Psychological barriers to Internet usage among older adults in the UK

A golden age of behavioural social psychology? Towards a social psychology of power and intergroup relations in the digital age

This paper explores the idea of a 'golden age' in social psychological research. I begin with 'behavioural social psychology'-research that leverages the behavioural traces that are a product of the digital age. I argue that the ability to analyse digital visual data, natural language data, and smartphone and ambient sensor data, has made substantial contributions to the state of social psychological knowledge. However, social psychology needs to do more than just leverage digital data for psychological benefit. Digital technologies construct and reflect a world that is marked by profound structural inequality and unfairness. Yet social psychology never really considers technology as being 'world-making' in its own right. More specifically, social psychology very rarely goes beyond considering what technology might do-to explore the question of who wins and who loses when technologies reshape our worlds. I point to a mosaic of work applying social identity approaches to new technologies as the starting point for a social psychology that engages with power and resistance in the digital age. Social psychology will not enter a truly golden age until we engage not only with the data, but also with the power structures of digital technology.

A Study on the Mechanisms Influencing Older Adults' Willingness to Use Digital Displays in Museums from a Cognitive Age Perspective

As older adults age, changes in their physiological, psychological, and cognitive functions often lead to inherent anxiety and fear regarding the use of digital technologies. Cognitive age, reflecting an older adult's mental perception of their chronological age, is a crucial moderating factor in shaping their willingness and behavior towards technology adoption. However, the mechanisms through which cognitive age impacts the behavior of older adults within the realm of digital technology utilization remain unclear. Thus, grounded in the Extended Technology Acceptance Model (ETAM) and employing structural equation modeling, this study intends to investigate mechanisms which influence older adults' behavioral intentions towards the use of museum digital displays. Consequently, it confirms that attitudes mediate the correlation between perceived usefulness, subjective norm, perceived self-efficacy, and the behavioral intention towards museum digital display utilization. Perceived ease of use does not directly affect attitudes, but instead exerts an indirect impact on attitude through perceived usefulness. Cognitive age negatively moderates the relationship between attitudes and the behavioral intention to use digital technologies. Additionally, the mediating role of attitudes in the correlation between older adults' perception of museum digital displays and behavioral intention is moderated by cognitive age. Specifically, older adults with a higher cognitive age value (who perceive themselves to be younger than their chronological age) exhibit a weaker mediating effect of attitudes on the relationship between perceived usefulness and behavioral intention compared to those with a lower cognitive age value (who perceive themselves to be older than their chronological age). The findings seek to unbox the "black box" of how cognitive age mediates the correlation between attitudes and behavioral intention towards the use of museum digital displays among older adults, providing valuable theoretical insights for the bidirectional enhancement of digital technology utilization, the overall well-being of older adults, and high-quality development in museums.

Educational interventions to reduce depression and anxiety in older adults with cancer in the community: a systematic review, meta-analysis and meta-regression of randomised controlled trials

BACKGROUND

Older adults make up half of those with cancer and are prone to mood disorders, such as depression and severe anxiety, resulting in negative repercussions on their health-related quality-of-life (HRQOL). Educational interventions have been shown to reduce adverse psychological outcomes. We examined the effect of educational interventions on the severity of psychological outcomes in older adults with cancer (OAC) in the community.

METHOD

This PRISMA-adherent systematic review involved a search of PubMed, MedLine, Embase and PsycINFO for randomised controlled trials (RCTs) that evaluated educational interventions impacting the severity of depression, anxiety and HRQOL in OAC. Random effects meta-analyses and meta-regressions were used for the primary analysis.

RESULTS

Fifteen RCTs were included. Meta-analyses showed a statistically insignificant decrease in the severity of depression (SMD = -0.30, 95%CI: -0.69; 0.09), anxiety (SMD = -0.30, 95%CI: -0.73; 0.13) and improvement in overall HRQOL scores (SMD = 0.44, 95%CI: -0.16; 1.04). However, subgroup analyses revealed that these interventions were particularly effective in reducing the severity of depression and anxiety in specific groups, such as OAC aged 60-65, those with early-stage cancer, those with lung cancer and those treated with chemotherapy. A systematic review found that having attained a higher education and income level increased the efficacy of interventions in decreasing the severity of adverse psychological outcomes.

CONCLUSION

Although overall meta-analyses were statistically insignificant, subgroup meta-analyses highlighted a few specific subgroups that the educational interventions were effective for. Future interventions can be implemented to target these vulnerable groups.

Enhancing diabetes therapy adherence: a comprehensive study on glucometer usability for type 2 diabetes patients

Background

Self-monitoring of blood glucose (SMBG) is a vital practice for type 2 diabetes (T2DM), and glucometers have the potential to improve therapy adherence. However, characteristics of glucometers improving their usability are underexplored. A knowledge gap exists regarding patients under 65, warranting further research for diabetes care improvement. Thus, this study aims to gather insights on glucometer accessibility, by analyzing the case of the Accu-Chek® Instant glucometer by Roche Diabetes Care GmbH.

Methods

Starting from a previous study having the objective of investigating devices' features able to improve SMBG in over 65 T2DM patients, using the same device, we enlarged the scale, designing a survey that collected answers from 1145 patients of the Center and South of Italy, both under and over 65. 957 answers were analyzed, according to a threshold of 50% completion of the answers.

Results

Our results show the major characteristics presented in Accu-Chek® Instant are appreciated differently between patients under 65 and over 65, and between patients with or without previous experience with a glucometer.

Discussions and conclusions

It emerged how Accu-Chek® was perceived as more user-friendly among individuals under 65 compared to those aged 65 and over, where more people had prior experience, indicating how such a glucometer can be particularly helpful for naive patients. The study provides valuable insights to the academic discourse on glucometer features and their influence on therapy adherence.

Prevalence and correlates of use of digital technology for managing hypertension among older adults

Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.

Glucometer Usability for 65+ Type 2 Diabetes Patients: Insights on Physical and Cognitive Issues

Background: Self-monitoring of blood glucose (SMBG) is of paramount relevance for type 2 diabetes mellitus (T2DM) patients. However, past evidence shows that there are physical and cognitive issues that might limit the usage of glucometers by T2DM patients aged 65 years and over. Objective: Our aim was to investigate the physical and cognitive issues related to the usage of glucometers by T2DM patients aged 65 years and over. Materials and Methods: The extant literature was analysed to define an original framework showing the logical nexus between physical and cognitive issues and quality of life. Then we collected evidence addressing the specific case of the Accu-Chek^® Instant glucometer produced by Roche Diabetes Care GmbH, which implements new features claiming to improve usability. We conducted 30 interviews with T2DM patients aged 65 years and over, three interviews with senior nurses, and a focus group with three senior physicians and three senior nurses. Results: From the interviews, both patients and nurses declared that they were generally satisfied with the Accu-Chek^® Instant glucometer's characteristics. In the focus group, the results were commented on and, in the light of some diverging answers, improvements have been set up for future implementation. Conclusions: Our study produces evidence and future suggestions about the usage of glucometers by type 2 diabetes patients aged 65 years and over.

Use of Digital Tools, Social Isolation, and Lockdown in People 80 Years and Older Living at Home

The COVID-19 crisis and associated lockdowns have exposed the extent of social isolation among older adults (OAs). Currently, the French government and medical, social, and charitable organizations are working to find means of limiting the multiple psychological and physical consequences of social isolation on the health of OAs. One proposal is to help the elderly become more comfortable using digital tools (DTs). However, the ability of DTs to reduce social isolation is disputed in the literature. This study aimed to collect the views of OAs on social isolation; to identify the determinants of the use or not of DTs, in particular in the context of a lockdown; and the role of DTs in the strategy to reduce social isolation. This qualitative study was based on 27 semi-structured individual interviews with OAs ≥ 80 years, in Côte-d’Or and Haute-Marne (French departments), from March to May 2021. A total of 96.3% of participants had already owned one or more DTs (mobile phone, tablet, or computer) for several years. The lockdown had not prompted the population to equip themselves more. The most common reason for using DTs was to maintain contact with relatives, and 63% of the participants said that DTs have a positive impact in reducing social isolation. However, there is a significant need for assistance and training in their use, especially since many services are now offered online. The participants suggested that the key to minimizing social isolation remained the maintenance of social contacts. In conclusion, DTs appear to be useful for helping the elderly maintain social links with relatives and, therefore, have a strategic place in the reduction of social isolation. However, these tools should not replace in-person interactions.

Social transformation and social isolation of older adults: Digital technologies, nursing, healthcare

Background

The incidence of social isolation among older adults is on the rise in today's health care climate. Consequently, preventing or ameliorating social isolation through technology in this age group is now being discussed as a significant social and health issue.

Aim

The purpose of the opinion paper is to clarify social transformation through technology and shed light on a new reality for older adults in situations of social isolation. Our goal is to persuade the reader that our position on this topic is a valid one. We support our claims with practice-based evidence and published research studies.

Methods

To do so, we checked the most recent literature, most of which came from the last decade. Our literature survey focused primarily on what is known about technology and how technology can affect social transformation and perceptions of social isolation.

Findings

Two dominant transformative realities became the focal points: the precarious implications of loneliness for older adults and the emerging reality of social change through digital technology central to eHealth and mHealth.

Discussion

To benefit from new technologies and reduce the detrimental effects of social isolation, we must engage older adults in a meaningful way and adapt the system of smart devices to reflect the specific physiological and psychological characteristics of the ageing population.

Conclusion

Older adults need to comprehend the meanings of their social experiences to preserve their active lifestyle. Human interactions may be desirable, but technological dominance may also minimize the adverse effects of social isolation.

Telehealth was beneficial during COVID-19 for older Americans: A qualitative study with physicians

Background

Individuals aged 65 and older face unique barriers to adoption of telehealth, and the coronavirus disease 2019 pandemic has provided a “natural experiment” in how to meet the health needs of older patients remotely. Physician perspectives on practical considerations surrounding telehealth adoption, motivations of use, and reasons for nonuse are necessary to inform the future of healthcare delivery. The objective is to understand the experiences of physicians using telemedicine for older patients.

Methods

From September to November 2020, we conducted 30‐min semi‐structured interviews using purposeful sampling to identify and enroll participants from diverse settings. We included 48 U.S.‐based physicians (geriatrician, n = 18, primary care, n = 15, emergency, n = 15) from all geographic regions, rural–urban and academic/community settings. Audio‐recorded interviews were professionally transcribed and analyzed using framework analysis. Major themes and subthemes were identified.

Results

Participants had a median (interquartile range) age of 37.5 (34–44.5), 27 (56%) were women. Five major themes emerged: (1) telehealth uptake was rapid and iterative, (2) telehealth improved the safety of medical care, (3) use cases were specialty‐specific (for geriatricians and primary care physicians telehealth substituted for in‐person visits; for emergency physicians it primarily supplemented in‐person visits), (4) physicians altered clinical care to overcome older patient barriers to telehealth use, and (5) telehealth use among physicians declined in mid‐April 2020, due primarily to patient needs and administrator preferences, not physician factors.

Conclusion

In this qualitative analysis, physicians reported a rapid, iterative uptake of telehealth and attenuation of use as coronavirus disease 2019 prevalence declined. Physician experiences during the pandemic can inform interventions and policies to help buoy telehealth for ongoing healthcare delivery and ensure its accessibility for older Americans.

Validating Habitual and Goal-Directed Decision-Making Performance Online in Healthy Older Adults

Everyday decision-making is supported by a dual-system of control comprised of parallel goal-directed and habitual systems. Over the past decade, the two-stage Markov decision task has become popularized for its ability to dissociate between goal-directed and habitual decision-making. While a handful of studies have implemented decision-making tasks online, only one study has validated the task by comparing in-person and web-based performance on the two-stage task in children and young adults. To date, no study has validated the dissociation of goal-directed and habitual behaviors in older adults online. Here, we implemented and validated a web-based version of the two-stage Markov task using parameter simulation and recovery and compared behavioral results from online and in-person participation on the two-stage task in both young and healthy older adults. We found no differences in estimated free parameters between online and in-person participation on the two-stage task. Further, we replicate previous findings that young adults are more goal-directed than older adults both in-person and online. Overall, this work demonstrates that the implementation and use of the two-stage Markov decision task for remote participation is feasible in the older adult demographic, which would allow for the study of decision-making with larger and more diverse samples.

Information and Communication Technologies as a Source of Customer Value in the Context of Balancing the Positions of Younger and Older Consumers

Information and communication technologies (ICT, new technologies) have revolutionized every aspect of consumers’ lives and become an important value creation tool for them. It is commonly believed that this process concerns young and adult persons (younger than 60, 60−) to a much greater extent than older persons (60 and older, 60+, seniors). It is therefore assumed that calendar age is the key determinant of customer behavior. Meanwhile, the qualities of ICT, by their very nature, act as a source of value for purchasers regardless of their chronological age. In this sense, ICT has the potential to balance the positions between younger and older consumers. The aim of this article is to illustrate the similarities and differences between the two age groups (60− and 60+) with respect to the manner of approaching and using ICT as a source of customer value. This article has been written on the basis of literature research, existing data, and the findings of quantitative and qualitative research conducted among Polish respondents. The author’s own research was conducted in three stages. The quantitative surveys were conducted using the direct survey method and a questionnaire-based random survey among 827 respondents (340 young and adults, and 487 seniors). The two qualitative studies made it possible to expand the scope of information gathered. They were conducted using targeted direct interviews in three mini groups using interview scripts and questionnaire-based observation of the three social media channels managed by seniors, with the most popular themes in Poland taken into account. The conducted studies prove that, despite the discrepancies in the percentage share of younger and older ICT users, individuals utilizing the same solutions speak of the same advantages and see the same risks. Moreover, respondents believe that, in the future, all consumers will be included in the digital world. The results may be useful for practitioners whose increasingly digitized offerings will be targeted at younger as well as a growing number of older consumers.

Can Online Communication Prevent Depression Among Older People? A Longitudinal Analysis

Evidence on the association between internet usage and incidence of depression remains mixed. We examined the associations between different categories of internet usage and developing clinical depression. We used data from the 2013 and 2016 waves of the Japan Gerontological Evaluation Study (JAGES) comprising 12,333 physically and cognitively independent adults aged ≥65 years. Participants were engaged in seven categories of internet usage: communication with friends/family, social media, information collection about health/medicine, searching for medical facilities, purchase of drugs and vitamins, shopping, and banking. We found that internet use for communication had a protective influence on the probability of developing clinical depression defined as the Geriatric Depression Scale scores ≥5 or self-reported diagnosed depression. Our findings support the role of online communication with friends/family in preventing clinical depression among older people. Online communication could be particularly useful in the COVID-19 crisis because many families are geographically dispersed and/or socially distanced.

Relationship Between Psychological Responses and the Appraisal of Risk Communication During the Early Phase of the COVID-19 Pandemic: A Two-Wave Study of Community Residents in China

The novel coronavirus disease (COVID-19) has affected hundreds of millions of people worldwide. Data collection in the ascending phase is crucial to address a rapidly evolving crisis by helping us understand the uncertain relationship between risk communication and psychological responses. Data were collected from 26 January 26, 2020, until February 17, 2020, with a mean test–retest interval of 16 days. A total of 846 adults from four residential communities in high-risk areas (Wuhan city) and low-risk areas (Zhengzhou city) were invited to complete a set of Internet-based questionnaires measuring the adoption of preventive behaviors, appraisal of risk communication, anxiety level, and susceptibility to emotional contagion. At the baseline assessment (Wave 1), 58 withdrew from the study, and 788 (433 females) completed the questionnaires. At the Wave 2 survey, 318 (185 females) adults from Wave 1 were retained. The results from cross-lagged models demonstrated reciprocal negative associations between anxiety and risk communication and between the appraisal of risk communication and the adoption of preventive behaviors. In addition, a higher appraisal of risk communication in the initial period of the outbreak mitigated the respondents' susceptibility to emotional contagion later on. Susceptibility to emotional contagion was positively associated with preventive behaviors taken. Furthermore, multiple-group structural equation modeling suggested that risk communication was more likely to affect the susceptibility to emotional contagion of people on the frontline of the outbreak than people living in low-risk areas. This study demonstrated the importance of risk communication aimed at encouraging appropriate countermeasures against virus outbreaks.

Effects of Sexual Function, Social Media Use, and Self-Efficacy on Quality of Life Among Home Parenteral Nutrition Patients

BACKGROUND

Quality of life (QOL) of home parenteral nutrition (HPN) patients is a critical issue for functioning and survival. This study evaluates the roles of sexual function (SF), self-efficacy (SE), and the use of social media (USM) in the QOL of HPN patients.

MATERIALS AND METHODS

The study model investigates the independent variables USM and SF and the dependent variable QOL, and SE is a mediator variable between SF and USM.

RESULTS

We included 203 participants with HPN who completed self-administered, validated questionnaires for QOL, SF, SE, and USM. Statistical analysis included a t-test, Sobel test, bootstrapping method, and Pearson correlations between variances. The mean HPN duration was 10.5 ± 8 years. Results show a significant correlation between QOL scores and SF (P = .001). USM was positively correlated with SE (P = .001). SE as a mediator between USM and SF was supported by significant results in the Sobel test. Patients with a stoma were significantly less sexually active and had lower SE ratings than those without a stoma.

CONCLUSION

Physical changes that affect SE and boost social relationships by allowing emotional support through social networks are important factors for QOL improvement. These findings may guide health professionals in the management of HPN patients.

The Impact of Superfast Broadband, Tailored Booklets for Households, and Discussions With General Practitioners on Personal Electronic Health Readiness: Cluster Factorial Quasi-Randomized Control Trial

Background

Electronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of “superfast” broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels.

Objective

This study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth.

Methods

This was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities.

Results

eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t₂₃₅=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t₂₅₅=3.191; P=.002 and t₂₅₈=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2%, 205/259 to 81.5%, 211/259) and mobile use was significantly greater (50.5%, 101/199 to 64.8%, 129/199). There was no change in eHealth inequality.

Conclusions

People in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others.

Trial Registration

ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x)

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.

Understanding Older Adult's Technology Adoption and Withdrawal for Elderly Care and Education: Mixed Method Analysis from National Survey

BACKGROUND

Elderly adults have comprised the fastest growing population adopting the Internet and computer technology over the past decade. However, how their experiences can shed light on elderly learning theory has not been examined much in the literature.

OBJECTIVE

This study investigated the factors and reasons associated with Internet adoption and withdrawal among older adults in Taiwan, and if any gender differences exist in this context.

METHODS

Data on participants aged 50 years and older from the nationally representative "Digital Opportunity Survey on Individuals and Households in Taiwan," who did not use the Internet in 2005 but adopted it in 2007 (n=1548), and those who reported using Internet in 2011 but then withdrew (n=1575), were analyzed. Factors and reasons associated with Internet adoption and withdrawal were examined using both quantitative and qualitative data.

RESULTS

Education level independently predicted Internet adoption behavior. With regard to the reasons for adoption, 66% (62/94) of participants indicated they started using the Internet to meet certain "needs"; for example, "keeping up with the world" (40.4%, 38/94) was listed as the most critical reason, followed by "job needs" (25.5%, 24/94). Older adults with a positive attitude toward the Internet with regard to increasing employment opportunities (OR 2.0, 95% CI 1.0-3.9, P=.04) and the amount of information obtained (OR 0.5, 95% CI 0.3-0.9, P=.01), as well as enriching recreation and entertainment (OR 0.6, 95% CI 0.4-0.9, P=.02), were less likely to withdraw from the Internet. The most common reason for Internet withdrawal was "psychological barriers" (eg, no available time, no meaningful use, or nothing worth reading/watching; 66.3%, 193/291), followed by "health barriers" (eg, eyes or body deteriorate with Internet use; 21.0%, 61/291). Although psychological barriers were the most important factor for Internet withdrawal for both men (72.5%, 100/138) and women (62%, 93/150), women were more likely than men to be affected by health barriers (26.0%, 39/150 vs 15.9%, 22/138; P=.004) and anthropic factors or accidental barriers (7.3%, 11/150 vs 2.9%, 4/138; P=.02).

CONCLUSIONS

Our findings that the need to keep up with the world associated with Internet adoption, and gender differences in reasons behind Internet withdrawal, such that women reported more health and anthropic factors or accidental barriers than man, may provide a new perspective that help health educators understand strategies that encourage older adults to keep learning, an important component of active aging.

Effects of digital engagement on the quality of life of older people

It is often asserted that older people's quality of life (QOL) is improved when they adopt information and communication technology (ICT) such as the Internet, mobile phones and computers. Similar assumptions are made about older people's use of ICT-based care such as telecare and telehealth. To examine the evidence around these claims, we conducted a scoping review of the academic and grey literature, coving the period between January 2007 and August 2014. A framework analysis approach, based on six domains of QOL derived from the ASCOT and WHOQOL models, was adopted to deductively code and analyse relevant literature. The review revealed mixed results. Older people's use of ICT in both mainstream and care contexts has been shown to have both positive and negative impacts on several aspects of QOL. Studies which have rigorously assessed the impact of older people's use of ICT on their QOL mostly demonstrate little effect. A number of qualitative studies have reported on the positive effects for older people who use ICT such as email or Skype to keep in touch with family and friends. Overall, the review unearthed several inconsistencies around the effects of older people's ICT use on their QOL, suggesting that implicit agreement is needed on the best research methods and instrumentation to adequately describe older people's experiences in today's digital age. Moreover, the available evidence does not consider the large number of older people who do not use ICT and how non-use affects QOL.

Internet use and psychological wellness during late adulthood

An aging population is best served by social, personal, and health support focused on maintaining and maximizing personal independence. The Internet affords numerous opportunities for individuals of all ages to communicate, access information, and engage in recreational activities. A community-based sample of 122 adults over 60 years of age completed a questionnaire which assessed three clusters of characteristics: (a) frequency and patterns of Internet use, (b) well-being (loneliness, life satisfaction, self-efficacy, social support, and depression), and (c) demographics (age, income, education). Significant correlations emerged between the three clusters of measured variables. Controlling for demographic differences, Internet use and self-efficacy remained significantly related. Among the sample of older adults, individuals who used the Internet more had higher perceptions of self-efficacy than those who used the Internet rarely or not at all.

Health care information seeking and seniors: determinants of Internet use

While seniors are the most likely population segment to have chronic diseases, they are the least likely to seek information about health and diseases on the Internet. An understanding of factors that impact seniors' usage of the Internet for health care information may provide them with tools needed to improve health. This research examined some of these factors as identified in the comprehensive model of information seeking to find that demographics, trust in health information websites, perceived usefulness of the Internet, and internal locus of control each significantly impact seniors' use of the Internet to seek health information.

[Old and offline? : Findings on the use of the Internet by people aged 65 years and older in Switzerland]

BACKGROUND

The supply of information and communication is becoming continuously more focused on the Internet. While the age groups up to 64 years have shown a vast increase in the use of the Internet since 1997, intensive use of the Internet by age groups above 64 years lags behind and this is not only the case in Switzerland. Against this background and an interest in finding out more about Internet (non)use of older people, two representative surveys were conducted in Switzerland, one in 2009 and another one in 2014.

MATERIAL AND METHODS

The data used were acquired throughout Switzerland via a standardized telephone survey. The random sample (2014) consisted of 1037 people aged between 65 and 100 years old.

RESULTS

Although the digital divide between the age groups has lessened over the past years, only 55.7 % of the elderly people interviewed were using the Internet in the autumn of 2014. Internet usage differs greatly between age groups. Resources such as education, income and health positively impact actual use of the Internet. Additionally, recommendations from a person's social environment, as well as an affinity for technology and a personal benefit assessment have a positive impact on Internet usage. In particular, security concerns and difficulties of use were mentioned as predominant reasons for the non-use of the Internet. Some of the people questioned felt excluded from society because they did not use the Internet.

CONCLUSION

Internet usage among elderly people depends on individual and social resources, as well as on general attitude towards technology and personal benefit expectations. The exclusion of today's elderly "offliners" should be avoided, even if the digital divide will decrease in the future.

Acceptance and use of health information technology by community-dwelling elders

OBJECTIVES

With the worldwide population growing in age, information technology may help meet important needs to prepare and support patients and families for aging. We sought to explore the use and acceptance of information technology for health among the elderly by reviewing the existing literature.

METHODS

Review of literature using PubMed and Google Scholar, references from relevant papers, and consultation with experts.

RESULTS

Elderly people approach the Internet and health information technology differently than younger people, but have growing rates of adoption. Assistive technology, such as sensors or home monitors, may help 'aging in place', but these have not been thoroughly evaluated. Elders face many barriers in using technology for healthcare decision-making, including issues with familiarity, willingness to ask for help, trust of the technology, privacy, and design challenges.

CONCLUSIONS

Barriers must be addressed for these tools to be available to this growing population. Design, education, research, and policy all play roles in addressing these barriers to acceptance and use.

An evaluation of healthcare information on the Internet: the case of colorectal cancer prevention

Health information, provided through the Internet, has recently received attention from consumers and healthcare providers as an efficient method of motivating people to get screened for colorectal cancer (CRC). In this study, the primary purpose was to investigate the extent to which consumers were better educated about CRC screening information because of the information available on the Internet. Another purpose was to identify how better-informed consumers, with reliable and trustworthy health information, were enabled to make sound decisions regarding CRC screening. The data used in this study was taken from the 2003 Health Information National Trends Survey. People aged 55 and older were classified based on their compliance with recommended CRC screening. The study applied the PRECEDE-PROCEED model to evaluate the effects of health information taken from the Internet regarding CRC screening. The credibility and reliance of cancer related information on the Internet was significantly associated with patient compliance to be screened for CRC. Experience and knowledge of Internet use had a significant impact on the utilization of CRC screening. This analysis suggests that the design and publishing websites concerning CRC should emphasize credibility and reliance. Websites providing information about CRC must also contain the most current information so that people are able to make educated decisions about CRC screening.

Internet use among older adults: association with health needs, psychological capital, and social capital

BACKGROUND

Previous studies have identified socioeconomic status and health status as predictors of older adults' computer and Internet use, but researchers have not examined the relationships between older adults' health needs and psychological capital (emotional well-being and self-efficacy) and social capital (social integration/ties and support networks) to different types of Internet use.

OBJECTIVE

This study examined (1) whether older adults' health conditions and psychological and social capital differentiate Internet users from nonusers, and (2) whether the Internet users differed in their types of Internet use on the basis of their health conditions and psychological and social capital.

METHODS

Data for this study came from the National Health and Aging Trends Study, which is based on a nationally representative sample of US Medicare beneficiaries aged 65 years and older. The sample for this study were those who resided in the community in their own or others' homes (N=6680). Binary logistic regression analysis was used to compare health needs, psychological capital, and social capital among (1) any type of Internet users and nonusers, (2) Internet users who engaged in health-related tasks and Internet users who did not, (3) Internet users who engaged in shopping/banking tasks and Internet users who did not, and (4) Internet users only used the Internet for email/texting and all other Internet users.

RESULTS

Depressive and anxiety symptoms, measures of psychological capital, were negatively associated with Internet use among older adults (odds ratio [OR] 0.83, 95% CI 0.70-0.98, P=.03 and OR 0.79, 95% CI 0.65-0.97, P=.03, respectively), whereas most measures of social capital were positively associated with Internet use. Having more chronic medical conditions and engaging in formal volunteering increased the odds of Internet use for health-related tasks by 1.15 (95% CI 1.08-1.23, P<.001) and 1.28 (95% CI 1.05-1.57, P=.02), respectively, but anxiety symptoms decreased the odds (OR 0.74, 95% CI 0.55-0.99, P=.05). Religious service attendance was negatively associated with Internet use for shopping/banking activities (OR 0.75, 95% CI 0.62-0.91, P=.01). Anxiety symptoms increased the odds of using the Internet only for emails/texting (OR 1.75, 95% CI 1.12-2.75, P=.02), but formal volunteering decreased the odds (OR 0.63, 95% CI 0.43-0.92, P=.02). Other correlates of Internet use solely for emails/texting were older age (80-84 years and ≥85 years), a black or "other" racial/ethnic background, a high school education or less than high school, and lower income.

CONCLUSIONS

The findings point to the importance of social capital in facilitating older adults' learning and adoption of Internet technology. Older adults who used the Internet for email/texting purposes only were the most socially and economically disadvantaged group of Internet users. Computer/Internet training for older adults and computer/Internet use for various purposes need to consider the significant role their social capital can play.

The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use

Background

Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults.

Objective

This study examined Internet use patterns, reasons for discontinued use, eHealth literacy, and attitudes toward computer/Internet use among low-income homebound individuals aged 60 and older in comparison to their younger counterparts—homebound adults under age 60.

Methods

Face-to-face or telephone surveys were conducted with 980 recipients of home-delivered meals in central Texas (78% were age 60 years and older and 22% under age 60). The eHealth Literacy Scale (eHEALS) and the efficacy and interest subscales of the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were used to measure the respective constructs. Age groups were compared with chi-square tests and t tests. Correlates of Internet use were analyzed with multinomial logistic regression, and correlates of eHEALS and ATC/IQ scores were analyzed with OLS regression models.

Results

Only 34% of the under-60 group and 17% of the 60 years and older group currently used the Internet, and 35% and 16% of the respective group members reported discontinuing Internet use due to cost and disability. In addition to being older, never users were more likely to be black (OR 4.41; 95% CI 2.82-6.91, P<.001) or Hispanic (OR 4.69; 95% CI 2.61-8.44, P<.001), and to have lower incomes (OR 0.36; 95% CI 0.27-0.49, P<.001). Discontinued users were also more likely to be black or Hispanic and to have lower incomes. Among both age groups, approximately three-fourths of the current users used the Internet every day or every few days, and their eHEALS scores were negatively associated with age and positively associated with frequency of use. Among the 60 and older group, a depression diagnosis was also negatively associated with eHEALS scores. ATC/IQ efficacy among never users of all ages and among older adults was positively associated with living alone, income, and the number of medical conditions and inversely associated with age, Hispanic ethnicity, and Spanish as the primary language. Although ATC/IQ interest among older adults was also inversely associated with age, it was not associated with Hispanic ethnicity and Spanish as the primary language.

Conclusions

This study is the first to describe in detail low-income disabled and homebound adults’ and older adults’ Internet use. It shows very low rates of Internet use compared to the US population, either due to lack of exposure to computer/Internet technology; lack of financial resources to obtain computers and technology; or medical conditions, disabilities, and associated pain that restrict use. Recommendations to reduce the digital divide among these individuals are provided.

Computer-related self-efficacy and anxiety in older adults with and without mild cognitive impairment

BACKGROUND

This study examines differences in computer-related self-efficacy and anxiety in subgroups of older adults, and changes in those measures after exposure to a systematic training program and subsequent computer use.

METHODS

Participants were volunteers in the Intelligent Systems for Assessment of Aging Changes study (ISAAC) carried out by the Oregon Center for Aging and Technology. Participants were administered two questionnaires before training and again 1 year later, which were related to computer self-efficacy and anxiety. Continuous recording of computer use was also assessed for a subset of participants.

RESULTS

Baseline comparisons by sex, age, education, living arrangement, and computer proficiency, but not cognitive status, yielded significant differences in confidence and anxiety related to specific aspects of computer use. At 1-year follow-up, participants reported less anxiety and greater confidence. However, the benefits of training and exposure varied by group and task. Comparisons based on cognitive status showed that the cognitively intact participants benefited more from training and/or experience with computers than did participants with mild cognitive impairment (MCI), who after 1 year continued to report less confidence and more anxiety regarding certain aspects of computer use.

CONCLUSION

After 1 year of consistent computer use, cognitively intact participants in this study reported reduced levels of anxiety and increased self-confidence in their ability to perform specific computer tasks. Participants with MCI at baseline were less likely to demonstrate increased efficacy or confidence than their cognitively intact counterparts.

Chinese Older Adults’ Internet Use for Health Information

Technological advancement benefits Internet users with the convenience of social connection and information search. This study aimed at investigating the predictors of Internet use to search for online health information among Chinese older adults. The Technology Acceptance Model (TAM) was applied to examine the predictiveness of perceived ease of use, perceived usefulness, and attitudes toward Internet use on behavioral intention to search for health information online. Ninety-eight Chinese older adults were recruited from an academic institute for older people and community centers. Frequency of Internet use and physical and psychological health were also assessed. Results showed that perceived ease of use and attitudes significantly predicted behavioral intention of Internet use. The potential influences of traditional Chinese values and beliefs in health were also discussed.

Review and recommendations for online physical activity and nutrition programmes targeted at over 40s

Issues addressed. Australia’s ageing population is becoming less physically active and increasingly overweight and obese. There is a need to support physical activity and healthy dietary practices to control overweight and obesity and to prevent chronic disease amongst the middle aged and older population (40 years or more). The Internet is emerging as a potentially effective method of delivering health promotion programmes. Methods. Literature relating to online physical activity and nutrition programmes published from 2000 to 2009 were identified through a search of four databases and by examining reference lists of relevant articles. Results. Eighteen relevant references were identified: 10 online physical activity programmes and eight online physical activity and nutrition programmes. Twelve studies reported significant short-term effects on behaviour change or weight loss, and four studies did not assess behaviour change, but focused on the usefulness of website strategies, attitude changes and/or recruitment methods. Seven studies experienced low retention rates. Conclusions. Evidence to date suggests that the Internet is no more effective than print materials, face-to-face programmes and other health promotion methods. Several studies found positive short-term effects from using Internet-based programmes, including those aimed at the target group (40 years or more). Therefore the use of the Internet as a method for delivering health promotion programmes is worthy of future consideration. So what? The Internet provides an opportunity for health promotion professionals to engage vastly more people in health promotion interventions, as well as providing a tool to interact and engage with them. From a population health perspective this is becoming more important as the incidence of lifestyle related diseases increases among middle to older aged people. Although online physical activity and healthy weight programmes vary in degrees of effectiveness, the Internet cannot be ignored as a future medium for health promotion. More research is needed to evaluate the effectiveness of such programmes.

Telemedicine and Older Neurology Outpatients: Use of NHS Direct and of the Internet in the UK

Telemedicine is one potential approach to address the under-serviced health needs of older people. This article presents data from a project investigating neurology patients’ awareness and use of the NHS Direct telephone helpline and the Internet over a 10-year period (2001–2010). Older people’s awareness and use of the NHS Direct telephone helpline was low compared to other age groups and did not change with time. Although Internet access and use was also low compared to other age groups, access did increase over time. Hence, future generations of older people may be amenable to health contacts and inputs via cyberspace.

Participation of older adults in cyberspace: how Australian older adults use the Internet

AIM

The present study explores how Australian older adults use the Internet.

METHOD

Older adults were recruited online to complete an online survey.

RESULTS

Participants primarily used the Internet for interpersonal communication, followed by information seeking, commerce and entertainment.

CONCLUSION

The Internet is an important technology in helping older adults lead independent and social lives.

Older members perform better in an internet-based behavioral weight loss program compared to younger members

BACKGROUND

New technology offers increased opportunities for weight control. However, it is not clear whether older people with less computer training can make use of this tool. Our objective was to examine how members above the age of 65 years performed in an internet-based behavioral weight loss program, compared to younger members.

METHODS

Data from members (n = 23,233) of an internet-based behavioral weight loss program were analyzed. We restricted our study to active participants accessing the weight club, during a 6-month period (n = 4,440). The number of logins, food intake, and weight records were examined. Participants were divided into age tertiles separately for men and women. The oldest tertile was further subdivided into two groups: above and below the age of 65 years.

RESULTS

Participants aged 65 or older were more likely to remain active in the weight club for at least 6 months compared to younger age groups. They had the highest frequency of recordings of food intake and current weight. Among women, those older than 65 years had on average the highest percentage of weight loss (5.6 kg, 6.8%). Men above 65 years of age had the highest number of logins, on average 161 times during the 6-month period.

CONCLUSION

Older participants are performing equally well or even better in an internet-based behavioral weight loss program than younger participants. Internet-based programs could be a promising and attractive option for older adults requiring assistance in losing weight.

Unobtrusive In-Home Monitoring of Cognitive and Physical Health: Reactions and Perceptions of Older Adults

While the potential benefits of unobtrusive in-home sensing technologies for maintaining health and independence of older adults have been highlighted in recent research, little is known about their views toward such technology. The aims of this project were to identify monitoring needs and expectations of community-residing elderly and their family members. Focus groups were presented with examples of in-home monitoring devices and data output; participants were asked to consider whether the data showed information that was meaningful to them, and how and to whom they would like to have such data disseminated. Content analysis of transcripts revealed four dominant themes: maintaining independence, detecting cognitive decline, sharing of information, and the tradeoff between privacy and usefulness of monitoring. The acceptance by elderly of unobtrusive in-home monitoring was closely tied to perceived utility of data generated by such systems. Privacy concerns appeared to be less of an issue than anticipated in this sample.

Promoting older adults' well-being through Internet training and use

The purpose of the current research was to test the psychological impact of learning how to use computers and the Internet in old age, hypothesizing that such activities would contribute to seniors' well-being and personal sense of empowerment. Employing a quasi-experimental research design, we offered a course, conducted in small groups, in computer operation and Internet browsing to 22 older adults (mean age of 80) who went to day-care centers for the elderly or resided in nursing homes. A comparison group of 26 participants (similar in all major respects) was engaged in other activities. Both groups were administered measures of physical functioning, life satisfaction, depression, loneliness and self-control at pre- and post-intervention four months later. Individual semi-structured interviews were conducted with participants who finished the computer course. ANCOVA was employed for controlling the effects of control variables and pre-intervention differences on participants who completed the activities. Results showed a significant improvement among participants in the intervention group in all measures except physical functioning, whereas deterioration in all measures was detected in the comparison group. Computer and Internet use seems to contribute to older adults' well-being and sense of empowerment by affecting their interpersonal interactions, promoting their cognitive functioning and contributing to their experience of control and independence.

Perceptions and behaviour of access of the Internet: a study of women attending a breast screening service in Sydney, Australia

OBJECTIVES

To describe the perceptions and behaviour in accessing health information from the Internet by women attending a BreastScreen, New South Wales (NSW) Service in Northern Sydney.

DESIGN

Cross-sectional study.

SETTING

A BreastScreen NSW Service in Northern Sydney.

MAIN OUTCOME MEASURES

Behaviour and perceptions of accessing of the Internet for breast health and screening information and other related health information.

PARTICIPANTS

Four hundred and fifteen women aged > or =40 years who had a screening mammogram at a BreastScreen NSW Service in Northern Sydney. Data were collected from 1 October to 22 December 2004 (study interval).

RESULTS

Four hundred and sixty-one eligible women were invited to participate in the study and of these 415 women agreed to participate in the study (participation rate=90%). Of the 415 women enrolled in the cohort, 80% (333/415) of women accessed the Internet in general and 62% (205/333) of the women who accessed the Internet also accessed health related information from the Internet, but only 7% of the total women accessed breast health and screening information from the Internet. Two hundred and eighty (70%) women in the cohort expressed their intention to access the Internet if they were diagnosed with breast cancer. Age (OR=0.94; 95% CI=0.91-0.97), marital status (OR=2.65; 95% CI=1.45-4.83), educational status (OR=3.26; 95% CI=1.77-6.02) and behavioural intention of accessing the Internet if diagnosed with breast cancer (OR=3.31; 95% CI=1.83-5.98) were found to be associated with access of Internet for general information. Furthermore, behavioural intention (OR=2.43; 95% CI=1.30-4.55), rating of computer skills as 'average' (OR=0.42; 95% CI=0.22-0.79) and 'not good to poor' (OR=0.23; 95% CI=0.11-0.49) were found to be associated with access of health related information from the Internet.

CONCLUSIONS

Information searching from the Internet is common among women having a screening mammogram. There is potential to provide guidance to women regarding accessing the BreastScreen NSW website and other reliable sources of Internet information on breast health, breast screening and cancer-related information.

When do older adults turn to the internet for health information? Findings from the Wisconsin Longitudinal Study

BACKGROUND

Understanding how and when patients use nonphysician sources of health information is important to facilitate shared decision making within provider outpatient visits. However, little is known about which older adults seek health information on the internet or when.

OBJECTIVE

To determine how patient characteristics are related to seeking health information online and to the timing of these searches in relation to doctor visits.

PARTICIPANTS

Six thousand two hundred and seventy-nine respondents (aged 63 to 66 years) who completed the 2004 round of phone and mail surveys (70% response) as part of the Wisconsin Longitudinal Study Graduate Sample.

MEASUREMENTS

Self-reported use of the internet to search for health information and timing of use.

RESULTS

One-third of respondents had searched online for information about their own health or health care. Half of these searched for health information unrelated to their last doctor visit, while 1/3 searched after a visit, and 1/6 searched before. Among respondents with internet access at home or work, years of education (odds ratio [OR]=1.09, confidence interval [CI]=1.06 to 1.13) and openness-to-experience (OR=1.26, CI=1.16 to 1.36) were positively associated with searching online for health information irrespective of timing in relation to doctor visits. Compared with those who had never sought health information online, sicker individuals (especially those with cancer, OR=1.51, CI=1.14 to 1.99) were more likely to seek information online after a doctor visit. Attitudinal and personality factors were related to seeking health information online before or unrelated to a visit.

CONCLUSIONS

There are important differences in the timing of online health information searches by psychological and health characteristics among older adults with internet access.

Health literacy and the World Wide Web: comparing the readability of leading incident cancers on the Internet

PRIMARY OBJECTIVE

to assess the readability level of Web-based information on leading incident cancers.

RESEARCH DESIGN

websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n=33), prostate (n=34), and colorectal (n=33) cancers were included in the final analysis.

METHODS

readability was assessed using SMOG, Flesch-Kincaid (F - K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10 - 30 lines of continuous text. Identical text was entered into Microsoft Word 2002 where F - K and FRE scores were determined automatically by the word processor.

RESULTS

the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F - K. The mean FRE score was 45.3, a score considered 'difficult'. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs.

CONCLUSIONS

findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.

Accessibility compliance rates of consumer-oriented Canadian health care Web sites

Vast amounts of consumer-based health care information are widely available on the World Wide Web. However, for some this material is inaccessible due to reliance on specialized computer equipment or software known as assistive technology. These tools, designed for people with sensory, physical, or learning disabilities, act as a median to interpret Web pages in accessible ways. Unfortunately, many websites, including those with health-related content are not designed to accommodate this equipment. No research has yet been published examining the extent of this problem in Canadian consumer-oriented health care sites. The purpose of this study was to investigate the percentage of accessible consumer-based health care websites of Canadian origin. A listing of such sites was randomly sampled for study inclusion. Each was assessed for accessibility based on the World Wide Web Consortium (W3C) Web Accessibility Initiative (WAI) Web Content Accessibility Guidelines (WCAG) 1.0 using the validation software Bobby. The results indicated that only about 40% of pages investigated were free of errors in accordance with WCAG 1.0 Priority 1 level. Websites should be constructed in compliance with these standards to better accommodate those using assistive devices.