Attitudes Toward Computers Across Adulthood From 1994 to 2013

Best practices for implementing a technology-based intervention protocol: Participant and researcher considerations

Technology-based interventions present a promising approach to support health and wellness for older adults with a range of cognitive abilities. Technology can enhance access to interventions and support scaling of programs to reach more people. However, the use of technology for intervention delivery requires particular attention to users' needs and preferences and ensuring the materials are adaptable and supportive of a diverse range of technology proficiency levels. We share best practices based on lessons learned from the deployment of a randomized controlled trial (RCT) wherein we delivered an 8-week social engagement intervention through a video technology platform called OneClick for older adults with varying cognitive abilities. We developed a set of best practices and guidelines informed by the lessons learned through this RCT implementation. Technology-based interventions require attention to the application (e.g., video calls), system requirements (e.g., system memory, broadband internet), training (e.g., adaptability based on user competency), and support (e.g., handouts, live contact). These best practices relate to user needs; training design; personnel responsibility; structuring delivery and content; and evaluating success. These research-based best practices can guide the design, development, and implementation of technology-based interventions to support older adults with varying cognitive abilities.

A focus group study for the design of a web-based tool for improving problem-solving in older adults

The development of easily accessible and usable social and cognitive enhancement trainings is becoming a priority to reduce the impact of aging on quality of life. Since most activities of daily living (e.g., making a meal) require problem-solving skills, problem-solving interventions could be used to improve and/or maintain functional abilities in aging to prolong independence. To design an effective problem-solving training and increase older adults' adherence to the training, this study examined older adults' perceptions of their challenges in activities of daily living, their skills and difficulties in using information technology (IT), and their motivations and expectations for participating in a web-based problem-solving training activity. Four focus groups (two in Italy and two in the Netherlands) were conducted with older adults aged between 65 and 84 years, a total of 27 participants. The data were analyzed using the Atlas.ti 8 software for the thematic analysis. The analysis identified five thematic areas: interests and activities, difficulties and concerns, experiences and motivations for training, expertise and resources, suggestions for the design of the new training. The results were used to develop a first prototype of a Shared, Web-based, Intelligent Flexible Thinking Training (SWIFT), adapted to future user needs. The participation of older adults in this design phase was critical to understanding their needs, motivations, and expectations regarding the implementation and use of a cognitive enhancement training.

Ageism and the digital divide in Switzerland during COVID-19: Lessons for the post-pandemic world

The COVID-19 pandemic erupted in early 2020. The Swiss Federal Council implemented a semi-lockdown in March 2020, asking people, particularly older adults, to stay at home to limit the transmission of the disease and to use digital tools to maintain their social relations and activities. This study inquired how older adults confronting precarity experienced these restrictions, how digital tools functioned in this context, and what learning could therefore be imbibed for the post-pandemic era. We conducted semi-structured telephone interviews with adults aged between 66 and 90 years living in a rural and mountainous Swiss region. The obtained data were subsequently thematically analyzed. The results revealed that the respondents experienced ageism during the semi-lockdown and reported limited or non-existent opportunities to use digital tools to maintain online social contact. This predicament increased their sense of loneliness and amplified their feelings of rejection by the outside world. These observations elucidate the need for the enhancement of non-ageist social support for older people, including individuals with limited social and material resources. We advocate the adoption of innovative initiatives in the post-pandemic era to better include precarious older people in our localities and neighborhoods.

Smartphone App Designed to Collect Health Information in Older Adults: Usability Study

BACKGROUND

Studies evaluating the usability of mobile-phone assessments in older adults are limited.

OBJECTIVE

This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting.

METHODS

We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent).

RESULTS

In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test.

CONCLUSIONS

Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences.

An exploration of factors involved in the roll out of a digital application in breast services: A case study approach

INTRODUCTION

Acceptance of new technologies in health care, by those who use them as part of their role, is challenging with confounding contextual factors surrounding the acceptance of technology. As healthcare is rapidly digitising, stakeholder groups should be included in each stage of evaluation and implementation to allow opportunities to influence and contribute to digital health policies. This research employed a case study methodology to initiate an exploration into the factors associated with implementing a digital application into a mammography service. It examined the initial implementation and subsequent impact of the rollout of a digital application (VA) within a breast service in South Australia.

METHODS

Stakeholders' opinions on team performance and feedback mechanisms of the digital application were evaluated through a staff questionnaire distributed through an online survey JISC.

RESULTS

The incorporation of digitised technology into a service is evidently met with challenges. Although there is potential value in utelising automated feedback for workflow improvement and patient services, it appears imperative to provide targeted and developmental resources for educational development and staff well-being during the implementation phase.

CONCLUSION

This case study approach delves into key discussion areas and serves as the initial insight into the implementation of a digital application. It could be regarded as a foundational reference for future evaluations of digital applications.

IMPLICATIONS FOR PRACTICE

Research around digital fluency within the radiography profession requires further consideration. Under-utilisation or resistance may result in missed opportunities to enhance patient experiences and care outcomes and support staff wellbeing. Therefore, continued engagement and the encouragement of user feedback during the implementation phase are crucial to demonstrate future acceptance of digital applications in clinical settings.

What would it take to improve the uptake and utilisation of mHealth applications among older Australians? A qualitative study

Objective Health-related apps on mobile devices (mHealth apps) have become an effective self-management tool and treatment support for patients. There is limited research, however, on how older people (50 and over) perceive the opportunity of using mHealth apps. Our aim was to investigate the perceptions of older people in Australia regarding the opportunity of using prescribed or doctor-recommended mHealth apps and provide insights which can enhance their uptake of mHealth. Methods This was a qualitative study using semi-structured interviews involving 21 participants aged 51-82 years. Qualitative thematic analysis was used to categorise the factors that influence the adoption of mHealth apps by older adults. Results We show that beyond the prominent influencing factors from technology adoption research (such as performance and effort expectancy, social influence and facilitating conditions), health-specific factors such as a trusting doctor-patient relationship and strong health self-efficacy positively influence the intended adoption of mHealth apps among older adults. In addition, the IT security and accurate interpretation of participants' input in an mHealth app can present barriers to mHealth app adoption. Conclusion Our analyses provide additional insights complementing existing technology adoption research. Their successful adoption and utilisation require further empirical evidence on its effectiveness along with attention to the voices of those who are meant to use them. To address potential barriers, improve the quality and security of mHealth apps, and thus achieve greater patient safety, the involvement of consumers, regulators and health professionals is necessary.

Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study

BACKGROUND

The enactment of the "Act to Improve Healthcare Provision through Digitalisation and Innovation " (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape.

OBJECTIVE

This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps.

METHODS

Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021.

RESULTS

The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps.

CONCLUSIONS

Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice.

Feasibility, Acceptability, and Impact of a self-guided e-learning Memory and Brain Health Promotion Program for Healthy Older Adults

OBJECTIVES

To examine the feasibility (e.g., completion rate), acceptability (e.g., satisfaction), and participant-reported impact (e.g., memory concerns, behavior change, goal attainment) of a self-guided, e-learning adaptation of a validated, facilitator-guided, in-person memory intervention for older adults.

METHODS

Participants were 139 healthy older adults (mean age: 73 ± 7, 73% women). Participation tracking and pre/post questionnaires embedded within the e-learning program were used to assess feasibility, acceptability, and impact.

RESULTS

Sixty-eight percent of participants completed the program. Anonymous feedback data indicated a high level of satisfaction with the program, the pace and clarity of the learning modules, and the user interface. Suggested improvements included offering more interaction with others and addressing minor platform glitches. There was a 41% decrease in the prevalence of concern about memory changes from baseline to posttest. The majority of participants reported an increase in use of memory strategies and uptake of health-promoting lifestyle behaviors. All participants reported moderate-to-high satisfaction with personal goal attainment.

CONCLUSIONS

The program demonstrated good feasibility, acceptability, and lead to reduction in age-related memory concerns.

CLINICAL IMPLICATIONS

Self-guided, e-learning programming shows promise for fostering positive adaptation to age-related memory changes and improving the uptake of evidence-based strategies to promote brain health among older adults.

Self-reported Changes in Use of and Attitudes Toward ICT in Three Generations in Sweden During the Early Phase of the COVID-19 Pandemic

COVID-19 has affected the daily activities of people worldwide. Recommendations introduced to reduce the spread of the virus led to increased use of Information and Communication Technologies (ICT) to meet everyday needs. Such rapid digitalization had not been seen previously and not been possible to study before. Hence, this study aimed to identify and describe self-reported changes in usage of and attitudes toward ICT among three generations in Sweden during the early phase of the COVID-19 pandemic. Additionally, it aimed to identify whether and how belonging to a specific generation was related to these changes. A national cross-sectional survey was conducted in June 2020 with a final sample of N = 3,000, stratified into three generations (30-39, 50-59, and 70-79-year-old persons). A majority reported using digital technology more often than before the pandemic. Compared to the youngest generation, the oldest and middle-aged generations reported that they used digital technology more often than before the pandemic. Our results show which technologies were considered essential for different generations during the early phase of the pandemic. This information can be used to guide policy makers based on knowledge concerning the needs and demands for digital technologies in everyday life among people of different ages.

Attitudes related to technology for active and healthy aging in a national multigenerational survey

Research is needed to understand attitudes toward and adoption of the broad range of technologies available to support active and healthy aging in different generations. The present article gives an overview of the GenerationTech survey and sample, and describes attitudes and acceptance related to technology in general and as a means to support active and healthy aging. A national survey was conducted with a random sample (n = 2,121) including men and women from three generations (30-39, 50-59 and 70-79-year-olds) in Sweden. The generations shared some attitudes toward and acceptance of technologies for active and healthy aging. However, what kind of technologies are preferred to support active and healthy aging and the reasons for using certain technologies differed by generation. The findings could help guide the development and implementation of technologies for active and healthy aging throughout the aging process.

Investigating smart city adoption from the citizen's insights: empirical evidence from the Jordan context

This study aims to investigate the factors that perceive citizens' intention to adopt smart city technologies in the Arab world. A self-administered questionnaire that included 312 end users as citizens in Amman, Jordan's capital city, was used in this study. This study uses advanced statistical techniques to test an expanded technology acceptance model (TAM) that incorporates the determinants of perceived usefulness, perceived ease of use, security and privacy, ICT infrastructure and inadequate Internet connectivity, social influence, and demographic profiles. Based on the results, perceived ease of use and ICT infrastructure and Internet connectivity showed positive association with the intention of citizens to adopt smart city services in Jordan. By recognizing the factors that predict citizens' adoption of smart city services, this study presents some theoretical implications and practical consequences related to smart city service adoption.

Public attitudes towards the use of novel technologies in their future healthcare: a UK survey

BACKGROUND

Innovation in healthcare technologies can result in more convenient and effective treatment that is less costly, but a persistent challenge to widespread adoption in health and social care is end user acceptability. The purpose of this study was to capture UK public opinions and attitudes to novel healthcare technologies (NHTs), and to better understand the factors that contribute to acceptance and future use.

METHODS

An online survey was distributed to the UK public between April and May 2020. Respondents received brief information about four novel healthcare technologies (NHTs) in development: a laser-based tool for early diagnosis of osteoarthritis, a virtual reality tool to support diabetes self-management, a non-invasive continuous glucose monitor using microwave signals, a mobile app for patient reported monitoring of rheumatoid arthritis. They were queried on their general familiarity and attitudes to technology, and their willingness to accept each NHT in their future care. Responses were analysed using summary statistics and content analysis.

RESULTS

Knowledge about NHTs was diverse, with respondents being more aware about the health applications of mobile apps (66%), followed by laser-based technology (63.8%), microwave signalling (28%), and virtual reality (18.3%). Increasing age and the presence of a self-reported medical condition favoured acceptability for some NHTs, whereas self-reported understanding of how the NHT works resulted in elevated acceptance scores across all NHTs presented. Common contributors to hesitancy were safety and risks from use. Respondents wanted more information and evidence to help inform their decisions, ideally provided verbally by a general practitioner or health professional. Other concerns, such as privacy, were NHT-specific but equally important in decision-making.

CONCLUSIONS

Early insight into the knowledge and preconceptions of the public about NHTs in development can assist their design and prospectively mitigate obstacles to acceptance and adoption.

Developing online fall prevention program: Older adult recommendations`

Falls are a critical public health problem for older adults making expanded access of evidence-based fall prevention programs to this population a priority. Online delivery could improve the reach of these needed programs, however associated benefits and challenges remain poorly explored. This focus group study was undertaken to gather older adults' perceptions regarding the transition of face-to-face fall prevention programs to online formats. Content analysis was used to identify their opinions and suggestions. Older adults had concerns related to technology, engagement, and interaction with peers that they valued during face-to-face programs. They provided suggestions they felt would improve the success of online fall prevention programs, especially including synchronous sessions and getting input during program development from older adults.

Understanding older adults' attitudes toward mobile and wearable technologies to support health and cognition

The use of technology to facilitate remote patient monitoring and virtual care is desirable due to the challenges of providing healthcare during the COVID-19 pandemic and the need for more efficient and effective methods to care for the expanding older adult population. Further, the collection and sharing of patient generated health data (PGHD) through these technologies holds promise with respect to improving outcomes and reducing the cost of care by facilitating the early detection and treatment of cognitive and health problems. Despite the potential benefits of these technologies, their promise might be hampered by low rates of acceptance and adoption among older adults. In an online survey, we assessed community-dwelling older adults' (N = 92) attitudes towards the use of wearable and mobile technologies for (1) predicting cognitive decline, (2) assisting with adherence to healthy activities, and (3) collecting self-report data to understand current and predict future health states. Participants generally agreed hypothetical technology solutions would be useful (M = 4.20, SD = 0.70 on a 1-5 agreement scale; 5 = "strongly agree"), that they were interested in learning more about these technologies (M = 4.04, SD = 0.74), and that they would be willing to adopt these technologies (M = 3.83, SD = 0.93), though attitudes varied. Although participants were generally positive toward these technologies, they were relatively neutral in terms of their agreement that privacy of generated data was a concern (M = 2.92, SD = 1.02). Privacy concerns were associated with lower interest and willingness to adopt. More positive general technology attitudes and higher mobile device proficiency were associated with greater acceptance and willingness to adopt these technologies. Finally, poorer self-rated health was related to negative attitudes toward these technologies. These findings highlight barriers and potential targets for intervention to increase uptake of these and similar technologies among older adults who may be reluctant to adopt remote monitoring technologies.

How Age and Gender Affect the Opinions of Computing Students Regarding Computer Usage and Design Needs

This study aimed to understand the perceptions of young computing science students about women and older people with regard to their computer literacy and how this may affect the design of computer-based systems. Based on photos, participants were asked how likely they thought the person depicted would be to use desktop computers, laptops and smartphones, and how much expertise they thought they would have with each technology. Furthermore, in order to see what impact this could have on systems being developed, we asked what design aspects would be important for the depicted person and whether they thought an adapted technology would be required. This study is based on an existing questionnaire, which was translated into German and extended to explore what impact this may have on system design. The results draw on 200 questionnaires from students in the first year of their Information and Communications Technology (ICT) studies at an Austrian university of applied sciences. Quantitative methods were used to determine if the perceptions varied significantly based on the age and gender of the people depicted. Qualitative analysis was used to evaluate the design aspects mentioned. The results show that there are biases against both older people and women with respect to their perceived expertise with computers. This is also reflected in the design aspects thought to be important for the different cohorts. This is crucial as future systems will be designed by the participants, and these biases may influence whether future systems meet the needs and wishes of all groups or increase the digital divide.

Chinese adult segmentation according to health skills and analysis of their use for smart home: a cross-sectional national survey

Background

Digital health has become a heated topic today and smart homes have received much attention as an important area of digital health. Smart home is a device that enables automation and remote control in a home environment via the internet. However, most of the existing studies have focused on discussing the impact of smart home on people. Only few studies have focused on relationship between health skills and use of smart home.

Aims

To analyze the health skills of Chinese adults and segment them to compare and analyze the use of smart home for each group.

Methods

We used data from 11,031 participants aged 18 and above. The population was clustered based on five health skills factors: perceived social support, family health, health literacy, media use, and chronic diseases self-behavioral management. A total of 23 smart homes were categorized into three sub-categories based on their functions: entertainment smart home, functional smart home, and health smart home. We analyzed demographic characteristics and utilization rate of smart home across different cluster. Each groups’ features and the differences in their needs for smart home functions were compared and analyzed.

Results

As a result of the survey on health skills, three groups with different characteristics were clustered: good health skills, middle health skills, and poor health skills. The utilization rate of smart home was the highest was good health skills group (total smart home: 92.7%; entertainment smart home: 61.1%, functional smart home: 77.4%, and health smart home: 75.3%; P < 0.001). For entertainment smart home, smart TV had the highest utilization rate (good health skills: 45.7%; middle health skills: 43.5%, poor health skills: 33.4%, P < 0.001). For functional smart home, smart washing machine (good health skills: 37.7%, middle health skills: 35.11%, poor health skills: 26.5%; P < 0.001) and smart air conditioner (good health skills: 36.0%, middle health skills: 29.1%, poor health skills: 24.6%) were higher than other of this category. For health smart home, sports bracelet has the highest utilization rate (good health skills: 37.3%, middle health skills: 24.5%, poor health skills: 22.8%).

Conclusion

People can be divided into different categories based on health skill profiles, those with good health skills had a better utilization rate of smart home. The government and smart home companies need to focus on people with poor smart home use in various ways to promote their use of smart homes for personal health management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08126-8.

A Grand Challenge for Psychology: Reducing the Age-related Digital Divide

World-wide population aging and rapid diffusion of digital technology have converged to produce an age-related digital divide in technology adoption, as seen in use of the internet and ownership of smartphones. Given the centrality of these technologies for full participation in modern society, reducing that gap is an important challenge for psychologists. We outline more and less malleable factors associated with technology adoption. We argue that interventions that can change both the aging user and the design of products will be necessary. Adaptive technology systems that incorporate artificial intelligence and extended reality represent promising new approaches to reducing the age-related digital divide.

Do older adults benefit from telepsychiatric care: Comparison to younger adults

BACKGROUND

Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults.

METHOD

Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks.

RESULTS

Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them.

CONCLUSION

Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.

Robot-Delivered Cognitive Stimulation Games for Older Adults

Cognitive stimulation games delivered on robots may be able to improve cognitive functioning and delay decline in older adults. However, little is known about older adults’ in-depth opinions of robot-delivered games, as current research primarily focuses on technical development and one-off use. This article explores the usability, acceptability, and perceptions of community-dwelling older adults towards cognitive games delivered on a robot that incorporated movable interactive blocks. Semi-structured interviews were conducted with participants at the end of a 12-week cognitive stimulation games intervention delivered entirely on robots. Participants were 10 older adults purposively sampled from two retirement villages. A framework analysis approach was used to code data to predefined themes related to technology acceptance (perceived benefits, satisfaction, and preference), and usability (effectiveness, efficiency, and satisfaction). Results indicated that cognitive games delivered on a robot may be a valuable addition to existing cognitive stimulation activities. The robot was considered easy to use and useful in improving cognitive functioning. Future developments should incorporate interactive gaming tools, the use of social anthropomorphic robots, contrasting colour schemes to accommodate macular degeneration, and cultural-specific imagery and language. This will help cater to the preferences and age-related health needs of older adults, to ultimately enhance usability and acceptability.

Investigating message framing to improve adherence to technology-based cognitive interventions

A cognitive intervention study was conducted with the purpose of exploring methods to improve adherence to a technology-based cognitive intervention and uncover individual differences that predict adherence (N = 120). The study was divided into two phases: Phase 1, in which participants were asked to follow a prescribed schedule of training that involved gamified neuropsychological tests administered via tablet, and Phase 2, in which participants were asked to play as frequently as they wished. Positive- and negative-framed messages about brain health were delivered via the software program, and measures of cognition, technology proficiency, self-efficacy, technology attitudes, and belief in the benefits of cognitive training were collected. Generalized linear mixed-effects models revealed that positive-framed messages encouraged greater adherence over negative-framed messages, but this effect was restricted to Phase 2 of the study in the absence of social pressure. Measures of memory and self-efficacy demonstrated some, but limited, ability to predict individual differences in adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Self-Perceptions of Aging and Everyday ICT Engagement: A Test of Reciprocal Associations

OBJECTIVES

Everyday information and communication technologies (EICTs), involving digital services, such as online shopping, e-banking, and video calling, are perceived to be associated with youth and a modern lifestyle. On the other hand, older adults are often portrayed as technology-alienated, less willing, and incapable of using EICT. The internalization of potentially negative age stereotypes may compromise actual later life engagement and the ability to perform EICT. At the same time, low engagement in EICT may also contribute to negative self-perceptions of aging (SPA), for example, related to physical loss, social loss, and personal competence. This study was, hence, designed to evaluate the temporal reciprocal associations of SPA and older adults' EICT use.

METHODS

The article was based on 2 waves (2014 and 2017) from the German Ageing Survey (DEAS), a nationally representative survey of middle-aged and older individuals aged 40 and older. A cross-lagged model (N = 3,600) was estimated to examine the reciprocal associations of SPA and EICT.

RESULTS

The lagged effect of SPA on EICT engagement was nonsignificant, whereas the lagged effect of EICT engagement on SPA in the domain personal competence was significant, indicating that greater EICT engagement predicted more positive SPA related to personal competence 3 years later.

DISCUSSION

These findings encourage researchers and policymakers to put further emphasis on the empowerment of older individuals in their EICT engagement. Interventions that promote lifelong learning and age-friendly environments can enhance a more positive aging experience.

Gender differences in information and communication technology use & skills: a systematic review and meta-analysis

Even though information and communication technology (ICT) is essential for everyday life and has gained considerable attention in education and other sectors, it also carries individual differences in its use and relevant skills. This systematic review aims to examine the gender differences in ICT use and skills for learning through technology. A comprehensive search of eight journal databases and a specific selection criterion was carried out to exclude articles that match our stated exclusion criteria. We included 42 peer-reviewed empirical publications and conference proceedings published between 2006 and 2020. For a subsample of studies, we performed a small-scale meta-analysis to quantify possible gender differences in ICT use and skills. A random-effects model uncovered a small and positive, yet not significant, effect size in favor of boys (g = 0.17, 95% CI [-0.01, 0.36]). However, this finding needs to be further backed by large-scale meta-analyses, including more study samples and a broader set of ICT use and skills measures. We highlight several concerns that should be addressed and more thoroughly in collaboration with one another to better IT skills and inspire new policies to increase the quality of ICT use. The findings from this review further suggest implications and present existing research challenges and point to future research directions.

Designing Acceptable Robots for Assisting Older Adults: A Pilot Study on the Willingness to Interact

The aim of this paper was to explore the psychosocial determinants that lead to acceptability and willingness to interact with a service robot, starting with an analysis of older users' behaviors toward the Robot-Era platform, in order to provide strategies for the promotion of social assistive robotics. A mixed-method approach was used to collect information on acceptability, usability, and human-robot interaction, by analyzing nonverbal behaviors, emotional expressions, and verbal communication. The study involved 35 older adults. Twenty-two were women and thirteen were men, aged 73.8 (±6) years old. Video interaction analysis was conducted to capture the users' gestures, statements, and expressions. A coded scheme was designed on the basis of the literature in the field. Percentages of time and frequency of the selected events are reported. The statements of the users were collected and analyzed. The results of the behavioral analysis reveal a largely positive attitude, inferred from nonverbal clues and nonverbal emotional expressions. The results highlight the need to provide robotic solutions that respect the tasks they offer to the users It is necessary to give older consumers dedicated training in technological literacy to guarantee proper, long-lasting, and successful use.

Using Electronic Medical Record Data for Research in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 Hospital in Beijing: Cross-sectional Study

BACKGROUND

With the proliferation of electronic medical record (EMR) systems, there is an increasing interest in utilizing EMR data for medical research; yet, there is no quantitative research on EMR data utilization for medical research purposes in China.

OBJECTIVE

This study aimed to understand how and to what extent EMR data are utilized for medical research purposes in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 hospital in Beijing, China. Obstacles and issues in the utilization of EMR data were also explored to provide a foundation for the improved utilization of such data.

METHODS

For this descriptive cross-sectional study, cluster sampling from Xuanwu Hospital, one of two Stage 7 hospitals in Beijing, was conducted from 2016 to 2019. The utilization of EMR data was described as the number of requests, the proportion of requesters, and the frequency of requests per capita. Comparisons by year, professional title, and age were conducted by double-sided chi-square tests.

RESULTS

From 2016 to 2019, EMR data utilization was poor, as the proportion of requesters was 5.8% and the frequency was 0.1 times per person per year. The frequency per capita gradually slowed and older senior-level staff more frequently used EMR data compared with younger staff.

CONCLUSIONS

The value of using EMR data for research purposes is not well studied in China. More research is needed to quantify to what extent EMR data are utilized across all hospitals in Beijing and how these systems can enhance future studies. The results of this study also suggest that young doctors may be less exposed or have less reason to access such research methods.

Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Mindfulness-Meditation Program Among Older Adults

BACKGROUND AND OBJECTIVES

Few studies have focused on the utility of mindfulness-meditation for well-being in older adults. The present study investigated the feasibility, acceptability, and preliminary efficacy of an app-based mindfulness-meditation program among older adults.

RESEARCH DESIGN AND METHODS

A community-based sample of 46 participants aged between 63 and 81 (M = 70.85, SD = 4.70) engaged with a 30-day app-based mindfulness-meditation program for 10 min daily on their smartphones. Each meditation session comprised focusing on the breath, mentally scanning the body, monitoring the mind's activity, and cultivating a nonjudgmental orientation toward experiences. Participants completed questionnaires at baseline, day 10, and day 30.

RESULTS

On average, participants completed 25 sessions and almost 4 h of application use across the 30 days. Results of linear mixed effects models showed significant improvements in positive affect, negative affect, and life satisfaction across the study interval, but no meaningful change in total mindfulness or perceived stress. Furthermore, relative to high levels of smartphone efficacy, low smartphone efficacy was associated with higher perceived stress and negative affect, and less life satisfaction at baseline; and steeper improvements on these outcomes across the study interval. On average, older adults rated the app-based mindfulness-meditation training as interesting, enjoyable, valuable, and useful.

DISCUSSION AND IMPLICATIONS

The findings provide preliminary support for the feasibility and acceptability of an app-based mindfulness-meditation program with community-dwelling older adults and demonstrate potential benefits for well-being. Results suggest the value of further research investigating the efficacy of digital mindfulness-meditation interventions for older adults via larger randomized controlled trials.

The ironic effect of older adults' increased task motivation: Implications for neurocognitive aging

Recent work suggests that most older adults who volunteer to take part in cognitive experiments are more motivated to do well than are undergraduate students. This empirical evidence is echoed by the impressions of cognitive aging researchers. We surveyed a large group (N = 88) of researchers asking about their perceptions of younger and older adults' motivation to take part in lab-based research. Not only were older adults seen as more motivated than younger adults, but researchers thought that the two groups participate for different reasons: younger adults to obtain course credit or monetary compensation, older adults to get a sense of their cognitive health, to further science, and out of curiosity. However, older adults' greater motivation to do well on cognitive tasks may leave them vulnerable to stereotype threat, the phenomenon by which individuals underperform when they are put in a position to either confirm or deny a negative stereotype about their group. In this opinion piece, we argue that most cognitive experiments, not just those designed to measure stereotype threat, likely induce some form of performance-related anxiety in older adults. This anxiety likely leads to greater task-related interference, or thoughts about how one is doing on the task, resulting in poorer performance. We discuss some of the potential implications for our understanding of neurocognitive aging.

Key changes to improve social presence of a virtual health assistant promoting colorectal cancer screening informed by a technology acceptance model

BACKGROUND

Understanding how older, minoritized patients attend to cues when interacting with web-based health messages may provide opportunities to improve engagement with novel health technologies. We assess acceptance-promoting and acceptance-inhibiting cues of a web-based, intervention promoting colorectal cancer (CRC) screening with a home stool test among Black women.

MATERIALS AND METHODS

Focus group and individual interview data informed iterative changes to a race- and gender-concordant virtual health assistant (VHA). A user-centered design approach was used across 3 iterations to identify changes needed to activate cues described as important; such as portraying authority and expertise. Questionnaire data were analyzed using non-parametric tests for perceptions of cues. Analysis was guided by the Technology Acceptance Model.

RESULTS

Perceptions of interactivity, social presence, expertise, and trust were important cues in a VHA-delivered intervention promoting CRC screening. Features of the web-based platform related to ease of navigation and use were also discussed. Participant comments varied across the 3 iterations and indicated acceptance of or a desire to improve source cues for subsequent iterations. We highlight the specific key changes made at each of three iterative versions of the interactive intervention in conjunction with user perception of changes.

DISCUSSION

Virtual agents can be adapted to better meet patient expectations such as being a trustworthy and expert source. Across three evolving versions of a Black, VHA, cues for social presence were particularly important. Social presence cues helped patients engage with CRC screening messages delivered in this novel digital context.

CONCLUSIONS

When using a VHA to disseminate health information, cues associated with acceptability can be leveraged and adapted as needed for diverse audiences. Patient characteristics (age, identity, health status) are important to note as they may affect perceptions of a novel health technologies ease of use and relevancy according to the leading models.

Contrasting Internet Adoption in Early and Advanced Old Age: Does Internet Self-Efficacy Matter?

OBJECTIVES

Understanding why older adults (including those in very old age) use or do not use the Internet can build on the technology acceptance model (TAM). In this cross-sectional study, we translate the TAM to the Internet and assume that perceived usefulness of the Internet (PUI) and perceived ease of use of the Internet (PEUI) will be revealed as major predictors of behavioural intention to use the Internet (BII). Additionally, we consider the role of Internet self-efficacy (ISE) as another major factor for older adults' Internet use. We also argue that life phase, particularly early as opposed to advanced old age, may moderate how PUI, PEUI and ISE relate to BII.

METHOD

A sample of 1,200 older adults aged 60 years and older (60-74 years, n = 658; 75-99 years, n = 542) was randomly drawn from the city of Stuttgart, Germany. Sociodemographic variables and major indicators of TAM and ISE were assessed based on a computer-assisted telephone interviewing procedure.

RESULTS

Latent structural equation modelling revealed that PUI is the more important predictor of BII in older adults. Furthermore, ISE revealed statistically meaningful positive links with PUI, PEUI and BII. Multi-group comparison revealed that PUI had a stronger linkage with BII in early old age, whereas ISE was more important for BII in advanced old age.

DISCUSSION

The results suggest that ISE may enrich the network of TAM constructs among older adults in general but specifically in advanced old age.

Women's attitudes to the use of AI image readers: a case study from a national breast screening programme

Background

Researchers and developers are evaluating the use of mammogram readers that use artificial intelligence (AI) in clinical settings.

Objectives

This study examines the attitudes of women, both current and future users of breast screening, towards the use of AI in mammogram reading.

Methods

We used a cross-sectional, mixed methods study design with data from the survey responses and focus groups. We researched in four National Health Service hospitals in England. There we approached female workers over the age of 18 years and their immediate friends and family. We collected 4096 responses.

Results

Through descriptive statistical analysis, we learnt that women of screening age (≥50 years) were less likely than women under screening age to use technology apps for healthcare advice (likelihood ratio=0.85, 95% CI 0.82 to 0.89, p<0.001). They were also less likely than women under screening age to agree that AI can have a positive effect on society (likelihood ratio=0.89, 95% CI 0.84 to 0.95, p<0.001). However, they were more likely to feel positive about AI used to read mammograms (likelihood ratio=1.09, 95% CI 1.02 to 1.17, p=0.009).

Discussion and Conclusions

Women of screening age are ready to accept the use of AI in breast screening but are less likely to use other AI-based health applications. A large number of women are undecided, or had mixed views, about the use of AI generally and they remain to be convinced that it can be trusted.

Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association

Secondary prevention of cardiovascular disease (CVD), the leading cause of morbidity and mortality, is critical to improving health outcomes and quality of life in our aging population. As mobile health (mHealth) technology gains universal leverage and popularity, it is becoming more user-friendly for older adults and an adjunct to manage CVD risk and improve overall cardiovascular health. With the rapid advances in mHealth technology and increasing technological engagement of older adults, a comprehensive understanding of the current literature and knowledge of gaps and barriers surrounding the impact of mHealth on secondary CVD prevention is essential. After a systematic review of the literature, 26 studies that used mHealth for secondary CVD prevention focusing on lifestyle behavior change and medication adherence in cohorts with a mean age of ≥60 years were identified. Improvements in health behaviors and medication adherence were observed, particularly when there was a short message service (ie, texting) component involved. Although mobile technologies are becoming more mainstream and are starting to blend more seamlessly with standard health care, there are still distinct barriers that limit implementation particularly in older adults, including affordability, usability, privacy, and security issues. Furthermore, studies on the type of mHealth that is the most effective for older adults with longer study duration are essential as the field continues to grow. As our population ages, identifying and implementing effective, widely accepted, cost-effective, and time-efficient mHealth interventions to improve CVD health in a vulnerable demographic group should be a top health priority.

Exacerbating Inequalities: Social Networks, Racial/Ethnic Disparities, and the COVID-19 Pandemic in the United States

OBJECTIVES

The disruption and contraction of older adults' social networks are among the less discussed consequences of the COVID-19 pandemic. Our objective was to provide an evidence-based commentary on racial/ethnic disparities in social network resources and draw attention to the ways in which disasters differentially affect social networks, with meaningful insight for the ongoing pandemic.

METHODS

We draw upon prior research on social networks and past natural disasters to identify major areas of network inequality. Attention is given to how pre-pandemic racial/ethnic network disparities are exacerbated during the current crisis, with implications for physical and mental health outcomes.

RESULTS

Evidence from the literature shows a robust association between strong social networks and physical and mental health outcomes. During times of crisis, access to social networks for older adults is disrupted, particularly for marginalized groups. We document pre-pandemic disparities in social networks resources and offer insight for examining the impact of COVID-19 on disrupting social networks among older adults.

DISCUSSION

Importantly, racial/ethnic disparities in social networks both prior to and as a result of the pandemic intensify existing inequalities and demonstrate the necessity of better understanding social network inequalities for marginalized older adults, particularly in the context of the COVID-19 health crisis.

The development of a mobile user interface ability evaluation system for the elderly

This research aimed to develop a comprehensive evaluation of the mobile user interface abilities of the elderly so that technology can be designed to meet individualized needs. A total of 135 older adults were evaluated with the developed system, the Elderly Mobile User Interface Ability Evaluation System (EMUIAES). The prediction of age and the use of technology on elderly mobile interface usage were investigated based on the findings of the evaluation. The relationship between performance on Fitts' task and elderly mobile user interface ability (EMUIA) was also examined. The findings showed a strong effect of age on the elderly's use of mobile user interfaces. Previous experience with personal and tablet computers also contributed to the use of mobile user interfaces. In addition, this research demonstrated the application of Fitts' law to describe the elderly mobile user interface behaviors, particularly for tasks involving fast tapping and pointing. The EMUIAES can provide future researchers and designers a comprehensive tool to describe the elderly's diverse behaviors and changes in their ability to use mobile interfaces. Individualized interface designs for elderly users can be developed based on these findings to improve the elderly users' experiences of using technology.

The Importance of User Involvement: A Systematic Review of Involving Older Users in Technology Design

BACKGROUND AND OBJECTIVES

There is a lack of understanding of how older adults' involvement and participation matters in actual design practice. This systematic literature review investigates existing empirical studies involving older users during the design of technologies and explores the nature and consequences of involving older people.

RESEARCH DESIGN AND METHODS

Our literature review is informed by the guidelines of the PRISMA statement. We examined the included studies by means of thematic content analysis to identify the nature of older users' involvement and existing evidence on what consequences it has.

RESULTS

In total, 40 empirical studies published in the period 2014-2018 are included in the review. Most empirical studies involve older people from local networks, with underlying stereotypical images and at lower levels of participation. The results reveal three main consequences of involving older users: learning, adjusted design, and an increased sense of participation. Furthermore, we found that user involvement is a structured process whose outcomes are contingent on a range of premises.

DISCUSSION AND IMPLICATIONS

Synthesizing the results, we develop the concept of user involvement and present an analytical framework. Our results have implications for researchers and policy makers, since they throw into question the widely held assumption that involving older people inevitably yields beneficial outcomes.

Implications for technological reserve development in advancing age, cognitive impairment, and dementia

This commentary draws connections between technological culture emergence and recent trends in using assistive technology to reduce the burden of Alzheimer's disease. By the technical-reasoning hypothesis, cognitively-impaired individuals will lack the cognitive ability to employ technologies. By the technological reserve hypothesis, social-motivational and cultural transmissibility factors can provide foundations for using technology as cognitive prosthetics even during neurodegenerative illnesses.

Exploring dementia family caregivers' everyday use and appraisal of technological supports

Family caregivers provide the majority of care for people with dementia, often balancing multiple caregiving roles. Technology-based interventions have demonstrated strong potential for supporting family caregivers in navigating these roles, yet translational uptake of these interventions remains limited. A comprehensive understanding of how caregivers engage and evaluate everyday technological supports is necessary to foster broader adoption. Through semi-structured interviews with 20 caregivers, the present study aimed to explore caregivers' everyday use and appraisal of technological supports. We found that caregivers use specific technological supports to meet specific caregiving needs (e.g. coordination, information seeking, direct care), and exhibit unique technology use patterns (e.g. trial-and-error) shaped by the caregiving need. Caregivers shared positive appraisals of technological supports for caregiving, citing the role of perceived utility, existing familiarity, and social resources in their acceptance and uptake. These findings illustrate important perspectives regarding everyday technology with immediate relevance for intervention design and functionality.

Home-Based Cognitively Assistive Robots: Maximizing Cognitive Functioning and Maintaining Independence in Older Adults Without Dementia

Promoting health and prolonging independence in the home is a priority for older adults, caregivers, clinicians, and society at large. Rapidly developing robotics technology provides a platform for interventions, with the fields of physically and socially assistive robots expanding in recent years. However, less attention has been paid to using robots to enhance the cognitive health of older adults. The goal of this review is to synthesize the current literature on home-based cognitively assistive robots (CAR) in older adults without dementia and to provide suggestions to improve the quality of the scientific evidence in this subfield. First, we set the stage for CAR by: a) introducing the field of robotics to improve health, b) summarizing evidence emphasizing the importance of home-based interventions for older adults, c) reviewing literature on robot acceptability in older adults, d) highlighting important ethical issues in healthcare robotics, and e) reviewing current findings on socially assistive robots, with a focus on translating findings to the CAR context. With this foundation in place, we then review the literature on CAR, identifying gaps and limitations of current evidence, and proposing future directions for research. We conclude that CAR is promising and feasible and that there is a need for more methodologically rigorous evaluations of CAR to promote prolonged home-based independence in older adults.

Prediction of (Non)Participation of Older People in Digital Health Research: Exergame Intervention Study

Background

The use of digital technologies is increasing in health care. However, studies evaluating digital health technologies can be characterized by selective nonparticipation of older people, although older people represent one of the main user groups of health care.

Objective

We examined whether and how participation in an exergame intervention study was associated with age, gender, and heart failure (HF) symptom severity.

Methods

A subset of data from the HF-Wii study was used. The data came from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective nonparticipation was examined as resulting from two processes: (non)recruitment and self-selection. Baseline information on age, gender, and New York Heart Association Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for nonparticipation were evaluated.

Results

Of the 1632 screened patients, 71% did not participate. The nonrecruitment rate was 21%, and based on the eligible sample, the refusal rate was 61%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of nonrecruitment. Gender had no effect. The most common reasons for nonrecruitment and self-selection were related to physical limitations and lack of time, respectively.

Conclusions

Results indicate that selective nonparticipation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such systematic selection can lead to biased research results that inappropriately inform research, policy, and practice.

Trial Registration

ClinicalTrial.gov NCT01785121, https://clinicaltrials.gov/ct2/show/NCT01785121

Prediction of the use of mobile device interfaces in the progressive aging process with the model of Fitts' law

PURPOSE

As the population ages, so do the potential users of technology, and older adults' behaviors when using mobile device interfaces are becoming increasingly important. A representative model for detecting older adults' behaviors and performance on the use of mobile device interfaces is needed to provide individualized designs. This research aimed to investigate the applicability of the broadly used model of Fitts' law to detect the progressive changes in the use of mobile device interfaces in older adults. The effect of experience with using technology on performance on a Fitts task was also examined.

METHOD

A sample of 135 older adults was recruited to test the application of Fitts' model to the use of technology by older adult users. Each participant was asked to finish tasks at 9 levels of difficulty, from easy to difficult, in a multidirectional tapping task. Analysis of variance was employed to examine the effect of age on performance on the Fitts task, movement time, and the standard deviation of movement time. Stepwise regression was used to investigate how well age and technology use could predict performance on the Fitts task.

RESULT

Performance on the Fitts task was sensitive to the gradual changes in abilities with aging. Rather than the amount of experience in using technology, age was the stronger predictor of older adults' performance on the Fitts task. Additionally, compared with the younger groups, the users above 80 years old demonstrated significantly higher behavioral variation during the use of mobile device interfaces.

CONCLUSION

This research confirmed that Fitts' law is applicable to the evaluation of the effects of aging on the use of mobile device interfaces. Adults above the age of 80 years should be a major focus for special individualized interface design. This finding can inform future designers and researchers in the development of individualized interface designs for older adult users to enhance their user experiences of mobile device technology.

RELEVANCE TO INDUSTRY

Future designers and researchers can apply the finding on Fitts' law in this research to develop user-friendly interface designs for mobile technology for older adults and thereby improve their user experiences to enhance their independence and quality of life through the use of technology.