Computer proficiency questionnaire: assessing low and high computer proficient seniors

PURPOSE OF THE STUDY

Computers and the Internet have the potential to enrich the lives of seniors and aid in the performance of important tasks required for independent living. A prerequisite for reaping these benefits is having the skills needed to use these systems, which is highly dependent on proper training. One prerequisite for efficient and effective training is being able to gauge current levels of proficiency. We developed a new measure (the Computer Proficiency Questionnaire, or CPQ) to measure computer proficiency in the domains of computer basics, printing, communication, Internet, calendaring software, and multimedia use. Our aim was to develop a measure appropriate for individuals with a wide range of proficiencies from noncomputer users to extremely skilled users.

DESIGN AND METHODS

To assess the reliability and validity of the CPQ, a diverse sample of older adults, including 276 older adults with no or minimal computer experience, was recruited and asked to complete the CPQ.

RESULTS

The CPQ demonstrated excellent reliability (Cronbach's α = .98), with subscale reliabilities ranging from .86 to .97. Age, computer use, and general technology use all predicted CPQ scores. Factor analysis revealed three main factors of proficiency related to Internet and e-mail use; communication and calendaring; and computer basics. Based on our findings, we also developed a short-form CPQ (CPQ-12) with similar properties but 21 fewer questions.

IMPLICATIONS

The CPQ and CPQ-12 are useful tools to gauge computer proficiency for training and research purposes, even among low computer proficient older adults.

Older Adults' Use of and Attitudes toward Activity Monitoring Technologies

Self-management of health is becoming increasingly important in today's healthcare climate. Activity monitoring technologies have the potential to support health self-management by tracking, storing, compiling, and providing feedback about an individual's engagement in movement activities. Older adults represent a fast growing segment of the population who may benefit from such technologies. To understand how to facilitate technology acceptance and adoption, more information is needed about older adults' attitudes and usage of such technologies. Eight older adult participants (M _age = 65.0 years; SD = 3.2; range = 61-69) used one of four activity monitoring technologies in their own homes for two weeks. Attitudes and usability issues were assessed and evaluated within a technology acceptance framework. Participants' initial attitudes were positive, but after using the technology for two weeks, attitudes were mixed. Three participants indicated they would continue using the technology, whereas five said they would abandon the technology. These data offer insight into older adults' use of and attitudes toward activity monitoring technologies and provide improvement opportunities for designers. The results suggest that efforts should focus on conveying the usefulness and personal benefits of activity monitoring technologies specific to older adults.

Self-Management of Wellness and Illness in an Aging Population

In this chapter, we review the last 10 years of literature on self-management of illnesses (acute/episodic and chronic) and wellness (e.g., health promotion). We focus on health self-management in the context of an aging population, wherein middle-aged adults are more likely to be managing wellness activities and older adults are often managing both maintenance of health and chronic illnesses. The critical issues related to self-management of health are discussed, including those imposed by health care demands and those stemming from individual differences in general abilities (e.g., motor, perception, cognition) and socioemotional characteristics. The dynamic relationship between theory and practice is highlighted. Health care demands reflect the nature of the illness or wellness activity and include managing comorbidities, symptoms, and medications; engaging in health promotion activities (e.g., exercise, diet); the required use of health technologies; the need for health-related information; and coordination of the care network. Individual differences in motor, perceptual, and cognitive abilities, as well as in the severity and complexity of the illness and the consequent demands, also impact how a person self-manages health. Cognitive abilities, such as decision making, knowledge, literacy (i.e., general, health, and e-health literacy), and numeracy are particularly implicated in the process of managing one’s own health and are especially important in the context of an aging population; therefore we give these cognitive abilities special attention in this chapter. Socioemotional characteristics, and attitudes and beliefs about one’s health, impact an individual’s self-management of health as well, impacting his or her motivation and goal-setting behaviors. Moreover, we discuss literature on interventions that have been used to improve self-management of health, and we examine the potential for technology. We conclude with guidelines for technology design and instruction, and discuss emerging themes.

How Do Older Adults Manage Osteoarthritis Pain? The Need for a Person-Centered Disease Model

In the United States, chronic pain affects at least 116 million Americans, differentially impacting older adults. One of the leading causes of pain for older adults is osteoarthritis. This disease affects approximately 14% of the United States population and can cause disability and mobility problems, in addition to having a high cost for the healthcare system. The methods individuals use to manage their pain are contingent upon their model of the disease (e.g., their beliefs about osteoarthritis pain management). The purpose of the present investigation was to: 1) understand what variables older adults with osteoarthritis believe impact pain, and 2) understand current approaches for self-management of osteoarthritis pain. We conducted structured interviews with eight older adults who have osteoarthritis. The interviews revealed current approaches in pain management, as well as gaps in knowledge. We propose an expansion of the idea of a general disease model for pain management that is patient-centered, allowing for personal customization of factors for reducing pain and increasing successful pain-management.

Everyday memory strategies for medication adherence

The need to manage chronic diseases and multiple medications increases for many older adults. Older adults are aware of memory declines and incorporate compensatory techniques. Everyday memory strategies used to support medication adherence were investigated. A survey distributed to 2000 households in the Atlanta metropolitan area yielded a 19.9% response rate including 354 older adults, aged 60-80 years. Older adults reported forgetting to take their medications, more so as their activity deviated from normal routines, such as unexpected activities. The majority of older adults endorsed at least two compensatory strategies, which they perceived to be more helpful in normal routines. Compensatory strategies were associated with higher education, more medications, having concern, and self-efficacy to take medications. As memory changes, older adults rely on multiple cues, and perceive reliance on multiple cues to be helpful. These data have implications for the design and successful implementation of medication reminder systems and interventions.

Addressing within-role conflicts of interest in surgery

In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard remedies for conflicts of interest are transparency and recusal, which are unlikely to address this conflict, in part because of unconscious bias. Alternative systemic measures may be more effective, but these require changes in the culture of surgery and accurate identification of surgical innovation.

Investigating Healthcare Providers' Acceptance of Personal Robots for Assisting with Daily Caregiving Tasks

Robots have potential to provide assistance to healthcare providers in daily caregiving tasks. The healthcare providers' acceptance of assistive robots will mediate the success or failure of implementation of robotic systems in care settings. It is essential to understand why and how providers would accept implementation of a robot in their daily work routines. We identified caregiving tasks with which healthcare providers would or would not accept assistance from a personal robot (Willow Garage's PR2). We also explored preferences for human or robot assistance. The healthcare providers we interviewed were quite open to the idea of receiving robot assistance for certain tasks.

Older Adults' Medication Management in the Home: How can Robots Help?

Successful management of medications is critical to maintaining healthy and independent living for older adults. However, medication non-adherence is a common problem with a high risk for severe consequences [5], which can jeopardize older adults' chances to age in place [1]. Well-designed robots assisting with medication management tasks could support older adults' independence. Design of successful robots will be enhanced through understanding concerns, attitudes, and preferences for medication assistance tasks. We assessed older adults' reactions to medication hand-off from a mobile manipulator robot with 12 participants (68-79 yrs). We identified factors that affected their attitudes toward a mobile manipulator for supporting general medication management tasks in the home. The older adults were open to robot assistance; however, their preferences varied depending on the nature of the medication management task. For instance, they preferred a robot (over a human) to remind them to take medications, but preferred human assistance for deciding what medication to take and for administering the medication. Factors such as perceptions of one's own capability and robot reliability influenced their attitudes.

The smooth (tractor) operator: insights of knowledge engineering

The design of and training for complex systems requires in-depth understanding of task demands imposed on users. In this project, we used the knowledge engineering approach (Bowles et al., 2004) to assess the task of mowing in a citrus grove. Knowledge engineering is divided into four phases: (1) Establish goals. We defined specific goals based on the stakeholders involved. The main goal was to identify operator demands to support improvement of the system. (2) Create a working model of the system. We reviewed product literature, analyzed the system, and conducted expert interviews. (3) Extract knowledge. We interviewed tractor operators to understand their knowledge base. (4) Structure knowledge. We analyzed and organized operator knowledge to inform project goals. We categorized the information and developed diagrams to display the knowledge effectively. This project illustrates the benefits of knowledge engineering as a qualitative research method to inform technology design and training.

Challenging the epistemological foundations of EBM: what kind of knowledge does clinical practice require?

This paper raises questions about the epistemological foundations of evidence-based medicine (EBM). We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge.

OLDER ADULTS' PREFERENCES FOR AND ACCEPTANCE OF ROBOT ASSISTANCE FOR EVERYDAY LIVING TASKS

Many older adults value their independence and prefer to age in place. Robots can be designed to assist older people with performing everyday living tasks and maintaining their independence at home. Yet, there is a scarcity of knowledge regarding older adults' attitudes toward robots and their preferences for robot assistance. Twenty-one older adults (M = 80.25 years old, SD = 7.19) completed questionnaires and participated in structured group interviews investigating their openness to and preferences for assistance from a mobile manipulator robot. Although the older adults were generally open to robot assistance for performing home-based tasks, they were selective in their views. Older adults preferred robot assistance over human assistance for many instrumental (e.g., housekeeping, laundry, medication reminders) and enhanced activities of daily living (e.g., new learning, hobbies). However, older adults were less open to robot assistance for some activities of daily living (e.g., shaving, hair care). Results from this study provide insight into older adults' attitudes toward robot assistance with home-based everyday living tasks.

Understanding Use Errors for Medical Devices: Analysis of the MAUDE Database

Use error is a type of error in a system wherein a user’s actions—or lack of actions— result in a different outcome than intended, possibly resulting in an adverse event. Use error in medicine is especially important, as adverse events can result in life-critical situations. Studies investigating use error have been conducted using databases of medical adverse events (e.g., the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of adverse events related to device usage). However, these studies are limited by being specific to a context of use (e.g., drug delivery pumps in anesthesia). Therefore, this study investigated use error for medical devices across all contexts of use through a systematic search of the MAUDE database. We found that use error 1) is reported across many sub-fields and contexts of medicine; 2) is associated with many steps in the device usage process; 3) occurs during device operation by both lay users and health professionals; 4) has varying underlying causes; 5) cooccurs in adverse events; and 6) results in a wide array of outcomes, including death. This analysis provides valuable insights into characteristics and context of use errors that can guide design to minimize such errors.

Younger and Older Adults’ Comprehension of Health Risk Probabilities: Understanding the Relationship between Format and Numeracy

The format in which a probability is presented and a person’s numeracy can influence comprehension of health risk probabilities (e.g., Galesic, Gigerenzer, & Straubinger, 2009). Many people, especially older adults, have inadequate numeracy (Kutner, Greenberg, & Baer, 2005), which may interact with comprehension of different formats (e.g., frequency, percent, or words). The relationship between probability format and numeracy on comprehension of health risk probabilities was investigated via questions and delayed tests of recall for 36 younger adults’ ( Mage=20.0, SD=2.2, range=18-27) and 36 older adults’ ( Mage=71.1, SD=2.4, range=66-75). No interaction between numeracy and format was identified; higher numeracy was positively correlated with higher accuracy on comprehension questions across all formats. The results suggest that percent format best supports comprehension and recall of health risk probabilities for younger and older adults in a probability comparison task.

The Domesticated Robot: Design Guidelines for Assisting Older Adults to Age in Place

Many older adults wish to remain in their own homes as they age [16]. However, challenges in performing home upkeep tasks threaten an older adult's ability to age in place. Even healthy independently living older adults experience challenges in maintaining their home [13]. Challenges with home tasks can be compensated through technology, such as home robots. However, for home robots to be adopted by older adult users, they must be designed to meet older adults' needs for assistance and the older users must be amenable to robot assistance for those needs. We conducted a needs assessment to (1) assess older adults' openness to assistance from robots; and (2) understand older adults' opinions about using an assistive robot to help around the home. We administered questionnaires and conducted structured group interviews with 21 independently living older adults (ages 65-93). The questionnaire data suggest that older adults prefer robot assistance for cleaning and fetching/organizing tasks overall. However their assistance preferences discriminated between tasks. The interview data provided insight as to why they hold such preferences. Older adults reported benefits of robot assistance (e.g., the robot compensating for limitations, saving them time and effort, completing undesirable tasks, and performing tasks at a high level of performance). Participants also reported concerns such as the robot damaging the environment, being unreliable at or incapable of doing a task, doing tasks the older adult would rather do, or taking up too much space/storage. These data, along with specific comments from participant interviews, provide the basis for preliminary recommendations for designing mobile manipulator robots to support aging in place.

Understanding age and technology experience differences in use of prior knowledge for everyday technology interactions

Technology designers must understand relevant prior knowledge in a target user population to facilitate adoption and effective use. To assess prior knowledge used in naturalistic settings, we systematically collected information about technologies used over 10-day periods from older adults with high and low technology experience and younger adults. Technology repertoires for younger adults and high technology older adults were similar; differences reflected typically different needs for kitchen and health care technologies between the age groups. Technology repertoires for low-technology older adults showed substantial technology usage in many categories. Lower usage compared to high-tech older adults for each category was limited primarily to PC and Internet technologies. Experience differences suggest preferences among low-technology older adults for basic technology usage and for working with people rather than technologies.

Participants in all groups were generally successful using their everyday technologies to achieve their goals. Prior knowledge was the most common attribution for success, but external information was also commonly referenced. Relevant prior knowledge included technical, functional, strategy, and self knowledge. High tech older adults did not report more problems than younger adults, but they did attribute more problems to insufficient prior knowledge. Younger adults attributed more problems to interference from prior knowledge. Low-tech older adults reported fewer problems, typically attributing them to insufficient prior knowledge or product/system faults. We discuss implications for further research and design improvements to increase everyday technology success and adoption for high-tech and low-tech older adults.

Testing relationships: ethical arguments for screening for type 2 diabetes mellitus with HbA1C

Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for individual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the individual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health.

Choosing the Right Task Analysis Tool

A variety of task-analytical tools are available to the human factors/ergonomics practitioner, who is challenged to find the right tool for the task at hand and to apply it appropriately. In this article, we compare a number of task analysis methods, including each method’s unique contribution and the expertise required to apply it. We describe how different task analysis methods can build on each other and provide examples to illustrate.

Understanding the effect of workload on automation use for younger and older adults

OBJECTIVE

This study examined how individuals, younger and older, interacted with an imperfect automated system. The impact of workload on performance and automation use was also investigated.

BACKGROUND

Automation is used in situations characterized by varying levels of workload. As automated systems spread to domains such as transportation and the home, a diverse population of users will interact with automation. Research is needed to understand how different segments of the population use automation.

METHOD

Workload was systematically manipulated to create three levels (low, moderate, high) in a dual-task scenario in which participants interacted with a 70% reliable automated aid. Two experiments were conducted to assess automation use for younger and older adults.

RESULTS

Both younger and older adults relied on the automation more than they complied with it. Among younger adults, high workload led to poorer performance and higher compliance, even when that compliance was detrimental. Older adults' performance was negatively affected by workload, but their compliance and reliance were unaffected.

CONCLUSION

Younger and older adults were both able to use and double-check an imperfect automated system. Workload affected how younger adults complied with automation, particularly with regard to detecting automation false alarms. Older adults tended to comply and rely at fairly high rates overall, and this did not change with increased workload.

APPLICATION

Training programs for imperfect automated systems should vary workload and provide feedback about error types, and strategies for identifying errors. The ability to identify automation errors varies across individuals, thereby necessitating training.

Understanding Predictors of Computer Communication Technology Use by Older Adults

Technologies have evolved to allow older adults the ability to communicate in a variety of ways, yet little work examines the perceptions that older adults have of these technologies. Our research explored older adults' use of computers for communication activities. We analyzed questionnaire data from two hundred and eighty-one participants with computer experience who answered questions about their background; the amount of experience they had with computers and other technologies, their perception of the importance of several communication activities for their quality of life, and how useful a computer is for those activities. A regression analysis explored the degree to which demographic variables, the importance of activities for their quality of life, and prior experience predicted respondents' attitudes about the computer's usefulness for communication activities. The findings, based on a group of older adult computer users, suggest that the importance of communication activities for an older adult's quality of life and their prior experience with computers are significant predictors of the perception of a computer's usefulness for communication activities. Previous research has found that one's experiences with a computer system are critical for adoption. Our work reaffirms that tenet, yet finds that the degree to which an activity is important for one's quality of life is also predictive of how useful a computer will be for that activity. Our findings also suggest that certain communication activities, such as email, are more preferred than other activities, such as chat groups. This present survey of experienced older adult computer users can guide development of training materials and products for older adults by informing designers of the ways by which older adults form perceptions about the usefulness of technologies.

NEEDS ASSESSMENT FOR CERTIFIED NURSING ASSISTANTS PROVIDING PERSONAL CARE

Home health care allows individuals to receive care in a home setting rather than a medical facility. This increasingly popular alternative to health care has many benefits; however, providing health care in a home setting involves unique challenges and difficulties for the health care providers, such as certified nursing assistants (CNAs). Human factors interventions and technological supports may ease difficulties home health care providers experience performing caregiving tasks. However, for such interventions to be effective there is a need to understand patient care within the context of a home environment. The purpose of this research was to conduct a needs assessment to identify 1) personal caretask characteristics, including the context in which they are carried out, and 2) challenges encountered during these tasks. Eight CNAs participated in structured interviews where in they were asked to describe difficulties and frustrations experienced when performing the tasks of toileting, bathing, and transfer. The results were categorized as patient- or provider-based difficulties, as well as along dimensions related to the environment, device design, and social influences. These data provide an understanding of the complexity of each task, and a means of highlighting areas of difficulty to provide guidance for designers of assistive technologies and other supportive interventions.

Older Adults' Needs for Assistance as a Function of Living Environment

As the older adult population grows and becomes more diverse, so will their needs and preferences for living environments. Many adults over 65 years of age require assistance in their living environment (Administration on Aging, 2009), however it is important for their feelings of well-being that the assistance does not restrict their autonomy (e.g., Barkay & Tabak, 2002). Moreover, autonomy enhancement may improve older adults' functionality (e.g., Greiner et al., 1996). This paper provides an overview of older adults' diverse living situations and an assessment of their needs for assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) when living in the community or in a long-term care residence, such as assisted living or skilled nursing. We also examine older adults' residential mobility patterns to understand potential unmet needs for assistance. This needs assessment highlights the specific areas that could benefit from human factors interventions to support older adults in making choice-driven decisions about where they live.

Challenges to Aging in Place: Understanding Home Maintenance Difficulties

Age-related declines in capabilities may compromise older adults' ability to maintain their homes thus threatening successful aging in place. Structured interviews were conducted with forty-four independently living older adults (M(age) = 76.1, SD = 4.7) to discuss difficult home maintenance tasks and how they managed those tasks. Solutions to managing difficulties were categorized as person-related or environment-related. The majority (85%) of responses were person-related solutions. An understanding of the specific challenges that older adults face in maintaining their homes can guide redesign efforts and interventions to effectively support older adults' desire to age in place.