Health and self-perceived barriers to internet use among older migrants: a population-based study

Self-identified barriers to health services among migrants 50 years of age or older: population-based survey study of Russian speakers in Finland

BACKGROUND

The compounded effect of a migratory background and ageing increases the risk of unequal medical treatment opportunities. The aim of this article is to investigate the social determinants of barriers to health services.

METHODS

The study uses population-based survey data of Russian-speaking migrants (50 + years) residing in Finland (n = 1082, 57% of men, mean age 63 years). Multiple correspondence analysis was performed as a dimension reduction procedure on six barriers to health services. Multiple ordinary least-squares linear regression was used for the predicted score of the barriers as an outcome variable.

RESULTS

Most of the sociodemographic characteristics were not associated with barriers to health services, except gender, as women tended to face more disadvantages. Migration-related factors, such as the need for interpreters for health services and experienced discrimination, were associated with an increased likelihood of reporting barriers to health services. Using the internet as a primary source of health information was associated with more access barriers to health services.

CONCLUSIONS

Migrants 50 years of age or older face multiple barriers to health services. Given that the healthcare needs increase with age, addressing this issue becomes crucial, necessitating improved access to health services for older migrants.

Nonuse of Blended Web-Based and Face-To-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study

BACKGROUND

The use of digital technologies for health care has been the focus of social studies, which have concentrated on the digital divide between individuals who use technology and those who do not-with the latter often being considered as individuals with shortcomings. In Denmark, 91% of the population have computers and 97 out of 100 families have internet access, indicating that lack of access to technology is not the primary reason for nonuse. Although previous studies have primarily focused on participants' perspectives of using internet-based treatment for alcohol use disorder (AUD), no study has investigated individuals' reasons to prefer face-to-face treatment over blended face-to-face and internet-based cognitive behavioral therapy (bCBT) for AUD among treatment-seeking populations.

OBJECTIVE

The aim of this qualitative study was to investigate the nonuse of bCBT among patients with AUD. Specifically, this study aims to explore patients' reasons for choosing not to receive treatment via this format.

METHODS

This study was conducted among Danish patients with AUD who were enrolled in the study "Blending internet treatment into conventional face-to-face treatment for alcohol use disorder (Blend-A)" but had not used bCBT. The participant group consisted of 11 patients with AUD: 3 women and 8 men. The age range of the participants was 29-78 years (mean 59 years). Individual semistructured interviews were conducted using cell phones to gather participants' reasons for not choosing bCBT. The interviews were recorded, transcribed, and analyzed using thematic analysis. Five authors performed the analysis in 3 steps: (1) two authors read the transcripts and coded themes from their immediate impression of the material, (2) one author provided feedback, which was used to group overlapping themes together or create new themes that better reflected the content, and (3) the remaining two authors provided feedback on the analysis to improve its structure, readability, and relevance to the research aim.

RESULTS

We found that the participants had various reasons for choosing face-to-face treatment over bCBT; these reasons were more related to personal matters and lesser to digital health literacy. We identified 4 themes related to personal matters for choosing face-to-face treatment over bCBT: (1) patients' need for attending sessions in person, (2) preference for verbal communication, (3) desire for immediate feedback, and (4) feeling more empowered and motivated with face-to-face sessions.

CONCLUSIONS

This study provides valuable insight into participants' perspectives on blended therapy for AUD and highlights the importance of considering personal factors when designing digital health interventions. Our study indicates that most of the participants choose not to use bCBT for AUD because they perceive such treatment formats as impersonal. Instead, they prefer direct communication with the therapist, including the ability to express and comprehend facial expressions and body language.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12888-021-03122-4.

Individual and dual trajectories of insomnia symptoms and body mass index before and after retirement and their associations with changes in subjective cognitive functioning

BACKGROUND

We examined individual and dual trajectories of insomnia symptoms and body mass index (BMI) before and after retirement, and their associations with changes in subjective cognitive functioning after retirement.

METHODS

We used the Helsinki Health Study's (n = 2360, 79% women, aged 40-60 at baseline, Finland) repeated surveys to identify the developmental patterns of insomnia symptoms and BMI (2000-2017) and changes in subjective cognitive functioning (2017-2022). We analysed the data using latent group-based dual trajectory modelling and logistic regression analysis.

RESULTS

Three latent groups were identified for insomnia symptoms (stable low, decreasing and increasing symptoms) and BMI (stable healthy weight, stable overweight and stable obesity). Insomnia symptoms were associated with declining subjective cognitive functioning and largely explained the effects in the dual models.

CONCLUSION

The association between dual trajectories of insomnia symptoms and BMI with subjective cognitive decline is dominated by insomnia symptoms.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

BACKGROUND

Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations.

OBJECTIVE

This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations.

METHODS

A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions.

RESULTS

The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023.

CONCLUSIONS

This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50798.

Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study

BACKGROUND

Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic.

OBJECTIVE

This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT.

METHODS

A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes.

RESULTS

Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed.

CONCLUSIONS

The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs.

Engaging older adults with a migration background to explore the usage of digital technologies in coping with dementia

Background

Coping with dementia can imply particular challenges for people with a migration background due to diversity in their life course, personal characteristics, and living environment. Some of the services available for people with dementia include digital technologies for care, providing health services, and maintaining or increasing participation, independence, and safety. This study aimed to explore the role of digital technology in coping with dementia in the lives of older adults with a migration background, and the possibilities to engage and collaborate with older adults.

Methods

This study combined a qualitative interview-based approach with citizen science principles in the design and execution of a project studying the use of Anne4Care.

Results and discussion

Participants valued that technology should provide health benefits and fit into aspects of their daily lives. Anne4Care was considered helpful in staying independent and connecting to loved ones in their country of birth. The participants needed to learn new competencies to work with the device, and not all had the material prerequisites, such as an internet connection. Still, this learning process was considered purposeful in their life, and the virtual assistant could be integrated into care and daily practices. The involvement of the older adults with dementia as co-researchers made them feel valuable and as equal partners during this research. An important prerequisite for the involvement of older adults with a migration background was existing relations with carers and care organizations.

Conclusion

Digital care technologies to cope with dementia can become a valuable part of care practices in the lives of older adults with a migration background. Involving older adults in the development of technology, acknowledging their expertise and needs, and working together in short iterations to adapt the technology for their specific needs and situations were experienced as valuable by the researchers, older adults, and care professionals.

Technology and Quality of Life of Older People in Times of COVID: A Qualitative Study on Their Changed Digital Profile

The situation caused by the COVID-19 pandemic brought negative consequences such as social isolation, limited access to routine health and social care services, and lack of self-esteem, especially for older people. In this context, technology took on an important role as the main means of communication and service delivery. The main objective of this study is to analyze the situation of the elderly and their access to technological resources in the time of COVID-19. Based on a qualitative methodology, 58 semi-structured interviews were conducted with people between 65 and 90 years old in Portugal. The results reveal specific difficulties in the use of this type of digital devices and a change in the digital use profile of this age group, characterized by more frequent use of digital devices such as smartphones, the incorporation of certain services such as video calls, and uses associated with communication and entertainment. This study shows that attitudes toward technology among the elderly should be studied further, and these results should be considered to develop and implement training programs specially designed for this age group in order to contribute to their well-being and quality of life.

Association between internet use and successful aging of older Chinese women: a cross-sectional study

Background

The internet has become ubiquitous in contemporary human life. However, little is known about the association between internet use and older people’s aging process, especially that of older women.

Methods

Using the nationally representative dataset of the China Longitudinal Aging Social Survey 2016, we examined the relationship between internet usage and the successful aging of older Chinese women. The sample in this study consisted of 2713 respondents with an average age of 69.963 years. Successful aging was defined as no major diseases, no disability, high cognitive functioning, high physical functioning, and active engagement with life. Older women’s internet use behavior was represented by internet use frequency. Probit and instrumental variable models were employed to test the association between internet use frequency and successful aging of older women. The Karlson/Holm/Breen (KHB) mediation analysis was used to estimate the mediating effect of social capital on the relationship between internet use frequency and older women’s successful aging.

Results

Using a probit model (coefficient = 0.030, p < 0.001) and an instrumental variable probit model (coefficient = 0.287, p < 0.001), it was found that a successful aging status was significantly correlated with an increase in internet use frequency. The functional mechanism analysis suggested that social capital partially mediated the overall association between internet use frequency and successful aging.

Conclusions

This study suggests that the more frequently older Chinese women use the internet, the greater the possibility of successful aging. Our findings provide new evidence from China about the determinants of older women’s aging process and aid in formulating targeted aging policies for older women in developing countries and regions.