Developing a Healthcare Technology Acceptance Model (H-TAM) for Older Adults with Hypertension

An investigation into the acceptance of intelligent care systems: an extended technology acceptance model (TAM)

With the aging population trend becoming increasingly pronounced, the health issues of elderly individuals living alone have become a focal point of societal concern. This study aims to investigate guardians of the elderly's acceptance of intelligent care systems for the elderly. This system integrates millimeter-wave radar and image recognition technologies to monitor the health status of seniors in real time and automatically alert their children in emergency situations. To evaluate the market acceptance of this emerging technology, we employed a Covariance-Based Structural Equation Modeling (CB-SEM) approach and constructed an acceptance model for the intelligent care system. Survey data were collected from 386 respondents in China. The results indicate that users of this system are more concerned with task completion rather than ease of use. Enhancements in information trust significantly promote perceived usefulness (PU), perceived ease of use (PEOU), and behavioral intention to use (BI). Individuals with higher risk perception sensitivity exhibit greater perceptions of the system's usefulness and ease of use. Aesthetics emerged as a significant factor influencing PU, PEOU, and BI, second only to information trust. When the system is perceived as well-designed, it is also deemed acceptable. An aesthetically pleasing system is not only considered useful but also easier to use. Interestingly, opinions from social circles did not directly impact BI or PEOU. they only influenced perceived usefulness. Moreover, higher privacy security requirements correlate with lower perceptions of the system's usefulness. Overall, improvements in perceived usefulness, information trust, and aesthetics significantly enhance user acceptance of the system. These findings provide theoretical support for developing more appealing intelligent care systems for the elderly and contribute new perspectives on understanding the key factors driving the adoption of such systems. Additionally, they enrich and refine the knowledge base within the TAM framework.

"It is very convenient when it works - successes and challenges with welfare technology" - a qualitative study

Welfare technology (WT) use is increasingly advocated to facilitate aging in place. However, it remains unclear how older adults and homecare staff perceive these digital technologies in practice. This qualitative study investigated the ways in which current WT either facilitated or fell short in supporting older adults in their daily lives and homecare staff at work. Four key themes were developed using thematic analysis: 1) Successes and challenges with ease of use (i.e., how simple it is to interact with the WT); 2) Successes and challenges with usefulness (i.e., how effective the WT is in achieving its intended purpose); 3) Challenges with appearance, sounds and physical location; and 4) Challenges with technical maintenance and vulnerabilities. Findings revealed paradoxes in both older adult and homecare staff user perceptions. For instance, some successes with WT's usefulness were highlighted, like GPS safety alarms in supporting older adult independence. However, challenges in usefulness were also exposed, like staff hiding "overused" safety alarms. Except for the medication robot, none of the WT devices clearly alleviated anticipated homecare staff shortages. WT perceived as auditorily or visually inadequate, that required more effort than users could comfortably manage, or that organizations could seamlessly integrate, were generally regarded as challenging. To overcome such challenges, greater involvement from older adults and homecare staff in the design and implementation of WT within homecare contexts is necessary. Refined criteria for prescribing WT to individuals, particularly regarding cognitive status, are additionally recommended by the researchers.

Exploring Acceptance of Digital Health Technologies for Managing Non-Communicable Diseases Among Older Adults: A Systematic Scoping Review

This review explores the acceptance of digital health (DH) technologies for managing non-communicable diseases (NCDs) among older adults (≥ 50 years), with an extended focus on artificial intelligence (AI)-powered conversational agents (CAs) as an emerging notable subset of DH. A systematic literature search was conducted in June 2024 using PubMed, Web of Science, Scopus, and ACM Digital Library. Eligible studies were empirical and published in English between January 2010 and May 2024. Covidence software facilitated screening and data extraction, adhering to PRISMA-ScR guidelines. The screening process finally yielded 20 studies. Extracted data from these selected studies included interventions, participant demographics, technology types, sample sizes, study designs and locations, technology acceptance measures, key outcomes, and methodological limitations. A narrative synthesis approach was used for analysis, revealing four key findings: (1) overall positive attitudes of older adults towards DH acceptance; (2) the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) are the most frequently used standard frameworks for evaluating technology acceptance; (3) the key facilitators of technology acceptance include perceived usefulness, ease of use, social influence, and digital or e-health literacy, while barriers involve technical challenges, usability issues, and privacy concerns; (4) the acceptance of AI-based CAs for NCD management among older adults remains inadequately evaluated, possibly due to limited adaptation of established frameworks to specific healthcare contexts and technology innovations. This review significantly contributes to the DH field by providing a comprehensive analysis of technology acceptance for NCD management among older adults, extending beyond feasibility and usability. The findings offer stakeholders valuable insights into how to better integrate these technologies to improve health outcomes and quality of life for older adults. Protocol Registration: PROSPERO (Registration ID: CRD42024540035).

Patients' intention to make an up-front payment at private outpatient clinics in Malaysia as a no-show reduction method

Regulating patients' no-show behavior is critical from the standpoints of sustainable medical services and operational efficiencies. The purpose of this study was to evaluate the patients' intention to make partial up-front payments at outpatient clinics. This was a cross-sectional study design introducing a self-administered questionnaire to 221 outpatients at a private health facility. The questionnaire measured the patient's demographic characteristics, perceived usefulness (PU), trust in the health facility, and intention to make upfront partial payments. Out of the total respondents, 57.4% were female. There were 34.8% Malays, 40.6% Chinese and 24.6% Indians. The majority (66.5%) of the respondents attained tertiary education. Nearly a third of the respondents (30.5%) reported an income between 3000 and 5000 Malaysian Ringgit (RM). Regarding payment mode, just more than half (51.1%) made self-payment, and 21.8% by guaranteed letter. A quarter (24.9%) waited more than 3 h for consultation and 59.6% visited the health facility more than 2 times in a year. Initial analysis showed that PU, trust, age, education, number of visits, and hours of waiting were significantly associated with the intention to make a partial payment. Multiple linear regression showed that perceived usefulness (B = 0.517, p < 0.001); trust in hospital management (B = 0.288, p < 0.001) and number of visits (B = 0.216, p < 0.001) were associated with the intention to make partial payment. Intention to make partial up-front payments is associated with higher perceived usefulness in making such payments and hospital trust. Visiting the health facility frequently was associated with a higher intention to make upfront partial payment. The result may guide further studies on potential remedies to no-show.

Older Adults' Acceptance of a Virtual Reality Group Intervention in Nursing Homes: Pre-Post Study Under Naturalistic Conditions

Background

Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults' individual characteristics on the acceptance of VR group activities in nursing homes is necessary.

Objective

This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group's perceptions of VR after participating in a VR intervention.

Methods

In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants' perceptions of VR.

Results

The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high.

Conclusions

This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals.

What Is the Real-Life Experience of Older Adults on Smart Healthcare Technologies? An Exploratory Interview Study

INTRODUCTION

Smart healthcare technologies (SHCTs) exhibit the great potential to support older Hong Kong adults with their health problems. Although there are various SHCTs in the Hong Kong market, and some adoption predictors have been proposed and investigated, little is known about older users' views on and real-life experiences with these technologies. This exploratory study examined the experiences, functional needs, and barriers of three kinds of SHCT (i.e., smart wearable devices, smart health monitors, and healthcare applications) with older adults in real life.

METHODS

A convenience sampling method was applied to recruit twenty-two older adults from the Hong Kong community. The interview was designed in semi-structured and conducted in a face-to-face setting. The content analysis was used to summarize the older adults' functional needs and barriers in real life.

RESULTS

We found older adults mainly applied SHCTs to address physical health, but there are few technological solutions for mental health in practice. There are four types of barriers in using SHCT. However, social support in Hong Kong community greatly helps reduce the barriers in technology use. Based on the findings, we discussed the possible solutions based on the social and technology perspective.

CONCLUSION

Current technologies still could not fully address older adults' needs for healthy aging, and various barriers still hinder the actual adoption. By deeply understanding and considering the social context, technology innovation can facilitate the adoption of SHCT and promote a healthy aging society.

Informing existing technology acceptance models: a qualitative study with older persons and caregivers

New technologies can help older persons age in place and support their caregivers. However, they need to be accepted by the end-users to do so. Technology acceptance models, such as TAM and UTAUT and their extensions, use factors like performance expectancy and effort expectancy to explain acceptance. Furthermore, they are based on quantitative methods. Our qualitative study investigates factors fostering and hindering acceptance among older persons and their caregivers for a variety of assistive technologies, including wearables, ambient sensors at home with and without cameras and social companion robots. The goal of this paper is twofold: On the one hand, it investigates the factors of technology acceptance models in a qualitative setting. On the other hand, it informs these models with aspects currently overlooked by them. The results reveal that performance expectancy and effort expectancy are relevant for acceptance. We also find that reliability, anxiety around technology and different social aspects have an influence on acceptance of assistive technology in aged care for all end-user groups. Our findings can be used to update current technology acceptance models and provide in-depth knowledge about the currently used factors.

Technology Assistance in Dementia (Tech-AiD): A Framework for Care in the Digital Age

Recent advances in digital technologies hold promise for supporting aging adults and their care partners as they navigate changes in cognitive and daily functioning associated with Alzheimer's disease and related dementias (ADRD). Commonly owned digital technologies, like smartphones, include features that could help maintain independence and reduce caregiver burden. However, we lack models for successful integration of technologies into treatment of persons with ADRD. We propose the Technology Assistance in Dementia (Tech-AiD) framework for aiding persons with ADRD and their care partners with using digital technologies to reach individualized goals. We discuss how technology use is impacted by a multitude of factors, including severity of cognitive impairment, technology proficiency, and barriers to adequate and equitable care, all of which are further complicated by health disparities. Further, we explore the potential benefits of technology use among patients with ADRD and their care partners, highlighting pertinent clinical and ethical challenges and drawing from evidence-based strategies to promote practical recommendations.

The Role of Initial Trust in the Behavioral Intention to Use Telemedicine Among Filipino Older Adults

This study investigated the behavioral intention of Filipino older adults toward using telemedicine and the pivotal role of initial trust in influencing this intention. A cross-sectional method was employed, involving a questionnaire administered to 180 participants using convenience sampling. The structural model test results indicate that subjective norm, attitude, and notably, initial trust positively impact the behavioral intention to use telemedicine, whereas perceived behavioral control does not significantly affect intention. This underscores the significance of subjective norm and attitude in shaping behavioral intention, consistent with the Theory of Planned Behavior (TPB), while the extended construct of initial trust played a crucial role in influencing the attitude and intention of older adults, highlighting its importance in technology adoption. The study aligns with the trend of increased telemedicine adoption during the COVID-19 pandemic, emphasizing the need for trust in sensitive healthcare contexts. Establishing initial trust is vital for successful telemedicine implementation among Filipino older adults, enhancing healthcare accessibility and well-being.

Empowering Healthcare through Precision Medicine: Unveiling the Nexus of Social Factors and Trust

This study investigated the impact of social factors on the acceptance of precision medicine (PM) using a quantitative survey grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. The findings revealed that social influence has a significantly positive effect on PM acceptance, while the influence of social media is found to be insignificant. Performance expectancy emerged as the most influential factor, demonstrating a significant relationship with PM acceptance. Trust plays a crucial moderating role, mitigating the impact of social factors on PM acceptance. While exploring the mediating effects of trust, we identified a significant mediation effect for social influence and performance expectancy on PM acceptance. However, the mediation effect of social media influence is insignificant. These findings highlight the importance of trust in shaping decisions regarding PM acceptance. These findings have significant implications for healthcare practitioners and policymakers aiming to promote the adoption of precision medicine in clinical practice.

Factors, Barriers, and Recommendations Related to Mobile Health Acceptance among the Elderly in Saudi Arabia: A Qualitative Study

The use of mobile health (mHealth) is providing value to the elderly, but their acceptance of it is lower than in other age groups. Thus, this study aims to explore the factors influencing their intention to use mHealth and identify barriers and suggested solutions among elderly people aged 50+ years in Saudi Arabia, guided by the Healthcare Technology Acceptance Model (H-TAM). In this qualitative study, 14 elderly people (six females and eight males) were recruited. Participants were included if they were Saudi, aged 50+ years, and used smartphones. Participants were engaged in semi-structured interviews, which were transcribed verbatim and thematically analyzed. Peer review was conducted and saturation was reached to maintain rigor. Three major themes emerged: (1) factors affecting intention to use, (2) concerns and barriers, and (3) solutions and recommendations. Influenced factors were identified as perceived usefulness, perceived need, perceived ease of use, perceived benefits, familiarity, trust in technology, advice acceptance, facilitating conditions (family support), and compatibility. Older participants, particularly those with lower educational attainment, displayed less familiarity with mHealth. Lack of digital literacy, health and aging issues, worry about making mistakes, and social issues emerged as central barriers. Addressing these factors in the design and promotion of mHealth can enhance its successful adoption among the elderly.

How I want technology used in my care: Learning from documented choices of people living with dementia using a dyadic decision making tool

While technologies for aging in place are promoted to support care partners and people living with dementia, perspectives of people living with dementia are underrepresented in both use decisions among families and discussions within academia and industry. This mixed-methods study examined the use preferences of twenty-nine people living with mild Alzheimer's disease (AD) for four categories of technologies: location tracking, in-home sensors, web-cameras, and virtual companion robots. Participants completed a novel dyadic intervention, Let's Talk Tech, where they documented their preferences of the four technology categories for care planning purposes. Post-test interviews were thematically analyzed and provide insight into selection processes. Technology preferences varied considerably by and within participant living with mild AD. Excepting location tracking, non-technology and low-technology options were more desirable than the featured technologies. Control over technology use was of great importance to people living with AD. Considerations given to technology preference selection imperfectly fit within the new Health Technology Acceptance Model (H-TAM) developed for older adults. These findings underscore the importance of including people living with dementia in decision making about technologies to support care at home and the need for further personalization and tailorable technological devices to accommodate and align with their preferences.

Acceptance of digital health services among older adults: Findings on perceived usefulness, self-efficacy, privacy concerns, ICT knowledge, and support seeking

Background

Over the last decade, the rapid advancements in information and communication technologies (ICTs) have also driven the development of digital health services and applications. Older adults could particularly benefit from these technologies, but they still have less access to the Internet and less competence in using it. Based on the empirical literature on technology acceptance among older adults, this study examines the relations of perceived usefulness, self-efficacy, privacy concerns, ICT knowledge, and support seeking (family, informal, formal/institutional) with older adults' intention to adopt new digital health services.

Methods

The study included 478 older adults who participated in an online or paper/pencil questionnaire (M = 70.1 years, SD = 7.8; 38% male). Sociodemographic characteristics, subjective health status, and variables related to technology acceptance were assessed.

Results

Latent structural equation modeling revealed that higher perceived usefulness, higher self-efficacy regarding digital health technologies, and lower privacy concerns contributed to a higher intention to use digital health services among older adults. Contrary to our expectations, general ICT knowledge was not a significant predictor. Older adults who reported seeking more support regarding technology problems from family members and formal/institutional settings also reported higher usage intentions, whereas informal support was not as relevant. Furthermore, higher age was associated with higher perceived usefulness and lower self-efficacy.

Discussion

Future studies should further explore mediating factors for intention and actual use of digital health services and develop educational programs including follow-up assessments.

Advances in Psychotherapy for Older Adults Using Video-to-Home Treatment

Providing telemental health services to older adults has become especially important during the COVID-19 pandemic. Video-to-home (VTH) treatment is an effective treatment modality; research shows that older adults are open to using VTH. However, there are unique barriers to using VTH with older adults. Barriers include access to technology, acceptance of technology, and physical and cognitive limitations. Additional concerns include establishing rapport with older patients and the policy and ethical concerns surrounding the use of VTH. Methods of addressing these barriers have been developed, and more research is needed to develop evidence-based VTH practice.

Older Adults and Smart Technology: Facilitators and Barriers to Use

Smart technologies (e.g., smartphones, smart security technologies, digital home assistants) have advanced over the years and will continue to do so. There are various benefits to using these technologies in one's life, such as an increase in productivity through automation and self-monitoring one's health. Older adults particularly may benefit from smart technologies to support their everyday activities and compensate for age related changes. In this study, we explored the experiences and attitudes of eighty older adults including those who had prior experience and those who had never used (or perhaps never heard of) smart technologies through an online survey. We assessed their general opinions toward using smart technology and explored what facilitated or hindered their use. Older adults rated the facilitators to use for each smart technology differently, with few commonalities between the order of the most agreed upon facilitators. However, older adults' opinions were consistent across each technology about their ignorance of technological features and cost of the smart technology, which could be potential barriers to use. Among those who had never used one of the smart technologies, privacy was the most commonly endorsed concern. The results from this study support the understanding of key considerations when developing and deploying smart technologies for older adults.