Aging, motor control, and the performance of computer mouse tasks

The development and validation of two complementary measures of drivers' hazard perception ability

Hazard perception in driving involves a number of different processes. This paper reports the development of two measures designed to separate these processes. A Hazard Perception Test was developed to measure how quickly drivers could anticipate hazards overall, incorporating detection, trajectory prediction, and hazard classification judgements. A Hazard Change Detection Task was developed to measure how quickly drivers can detect a hazard in a static image regardless of whether they consider it hazardous or not. For the Hazard Perception Test, young novices were slower than mid-age experienced drivers, consistent with differences in crash risk, and test performance correlated with scores in pre-existing Hazard Perception Tests. For drivers aged 65 and over, scores on the Hazard Perception Test declined with age and correlated with both contrast sensitivity and a Useful Field of View measure. For the Hazard Change Detection Task, novices responded quicker than the experienced drivers, contrary to crash risk trends, and test performance did not correlate with measures of overall hazard perception. However for drivers aged 65 and over, test performance declined with age and correlated with both hazard perception and Useful Field of View. Overall we concluded that there was support for the validity of the Hazard Perception Test for all ages but the Hazard Change Detection Task might only be appropriate for use with older drivers.

Advanced practice registered nurse usability testing of a tailored computer-mediated health communication program

This study tested the usability of a touch-screen-enabled Personal Education Program with advanced practice RNs. The Personal Education Program is designed to enhance medication adherence and reduce adverse self-medication behaviors in older adults with hypertension. An iterative research process was used, which involved the use of (1) pretrial focus groups to guide the design of system information architecture, (2) two different cycles of think-aloud trials to test the software interface, and (3) post-trial focus groups to gather feedback on the think-aloud studies. Results from this iterative usability-testing process were used to systematically modify and improve the three Personal Education Program prototype versions-the pilot, prototype 1, and prototype 2. Findings contrasting the two separate think-aloud trials showed that APRN users rated the Personal Education Program system usability, system information, and system-use satisfaction at a moderately high level between trials. In addition, errors using the interface were reduced by 76%, and the interface time was reduced by 18.5% between the two trials. The usability-testing processes used in this study ensured an interface design adapted to APRNs' needs and preferences to allow them to effectively use the computer-mediated health-communication technology in a clinical setting.

Older Adults and Diffusion of Assistive Web-Base Technologies

Recent surveys show that the number of people over the age of 65 is increasing worldwide and there is a considerable discussion about the scope of improving the older adults’ autonomy and independence, using recent developments in information technology. One of such development is web services and it is rapidly becoming a major means of accessing healthcare in the community and many government services for the older adults. However several researchers argue that age-related cognitive impairments have a detrimental effect on use of such web services by older adults. However, little and systematic applied research has been conducted on how age related cognitive impairments might affect the usage of web services by older adults. Undoubtedly, understanding the relationship between the cognitive changes that accompany aging and their impact on older adults’ usage of web services will be beneficial for designing web services for this group. The article demonstrates how such understanding has been employed to develop an assistive technology to improve older adults’ interaction with online forms (e.g. state benefit application form). However, the article acknowledges that this new assistive technology does not guarantee that people with age-related cognitive impairments accept it, as diffusion of innovation research shows that getting a new technology adopted, even when it has noticeable advantage, is often very difficult. Consequently, the article identifies critical factors that need to be considered when adopting this new assistive technology, drawing on Rogers’s theory of Diffusion of Innovations.

Adjustment to a complex visuo-motor transformation at early and late working age

Age-related changes of adjustment to visuo-motor transformations were studied for a complex transformation modelled after those encountered in laparoscopic surgery. Movement times of aimed movements were initially almost identical for the two age groups and diverged in the course of practice. In test phases without visual feedback, no age-related variation of the adaptive shifts and after effects of amplitude and curvature of hand movements were observed, but only of their direction. Directional adaptive shifts were bimodally distributed, with one mode near to perfect adaptation ('adapters') and the other one near to absence of adaptation ('non-adapters'). Among the young participants, adapters were more frequent than among the old participants. These findings extend previous results on age-related changes of adjustment to simple transformations to complex transformations. They are consistent with the claim that age-related changes of adjustment to visuo-motor rotations come about primarily by impairments of strategic corrections. A link is established between basic-research findings and transformations encountered outside the laboratory: what suffers at higher working age is explicit knowledge of visuo-motor rotations and the strategic corrections based on it. This suggests the provision of opportunities for explicit-knowledge acquisition for those of a higher age.

Technology use by rural and urban oldest old

OBJECTIVES

Technologies designed to optimally maintain older people as they age in their desired places of residence are proliferating. An important step in designing and deploying such technologies is to determine the current use and familiarity with technology in general among older people. The goal of this study was to determine the extent that community-dwelling elderly at highest risk of losing independence, the oldest old, use common electronic devices found in residential urban or rural settings.

METHODS

We surveyed 306 nondemented elderly age 85 or over; 144 were part of a rural aging study, the Klamath Exceptional Aging Project, and 181 were from an urban aging cohort in Portland.

RESULTS

The most frequently used devices were televisions, microwave ovens, and answering machines. Persons with mild cognitive impairment were less likely to use all devices than those with no impairment. Higher socioeconomic status and education were associated with use of more complicated devices. Urban respondents were more likely than rural ones to use most devices.

CONCLUSION

Technology use by very old community-dwelling elderly is common. There are significant differences in use between rural and urban elderly.

Developing assistive web‐base technologies for adults with age‐related cognitive impairments

Purpose

Little systematic applied research has been conducted on how age‐related cognitive impairments might affect older adults' usage of web service and this paper aims to fill some of that gap.

Design/methodology/approach

An analysis of the relationship between the cognitive changes of aging and the usage of web services. Supported by field research with the key stakeholders, including older adults and organisations that provide services for older adults. This consists of focus group sessions with key stakeholders and individual interviews with older adult users. Older adult users also complete an online form using a think aloud protocol. The data are analysed using a thematic content analysis technique.

Findings

Issues around older adults' relationship with technology and the challenges they face along with the strengths and weaknesses of online forms and means to improve them. In particular, there are issues of fear and frustration, inconsistency and visual clutter, and a feeling of neglect by service providers. Users also identify a strong need for human rather than machine support when struggling with the technology.

Research limitations/implications

The findings only now being applied to an existing system in the Delivering Inclusive Access to Disabled and Elderly Members (DIADEM) project and it still needs to evaluate of usability of DIADEM. Further research also needs to consider the technology adoption model for system like DIADEM.

Practical implications

The findings have implications in form design and transaction delivery for online services.

Originality/value

The perception of neglect by service providers is new and this with the needs for consistency and for human support lead to novel approaches in the DIADEM system.

Exploring Methods to Improve Pen-Based Menu Selection for Younger and Older Adults

Tablet PCs are gaining popularity, but many individuals still struggle with pen-based interaction. In a previous baseline study, we examined the types of difficulties younger and older adults encounter when using pen-based input. The research reported in this article seeks to address one of these errors, namely, missing just below. This error occurs in a menu selection task when a user’s selection pattern is downwardly shifted, such that the top edge of the menu item below the target is selected relatively often, while the corresponding top edge of the target itself is seldom selected. We developed two approaches for addressing missing just below errors: reassigning selections along the top edge and deactivating them. In a laboratory evaluation, only the deactivated edge approach showed promise overall. Further analysis of our data revealed that individual differences played a large role in our results and identified a new source of selection difficulty. Specifically, we observed two error-prone groups of users: the low hitters, who, like participants in the baseline study, made missing just below errors, and the high hitters, who, in contrast, had difficulty with errors on the item above. All but one of the older participants fell into one of these error-prone groups, reinforcing that older users do need better support for selecting menu items with a pen. Preliminary analysis of the performance data suggests both of our approaches were beneficial for the low hitters, but that additional techniques are needed to meet the needs of the high hitters and to address the challenge of supporting both groups in a single interface.

A systematic review of patient acceptance of consumer health information technology

A systematic literature review was performed to identify variables promoting consumer health information technology (CHIT) acceptance among patients. The electronic bibliographic databases Web of Science, Business Source Elite, CINAHL, Communication and Mass Media Complete, MEDLINE, PsycArticles, and PsycInfo were searched. A cited reference search of articles meeting the inclusion criteria was also conducted to reduce misses. Fifty-two articles met the selection criteria. Among them, 94 different variables were tested for associations with acceptance. Most of those tested (71%) were patient factors, including sociodemographic characteristics, health- and treatment-related variables, and prior experience or exposure to computer/health technology. Only ten variables were related to human-technology interaction; 16 were organizational factors; and one was related to the environment. In total, 62 (66%) were found to predict acceptance in at least one study. Existing literature focused largely on patient-related factors. No studies examined the impact of social and task factors on acceptance, and few tested the effects of organizational or environmental factors on acceptance. Future research guided by technology acceptance theories should fill those gaps to improve our understanding of patient CHIT acceptance, which in turn could lead to better CHIT design and implementation.

Usability testing by older adults of a computer-mediated health communication program

Failure to adhere to an antihypertensive regimen and interactions between antihypertensives and other medicines represent serious health threats to older adults. This study tested the usability of a touch-screen-enabled personal education program (PEP). Findings showed that older adults rated the PEP system usability, system usefulness, and system-use satisfaction at a moderately high level for prototype-1 and at an exceptionally high level for prototype-2. A 201.91% reduction in interface errors and a 31.08% decrease in interface time also were found between the two trials. This participatory usability design was highly successful in tailoring its program interface design to accommodate older users to enhance their health communication and technology use efficacy.

A framework of interaction costs in information visualization

Interaction cost is an important but poorly understood factor in visualization design. We propose a framework of interaction costs inspired by Norman's Seven Stages of Action to facilitate study. From 484 papers, we collected 61 interaction-related usability problems reported in 32 user studies and placed them into our framework of seven costs: (1) Decision costs to form goals; (2) System-power costs to form system operations; (3) Multiple input mode costs to form physical sequences; (4) Physical-motion costs to execute sequences; (5) Visual-cluttering costs to perceive state; (6) View-change costs to interpret perception; (7) State-change costs to evaluate interpretation. We also suggested ways to narrow the gulfs of execution (2-4) and evaluation (5-7) based on collected reports. Our framework suggests a need to consider decision costs (1) as the gulf of goal formation.

Investigation of Input Devices for the Age-differentiated Design of Human-Computer Interaction

Demographic change demands new concepts for the support of computer work by aging employees. In particular, computer interaction presents a barrier due to a lack of experience and age-specific changes in performance. This article presents a study in which different input devices (mouse, touch screen and eye-gaze input) were analyzed regarding their usability and according to age diversity. Furthermore, different Hybrid Interfaces that combine eye-gaze input with additional input devices were investigated.

Goal Crossing with Mice and Trackballs for People with Motor Impairments

Prior research shows that people with motor impairments face considerable challenges when using conventional mice and trackballs. One challenge is positioning the mouse cursor within confined target areas; another is executing a precise click without slipping. These problems can make mouse pointing in graphical user interfaces very difficult for some people. This article explores goal crossing as an alternative strategy for more accessible target acquisition. In goal crossing, targets are boundaries that are simply crossed by the mouse cursor. Thus, goal crossing avoids the two aforementioned problems. To date, however, researchers have not examined the feasibility of goal crossing for people with motor difficulties. We therefore present a study comparing area pointing and goal crossing. Our performance results indicate that although Fitts' throughput for able-bodied users is higher for area pointing than for goal crossing (4.72 vs. 3.61 bits/s), the opposite is true for users with motor impairments (2.34 vs. 2.88 bits/s). However, error rates are higher for goal crossing than for area pointing under a strict definition of crossing errors (6.23% vs. 1.94%). We also present path analyses and an examination of submovement velocity, acceleration, and jerk (the change in acceleration over time). These results show marked differences between crossing and pointing and almost categorically favor crossing. An important finding is that crossing reduces jerk for both participant groups, indicating more fluid, stable motion. To help realize the potential of goal crossing for computer access, we offer design concepts for crossing widgets that address the occlusion problem, which occurs when one crossing goal obscures another in persistent mouse-cursor interfaces. This work provides the motivation and initial steps for further exploration of goal crossing on the desktop, and may help researchers and designers to radically reshape user interfaces to provide accessible goal crossing, thereby lowering barriers to access.

Learning new visuo-motor gains at early and late working age

Modern workplaces often require adaptation to novel visuo-motor transformations. Findings on age-related variations of such adaptation are rather inconsistent, suggesting that whether or not age-related impairments do occur depends on boundary conditions. This paper examined the hypotheses that age-related variations affect primarily strategic adjustments to novel transformations and can be found for complex (non-linear) transformations, but not for simple (linear) ones. After a practice period with linear and non-linear visuo-motor transformations, open-loop performance, after-effects and explicit knowledge were examined. Consistent with previous findings, older participants had longer movement times and shorter open-loop amplitudes, more so for long than for short target amplitudes. However, the study did not find any age-related variation of adaptation to a novel visuo-motor gain. Regarding adaptation to a non-linear transformation, the findings suggest slightly superior explicit knowledge of younger adults and the development of slightly more efficient closed-loop processes in the course of practice.

Notebook input devices put to the age test: the usability of trackpoint and touchpad for middle-aged adults

In two experiments, the usability of input devices integrated into computer notebooks was under study. The most common input devices, touchpad (experiment 1) and trackpoint (experiment 2) were examined. So far, the evaluation of mobile input devices has been restricted to younger users. However, due to ongoing demographic change, the main target group of mobile devices will be older users. Therefore, the present study focused on ageing effects. A total of 14 middle-aged (40-65 years) and 20 younger (20-32 years) users were compared regarding speed and accuracy of cursor control in a point-click and a point-drag-drop task. Moreover, the effects of training were addressed by examining the performance increase over time. In total, 640 trials per task and input device were executed. The results show that ageing is a central factor to be considered in input device design. Middle-aged users were significantly slower than younger users when executing the different tasks. Over time, a significant training effect was observed for both devices and both age groups, although the benefit of training was greater for the middle-aged group. Generally, the touchpad performance was higher than the trackpoint performance in both age groups, but the age-related performance decrements were less distinct when using the touchpad.

Development of Theory-based, Online Health Learning Modules for Older Adults

Recently, the number of older adult online users has increased rapidly. In 2004, 22% of Americans aged 65 years or older (about 8 million) used the Internet, and 66% of them performed online searches for health information. The Web, therefore, can serve as a useful medium to educate older adults on selected health topics. In this study, the researchers developed four Web-based learning modules related to hip fracture prevention and tested the usability of these modules employing eight older adult online users. The findings from the usability tests demonstrated that the online learning modules were usable to the older adult participants. Additionally, these individuals could acquire health knowledge using these online modules. The important lessons learned through the research process will assist the researchers in conducting further studies in using health Web learning modules for older adults. A further study will be conducted to test the effects of these modules on preventing hip fractures.

Effect of computer mouse gain and visual demand on mouse clicking performance and muscle activation in a young and elderly group of experienced computer users

The present study evaluated the specific effects of motor demand and visual demands on the ability to control motor output in terms of performance and muscle activation. Young and elderly subjects performed multidirectional pointing tasks with the computer mouse. Three levels of mouse gain and three levels of target size were used. All subjects demonstrated a reduced working speed and hit rate at the highest mouse gain (1:8) when the target size was small. The young group had an optimum at mouse gain 1:4. The elderly group was most sensitive to the combination of high mouse gain and small targets and thus, this age group should avoid this combination. Decreasing target sizes (i.e. increasing visual demand) reduced performance in both groups despite that motor demand was maintained constant. Therefore, it is recommended to avoid small screen objects and letters. Forearm muscle activity was only to a minor degree influenced by mouse gain (and target sizes) indicating that stability of the forearm/hand is of significance during computer mouse control. The study has implications for ergonomists, pointing device manufacturers and software developers.

Touch a screen or turn a knob: choosing the best device for the job

Input devices enable users to interact with systems. In two experiments, we assessed whether and how task demands and user age influenced task performance for a direct input device (touch screen) and an indirect input device (rotary encoder). In Experiment 1, 40 younger (18-28 years) and 40 middle-aged to older adults (51-65 years) performed tasks using controls such as sliders, up/down buttons, list boxes, and text boxes while using a system. The optimal input device to facilitate performance was dependent on the task being performed and the age of the user. In Experiment 2, touch screen use was assessed for 20 younger (19-23 years) and 20 older adults (51-70 years). Task demands were manipulated through button size, movement distance, direction, and type of movement. Performance was moderated by the age of the user and by task demands. Actual or potential applications of this research include guidance for the optimal selection of input devices for different user populations and task characteristics.

Effect of tactile feedback on movement speed and precision during work-related tasks using a computer mouse

Effects of tactile feedback on movement accuracy and speed were studied. Younger and older participants performed three tasks (1, select and drag word; 2, menu navigation; 3, select and drag cell) using commercial software and a mouse with or without tactile feedback. Task time and error number were recorded. Tasks were divided according to presence or absence of tactile feedback, and participants were divided into subgroups (high, average, low) based on Task 1 performance. Overall, older participants took longer (p < .0001) and made more errors (p < .001) than younger participants. There was an effect of feedback by task in younger participants for all six outcomes (p < 0.02). At the task level, with feedback, younger participants reduced performance time (13%) and errors (24%) on Task 1. Low- and average-performance younger participants benefited most from feedback for Task 1. Older low-performance participants also benefited from feedback for Task 1. For Task 3, older participants tended to take more time and make more errors with feedback. Tactile feedback may enhance performance when feedback is event related. Older people may not integrate sensation as well as younger individuals to enhance performance. Potential applications of this research include the development of tactile feedback interfaces to facilitate computer use.

Usability of Health Web Sites for Older Adults

Although an increasing number of Web sites are devoted to providing health information to older adults, many sites have usability problems unique to this population. The purpose of this study was to explore the usability of three health-promoting Web sites specifically designed for use by older adults. This descriptive study used two usability assessment methods: (1) a heuristic evaluation by four experts in Web usability and gerontology and (2) a usability test by 10 senior Web users with a mean age of 73.9. The design aspects identified as inappropriate for seniors by experts were as follows: small font size, too much information on one page, and a failure to provide instructions. The older adults in this sample preferred a simple design with clear instructions. During testing, these individuals expressed great interest in online health information. However, they needed instructions on how to search for credible health information online. Some usability-testing methods might need to be modified for older adults' specific needs.

Installing Computers in Older Adultsʼ Homes and Teaching Them to Access a Patient Education Web Site

This article describes the experiences of nurses who, as part of a large clinical trial, brought the Internet into older adults' homes by installing a computer, if needed, and connecting to a patient education Web site. Most of these patients had not previously used the Internet and were taught even basic computer skills when necessary. Because of increasing use of the Internet in patient education, assessment, and home monitoring, nurses in various roles currently connect with patients to monitor their progress, teach about medications, and answer questions about appointments and treatments. Thus, nurses find themselves playing the role of technology managers for patients with home-based Internet connections. This article provides step-by-step procedures for computer installation and training in the form of protocols, checklists, and patient user guides. By following these procedures, nurses can install computers, arrange Internet access, teach and connect to their patients, and prepare themselves to install future generations of technological devices.

Internet-based patient education and support interventions: a review of evaluation studies and directions for future research

The Internet provides patients, families, and health providers with unparalleled opportunities to learn, inform, and communicate with one another. This paper is a review of studies that have evaluated the impact of professionally facilitated Internet-based programs for diverse clinical populations on health outcomes, utilization, and user satisfaction. The findings suggest that some outcomes in certain groups can be moderately improved and that user satisfaction has been generally positive. Given the increasing need to provide timely and effective patient-centered care, a stronger evidence base for eHealth applications must be established before broader deployment of such programs will take place.

Usability of a computer-assisted interview system for the unaided self-entry of patient data in an urban rheumatology clinic

OBJECTIVE

This study quantified the ease of use for patients and providers of a microcomputer-based, computer-assisted interview (CAI) system for the serial collection of the American College of Rheumatology Patient Assessment (ACRPA) questionnaire in routine outpatient clinical care in an urban rheumatology clinic.

DESIGN

A cross-sectional survey was used.

MEASUREMENTS

The answers of 93 respondents to a computer use questionnaire mailed to the 130 participants of a previous validation study of the CAI system were analyzed. For a 30-month period, the percentage of patient visits during which complete ACRPA questionnaire data were obtained with the system was determined.

RESULTS

The computer system provided cost and labor savings in the collection of 2,476 questionnaires for 2,964 patients visits over 30 months for a capture rate of 83.5%. In the last 12 of those months, 1,035 questionnaires were collected for 1,062 patient visits (97.5% capture). There were no missing data. The prestudy capture rate was 13.5%, with 33% of surveys having complete data. Patients rated the overall usability of the system as good (mean = 1.34, standard deviation = 0.61) on a scale of 0-2, where 2 = good, but expressed difficulty with mouse manipulation and concerns about the privacy of the data entry environment. CONCLUSION The system proved easy to use and cost-effective for the (mostly) unaided self-entry of self-report data for each patient for each visit in routine outpatient clinical care in an urban rheumatology clinic.

A new approach to the mouse arm syndrome

OBJECTIVES

The study validates a new computer mouse concept. The tested device is a small mouse with a pivoting pen-shaped handle. The hypothesis behind the design is the assumptions that the pen grip requires less static tension than the normal mouse grip and that fine-motor, high precision tasks normally are done with finger movements with forearm at rest.

METHODS

Four muscles were monitored with electromyography (EMG) during work with a new mouse and with a traditional mouse.

RESULTS

EMG activity was significant lower, in M. pronator teres--46%, M. extensor digitorum--46%, M. trapezius--69%, and M. levator scapulae--82%, during work with the new mouse as compared to the traditional mouse.

CONCLUSION

Altering the design of the computer mouse can significantly reduce muscular tension.

Light pen use and practice minimize age and hand performance differences in pointing tasks

We contrasted performance with mouse and light pen input devices for younger, middle-aged, and older adults (N = 72) who were experienced mouse users. Participants used both preferred and nonpreferred hands to perform a menu target selection task. The light pen minimized age differences in performance relative to the mouse. Older adults were more lateralized on a handedness test than young adults and were less efficient using their nonpreferred hand. With practice, older adults improved their response time more than other age groups did. The mouse was rated as more acceptable and easier to use than the light pen across trials, despite the performance advantage of the light pen for all age groups. Usability ratings correlated moderately with performance. A benefit-cost analysis indicated that the more efficient light pen might cover its greater initial cost within 11 months for an older adult and within 23 months for a younger adult. Actual or potential applications of this research include advising older adults to persist with practice for new input devices, advising those who must switch to their non-preferred hand to select a direct positioning device, and providing a methodology for determining the potential payback interval when switching to a faster, though more expensive, input device.

Quality assurance processes for designing patient education web sites

In the future, more nurses and other healthcare professionals will be providing patient education on the Internet. Having knowledge of processes that lead to quality patient education Web site design is essential. These quality assurance processes include determining the site's purpose, selecting the user population, establishing the expected clinical and learning outcomes, providing an educational framework, incorporating specific design principles, and multiple and ongoing site evaluation. Therefore, Web site development processes designed to undergird quality patient education are presented, and an example Web site is used to illustrate them.

Word-processing training and retraining: effects of adult age, experience, and interface

Novice (Experiment 1) and experienced (Experiment 2) young, middle-aged, and older adults learned a new word-processing application in keystrokes, menus, or menus-plus-icons interface conditions. Novices showed strong age differences in the time to complete the 3-day tutorial and in declarative and procedural tests of word-processing knowledge. Menus and menus-plus-icons were superior to keystrokes condition. though interface did not interact with age. Experienced users showed age-related slowing in learning rate but minimal age differences in test performance when retrained on a new word-processing program. Age and computer experience accounted for much of the variance in both learning time and word-processing performance; interface type, speed of processing, and spatial generation ability made additional contributions. Experience interacted with age to predict performance. Implications for training and retraining older workers are discussed.