Toward a Theory of HealthIT Adoption Across the Lifespan: Findings from Five Years in the Community

"A Matter of Life and Death": Mitigating the Gray Digital Divide in Using Health Information Technologies in the Post-Pandemic Era

A pervasive issue in healthcare is that elderly populations have fallen far behind in using healthcare technologies, a phenomenon known as the gray digital divide. Even more concerningly, the COVID-19 pandemic has dramatically catalyzed health digitization with the potential for lasting demographic-wide impacts. Against this backdrop and drawing on both the digital divide literature and the unified theory of acceptance and use of technology (UTAUT2), we investigated elderly populations' usage of healthcare technologies through analyzing HINTS 6 (2022) survey data. Results show a widespread first- and second-level digital divide in using health information technologies (HITs) between people aged 65 and up and people aged 18-64, including Internet access, health-related Internet use, health-related social media use, health app use, use of wearable electronic health devices, telehealth visits, and accessing online medical records. Moreover, this study finds that education consistently positively predicts Internet use and use of various HITs by the elderly; income is the next reliable predictor but not as consistent as education. Health-related variables are less consistent in predicting the elderly's use of HITs. Theoretical and practical implications of these results are discussed to inform the mitigation of the gray digital divide in healthcare.

Higher education managers’ perspectives on quality management and technology acceptance: A tale of elders, mediators, and working bees in times of Covid-19

The Covid-19 pandemic has emphasized the role of educational management information systems (EMIS) for quality management (QM) in higher education, and set new directions for post-pandemic studies. Successful implementation of QM processes depends largely on managers' perceptions about quality and educational technology. However, higher education managers’ profiles regarding these quality perceptions and their EMIS acceptance have been insufficiently investigated so far. In response to this research gap, we identified such profiles based on a quantitative survey of N = 70 managers from Chilean higher education institutions during the Covid-19 pandemic. A cluster analysis revealed three distinct manager types: “Elders” (oldest participants, almost equally distributed across positions, with least frequent EMIS access, moderate EMIS acceptance, and highest QM perceptions), “Mediators” (in operational and middle-management positions, with moderately frequent access to EMIS, and lowest EMIS acceptance and QM perceptions), and “Working Bees” (younger females in operational positions, with most frequent EMIS access, highest EMIS acceptance, and moderate QM perceptions). Knowledge of these profiles may enable customized training in the recovery after the Covid-19 pandemic.

Patient Perspectives on the Development of a Novel Mobile Health (mHealth) Application for Dietary Supplement Tracking and Reconciliation – A Qualitative Focus Group Study

Background: More than 170 million adults use dietary supplements (DS) in the United States, which can have both benefit and harm to patient health. DS use is often poorly documented in the medical record and can pose health risks if not properly communicated with providers. Reasons for poor DS documentation include low disclosure rates, time constraints of clinical encounters, and providers’ failure to inquire about DS use. This study was conducted to assess patients’ views on the facilitators and barriers to using a mobile health (mHealth) application (app) to collect and share DS information with their healthcare providers. Methods: Utilizing a theory-based conceptual model, we conducted seven patient focus groups (FGs) to assess opinions on DS safety, provider communication, comfort with technology use, and our proposed mHealth app. Participants were recruited from the general public and through patient advisory groups. Patient views will inform the creation of an mHealth app to improve DS patient-provider communication and tracking and reconciliation in the electronic medical record (EMR). Results: Overall, participants believe their DS information is inaccurately represented in the EMR leading to safety concerns and negatively impacting overall quality-of-care. Participants desired an app designed with: 1) Health Insurance Portability and Accountability Act (HIPAA)-compliance; 2) ease of use for a variety of technical efficacy levels; 3) access to reliable DS information, including a DS-drug interaction checker; 4) integration with the EMR. Conclusion: An app to simplify and improve DS entry and reconciliation was of interest to patients, as long as it maintained health autonomy and privacy and possessed key valuable features.

Understanding and Predicting the Adoption of Fitness Mobile Apps: Evidence from China

Increasing global interest in diet and fitness mobile applications (apps) has prompted the question: What are the factors affecting users' adoption and usage behaviors on a specific fitness app? By combining the unified theory of acceptance and use of technology (UTAUT) with the health belief model (HBM), and including risk perception of information technology with the farsighted planner and myopic doer from the theory of self-control, we explore the understanding of this academic question. We analyzed data from 8,840 users of Boohee, a diet and fitness app (ranked first in the weight-loss category on the App Store in China). Structural equation modeling revealed that self-efficacy as well as the perceived benefits, barriers, and threats of weight loss significantly influence a fitness app's performance expectancy, which, in turn, predicts users' intention to adopt it. Furthermore, actual usage behavior (i.e., diet, exercise, weight, and login records within 30 days after respondents completed the questionnaire) is positively affected by weight-loss intention and behavioral intention to use the app and negatively affected by users' risk perception. The main findings of this research could help healthcare practitioners and app developers find better ways to encourage people to adopt health apps for various reasons. App developers should attach more importance to users' actual continuous use behavior than to their intention to use an app. They should provide sufficient introductory information about their apps, thereby reducing users' risk perception and generating reasonable performance expectancy of the app, so as to improve users' actual continuous use behavior.

Continuance intention of baby boomer and X generation as new users of digital payment during COVID-19 pandemic using UTAUT2

The emergence of social distancing and stay at home regulations during the COVID-19 pandemic directly affects people’s lifestyle, including baby boomers and X generation. Many of them have started using digital payments for online or offline transactions to minimize contact with others. This study aims to analyze the continuance intention of the baby boomers and X generation toward the use of digital payments using UTAUT2 (Unified Theory of Acceptance Technology). Data were collected from 320 users with an age range of 40–74 who had just started using digital payments during this pandemic. Structural equation modeling has been used to analyze the data. The result indicates that UTAUT indicators positively affect user satisfaction. User satisfaction positively affects inertia. Overall satisfaction and inertia positively affect continuance intention. Therefore, digital payment companies and banks with digital services can expand their target market beyond Millennials and pay more attention to the older generation like baby boomers and X generation. Managers can find the results of this study useful and beneficial to develop their marketing strategy and take advantage of this situation to increase digital payment users to a broader age range.

Using Technology Adoption Theory and a Lifespan Approach to Develop a Theoretical Framework for eHealth Literacy: Extending UTAUT

Advancements in health information technology (HealthIT) and the electronic exchanges of health information have "revolutionized" health systems in the US. However, adopting technological developments into the healthcare system has the potential to benefit populations with more resources, further exacerbating health status disparities. Efficacious utilization of HealthIT requires eHealth literacy. Although eHealth literacy is comprised of six factors, new research indicates that the components related to technology literacy may be more impactful in eHealth literacy among certain populations (e.g., older populations who shoulder a greater illness-management burden). Recognizing the importance of technology literacy in eHealth literacy across the lifespan, we investigate generational differences in New Communication Technology (NCT) use and eHealth literacy, especially considering how NCT adoption theory might systematically inform scholars' understanding of eHealth literacy. Participants included 525 adults primarily in the Midwestern United States. We found significant differences between generational groups across all variables. We found that UTAUT determinants such as performance expectancy and effort expectancy explained 38% of the variance in eHealth literacy, controlling for age, sex, level of education, and prior online health information seeking. Finally, we engaged with early critiques of UTAUT, finding that when applying UTAUT in voluntary (vs. mandatory) contexts, scholars should reconsider variables previously dismissed, such as attitude. In doing this, we extend UTAUT in three ways: new contexts (voluntary NCT adoption), endogenous theoretical mechanisms (eHealth literacy), and exogenous variables (attitude; lifespan). These findings underscore a need for a targeted approach to improve eHealth literacy and health self-management across generations.

Mobile technology adoption across the lifespan: A mixed methods investigation to clarify adoption stages, and the influence of diffusion attributes

We conducted a multi-study, mixed-methods, longitudinal investigation to examine how mobile technology diffuses across the lifespan, in real time, within a multi-generational population, while seeking local knowledge through community-based participatory research. Using qualitative methods (QUAL), we examined technology adoption within and across three iterations (16 weeks) of a nine-wave longitudinal community technology-training workshop, situated within a 15-wave study. In parallel, we interrogated existing conceptualization and operationalization of diffusion of technology variables, then deductively evaluated the dominant DOI-related variables re-conceptualized through the community study in a large cross-sectional quantitative (QUAN) investigation. We interpreted our results consistently and iteratively with a mixed-methods approach that included conceptualization, operationalization, and empirical testing. We discovered that oft-conflated concepts of knowledge, use, and ownership represent distinct stages of adoption. Our findings suggest constant feedback/permeable boundaries between these stages, and that DOI attributes may influence mobile technology adoption stages differentially. We suggest that innovators seeking to facilitate mobile technology adoption should focus on reducing complexity, and establishing calibration of complexity perceptions. We propose a lifespan mobile technology diffusion model, and call to question the language used in investigations related to the digital divide. We strive to clarify labels that may stereotype vulnerable populations, such as older adults. Our research contributes to theories of technology adoption - particularly after the introduction of digital communication - the diffusion of innovations in the community over time, and technology adoption process as affected by interpersonal communication and relationships, including among the technologically undercapitalized and the digitally privileged.