application. Please follow this format:
UBC GREB | January 15, 2017 to January
15, 2018
Are you a student (graduate or
undergraduate)applying for ethics approval Yes
for a thesis project?
If you answer 'Yes' in 1.7, ensure that the
Principal Investigator in this application is
your thesis supervisor and add your name
to the "Other Project Member" category at
the bottom of the page. Please click the
info button for important instructions.
Have all of the named researchers
completed the TCPS2:CORE (Course on
Research Ethics)? If yes, upload each of
the certificates using the attachments tab
of this application. No application will be
Yes
processed until all of these certificates are
supplied. If you have comparable
certification from another site, please
upload the certification with an explanation.

1.10

1.11

1.12

If you have uploaded comparable
certification from a source other than the
TCPS2:CORE, please describe here.
(Provide a link to the program or an
institutional description, if available)
For student researchers(if you answered
'yes' in 1.7) - describe any potential
conflicts of interest for the researchers
such as non-academic benefits, (eg.
financial remuneration, patent ownership,
employment, consultancies, board
membership, share ownership, stock
options, etc.) expected by the researchers,
partner organizations, or collaborators as a
result of the research. Also describe any
non-disclosure agreements or any other
restrictions anticipated to affect the
research
Attachments checklist - Ensure that the
following documents are attached to this
application using the Attachments tab.
Incomplete application will not be
reviewed.- TCPS2:CORE certificates (or
equivalent) for each of the researchers.- All
Recruitment materials (also see 'Research
Participants and Recruitment' tab)- All
consent and release materials (also see
the 'Consent' tab)- Other relevant
documents

2. Risk & Review

#
2.1

2.2

Question
Answer
(Optional) Would you like to determine the
level of risk and review required for this
project?
From the 'Risk and Review' assessment,
the proposed research project is expected
to require the following (choose one). Do
Level 2 - Low Risk
not attach the 'Risk and Review'
assessment

3. Summary of Proposed Research

#

Question

Answer

3.1

This research aims to address the issue of
mental health care for elderly individuals,
highlighting that mental health issues are
not exclusive to younger generations. The
study specifically addresses the challenges
adult children living overseas face, the
issue of noticing their mood changes and
seeking to provide remote care for their
aging parent's mental health. My research
plan involves using participatory and
interview methods to explore the reasons
behind psychological changes in elderly
Summary of Proposed Research: Describe
individuals. Moreover, by interviewing
the purpose of the proposed research
professionals, I will gain further insights
project in non-technical language (200
into the psychological issues and
words max, please see info button for
challenges currently faced by the elderly.
details)
These methods can provide deep insights
into psychological changes in the elderly
and help to reveal social and cultural
factors associated with them. This type of
research can also provide valuable insights
and guidelines for mental healthcare better
to support the health and well-being of
elderly individuals.The main research
question is: How can adult children living in
Canada provide better remote care to
enhance aging parents' mental well-being
residing in China?

3.2

The goal is to have a better understanding
of the elderly's actual needs through
research and to learn the what are current
mental issues that the elderly are
struggling with from the professionals'
perspectives. At the same time, I plan to
explore the significant issues and
difficulties that adult children face during
remote care through interviews. The
possible methodologies are interviewing
adult caregivers in Canada, interviewing
counsellors and professors who focus on
elderly care, applying autoethnography and
journaling stories and
experiences.Interview MethodsPossible
interview questions for adult children
participants will be:1. Can you briefly
describe your current situation as an adult
Methodology (200 words max):Describe
child living abroad and providing remote
this project's methodological approach to
care for your elderly parent(s)?2. What
participant research activities. Include
specific challenges do you face in providing
details on what will be expected of
remote care for your parent(s)? How do
participants. Attach survey, interview
these challenges affect your daily life and
questions and other documents related to
overall well-being?3. How do you stay
the research methods. Include a timetable
connected with your parent(s) despite the
for participant research activities.
distance? What methods or technologies
do you use to maintain regular
communication?4. How do you handle
emergencies or sudden health issues with
your parent(s) when you are physically far
away? Do you have any contingency plans
in place?5. Have you encountered any
emotional or psychological challenges in
providing remote care for your parent(s)?
How do you cope with the emotional stress
and guilt of being physically distant?6. In
your opinion, what kind of support or
resources would be helpful for adult
children living abroad who are providing
remote care for their parent(s)?7. Have you
sought any professional assistance or
consulted experts in caregiving, mental
health, or geriatrics to help you navigate

the challenges of remote care? If so, what
kind of support have you
received?Possible interview questions for
counsellors will be:1. Can you tell us about
your experience providing counselling
services for elderly individuals?2. What are
the unique challenges and considerations
when working with the elderly population in
a counselling setting?3. How do you
approach building trust and rapport with
elderly clients who may hesitate or resist
counselling?4. Can you share an example
of a successful outcome you achieved
while working with an elderly client? How
did you approach their unique needs and
circumstances?5. How do you address
cultural or generational differences when
counselling elderly individuals from diverse
backgrounds?6. How do you believe the
relationship or connection between elderly
care and living distance impacts the mental
well-being of elderly individuals?Possible
interview questions for Professor Peng will
be:1. What motivated you to explore the
topic of psychology and life in the age of
longevity, explicitly focusing on the elderly
population?2. Can you share insights or
findings from your book regarding the
unique challenges elderly individuals face
in maintaining their mental health and
overall quality of life?3. Are there any
particular aspects of aging that your book
highlights which are often overlooked or
misunderstood by society or traditional
psychological perspectives?4. Can you
discuss any specific cultural or societal
factors explored in your book that influence
the psychological experiences of elderly
individuals in different parts of the
world?(still reading the book and will be
asking questions related to the content and
any statement she made in the
book.)AutoethnographyI will chat with my

3.3

grandparents, family members and friends
to learn more about how they understand
and think about this topic.JournalingI will
note any publications, posters and
promotions in either the community or the
hospital without filming or recording any
individuals.
I plan to interview one counsellor and one
professor.The counsellor is YING Ma, a
licenced professional counsellor with over
Professional Expertise / Qualifications:If
ten years of counselling experience, mainly
any of the research activities require
with clients struggling with intimate
professional expertise or recognized
relationships, family relationships, parentqualifications (eg. first aid certification,
child relationships, and workplace
registration as a clinical psychologist or
relationships.Professor Peng Huamao from
counsellor, health practitioner qualifications the Beijing Normal University faculty of
or expertise, etc), describe them here.

psychology, I am reading her book "Hello,
my later life - Psychology and Life in the
Age of Longevity. I will reach out to her via
email.

4. Research Participants and Recruitment

#

4.1

4.2

Question
Answer
Participants: Indicate the groups that will
be targeted for recruitment in the research
My research consists of two primary
project. Describe any specific inclusion or
groups: 1. Professional experts2. Adult
exclusion criteria (example: undergraduate
children as a caregiver
students, specific age ranges, genders,
etc)
I plan to conduct interviews with seven
Number of Participants: What is the
participants: five adult children, one
expected number of participants?
counsellor, and one professor, perhaps
more along with the research process.

4.3

1. Professional expertsI have had a
personal connection with counsellor Ying
Ma for a long time, and she agreed to the
idea of interviewing her for my thesis.I want
to interview Professor Peng because she is
one of the experts researching elderly
psychology in China. I have watched one
of the Ted talks on Youtube, and am also
reading her books. I will connect with her
via email. I may interview more experts
along with the research process.2. Adult
Children as a caregiverI will interview my
friends and people in the immigration
service community in Coquitlam. Many of
them have similar experiences of living
separately with their parents and
grandparents at a distance and facing the
issue of distance care.Participants will be
voluntarily interviewed with their consent to
Recruitment: Describe how participants will the agreement.The following claim will be
be recruited, and by whom. Attach any
presented before participants sign the
materials that might be used for
consent form:This research explores the
recruitment (eg. email text, posters, fliers, complex interaction between people
advertisements, letters, telephone scripts). residing in China and their adult children
living abroad. It is crucial to acknowledge
that participants may exhibit vulnerability
due to their potential reliance on familial
support or assistance from services.
However, it is essential to clarify that the
primary objective of this research is not to
provide immediate solutions or
interventions. Instead, the purpose is to
engage in a comprehensive investigation,
study, and exploration of the issue.
Through this research, we strive to
enhance our understanding to identify
potential areas for improvement and
innovation that could inform the
development of interventions for a wider
audience.I can assist in connecting with
community workers if participants need
professional help, such as providing
helplines.Helpline in China:Free

counselling helpline for Zhejiang
Province0571-85029595 (24
hours)Helpline in Canada:Wellness
Together Canadacall 1-866-585-0445 or
text WELLNESS to 741741 for adultsYou
can also visit Wellness Together Canada
(https://www.wellnesstogether.ca/enCA?lang=en-ca) To access different levels
of support, including:1. one-on-one
counselling2. credible articles and
information3. self-guided courses and
programs4. peer support and coaching
4.4
4.5

4.6

4.7

4.8

4.9

4.10
4.11

Incentives: Will participants be offered
No
incentives to encourage their participation?
If yes to above, describe the incentive
plans and the rationale for using incentives.
Participants and vulnerability: Are there
circumstances that cause the participants
No
or participant group(s)to be vulnerable in
the context of research?
If yes to above, describe the particular way
participant vulnerability may be affected by
the research and any measures that are
planned to address potential risks
associated with these vulnerabilities.
Are people from First Nations, Inuit, Metis
or other Indigenous backgrounds being
No
specifically invited to participate in this
research?
If yes to above, describe any additional
reviews/approvals/consultations/cultural
protocols required to complete this
research. Ensure your rationale for
engaging with specific individuals or
communities is described in 3.1.
Research Locations : Select all locations
Other (describe)
where participant research will occur.
1. Jiaxing, Zhejiang, China2. Coquitlam &
Provide details of the locations listed above
Vancouver, BC, Canada3. through Zoom

4.12

Participant Access to Research Results:
Describe your plans to provide or share
results of your research with participants.
This might include invitations to final
presentations or exhibitions, or copies of
publications produced. Content here
should be consistent with descriptions in
the consent forms provided.

The research data will be collected and
transcribed into the form of a research
summary and infographics and made
available to participants upon request. All
the participants will also be invited to the
final thesis presentation. These invitations
will be communicated to participants
verbally and in writing on all consent forms.

5. Risk vs Benefit

#

5.1

5.2

5.3

5.4

Question

Answer
This project aims to improve the quality of
care and support for elderly individuals,
with a particular focus on their mental
health and emotional well-being. This
project aims to identify the challenges
Describe any known or anticipated direct or faced by elderly individuals and their
indirect benefits to the research community families in accessing care and support and
or society that may emerge from the
look for insights from the findings of the
proposed research.
research. Finally, I wish to use this
research as a case study and identify
potential areas for improvement and
innovation that could inform the
development of interventions for a wider
audience.
Psychological or emotional
Risks of Research: Check any that apply - risks|Personal/Sensitive information: the
list all risks likely to be faced by
proposed research involves the disclosure
participants in the proposed research.
of information that is intimate or sensitive in
nature (describe in detail)
Describe the risks identified and
During the research process, emotional
contextualize them related to risks faced by and affective topics may be discussed.
participants in every day activities. See info Furthermore, personal health conditions
button for details.
will also be an important factor.
In terms of confidential information,
Risk Mitigation: Describe how the
participants have full authority to refuse to
researchers will mitigate the risks identified disclose any information. Anonymity will be
above. Describe whether the researchers maintained during the entire interview. If
have the skills to deal with identified risks participants exhibit discomfort or no longer
or whether additional experts will be
want to participate in the research, the
recruited. Describe any resources that will activity will be ended immediately. This will
be made available to participants.
be identified in verbal and written forms
during the activity with participants.

6. Consent

#
6.1

6.2

Question
Consent Documents: Check all of the
following consent and release documents
that will be used in this project.

Describe any special consent provisions
selected above

Answer
Consent Form
Because of the cultural inclination and
informal nature of the interaction between
an interviewer and an interviewee, the
potential participants will be contacted by
word-of-mouth methods. Only those who
have given their verbal consent to
participate will be included in the final list of
participants, and they will be asked to sign
an agreement.A consent form will be
issued before the interview. Please find
attached the consent form.

7. Confidentiality and Security

#

Question

7.1

Confidentiality: Indicate the level of
confidentiality built into the research
design.

7.2

Describe the rationale for the collection of
identifiable research materials

Answer
Indirectly Identifiable - the research
materials (data) can reasonably be
expected to identify specific participants
through a combination of indirect identifiers
like place of residence or date of birth
(describe)
The interview will be completely
anonymous, and the research material may
involve information such as age and
location.

7.3

7.4

I will collect anonymous data through
screen recordings or voice recordings. I will
conduct either face-to-face or online
interviews. I will do voice recording for
people taking interviews in person, and if
the interview takes place online through
WeChat or Zoom, I will utilize screen
Storage & Destruction of Confidential
recording. Due to policy restrictions, it is
Material: Describe in detail how identifiable
important to note that for online interviews
materials/data will be collected, stored,
with any participants residing in China,
retained and destroyed at the end of the
WeChat will be used as the preferred
data lifecycle.
communication platform. Zoom is currently
banned in China, and accessing it through
a VPN is illegal and against the
law.Anonymous data will be gathered,
securely stored in digital format on locally
stored, password-protected hard drives,
and deleted upon completion of the project.
In the event that the university requires it,
the research data will be submitted to the
supervising faculty member at Emily Carr
Location of Data: Describe the location for
University for safe storage upon completion
long-term storage of confidential materials
of the project. If the university does not
require it, these digital materials can be
deleted at the end of the project.

8. Monitoring

#

8.1

8.2

8.3

Question
Once REB approval has been obtained, it
is the responsibility of the PI to maintain
the ethics file in up-to-date good standing
and make appropriate reports (such as
Severe Adverse Event reporting) and
No
amendments (please see Info button for
more details).Is it expected that the
proposed research will require additional
monitoring beyond the minimum annual
requirement?
If you answered yes to the above, please
describe your plans for this.
Is it expected that the proposed research
will continue beyond the conclusion of this No
project?

Answer

8.4

If yes to above, describe in detail.

Attachments
Doc / Agreement

Consent Materials

ECU-REB Approval
Certificate

Other Document

Version Date

File Name

Description

2023/06/19

Emily Carr University
Research Informed
Consent Form_in
June.pdf

N/A

2023/07/05

20230705_Zhang_Her
tz_Approval_Certificat
e.pdf

N/A

2023/06/19

Email Invitation Draft
to experts.pdf

Email invitation
template to experts

The explanation about
using WeChat as an
online interview
tool.pdf

The explanation
about using WeChat
as an online interview
tool for my research

REB Autoethnography
and Research Ethics
Guide and
QuestionnaireJune
2020-3.pdf

OCADU REB Autoethnography
guidelines for use as a
resource.

Recruitment Script.pdf

Recruitment Script

Garnet
Hertz's_tcps2_core_c
ertificate.pdf

Principle
investigator's TCPS
certificate

tcps2_core_certificate.
pdf

Violet Zhang's
TCPS2 certificate

Other Document

Other Document

Recruitment Scripts

TCPS2:CORE
certificate (or
equivalent)

TCPS2:CORE
certificate (or
equivalent)

2023/06/19