Privacy Concerns and Disclosure Behavior in a Health Setting

Health care practitioners need complete and accurate information to provide quality care to their patients. However, health information is considered to be highly private. Patients may have concerns about disclosing such information, especially if asked to provide this information using technology. The goal of this study was to investigate how participants' experience with a technology affect their level of disclosure in a health setting. Specifically, we were interested in understanding how the use of a health database system influences the disclosure of private health information. We asked 12 younger and 12 older adults to interact with a computerized health data entry system and then to rate the completeness and accuracy of their intended disclosures. Results indicate that, for the most part, participants would provide complete and accurate information using such a system. Younger adults were less likely than older adults to intend to disclose sensitive information, suggesting that additional information gathering may be appropriate for younger adults. The importance of providing a reason for the request of each piece of health information is discussed in relation to the setting where information is gathered.

Understanding the Required Resources in Line Graph Comprehension

Visual line graphs are a prevalent form of communication as they provide a pictorial means to display relationships between entities. As such, understanding the cognitive resources required in processing line graphs would inform designers how to optimize the use of graphical displays. This study systematically investigated how graph task performance changes as a function of attention allocation (full or divided) and concurrent memory task (spatial or verbal). Twenty-four younger adults (mean age 19.2 years) completed either a trend comparison task or a point estimation task and a concurrent spatial or verbal task. Trend comparison performance did not significantly differ between the full and divided attention conditions; mean performance for all conditions was over 90% accurate. Interestingly, participants' point estimation performance was significantly better for the two divided attention conditions compared to the full attention condition which may be attributed to a motivational or stimulus effect. This study provides a base from which more research can be conducted to understand the verbal and spatial resources required in graph comprehension.

Feedback Support for Training: Accounting for Learner and Task

Years of research on feedback has not produced universal prescriptions for feedback during training. Results are split in two directions; those recommending more feedback during training and those recommending less. This has resulted in no unified theory and little understanding of other factors that might affect feedback mechanisms. The current experiment manipulated the cognitive load of the task and measured the working memory capacities of the learners to see whether forcing the learner to self-evaluate affects learning of a cognitive task and how this might be moderated by learner ability and task load. Results generally showed that reducing task load through supportive feedback resulted in more learning.

Assessing design features of virtual keyboards for text entry

OBJECTIVE

The present research examined design of a virtual keyboard for text entry with a rotary controller, emphasizing users who differ in age and system experience.

BACKGROUND

Existing research has minimally addressed usage frequency, age, and the effects of display shape and letter arrangement on movement and visual search components of text entry tasks. The present research was conducted to close these gaps.

METHOD

Two experiments were completed to examine younger (18-28 years) and older (60-75 years) adults' movement and visual search capabilities using four keyboard shapes and three keyboard arrangements. In a third experiment examining combined effects on shape design, 32 younger (18-28 years) and 32 older (60-75 years) adults entered words on the two best shapes from the first experiments.

RESULTS

For the movement task, movement time was lowest for shapes with higher shape-controller compatibility. For the visual search task, search time and accuracy were best on the alphabetic arrangement. In the combined task, shape did not significantly influence performance at different levels of practice. Transfers, however, suggested that the shape with salient visual features elicited a text entry strategy for older adults that may promote more consistent performance under occasional usage.

CONCLUSION

The studies together demonstrate that keyboard shape is important for efficient performance. Shape-controller compatibility facilitated performance in both age groups. Salient features facilitate performance, especially for older adults. In nearly all cases alphabetic arrangement yielded the best performance.

APPLICATION

Recommendations are provided for virtual keyboard design for different usage frequencies, contexts, and users.

Environmental support: an integrative framework

OBJECTIVE

In this qualitative review, we develop an integrative framework to bring coherence to the concept of environmental support (ES) in the fields of human factors and cognitive aging.

BACKGROUND

The ES hypothesis, originally formulated to explain effects of retrieval support on age-related differences in memory by reducing need for self-initiated processing, has been applied to many domains, such that the concept now encompasses many manipulations and measures. We developed a framework in which different types of ES share a common function (external support of performance) but differ in how this function is accomplished. ES improves performance by reducing task demands on mental resources or promoting effective use of resources. Previous reviews show that ES can decrease age-related differences in performance (more benefit for older adults), provide equal benefit, or increase differences (more benefit for younger adults). We proposed that the outcome will depend on properties of the ES, task, and person.

METHOD

We applied our framework to the domains of language comprehension and human-computer interaction, selecting studies representative of differing outcomes for ES.

RESULTS

In both domains, we found that outcomes depended on ES, task, and person. Age differences were more likely to be reduced by ES that imposed minimal prerequisites for use and targeted processes that needed support.

CONCLUSION

Our review helps refine the ES concept by identifying conditions under which age differences in performance are reduced or magnified by ES.

APPLICATIONS

The framework provides guidance for human factors practitioners to design tasks and environments for older adults.

Assessing age-related patterns in strategy selection on a mathematical problem-solving task

We examined age-related differences in strategy-choice behavior in 27 younger and 28 older adults. Participants solved 4 two-digit by two-digit multiplication problems. We expected them to initially calculate the answers but eventually switch to a retrieval strategy, recalling answers from memory. Three groups emerged: younger adults who met the criterion (20 consecutive, correct, retrieval trials selected and answered in time), older adults who met the criterion, and older adults who did not meet the criterion. Younger and older adults who met the criterion had similar performance patterns. Some older adults who did not meet the criterion were slower to learn, whereas others seemed to be averse to the retrieval strategy. Thus, older adult patterns in strategy choice are considerably more varied than younger adult patterns, suggesting different explanations for differences in memory performance.

Exclusion of women from clinical research: myth or reality?

OBJECTIVE

To determine the proportion of male and female research participants and rates of sex-based analysis and sex-specific reporting in published Australian clinical research.

PARTICIPANTS AND METHODS

We assessed 400 clinical studies involving Australian-only participants, published in journals between January 1, 2003, and May 31, 2006 (100 per year). Numbers of male and female participants in each study and presence or absence of analysis by sex (covariate adjustment, subgroup analysis, or sex-specific reporting) were recorded. Sex-specific studies were evaluated to determine whether the exclusion of one sex was biologically necessary.

RESULTS

The total sample comprised 546,824 participants, of whom 73% were female; 36 studies were male-only, 78 were female-only. Of the participants in 286 studies that were not sex-specific, 56% were female. Of 114 sex-specific studies, the segregation by sex was deemed to be biologically necessary in 62%, ie, the research related directly to male or female biological function. More than one-quarter (28%) of studies with 30 participants or more published covariate adjustment or subgroup analysis by sex; 7% included sex-specific reporting of results.

CONCLUSION

We found no routine exclusion of women; however, few publications analyzed results by sex. Some studies excluded women or men for apparently arbitrary reasons. Research performed with male-only participants differed in nature and size from that performed with female-only participants. These data indicate the need to track the sex of research participants. In addition, they provide the basis for assessing appropriate inclusion of men and women in research and for comparing any relationship between different international regulatory models and the rates of female participation in research.

Privacy and Technology: Folk Definitions and Perspectives

In this paper we present preliminary results from a study of individual differences in privacy beliefs, as well as relate folk definitions of privacy to extant privacy theory. Focus groups were conducted with young adults aged 18-28 and older adults aged 65-75. Participants first shared their individual definitions of privacy, followed by a discussion of privacy in six scenarios chosen to represent a range of potentially invasive situations. Taken together, Westin's and Altman's theories of privacy accounted for both younger and older adults' ideas about privacy, however, neither theory successfully accounted for findings across all age and gender groups. Whereas males tended to think of privacy in terms of personal needs and convenience, females focused more on privacy in terms of others, respecting privacy rights, and safety. Older adults tended to be more concerned about privacy of space rather than information privacy. Initial results reinforce the notion that targeting HCI design to the user population, even with respect to privacy, is critically important.

Usability of an adaptive computer assistant that improves self-care and health literacy of older adults

OBJECTIVES

We developed an adaptive computer assistant for the supervision of diabetics' self-care, to support limiting illness and need for acute treatment, and improve health literacy. This assistant monitors self-care activities logged in the patient's electronic diary. Accordingly, it provides context-aware feedback. The objective was to evaluate whether older adults in general can make use of the computer assistant and to compare an adaptive computer assistant with a fixed one, concerning its usability and contribution to health literacy.

METHODS

We conducted a laboratory experiment in the Georgia Tech Aware Home wherein 28 older adults participated in a usability evaluation of the computer assistant, while engaged in scenarios reflecting normal and health-critical situations. We evaluated the assistant on effectiveness, efficiency, satisfaction, and educational value. Finally, we studied the moderating effects of the subjects' personal characteristics.

RESULTS

Logging self-care tasks and receiving feedback from the computer assistant enhanced the subjects' knowledge of diabetes. The adaptive assistant was more effective in dealing with normal and health-critical situations, and, generally, it led to more time efficiency. Subjects' personal characteristics had substantial effects on the effectiveness and efficiency of the two computer assistants.

CONCLUSIONS

Older adults were able to use the adaptive computer assistant. In addition, it had a positive effect on the development of health literacy. The assistant has the potential to support older diabetics' self care while maintaining quality of life.

Human factors considerations in implementing telemedicine systems to accommodate older adults

The number of older adults is increasing, and telemedicine has the potential to improve their access to health care. Telemedicine systems have been shown to benefit older adults by increasing peer support interactions, providing health-care access to older adults in rural communities, reducing the cost of health care, increasing exercise, reducing pain and depression, and, perhaps most important, improving functional independence. However, older adults may have different needs from other users when interacting with telemedicine systems, because of age-related changes in perceptual, motor and cognitive abilities. The design of telemedicine technologies should, therefore, capitalize on older adults' strengths while minimizing their weaknesses. The field of human factors has much to offer in optimizing interactions between older adults and telemedicine technologies. Future research should take advantage of human factors methodologies to best design telemedicine technologies for an older population.

Training older adults to use new technology

Enabling older adults to interact with new technologies is an important immediate and long-term goal for training research. The literature provides general guidance for developing training programs; however, it is important to determine the type of training that works best for younger and older adults, for immediate performance, and for learning. In the present study we assessed the relative benefits of guided action training and guided attention training for younger and older adults learning to use a novel technology system. Guided action training yielded better performance during training for both age groups. However, assessments of learning revealed a clear benefit of guided attention training for both age groups. These data suggest differences in training benefits for immediate performance versus more general learning.

Organ donation after cardiac death: legal and ethical justifications for antemortem interventions

Organ donation after cardiac death increases organ availability, but raises several legal and ethical issues, including consent. Medical interventions for people who are unconscious usually require guardian consent and must meet patients' best-interests standards. Antemortem procedures can improve the success of organ transplant after cardiac death, but do not serve the patient's medical interests, and it is contentious whether consent for antemortem interventions is legal under current Australian guardianship legislation. We argue that consent decisions should take patients' wishes as well as their medical interests into account. Antemortem interventions are ethically and legally justified if the interventions are not harmful and the person concerned wished to be an organ donor.

Designing a Technology Coach: A multidisciplinary team models a system that can alert users of a complex medical device when they make an error

Technology in the home environment has the potential to support older adults in a variety of ways. We took an interdisciplinary approach (human factors/ergonomics and computer science) to develop a technology "coach" that could support older adults in learning to use a medical device. Our system provided a computer vision system to track the use of a blood glucose meter and provide users with feedback if they made an error. This research could support the development of an in-home personal assistant to coach individuals in a variety of tasks necessary for independent living.

Factors predicting the use of technology: findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE)

The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults. The sample included 1,204 individuals ranging in age from 18-91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption.

Older adults' motivated choice for technological innovation: evidence for benefit-driven selectivity

This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology. Regardless of whether their decision about the new technology was positive or negative and irrespective of their e-mail experience, participants focused on benefits rather than costs. For traditional media, both costs and benefits were important. Results contradict the common belief that barriers such as usability problems determine whether older people use new technology and indicate the decisive role of perceived benefits for successful innovation.

Human Factors Goes to the Golf Course: Knowledge Engineering of Commercial Mowing

Before a new fairway mower can be made more user-centered, steps must be taken to understand how operators interact with the existing model.

Factors predicting the use of technology: findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE)

The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults. The sample included 1,204 individuals ranging in age from 18-91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption.

Feminism and public health ethics

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health.

Older adults' motivated choice for technological innovation: evidence for benefit-driven selectivity

This study examined older adults' motivation to adopt technological innovation. Sixty-eight older e-mail users and nonusers discussed the use of e-mail and of traditional communication methods in 18 focus groups. The results show older adults' benefit-driven approach to new communication technology. Regardless of whether their decision about the new technology was positive or negative and irrespective of their e-mail experience, participants focused on benefits rather than costs. For traditional media, both costs and benefits were important. Results contradict the common belief that barriers such as usability problems determine whether older people use new technology and indicate the decisive role of perceived benefits for successful innovation.