Voices in the wake of eHealth : older adults’ and occupational therapists’ perceptions of using information and communication technology

Abstract: Background People increasingly have access to and use information and communication technologies (ICTs) such as mobile phones and computers, and many social services are moving online. The digitalization of society also includes how health care is offered, as many health care tasks can be handled online. Even though most of us are online, not all are. Older adults with cognitive impairment (CI) may perceive everyday technology (ET) use, ICTs included, as more difficult than older adults without a cognitive decline. Because older adults with CI might be especially vulnerable to the challenges that new technology brings, it is important to pay attention to their experiences and perceptions of ICT use. Moreover, health care professionals, such as occupational therapists (OTs), are also influenced by the digitalization in health care. For example, they may need to adjust to new technologies and new digital methods of performing work tasks that traditionally have been conducted with pen and paper. The overall aim of this thesis was to contribute knowledge about how older adults with CI experience and perceive the use of eHealth. The thesis also aimed to contribute knowledge about eHealth use based on OTs’ evaluations of the usability of a digitized questionnaire. Method To gain knowledge about the use of eHealth among older adults with CI, both qualitative (Study I) and quantitative (Study II) research methods were used. In Study I, older adults with CI participated in in-depth interviews about their experiences using eHealth. The data were analysed using a constant comparative method inspired by constructivist grounded theory. Subsequently, in Study II structured interviews were conducted with older adults with CI using the Short Everyday Technology Use Questionnaire+ (S-ETUQ+) to allow comparisons of ICT use for eHealth against other general ICT use. The data were analysed using descriptive statistics. In Study III, structured interviews were conducted using the Short Everyday Technology Use Questionnaire (S-ETUQ) to compare how older adults with CI perceived ET use in comparison with their proxies’ estimates. The data were analysed using descriptive and interferential statistics. To better understand the usability of the digital version of the ETUQ (the ETUQ app) as evaluated by the OTs, Study IV used both qualitative and quantitative methods to collect data and analysed them through content analysis and descriptive statistics. Results The findings from Study I were summarized in a model called the eHealth staircase supported by habits, with three steps picturing levels of complexity in the use of eHealth: 1) Analogue use, 2) One-way-use and 3) Interactive use. Most participants were located at a step 1, and their use was influenced by their habits in contacting health care. In Study II, fewer participants viewed the 16 ICTs corresponding to 5 devices (e.g. landline telephone and computer) as relevant for eHealth compared to the perceived relevance for general use. This was interpreted as, the purpose for using ICT affects its perceived relevance. A significant difference in the perceived difficulty of eHealth use versus general ICT use was found for one ICT (SMS/email on smartphones). Next, Study III revealed no significant differences at a group level between older adults’ perceptions compared to their proxies’ estimates concerning ET use. However, significant differences were found in perceived and estimated difficulty with ET use within 4 of 21 the dyads. Lastly, the result of Study IV showed that the ETUQ app was perceived as being highly usable among the OTs, with 94.4% of the subtasks being performed with ease. Moreover, nearly all participants favoured the ETUQ app over the paper version, as the new digital elements improved client communication, given that the risk of technical errors would be reduced. The app also offered a visual summary, which was considered useful for clarifying data. Conclusion In summary, this thesis contributes clinically valuable knowledge for health care providers regarding the use of eHealth among older adults with CI. The use of eHealth among older adults with CI is dependent on several aspects, such as habits, existing relationship to ICTs and the availability of support. However, because the use of ICTs was less relevant for eHealth than for general purposes, these results indicate that the purpose for using ICTs affects their relevance. Because online eHealth is not an option for everyone, it is important that health care providers offer alternatives for clients to communicate besides the Internet: for example, by telephone or postal mail. The high level of agreement between older adults with CIs’ self-reported perceptions of ET use and their proxies’ estimation corroborated the pairs of responses within the dyads. This indicates that older adults with CI can be used as the primary source of information concerning their own perceptions and that proxies may also contribute valuable insights and support. We need research that includes older adults with CI in order to maintain focus on their use of ET, including their own perceptions regarding eHealth use. OTs’ high usability rating of the ETUQ app suggests that digital tools are likely to have great potential for data collection and analysis, as well as for communication with clients regarding ET use, both in research and in clinical health care. In order to achieve high usability and usefulness, the intended end users must be included in evaluations such as this one.