Gerontechnology acceptance by elderly Hong Kong Chinese: a senior technology acceptance model (STAM)

Integrating usability and social cognitive theories with the technology acceptance model to understand young users’ acceptance of a health information portal

The past decade has seen the proliferation of health information portals; however, consumer acceptance of the portals has proven difficult and rate of use has been limited. This study developed a consumer acceptance model by integrating usability and social cognitive theories with the technology acceptance model to explain young Internet users’ acceptance of health information portals. Participants (n = 201) completed a self-report questionnaire measuring model constructs after attending a usability testing with a typical health information portal. Results showed that the hypothesized model accounted for 56 percent of the variance in behavioral intention to use the portal and explained consumer acceptance well. Both subjective usability and application-specific self-efficacy served as significant antecedents in the model, while application-specific self-efficacy also moderated the effect of subjective usability on perceived ease of use. The findings can help practitioners with the design and implementation of health information portals and other health informatics applications in support of consumer acceptance.

Exerting Explanatory Accounts of Safety Behavior of Older Construction Workers within the Theory of Planned Behavior

Older construction workers are vulnerable to accident risks at work. Work behavior affects the occurrence of accidents at construction sites. This study aims to investigate the organizational and personal factors that underlie the safety behaviors of older construction workers considering their age-related characteristics. A cross-sectional questionnaire survey, which involves 260 older construction workers (aged 50 and over), was conducted, and an integrative old-construction-worker safety behavior model (OSBM) was established on the basis of the theory of planned behavior (TPB). Results showed that the OSBM provides a considerably good explanation of the safety behaviors of older construction workers. The explained variances for safety participation and compliance are 74.2% and 63.1%, respectively. Subjective norms and perceived behavioral control are two critical psychological drivers that proximally affect the safety behaviors of workers. Moreover, safety knowledge, management commitment, and aging expectation are the distal antecedents that significantly influence psychological drivers. This study proves the mediating role of psychological factors on predicting safety behaviors among older construction workers, thereby promoting an understanding of "how" and "why" their safety behaviors occur. Furthermore, the identified effects of several critical organizational and personal factors, particularly age-related factors, provide new insights into the safety behaviors of older construction workers.

Understanding changes and stability in the long-term use of technologies by seniors who are aging in place: a dynamical framework

Background

If technologies are to support aging in place, then it is important to develop fundamental knowledge on what causes stability and changes in the use of technologies by seniors. However, longitudinal studies on the long-term use of technologies that have been accepted into the home (i.e., post-implementation use) are very scarce. Many factors potentially could influence post-implementation use, including life events, age-related decline, changes in personal goal orientation, and various types of social influences. The aforementioned factors are likely to be interrelated, adding to the complexity. The goal of this study is to better understand changes and stability in the use of technologies by independent-living seniors, by using a dynamical systems theory approach.

Methods

A longitudinal qualitative field study was conducted involving home visits to 33 community-dwelling seniors in the Netherlands, on three occasions (2012–2014). Interviews were held on technology usage patterns, including reasons for stable, increased, declined and stopped use. Technologies were included if they required electric power in order to function, were intended to be used in or around the home, and could support activities of daily living, personal health or safety, mobility, communication, and physical activity. Thematic analysis was employed, using constant case comparison to better understand dynamics and interplay between factors. In total, 148 technology use patterns by 33 participants were analyzed.

Results

A core of six interrelated factors was closely linked to the frequency of technology use: emotional attachment, need compatibility, cues to use, proficiency to use, input of resources, and support. Additionally, disruptive forces (e.g., social influences, competition with alternative means, changes of personal needs) could induce change by affecting these six factors. Furthermore, long-term technology use was in some cases more resilient to disruption than in other cases. Findings were accumulated in a new framework: Dynamics In Technology Use by Seniors (DITUS).

Conclusions

Similar to aging, the use of technologies by older people is complex, dynamic and personal. Periods of stability and change both occur naturally. The DITUS framework can aid in understanding stability and instability of technology use, and in developing and implementing sustainable technological solutions for aging in place.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1241-9) contains supplementary material, which is available to authorized users.

The Acceptance Behavior of New Media Entertainment Among Older Adults: Living Arrangement as a Mediator

New media entertainment is currently being spotlighted by business practitioners and researchers. This article highlighted this issue of elder online users and explored the factors affecting their acceptance decisions in new media entertainment. Older adults prefer to status and value orientations, so their online acceptance of new media entertainment is significantly influenced by the perceived usefulness and social benefits. In addition, types of living arrangement significantly affect technology acceptance model of older adults.

How Prefrail Older People Living Alone Perceive Information and Communications Technology and What They Would Ask a Robot for: Qualitative Study

Background

In the last decade, the family system has changed significantly. Although in the past, older people used to live with their children, nowadays, they cannot always depend on assistance of their relatives. Many older people wish to remain as independent as possible while remaining in their homes, even when living alone. To do so, there are many tasks that they must perform to maintain their independence in everyday life, and above all, their well-being. Information and communications technology (ICT), particularly robotics and domotics, could play a pivotal role in aging, especially in contemporary society, where relatives are not always able to accurately and constantly assist the older person.

Objective

The aim of this study was to understand the needs, preferences, and views on ICT of some prefrail older people who live alone. In particular, we wanted to explore their attitude toward a hypothetical caregiver robot and the functions they would ask for.

Methods

We designed a qualitative study based on an interpretative phenomenological approach. A total of 50 potential participants were purposively recruited in a big town in Northern Italy and were administered the Fried scale (to assess the participants’ frailty) and the Mini-Mental State Examination (to evaluate the older person’s capacity to comprehend the interview questions). In total, 25 prefrail older people who lived alone participated in an individual semistructured interview, lasting approximately 45 min each. Overall, 3 researchers independently analyzed the interviews transcripts, identifying meaning units, which were later grouped in clustering of themes, and finally in emergent themes. Constant triangulation among researchers and their reflective attitude assured trustiness.

Results

From this study, it emerged that a number of interviewees who were currently using ICT (ie, smartphones) did not own a computer in the past, or did not receive higher education, or were not all young older people (aged 65-74 years). Furthermore, we found that among the older people who described their relationship with ICT as negative, many used it in everyday life. Referring to robotics, the interviewees appeared quite open-minded. In particular, robots were considered suitable for housekeeping, for monitoring older people’s health and accidental falls, and for entertainment.

Conclusions

Older people’s use and attitudes toward ICT does not always seem to be related to previous experiences with technological devices, higher education, or lower age. Furthermore, many participants in this study were able to use ICT, even if they did not always acknowledge it. Moreover, many interviewees appeared to be open-minded toward technological devices, even toward robots. Therefore, proposing new advanced technology to a group of prefrail people, who are self-sufficient and can live alone at home, seems to be feasible.

Older Adults and Digital Society: Scientific Coverage

While there is a progressive ageing of the population, we are witnessing a rapid development of new information and communication technologies (ICTs). Although for most of society this technology is within reach, there are population segments for whom access is limited, especially adults who are considered of old age. Due to the relevance that the relationship between ICTs and older adults acquires in today’s society, it is necessary to carry out an analysis of the scientific literature in order to understand the knowledge structure of this field. In this research, a comparative bibliometric analysis of 172 documents published in the Web of Science (WoS) and Scopus databases was carried out until 2018 and is complemented by a co-citation analysis. The results show that this subject is incipient and is in its exponential growth stage, with two thirds of the production concentrated in the 2012–2018 period. Four out of five authors are transient with a single authorship and the collaboration level is high. The most productive country is Germany followed by the United States and Australia.

A Novel Instrument for Measuring Older People's Attitudes Toward Technology (TechPH): Development and Validation

BACKGROUND

The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons' technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome.

OBJECTIVE

The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people.

METHODS

Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA).

RESULTS

The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (χ²₈=21.2, χ²/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036).

CONCLUSIONS

The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries.

Predictors of Seniors' Interest in Assistive Applications on Smartphones: Evidence from a Population-Based Survey in Slovenia

Assistive applications (apps) on smartphones could contribute to a better quality of life for seniors living independently at home. At present, there is a lack of empirical evidence of seniors' acceptance of such apps. The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS) model was recently proposed for studying the interplay between acceptance factors by integrating the personal, social and technological domains of seniors' daily lives. This study aimed to explore how four groups of factors, clustered in accordance with the C-TAILS model, predict seniors' interest in assistive apps, on a representative sample of the Slovenian population aged 55 years or older. The 617 respondents, who were contacted though a telephone survey, answered a questionnaire about their interest in three groups of assistive apps and four groups of potentially associated acceptance factors. Three linear regression models were used to analyse the association between the factors and the seniors' interest in the three types of assistive apps. Smartphone-related dispositional traits were the strongest predictors across all three models. Among mobile phone usage patterns, smartphone use and the breadth of mobile phone features used were significant factors, while the significance of seniors' personal characteristics and socio-economic conditions varied across the models. Hence, awareness that these factors play different roles in the acceptance of different assistive apps is needed in order to design viable interventions for their acceptance among seniors.

An Evaluation of a Low-Intensity Cognitive Behavioral Therapy mHealth-Supported Intervention to Reduce Loneliness in Older People

There is a high prevalence of loneliness among older people, especially in residential care settings. Loneliness is often accompanied by maladaptive cognitions which can affect the maintenance and establishment of meaningful social connections. This study implemented and evaluated a low-intensity Cognitive Behavior Therapy (LI-CBT) mHealth-supported intervention which targeted maladaptive cognitions in older people (≥60 years) experiencing loneliness. The three-month intervention using WhatsApp was implemented with older people in four inner-city residential care facilities. The intervention included three components: technology acceptance, psycho-education, and individualized positively worded messages addressing maladaptive cognitions. The intervention was evaluated using a randomized control design. Key outcomes were measured pre-, post-, and one month after the intervention. There were significant changes in social cognition (YSQ-SF T₀-T₁-T₂, X² = 9.69, p = 0.008) and loneliness levels (total loneliness T₀-T₁-T₂, X² = 14.62, p = 0.001), and an increase in WhatsApp usage (T₀ = 26% vs. T₁ = 60%, X²=15.22, p = 0.019). At 1-month follow-up, even with a significant reduction in WhatsApp usage, a significant reduction in loneliness was maintained. LI-CBT delivered via instant messaging may be effective in reducing loneliness experienced by older people.

‘That's for old so and so's!’: does identity influence older adults’ technology adoption decisions?

The role of identity in older adults’ decision-making about assistive technology adoption has been suggested but not fully explored. This scoping review was conducted to understand better how older adults’ self-image and their desire to maintain this influence their decision-making processes regarding assistive technology adoption. Using the five-stage scoping review framework by Arksey and O'Malley, a total of 416 search combinations were run across nine databases, resulting in a final yield of 49 articles. From these 49 articles, five themes emerged: (a) resisting the negative reality of an ageing and/or disabled identity; (b) independence and control are key; (c) the aesthetic dimension of usability; (d) assistive technology as a last resort; and (e) privacy versus pragmatics. The findings highlight the importance of older adults’ desire to portray an identity consistent with independence, self-reliance and competence, and how this desire directly impacts their assistive technology decision-making adoption patterns. These findings aim to support the adoption of assistive technologies by older adults to facilitate engagement in meaningful activities, enable social participation within the community, and promote health and wellbeing in later life.

Identifying Features that Enhance Older Adults' Acceptance of Robots: A Mixed Methods Study

BACKGROUND

With global aging, robots are considered a promising solution for handling the shortage of aged care and companionships. However, these technologies would serve little purpose if their intended users do not accept them. While the socioemotional selectivity theory predicts that older adults would accept robots that offer emotionally meaningful relationships, selective optimization with compensation model predicts that older adults would accept robots that compensate for their functional losses.

OBJECTIVE

The present study aims to understand older adults' expectations for robots and to compare older adults' acceptance ratings for 2 existing robots: one of them is a more human-like and more service-oriented robot and the other one is a more animal-like and more companion-oriented robot.

METHODS

A mixed methods study was conducted with 33 healthy, community-dwelling Taiwanese older adults (age range: 59-82 years). Participants first completed a semi-structured interview regarding their ideal robot. After receiving information about the 2 existing robots, they then completed the Unified Theory of Acceptance and Use of Technology questionnaires to report their pre-implementation acceptance of the 2 robots.

RESULTS

Interviews were transcribed for conventional content analysis with satisfactory inter-rater reliability. From the interview data, a collection of older adults' ideal robot characteristics emerged with highlights of humanlike qualities. From the questionnaire data, respondents showed a higher level of acceptance toward the more service-oriented robot than the more companion-oriented robot in terms of attitude, perceived adaptiveness, and perceived usefulness. From the mixed methods analyses, the finding that older adults had a higher level of positive attitude towards the more service-oriented robot than the more companion-oriented robot was predicted by higher expectation or preference for robots with more service-related functions.

CONCLUSION

This study identified older adults' preference toward more functional and humanlike robots. Our findings provide practical suggestions for future robot designs that target the older population.

Remote home physical training for seniors: guidelines from the AAL-supported MOTION project

European population will face an unprecedented aging era in the next years. Albeit aging in itself is a success goal, it may bring with it a general decline and functional limitations. In order to decelerate such decline, one of the most efficient strategies is physical activity. The present paper reports the insight emerging from three focus-group interviews organized at the beginning of the MOTION-Remote Home Physical Training for Seniors project, whose main aim regarded the implementation of an ICT system capable of offering home-based gym sessions to healthy seniors. The sixteen interview participants (11 females and 5 males, averaged age 72.3) provided several indications, which were grouped into the following themes: (1) ICT technical characteristics; (2) Platform accessibility; (3) Physical program features; (4) Psychological factors. At the end of the thematic analysis, results suggest that theoretical frameworks mainly focusing on ICT issues might be insufficient to endorse the successful development and maintenance of ICT systems such as MOTION, which challenges seniors to accept ICT while staying committed to the physical exercise program .

Health monitoring through wearable technologies for older adults: Smart wearables acceptance model

In the context of a fast aging population, ubiquitous usage of smart wearable systems can alleviate the social burden caused by the increasing need of older adults for healthcare and assistance. To facilitate and encourage the use of smart wearable systems among older adults, this study investigated the factors that contribute to the acceptance of such systems, and smart wearables acceptance model for older adults was developed using structural equation modeling. The model was validated using 146 survey samples collected from adults aged 60 years and above. The results indicated that perceived usefulness, compatibility, facilitating conditions, and self-reported health status significantly and positively affect older adults' intention to use such technologies. Useful implications and insights were provided to future researchers and practitioners to enhance older adults' acceptance of smart wearable systems.

Technology Adoption by Older Adults: Findings From the PRISM Trial

Background and Objectives

There is growing evidence of the benefits of computers for older adults. Yet, adoption rates are lower compared with younger adults. Extant theoretical models of technology acceptance are limited in their application to older adults-studies on which these models are based included a limited sample of older adults or none at all; none assessed use of a technology specifically designed for older adults; and most only measured intention to use a technology or short-term use, rather than longer-term use (i.e., adoption). We assessed adoption of a computer system specifically designed for older users, for a diverse sample, over an extended period of time.

Research Design and Methods

We analyzed archival data from 150 ethnically diverse older adults (65-98 years of age) who participated in the Personal Reminder Information and Social Management (PRISM) randomized controlled trial (Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J, Fisk AD,…Nair SN. The personalized reminder information and social management system (PRISM) trial: Rationale, methods and baseline characteristics. Contemp Clin Trials. 2015;40:35-46; Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J. Improving social support for older adults through technology: Findings from the PRISM randomized controlled trial. Gerontologist. 2017;58:467-477). We examined the extent to which attitudes, personal characteristics (e.g., age, gender, and personality), and cognitive abilities predicted mid-term and long-term adoption of a computer system designed for older adults.

Results

There were individual differences in PRISM use over time. Regression analyses indicated that individual differences in earlier use of the system, executive functioning, and computer efficacy predicted long-term use.

Discussion and Implications

These data provide insights for broader-based models of technology acceptance to guide design, instruction, and deployment of products for older adults. Specifically, the provision of opportunities to foster efficacy and gain positive experience with computer technologies may play a critical role in the likelihood that older adults adopt such technologies.

Trial Registration

NCT01497613.

Attitudes Toward Computers Across Adulthood From 1994 to 2013

Background and Objectives

Regardless of the increased deployment of technologies in everyday living domains, barriers remain that hamper technology adoption by older adults. Understanding barriers to adoption such as individual differences in attitudes toward computers is important to the design of strategies to reduce age-related digital disparities.

Research Design and Methods

This article reports a time-sequential analysis of data from the Edward R. Roybal Center on Human Factors and Aging Research and the Center for Research and Education on Aging and Technology Enhancement (CREATE) on computer attitudes among a large (N = 3,917), diverse sample of community-dwelling adults aged from 18 to 98 years. The data were gathered from 1994 to 2013.

Results

The findings indicated that there are still age disparities in attitudes; older adults report less comfort with and less efficacy about using computers than younger people. We also found a cohort (birth year) effect; attitudes are generally more positive among more recent birth cohorts. Those who have more education and experience with computers also have more positive attitudes. Males generally have more positive attitudes than females; however, the gender difference decreases with increased age.

Discussion and Implications

Technology affords potential benefits for older people, but lack of uptake in technology clearly puts older adults at a disadvantage in terms of negotiating today's digital world. This article provides insight into attitudinal barriers that may affect on technology uptake among older adults. The findings have implications for the design of technology training programs, design of technology systems, and policy.

The use of smartphones for wayfinding by people with mild dementia

The aim of this study was to explore the acceptability, feasibility and usability of older people with mild dementia to use smartphone for wayfinding. Thirty cognitively normal older people and 16 people with mild dementia were recruited to participate in a wayfinding trial in the free-living environment. Five feasibility and three acceptability markers were compared between the groups. Content analysis on the video-recorded trial processes and individual interviews was employed to identify the usability issues. The results found that there were no significant between-group differences on the feasibility markers, except that the people with mild dementia needed significantly more time to complete the wayfinding trial and workshop; or on the acceptability items. Sensory/cognitive impairment and GPS signal reliability affected their usability. Mild dementia does not limit the older people to use smartphones for wayfinding in the free-living environment. Future studies should examine the efficacy and safety of smartphone to promote outdoor independence of the people with mild dementia.

Exploring Older Adults' Video Game Use in the PRISM Computer System

Background and Objective

As part of the PRISM (Personal Reminder Information & Social Management) randomized field trial, a large group of older adults (N = 150) received a computer system in their home that presented them with the opportunity to play eleven different video games. While researchers have often assessed older adults’ gaming preferences and habits through survey data and focus groups, this trial represented a unique opportunity to study gaming behavior “in the wild” over an entire year.

Research Design and Methods

We present an exploration of game usage data, individual differences in game preferences and gaming habits, and individual difference predictors of game use.

Results

Although few individual difference variables consistently predicted game use and preferences, there were clear favorites among the different games, and results demonstrate that given the opportunity and training many older adults may become active and long-term gamers.

Discussion and Implications

Findings have implications for designing video games that older adults enjoy, supporting enjoyable and meaningful interactions with video games across the life span, and for designing cognitive, social, and health interventions involving games.

Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study

Background

The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people’s intention to use technology.

Objective

The objective of this study was to understand community-dwelling older people’s readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators.

Methods

A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people’s intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people’s actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2).

Results

In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people’s perception of videoconferencing. Older people’s (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people’s capacities and incapacities in using digital technology: (1) “self-efficacy and digital literacy,” (2) “obstacles to using technology,” (3) “prior experience and frequency of use,” (4) “sources of support and facilitating conditions,” and (5) “performance expectancy.” These 5 themes recurred in all 15 observations.

Conclusions

Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people’s intention to use videoconferencing. Self-efficacy appeared to play a role in both older people’s intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people’s effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people’s capacities to make use of digital technology.

Aging barriers influencing mobile health usability for older adults: A literature based framework (MOLD-US)

BACKGROUND

With the growing population of older adults as a potential user group of mHealth, the need increases for mHealth interventions to address specific aging characteristics of older adults. The existence of aging barriers to computer use is widely acknowledged. Yet, usability studies show that mHealth still fails to be appropriately designed for older adults and their expectations. To enhance designs of mHealth aimed at older adult populations, it is essential to gain insight into aging barriers that impact the usability of mHealth as experienced by these adults.

OBJECTIVES

This study aims to synthesize literature on aging barriers to digital (health) computer use, and explain, map and visualize these barriers in relation to the usability of mHealth by means of a framework.

METHODS

We performed a scoping review to synthesize and summarize reported physical and functional age barriers in relation to digital (mobile) health applications use. Aging barriers reported in the literature were mapped onto usability aspects categorized by Nielsen to explain their influence on user experience of mHealth. A framework (MOLD-US) was developed summarizing the evidence on the influence of aging barriers on mHealth use experienced by older adults.

RESULTS

Four key categories of aging barriers influencing usability of mHealth were identified: cognition, motivation, physical ability and perception. Effective and satisfactory use of mHealth by older adults is complicated by cognition and motivation barriers. Physical ability and perceptual barriers further increase the risk of user errors and fail to notice important interaction tasks. Complexities of medical conditions, such as diminished eye sight related to diabetes or deteriorated motor skills as a result of rheumatism, can cause errors in user interaction.

CONCLUSIONS

This research provides a novel framework for the exploration of aging barriers and their causes influencing mHealth usability in older adults. This framework allows for further systematic empirical testing and analysis of mHealth usability issues, as it enables results to be classified and interpreted based on impediments intrinsic to usability issues experienced by older adults. Importantly, the paper identifies a key need for future research on motivational barriers impeding mhealth use of older adults. More insights are needed in particular to disaggregating normal age related functional changes from specific medical conditions that influence experienced usefulness of mHealth by these adults.

Enhancing ICT infrastructure in public services

Purpose

The purpose of this paper is to investigate the factors which influence mobile government (m-government) services adoption in India.

Design/methodology/approach

Adoption behavior of m-government services by 311 respondents is probed by using a multiple set of constructs drawn from technology acceptance model (TAM), unified theory of acceptance and use of technology (UTAUT), theory of planned behavior (TPB) and hierarchical regression analysis. Specifically, eight hypotheses were tested around constructs like Perceived Usefulness (PU), Perceived Ease of Use (EOU), Compatibility (COM), Trust (T), Influence (I), Self-Efficacy (SE), Facilitating Conditions (FC), Attitude (ATT) and Behavioral Intention to Adopt m-government services (BI).

Findings

Results show that PU, EOU, T and ATT were found to have significant influence on the adoption of m-government services. Furthermore, demographic variables (age, marital status, occupation, educational qualification and frequency of using m-government services) were not found to be significant predictors for the adoption of m-government services in India.

Originality/value

While most of the technology adoption studies are focused on commercial activities, studies on internet interfaces vis-à-vis the public services are limited to investigation of e-government services. Besides, there are more studies contextualized in the developed countries as compared to developing countries. Academic research on m-government adoption is scant and the present paper is a significant contribution in the Indian context.

Older adults' acceptance of a robot for partner dance-based exercise

Partner dance has been shown to be beneficial for the health of older adults. Robots could potentially facilitate healthy aging by engaging older adults in partner dance-based exercise. However, partner dance involves physical contact between the dancers, and older adults would need to be accepting of partner dancing with a robot. Using methods from the technology acceptance literature, we conducted a study with 16 healthy older adults to investigate their acceptance of robots for partner dance-based exercise. Participants successfully led a human-scale wheeled robot with arms (i.e., a mobile manipulator) in a simple, which we refer to as the Partnered Stepping Task (PST). Participants led the robot by maintaining physical contact and applying forces to the robot's end effectors. According to questionnaires, participants were generally accepting of the robot for partner dance-based exercise, tending to perceive it as useful, easy to use, and enjoyable. Participants tended to perceive the robot as easier to use after performing the PST with it. Through a qualitative data analysis of structured interview data, we also identified facilitators and barriers to acceptance of robots for partner dance-based exercise. Throughout the study, our robot used admittance control to successfully dance with older adults, demonstrating the feasibility of this method. Overall, our results suggest that robots could successfully engage older adults in partner dance-based exercise.

User-Centered Evaluations with Older Adults: Testing the Usability of a Mobile Health System for Heart Failure Self-Management

Many older adults living with heart failure struggle to follow recommended self-management routines. To help older adults with heart failure more effectively and efficiently self-manage their disease, we developed Engage, a mobile health application promoting the performance, logging, and sharing of routine self-management behaviors. This paper reports on the usability evaluation of the Engage system with 15 older adults with heart failure and informal caregivers. In two phases, participants used Engage during a task-based usability test (n=5) and a scenario-based usability test (n=10). Usability and performance data were assessed through video-recorded observation and the administration of the system usability scale (SUS) and NASA Task Load Index (TLX). We found that task-based testing was useful in quickly identifying problems within our application, but scenario-based testing elicited more valuable feedback from older adults. A comparison of the different evaluation methods used and the discussion of the challenges encountered provide multiple implications for the practice of usability testing of mobile health products with older adults.

Everyday Functioning Benefits from an Assisted Living Platform amongst Frail Older Adults and Their Caregivers

Ambient assisted living technologies (AAL) are regarded as a promising solution to support aging in place. Yet, their efficacy has to be demonstrated in terms of benefits for independent living and for work conditions of caregivers. Hence, the purpose of this study was to assess the benefits of a multi-task AAL platform for both Frail older Individuals (FIs) and professional caregivers with respect to everyday functioning and caregiver burden. In this context, a 6-month field study involved 32 FIs living at home (half of them were equipped by the platform and the remaining half were not, as a control condition) and their caregivers. Everyday functioning measures were reported by frail participants and caregivers. Self-reported burden measures of caregiver were also collected. The main results showed that the caregiver's estimates of everyday functioning of equipped participants were unchanged across time, while they decreased for the control participants. Also, a reduction of self-reported objective burden was obtained after 6 months of AAL intervention for the equipped group, compared to the control group. Overall, these results highlighted the potential of AAL as a relevant environmental support for preventing both functional losses in FIs and objective burden professional caregiver.

Origins and consequences of technology acquirement by independent-living seniors: towards an integrative model

Background

Living independently can be challenging for seniors. Technologies are expected to help older adults age in place, yet little empirical research is available on how seniors develop a need for technologies, how they acquire these technologies, and how these subsequently affect their lives. Aging is complex, dynamic and personal. But how does this translate to seniors’ adoption and acceptance of technology? To better understand origins and consequences of technology acquirement by independent-living seniors, an explorative longitudinal qualitative field study was set up.

Methods

Home visits were made to 33 community-dwelling seniors living in the Netherlands, on three occasions (2012–2014). Semi-structured interviews were conducted on the timeline of acquirements, and people and factors involved in acquirements. Additionally, participants were interviewed on experiences in using technologies since acquirement. Thematic analysis was employed to analyze interview transcripts, using a realist approach to better understand the contexts, mechanisms and outcomes of technology acquirements.

Results

Findings were accumulated in a new conceptual model: The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS), which provides an integrative perspective on why and how technologies are acquired, and why these may or may not prove to be appropriate and effective, considering an independent-living senior’s needs and circumstances at a given point in time. We found that externally driven and purely desire-driven acquirements led to a higher risk of suboptimal use and low levels of need satisfaction.

Conclusions

Technology acquirement by independent-living seniors may be best characterized as a heterogeneous process with many different origins, pathways and consequences. Furthermore, technologies that are acquired in ways that are not congruent with seniors’ personal needs and circumstances run a higher risk of proving to be ineffective or inappropriate. Yet, these needs and circumstances are subject to change, and the C-TAILS model can be employed to better understand contexts and mechanisms that come into play.

Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An Integrative Review

Background

Optimal management of chronic diseases, such as type 2 diabetes and hypertension, often include prescription medications. Medication adherence (MA) is one component of self-management. Optimization through digital health—eHealth and mHealth—could enhance patient awareness and/or communication between the patient and provider.

Objective

Medication adherence is a major issue that affects 50%-60% of chronically ill adults. Digital health refers to eHealth and mHealth, collectively, and as these technologies become more accessible, remote health delivery is increasingly available as an adjunct to improve medication adherence; communicate with patients and providers; and provide education to patients, families, and communities. The objective of this integrative review was to examine the types of digital health technologies that targeted medication adherence in the adult population with diabetes or hypertension.

Methods

An integrative review was conducted using databases within EBSCOhost, PubMed, and Scopus. Eligible studies available as of September 2016 had to be written in English, had to contain digital health interventions to improve medication adherence to prescription medications in adults 18 years or older, and had to focus on diabetes or hypertension.

Results

Of the 337 located studies, 13 (3.9%) used a digital health intervention for medication adherence to prescribed medications for diabetes or hypertension and were assessed according to the Chronic Care Model.

Conclusions

The 13 studies included in this review found no conclusive evidence of improved medication adherence using digital health interventions such as interactive voice response (IVR), short message service (SMS) text messaging, telemonitoring, and interactive software technology. Among the 13 studies were digital health interventions that foster medication adherence via one-way communication to the patient or two-way communication between the patient and health care provider for adjunct medication adherence strategies. More research is needed to determine which digital health interventions are most beneficial for individuals with diabetes or hypertension.

Older Adults' Acceptance of Activity Trackers

OBJECTIVE

To assess the usability and acceptance of activity tracking technologies by older adults.

METHOD

First in our multimethod approach, we conducted heuristic evaluations of two activity trackers that revealed potential usability barriers to acceptance. Next, questionnaires and interviews were administered to 16 older adults ( Mage = 70, SDage = 3.09, rangeage = 65-75) before and after a 28-day field study to understand facilitators and additional barriers to acceptance. These measurements were supplemented with diary and usage data and assessed whether and why users overcame usability issues.

RESULTS

The heuristic evaluation revealed usability barriers in System Status Visibility, Error Prevention, and Consistency and Standards. The field study revealed additional barriers (e.g., accuracy, format) and acceptance-facilitators (e.g., goal tracking, usefulness, encouragement).

DISCUSSION

The acceptance of wellness management technologies, such as activity trackers, may be increased by addressing acceptance-barriers during deployment (e.g., providing tutorials on features that were challenging, communicating usefulness).

Technology-assisted communication in older persons in a residential care facility in South Africa

Relocation to residential care facilities by older persons (60+) can decrease their social connectedness with their primary networks. The purpose of the study was to identify the use and acceptance of technology-assisted communication to increase social connectedness in older persons (N = 103) in an urban residential care facility in South Africa. The research design was a non-experimental quantitative descriptive survey using self-administered questionnaires based on the Technology Acceptance Model. All residents were included in the study. Perceived Ease of Use, Perceived Usefulness and Attitude scales were calculated and the Behavioural Intention for technology use was measured. Participants with the highest Behavioural Intention were residents in their first year of relocation, younger participants (60–74 years), divorced participants and participants with higher educational qualifications. Perceived Ease of Use and Perceived Usefulness were low and were directly correlated. Perceived Ease of Use contributed significantly towards Attitudes concerning technology use. The overall Behavioural Intention for technology use was good (60/75) and the Technology Acceptance Model pathway was confirmed using Structural Equation Modelling. Video chat offered greatest appeal for future use.

Elderly and technology tools: a fuzzyset qualitative comparative analysis

The number of senior citizens is growing globally and governments are striving to find innovative solutions to deal with complex care demands of this part of the population. Technology has been an answer to this situation; however, it is very important that the elderly accept and actually use the technology. This paper empirically tests the senior technology acceptance model using the fsQCA method to analyse data with a sample of 811 seniors aged 60 and over living in Sweden. The results revealed that the necessary conditions for high "perceived ease of use" and "perceived usefulness" are gerontechnology self-efficacy, gerontechnology anxiety, and cognitive abilities; however, each of these is not sufficient on its own. Self-reported health conditions and physical function also play a peripheral role in achieving the desired outcome. Theoretical and managerial implications are discussed at the end of the paper.

Personal and other factors affecting acceptance of smartphone technology by older Chinese adults

It has been well documented that in the 21st century, there will be relatively more older people around the world than in the past. Also, it seems that technology will expand in this era at an unprecedented rate. Therefore, it is of critical importance to understand the factors that influence the acceptance of technology by older people. The positive impact that the use of mobile applications can have for older people was confirmed by a previous study (Plaza et al., 2011). The study reported here aimed to explore and confirm, for older adults in China, the key influential factors of smartphone acceptance, and to describe the personal circumstances of Chinese older adults who use smartphone. A structured questionnaire and face to face individual interviews were used with 120 Chinese older adults (over 55). Structural Equation Modeling was used to confirm a proposed smartphone acceptance model based on Technology Acceptance Model (TAM), and the Unified Theory of Acceptance and Use of Technology (UTAUT). The results showed that those who were younger, with higher education, non-widowed, with better economic condition related to salary or family support were more likely to use smartphone. Also, cost was found to be a critical factor influencing behavior intention. Self-satisfaction and facilitating conditions were proved to be important factors influencing perceived usefulness and perceived ease of use.

"Grandma, You Should Do It--It's Cool" Older Adults and the Role of Family Members in Their Acceptance of Technology

Despite its potential, the acceptance of technology to support the ability to live independently in one’s own home, also called aging in place, is not optimal. Family members may play a key role in technology acceptance by older adults; however, it is not well understood why and how they exert influence. Based on open interviews with 53 community-dwelling older adults, this paper describes the influence of family members, including spouses, on the use of various types of consumer electronics by older adults as was reported by themselves. Such a broad focus enables understanding the use of technology as was reported by older adults, instead of its intended use. Our study reveals that the influence of each family member has its own characteristics. The influence of technology acceptance is a natural and coincidental part of the interaction with spouses and grandchildren in which entertainment and pleasure are prominent. This is also partly true for the influence of children, but their influence also is intentional and driven by concerns. Our study indicates the importance of including all family members when implementing technology in the lives of older adults. Besides information for children about the use(fullness) of devices, it is worthwhile to give grandchildren an important role, because older adults easily adopt their enthusiasm and it might eventually lighten the burden on children.

Determinants of the intention to use e-Health by community dwelling older people

BACKGROUND

In the future, an increasing number of elderly people will be asked to accept care delivered through the Internet. For example, health-care professionals can provide treatment or support via telecare. But do elderly people intend to use such so-called e-Health applications? The objective of this study is to gain insight into the intention of older people, i.e. the elderly of the future, to use e-Health applications. Using elements of the Unified Theory of Acceptance and Use of Technology (UTAUT), we hypothesized that their intention is related to the belief that e-Health will help (performance expectancy), the perceived ease of use (effort expectancy), the beliefs of important others (social influence), and the self-efficacy concerning Internet usage.

METHODS

A pre-structured questionnaire was completed by 1014 people aged between 57 and 77 (response 67%). The hypothesized relationships were tested using nested linear regression analyses.

RESULTS

If offered an e-Health application in the future, 63.1% of the respondents would definitely or probably use it. In general, people with a lower level of education had less intention of using e-Health. The majority of respondents perceived e-Health as easy to use (60.8%) and easy to learn (68.4%), items that constitute the scale for effort expectancy. Items in the performance expectancy scale generally scored lower: 45.8% perceived e-Health as useful and 38.2% perceived it as a pleasant way to interact. The tested model showed that expected performance and effort were highly related to intention to use e-Health. In addition, self-efficacy was related to intention to use while social influence was not.

CONCLUSIONS

Acceptance of e-Health can be increased by informing people about the potential benefits of e-Health and letting them practice with the application. Special attention should be paid to people with less education and people who have not used the Internet before.

Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: a systematic review and meta-analysis

Emerging telemedicine programs offer potential low-cost solutions to the management of chronic disease. We sought to evaluate the clinical effectiveness and cost effectiveness of telemedicine approaches on glycemic control in patients with type 2 diabetes mellitus. Using terms related to type 2 diabetes and telemedicine, MEDLINE, Cochrane, EMBASE, and CINAHL Plus were searched to identify relevant studies published through February 28, 2014. Data from identified clinical trials were pooled according to telemedicine approach, and evaluated using conventional meta-analytical methods. We identified 47 articles, from 35 randomized controlled trials, reporting quantitative outcomes for hemoglobin A1c (HbA1c). Twelve of the 35 studies provided intervention via telephone, either in the form of a call or a text message; 19 studies tested internet-based programs, employing video-conferencing and/or informational websites; and four studies used interventions involving electronically transmitted recommendations made by clinicians in response to internet-based reporting by patients. Overall, pooled results from these studies revealed a small, but statistically significant, decrease in HbA1c following intervention, compared to conventional treatment (pooled difference in means=-0.37, 95% CI=-0.49 to -0.25, Z=-6.08, P<0.001). Only two of the 35 studies included assessment of cost-effectiveness. These studies were disparate, both in terms of overall expense and relative cost-effectiveness. Optimization of telemedicine approaches could potentially allow for more effective self-management of disease in type 2 diabetes patients, though evidence to-date is unconvincing. Furthermore, significant publication bias was detected, suggesting that the literature should be interpreted cautiously.