A multilevel modeling approach to examining individual differences in skill acquisition for a computer-based task

Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study

BACKGROUND

Older adults tend to have insufficient health literacy, which includes eHealth literacy-the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults' low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults' eHealth literacy.

OBJECTIVE

The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults' learning with CL versus IL for eHealth literacy.

METHODS

Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy.

RESULTS

eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases).

CONCLUSIONS

Older adults' eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains.

Memory decay distinguishes subtypes of gist

Memories are thought to become more gist-like over time. Multiple related memories might form generalized memory representations, losing specific details but enhancing or retaining gist. The time course within which gist memory emerges, however, is the subject of less consensus. To address this question, we focused our design on four kinds of gist: inferential gist (relations extracted across non-contiguous events), statistical learning (regularities extracted from a series), summary gist (a theme abstracted from a temporally contiguous series of items), and category gist (characterization of a stimulus at a higher level in the semantic hierarchy). Seventy participants completed memory encoding tasks addressing these types of gist and corresponding retrieval tasks the same evening, the morning after, and one week later, as well as an MRI at a later time point. We found little evidence that gist slowly emerges over time or that gist traces are more resistant to forgetting than detail traces. Instead, we found that initial gist memory shortly after encoding was either retained over time or decayed. Inferential gist and statistical learning were retained over a week, whereas memory for category and summary gist decayed. We discuss several interpretations for differences between these two subtypes of gist. Individual differences in REM or slow-wave sleep and hippocampal volumes did not predict changes in memory for these four kinds of gist in a healthy young adult population.

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.

"There's Not Enough Knowledge Out There": Examining Older Adults' Perceptions of Digital Technology Use and Digital Inclusion Classes

Older adults' definitions of digital technology, and experiences of digital inclusion sessions, were examined using qualitative approaches. Seventeen older adults (aged between 54 and 85 years) participated in two focus groups that each lasted approximately 90 min to explore how older adults understood technology within their lived experience. Interpretative phenomenological analysis yielded two main themes: thirst for knowledge and a wish list for digital technology sessions. A separate content analysis was performed to identify what technology older adults identified as digital technology. This analysis revealed that the older adults most frequently defined digital technology as computers and telephones. The findings support the conclusions that this group of older adults, some of whom were "successful users," have a wide knowledge of digital technology, are interested in gaining more skills, and desire knowledge acquisition through personalized one-to-one learning sessions.

An Analysis of Age, Technology Usage, and Cognitive Characteristics Within Information Retrieval Tasks

This work presents two studies that aim to discover whether age can be used as a suitable metric for distinguishing performance between individuals or if other factors can provide greater insight. Information retrieval tasks are used to test the performance of these factors. First, a study is introduced that examines the effect that fluid intelligence and Internet usage has on individuals. Second, a larger study is reported on that examines a collection of Internet and cognitive factors in order to determine to what extent each of these metrics can account for disorientation in users.

This work adds to growing evidence showing that age is not a suitable metric to distinguish between individuals within the field of human-computer interaction. It shows that factors such as previous Internet experience and fluid-based cognitive abilities can be used to gain better insight into users’ reported browsing experience during information retrieval tasks.

Retrieval practice and spacing effects in young and older adults: An examination of the benefits of desirable difficulty

In the present study, we examined how the function relating continued retrieval practice (e.g., one, three, or five tests) and long-term memory retention is modulated by desirable difficulty (R. A. Bjork, 1994). Of particular interest was how retrieval difficulty differed across young and older adults and across manipulations of lag (Exp. 1) and spacing (Exp. 2). To extend on previous studies, the acquisition phase response latency was used as a proxy for retrieval difficulty, and our analysis of final-test performance was conditionalized on acquisition phase retrieval success, to more directly examine the influence of desirable difficulty on retention. The results from Experiment 1 revealed that continued testing in the short-lag condition led to consistent increases in retention, whereas continued testing in the long-lag condition led to increasingly smaller benefits in retention for both age groups. The results from Experiment 2 revealed that repeated spaced testing enhanced retention relative to taking one spaced test, for both age groups; however, repeated massed testing only enhanced retention over taking one test for young adults. Across both experiments, the response latency results were overall consistent with an influence of desirable difficulty on retention. The discussion focuses on the role of desirable difficulty during encoding in producing the benefits of lag, spacing, and testing.

Outcomes from a peer tutor model for teaching technology to older adults

A key component of social work ethics is social justice and equitable access to resources. Increasingly, this includes access to technology. This study addresses issues related to the ‘digital divide’ by testing a peer tutor model (Technology and Aging Project, TAP2) to teach adults aged 60 and older how to use information and communication technologies (ICTs) such as email, the internet, online chat rooms and discussion groups, internet-based support groups, and voice technology and webcams. Participants from the control group of a previous programme, TAP1 (N=19) participated in a six-month computer training programme. Six participants who had successfully completed the TAP1 training were selected to be peer tutors. Data were collected from tutors and learners at baseline, three months, six months and nine months (three months after the end of training). The current study reports on learner outcomes only. Measures include computer, social support, and mental health-related outcomes. Learners reported a significant and consistent increase over time in their confidence completing certain computer-related tasks and their overall use of ICTs. Mental health and social support outcomes did not change. Overall, the peer tutor model appeared to be at least as effective as the previous staff-directed model.

Effects of an eHealth literacy intervention for older adults

Background

Older adults generally have low health and computer literacies, making it challenging for them to function well in the eHealth era where technology is increasingly being used in health care. Little is known about effective interventions and strategies for improving the eHealth literacy of the older population.

Objective

The objective of this study was to examine the effects of a theory-driven eHealth literacy intervention for older adults.

Methods

The experimental design was a 2 × 2 mixed factorial design with learning method (collaborative; individualistic) as the between-participants variable and time of measurement (pre; post) as the within-participants variable. A total of 146 older adults aged 56–91 (mean 69.99, SD 8.12) participated in this study during February to May 2011. The intervention involved 2 weeks of learning about using the National Institutes of Health’s SeniorHealth.gov website to access reliable health information. The intervention took place at public libraries. Participants were randomly assigned to either experimental condition (collaborative: n = 72; individualistic: n = 74).

Results

Overall, participants’ knowledge, skills, and eHealth literacy efficacy all improved significantly from pre to post intervention (P < .001 in all cases; effect sizes were >0.8 with statistical power of 1.00 even at the .01 level in all cases). When controlling for baseline differences, no significant main effect of the learning method was found on computer/Web knowledge, skills, or eHealth literacy efficacy. Thus, collaborative learning did not differ from individualistic learning in affecting the learning outcomes. No significant interaction effect of learning method and time of measurement was found. Group composition based on gender, familiarity with peers, or prior computer experience had no significant main or interaction effect on the learning outcomes. Regardless of the specific learning method used, participants had overwhelmingly positive attitudes toward the intervention and reported positive changes in participation in their own health care as a result of the intervention.

Conclusions

The findings provide strong evidence that the eHealth literacy intervention tested in this study, regardless of the specific learning method used, significantly improved knowledge, skills, and eHealth literacy efficacy from pre to post intervention, was positively perceived by participants, and led to positive changes in their own health care. Collaborative learning did not differ from individualistic learning in affecting the learning outcomes, suggesting the previously widely reported advantages of collaborative over individualistic learning may not be easily applied to the older population in informal settings, though several confounding factors might have contributed to this finding (ie, the largely inexperienced computer user composition of the study sample, potential instructor effect, and ceiling effect). Further research is necessary before a more firm conclusion can be drawn. These findings contribute to the literatures on adult learning, social interdependence theory, and health literacy.

TRAINING OLDER WORKERS FOR TECHNOLOGY-BASED EMPLOYMENT

An increasingly aging workforce and advances in technology are changing work environments and structures. The continued employability of older adults, particularly those of lower socioeconomic status (SES), requires them to participate in training programs to ensure their competence in today's workplace. Focus groups with 37 unemployed adults (51-76 years old) were conducted to gather information about barriers and obstacles for returning to work, training needs and formats, work experiences, and perceptions of the characteristics of an ideal job. Overall, results indicated that participants experienced age discrimination and lack of technology skills. They also expressed a desire to receive additional training on technology and a preference for classroom training.