Technology and Aging

Everyday Digital Literacy Questionnaire for Older Adults: Instrument Development and Validation Study

BACKGROUND

The need for digital literacy in aging populations is increasing in the digitalizing society. Digital literacy involves the identification, evaluation, and communication of information through various digital devices or relevant programs.

OBJECTIVE

The aims of this study were to develop an Everyday Digital Literacy Questionnaire (EDLQ), a digital literacy assessment scale, and subsequently evaluate its psychometric properties using a population of community-dwelling older adults in South Korea.

METHODS

The EDLQ was developed using an instrument development design. A nationwide survey was conducted, and the study included 1016 community-dwelling older adults (age ≥60 years). To evaluate the psychometric properties, the participants were randomly divided into 2 groups (n=508 each), and the internal consistency (Cronbach α and McDonald ω), structural validity (exploratory factor analysis and confirmatory factor analysis), hypothesis-testing construct validity using the eHealth Literacy Scale (eHEALS), and measurement invariance were analyzed.

RESULTS

Among the initial 30 items of the EDLQ, 22 items with a 3-factor solution had a total explained variance of 77%. The domains included "information and communication" (9 items), "content creation and management" (4 items), and "safety and security" (9 items). Confirmatory factor analysis was conducted with this 3-factor solution (χ2206=345.1; normed χ2206=1.7; comparative fit index=0.997; Tucker-Lewis index=0.997; root-mean-square error of approximation=0.036; standardized root-mean-square residual=0.050; composite reliability=0.903-0.959; average variance extracted=0.699-0.724; R2=0.616-0.773). Hypothesis-testing construct validity with the eHEALS revealed a strong correlation (r=0.75). Cronbach α and McDonald ω coefficients were .98 and 0.98, respectively. The fit indices for measurement invariance, including the configural, metric, and scalar invariance models, demonstrated a satisfactory fit to the data. Our findings suggest that the psychometric properties of the 22-item EDLQ are valid and reliable for assessing digital literacy among older Korean adults.

CONCLUSIONS

In this study, we developed a digital literacy measure with strong psychometric properties that made it suitable for assessing the digital literacy of community-dwelling older adults in Korea. To broaden its applicability, however, further assessment of its feasibility for use with different languages and cultures is necessary. Moreover, more empirical research on digital literacy and related factors in older adults can facilitate the development of personalized digital health care services and educational interventions in the digital society.

The effect of m-health applications on self-care improvement in older adults: A systematic review

PARTICIPANTS

Four electronic databases were searched on March 6, 2020 including Scopus, PubMed, ISI, and Embase.

METHODS

Our search consisted of concepts of "self-care," "elderly" and "Mobile device." English journal papers and, RCTs conducted for individuals older than 60 in the last 10 years were included. A narrative approach was used to synthesize the data due to the heterogeneous nature of the data.

RESULTS

Initially, 3047 studies were obtained and finally 19 studies were identified for deep analysis. 13 outcomes were identified in m-health interventions to help older adults' self-care. Each outcome has at least one or more positive results. The psychological status and clinical outcome measures were all significantly improved.

CONCLUSION

According to the findings, it is not possible to draw a definite positive decision about the effectiveness of interventions on older adults because the measures are very diverse and have been measured with different tools. However, it might be declared that m-health interventions have one or more positive results and can be used along with other interventions to improve the health of older adults.

Conceptual Design of an Extended Reality Exercise Game for the Elderly

Facing the increasingly serious ageing problem, IT technology is being applied more and more to alleviate the increasing health demands of the elderly. Virtual reality (VR) games, in particular, have been shown to benefit the physical and mental health of the elderly. However, almost all consumer-level VR games address the general user, not considering the characteristics of the elderly, such as their particular needs regarding cognitive aspects and safety. In addition, the existing VR rowing games’ research typically focuses on athlete training or is based on a rowing machine. Extending on previous research, this paper proposes a conceptual design of a VR rowing game, VRrowing to provide a home exercise game for the elderly which benefits both physical and mental health. This research first analysed the relevant literature and existing VR exercise games for the elderly to find characteristics and their particular needs. Then, following design principles (in exercise games, human–computer interaction, and user interfaces (UIs)) for the elderly, this study proposed a conceptual design of VRrowing through the MDA framework (standing for mechanics, dynamics, and aesthetics). The results cover the system architecture, activities and tasks, patterns and roles, mechanics and structures, and UI examples. Based on comprehensive consideration of the results from relevant research and fostering strengths and circumventing weaknesses, VRrowing was designed as a sports game, aimed at the elderly according to their characteristics and needs, which fills the void of home VR rowing games for seniors’ exercise. This research has reference value for scientific research or development personnel in VR game applications and evaluations, especially for such games targeting the elderly.

[Living Lab and technologies for the elderly]

The living lab is an approach that encourages the design and development of innovative technological solutions in a process of coconstruction involving users and other key players. Its methodology develops the technologies of the Broca living lab, dedicated to the care of elderly people with cognitive disorders and their carers.

Mobile Health Apps: Improving Usability for Older Adult Users

With smartphone use among older populations on the rise, older adults have increased access to health-focused mobile apps. Despite their potential benefits for managing health, currently no guidelines exist for designing these apps specifically for older adult users. We evaluated the usability of one medication management app and two congestive heart failure management apps using cognitive walkthroughs, heuristic analysis, and user testing. We identified design issues that may affect usability for older users, including poor navigation, small button sizes, and inadequate data visualizations. We provide guidelines for developers of health apps to facilitate use by older adults.

Understanding adherence to assistive devices among older adults: a conceptual review

Purpose: The aim of this study was to identify and examine how existing literature has conceptualized adherence to assistive devices (ADs) among older adults. Methods: English articles were searched in MEDLINE, PubMed, and CINAHL (January 1990 to October 2017) for the key words "acceptance", "adherence", "assistive devices", "compliance", "concept," and relevant synonyms. Bibliographies of selected articles were also examined. Articles were analyzed if the following conditions were met conjointly: (1) attempted to define or conceptualize adherence to some degree; (2) were concerned with any AD for older adults; (3) were concerned with adults aged 65 years or older. Results: Sixteen of the 484 articles were included. Adherence to ADs among older adults seemed to be conceptualized under three core themes: psychological, contextual, and functional factors; each with their own unique considerations related to adherence that are analyzed in this study. Conclusion: This review identified a large gap in knowledge about adherence to ADs. Adherence is multi-factorial and highly specific to the individual's circumstances and their relationship with their health care practitioner. Further empirical research should focus on how the three core themes of adherence interact with and influence each other. Implications for rehabilitation Health care professionals who assess for, and recommend ADs should foster a shared decision-making relationship with their clients This review identifies some of the key themes that practitioners should consider when developing and implementing AD regimens with older adults Conceptualizing AD adherence among older adults will help improve monitoring of and quality of care for AD users.

Usability Studies on Mobile User Interface Design Patterns: A Systematic Literature Review

Mobile platforms have called for attention from HCI practitioners, and, ever since 2007, touchscreens have completely changed mobile user interface and interaction design. Some notable differences between mobile devices and desktops include the lack of tactile feedback, ubiquity, limited screen size, small virtual keys, and high demand of visual attention. These differences have caused unprecedented challenges to users. Most of the mobile user interface designs are based on desktop paradigm, but the desktop designs do not fully fit the mobile context. Although mobile devices are becoming an indispensable part of daily lives, true standards for mobile UI design patterns do not exist. This article provides a systematic literature review of the existing studies on mobile UI design patterns. The first objective is to give an overview of recent studies on the mobile designs. The second objective is to provide an analysis on what topics or areas have insufficient information and what factors are concentrated upon. This article will benefit the HCI community in seeing an overview of present works, to shape the future research directions.

Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure

Background

Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts.

Objective

The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework.

Methods

We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow.

Results

We identified 5 high-level macrocognitive processes affecting medication management—sensemaking, planning, coordination, monitoring, and decision making—and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools.

Conclusions

Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation.

The influence of age in usability testing

The effects of age in usability testing were examined in an experiment. Sixty users from two age groups (M = 23.0 yrs, M = 58.1 yrs) operated two technical devices (keyboard-based and touchscreen-based smartphones). In addition to various performance measures (e.g. task completion time, task completion rate), several subjective measures were taken (e.g. perceived usability, affect, and workload). The results showed better performance scores for younger adults than older adults for task completion time. For older adult users there was a mismatch between usability ratings and task completion time but not between usability ratings and task completion rate. Age-related differences in the importance of speed and accuracy in task completion point to the need to consider more strongly the factor user age in usability research and practice.

Evaluating the effectiveness of a memory aid system

BACKGROUND

The ability to remember future intentions is compromised in both healthy and cognitively impaired older adults. Assistive technology provides older adults with promising solutions to cope with this age-related problem. However, the effectiveness and efficiency of such systems as memory aids is seldom evaluated in controlled, randomized trials.

OBJECTIVES

We evaluated the effectiveness of a memory aid system, the InBad (engl. InBath), for bathroom-related daily care. Conceptually, the InBad learns user behavior patterns and detects deviations from the learned pattern in order to notify the user of a forgotten task.

METHODS

We simulated a challenging morning routine consisting of 22 bathroom activities with a sample of 60 healthy older adults. Participants were randomly assigned to three groups: (1) 'no memory support', i.e., participants received no support at all, (2) 'list support', i.e., participants could retrieve a list of all activities, and (3) 'system support', i.e., participants received prompts for specific activities that had not yet been executed.

RESULTS

Both support groups executed significantly more activities compared to the 'no support' group. In addition, system support resulted in significantly better performance compared to list support with no significant differences between the two groups in overall task duration.

CONCLUSION

The assistive support system was the most effective and efficient memory aid. The results suggest that assistive technology has the potential to enable older adults to remain safe and independent in their own home.

User profiles and personas in the design and development of consumer health technologies

BACKGROUND

"The graying of the globe" has resulted in exponential rise in health care expenses, over-worked health care professionals and a growing patient base suffering from multiple chronic diseases, one of which is diabetes. Consumer health technologies (CHT) are considered important catalysts for empowering health care consumers to take a proactive role in managing their health and related costs. Adoption rate and usability of such devices among the aging is far from being satisfactory. Past studies noted the motivation for adoption by the aging is dependent on the suitability/relevance, perceived usability and anticipated benefits associated with usage of technological innovation. Traditional information technology (IT) development adopts a systematic approach without necessarily using a specific user model that personalizes the system to the aging user groups. The aging patient population has unique needs arising from progressive deterioration in both physiological and psychological abilities. These needs are often ignored in the design, development, trial and adoption of consumer health products resulting in low adoption and usage.

OBJECTIVES

The main objective of this research is to investigate the user-centered design (UCD), specifically user profiles and personas, as methodological tools to inform the design and development of CHT devices for an aging population. The adoption of user profile and persona has not received much attention in health care informatics research and, in particular, research involving CHT. Our work begins to fill this void in three ways. We (1) illuminate the process of developing CHT user profiles and personas for a Chinese elder population with a demanding health care needs, i.e., self-management of chronic diabetes, with the hope that the resulting profiles and personas may be used as foundational material for informing the design, development and evaluation of CHT in other similar contexts; (2) call attention to how to further enhance and complement traditional user profile and persona techniques for CHT design by integrating cognitive structures and present behavior that drive health care thinking, future behavior and demand; (3) show how the profiles and personas can be used to inform requirements, design and implementation decisions for a technology aimed at facilitating CHT adoption and diffusion for the elderly.

METHODOLOGY

To exemplify process and application, we use an action-research methodology, where user profiles and personas of an aging patient population were developed. The resultant profiles and personas were leveraged to improve the design, development and implementation plans of a smart phone application to assist chronically ill aging Chinese diabetic population capable of disease self-management.

RESULTS

The results from the study show that user profile and persona can be a valuable methodological approach in capturing the conceptual model of the aging and informing the design and development decisions of CHT. The demonstration of techniques used in this study can serve as a guideline to CHT developers in bringing conceptual user modeling into the design of software interfaces targeted for users with specific health care needs. Specifically, the study provides guidance on the creation and use of profiles and personas to tap into the conceptual models of the targeted elderly population reflecting their preferences, capabilities and attitudes towards using technology in self-management care in general and the smart phone diabetes management application in particular. Insight into the mental model of the aging group has been shown to inform later stages of UCD development (e.g., the creation of prototypes and usability testing) as well as implementation and adoption strategies. The World Health Organization (WHO) predicts that by 2025, 80% of all new cases of diabetes are expected to appear in the developing countries. In fact, the number of diabetic patients in China is estimated to rise to 42.3 million in 2030 from 20.8 million in 2000. Thus, we investigate the Chinese aging population in order to demonstrate the process of developing and using user profile and persona. We hope that the resultant conceptual model of the Chinese aging diabetic population can be used in future research to guide CHT designers interested in designing health care devices for this vulnerable user group.

Principles for Designing Effective and Efficient Training of Complex Cognitive Skills

This chapter describes principles for the design of training of complex cognitive tasks that pose relatively great challenges to the cognitive capacity of the trainee. Using the theoretical framework of cognitive load, we argue that the structures that constitute human cognitive architecture need to be taken into account in the design of effective and efficient training. For training complex cognitive tasks, this means that cognitive load needs to be controlled by optimizing the relationship between (a) the intrinsic load imposed by the complexity of the training task and (b) the effective (germane) and ineffective (extraneous) loads imposed by the design of the training tasks. Design principles for training tasks, for sequences of training tasks in fixed training programs (in which all trainees receive the same sequence), and for ways to create adaptive or personalized training programs (in which each trainee receives a personalized sequence) are discussed. Simple to complex sequencing of training tasks, decreasing support, increasing contextual interference, and spacing are discussed as effective principles for fostering learning and transfer in fixed training programs. System-controlled, shared-responsibility, and advisory models for task selection are discussed as possible models to be used to foster learning and transfer in adaptive training programs.