Understanding Technology Preferences and Requirements for Health Information Technologies Designed to Improve and Maintain the Mental Health and Well-Being of Older Adults: Participatory Design Study

Haley M LaMonica, Tracey A Davenport, Anna E Roberts, Ian B Hickie, Haley M LaMonica, Tracey A Davenport, Anna E Roberts, Ian B Hickie

Abstract

Background: Worldwide, the population is aging rapidly; therefore, there is a growing interest in strategies to support and maintain health and well-being in later life. Although familiarity with technology and digital literacy are increasing among this group, some older adults still lack confidence in their ability to use web-based technologies. In addition, age-related changes in cognition, vision, hearing, and perception may be barriers to adoption and highlight the need for digital tools developed specifically to meet the unique needs of older adults.

Objective: The aim of this study is to understand the use of technology by older adults in general and identify the potential barriers to and facilitators of the adoption of health information technologies (HITs) to support the health and well-being of older adults to facilitate implementation and promote user uptake. In addition, this study aims to co-design and configure the InnoWell Platform, a digital tool designed to facilitate better outcomes for people seeking mental health services, to meet the needs of adults 50 years and older and their supportive others (eg, family members, caregivers) to ensure the accessibility, engagement, and appropriateness of the technology.

Methods: Participants were adults 50 years and older and those who self-identified as a supportive other (eg, family member, caregiver). Participants were invited to participate in a 3-hour participatory design workshop using a variety of methods, including prompted discussion, creation of descriptive artifacts, and group-based development of user journeys.

Results: Four participatory design workshops were conducted, including a total of 21 participants, each attending a single workshop. Technology use was prevalent, with a preference indicated for smartphones and computers. Factors facilitating the adoption of HITs included personalization of content and functionality to meet and be responsive to a consumer's needs, access to up-to-date information from reputable sources, and integration with standard care practices to support the relationship with health professionals. Concerns regarding data privacy and security were the primary barriers to the use of technology to support mental health and well-being.

Conclusions: Although HITs have the potential to improve access to cost-effective and low-intensity interventions at scale for improving and maintaining mental health and well-being, several strategies may improve the uptake and efficacy of technologies by the older adult community, including the use of co-design methodologies to ensure usability, acceptability, and appropriateness of the technology; support in using and understanding the clinical applications of the technology by a digital navigator; and ready availability of education and training materials.

Keywords: aging; community-based participatory research; health care reform; mental health; mobile phone; stakeholder participation; technology.

Conflict of interest statement

Conflicts of Interest: IH was an inaugural commissioner on Australia’s National Mental Health Commission (2012-2018). He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC), University of Sydney. The BMC operates early-intervention youth services at Camperdown under contract to headspace. He is the Chief Scientific Adviser to, and an equity shareholder in, InnoWell. InnoWell was formed by the University of Sydney (45% equity) and PwC (45% equity) to deliver the Aus $30 (US $21.10 million) million Australian Government–funded Project Synergy (2017-2020), a 3-year program for the transformation of mental health services and to lead transformation of mental health services internationally through the use of innovative technologies. The other authors have no conflicts of interest to disclose. The source of funding does not entail any potential conflict of interest for the other members of the Project Synergy Research and Development Team.

©Haley M LaMonica, Tracey A Davenport, Anna E Roberts, Ian B Hickie. Originally published in JMIR Aging (http://aging.jmir.org), 06.01.2021.

Figures

Figure 1
Figure 1
App prototype of a digital tool to support health and well-being.
Figure 2
Figure 2
User journey demonstrating how a consumer might engage with the prototype.

References

    1. Population Projections, Australia, 2006 to 2101. Australian Bureau of Statistics. 2008. [2020-06-16]. .
    1. An Ageing Australia: Preparing for the Future. Canberra, Australia: Commonwealth of Australia; 2013.
    1. Communications Report 2013-14. The Australian Communications and Media Authority (ACMA) 2015. [2020-09-24]. .
    1. Anderson M, Perrin A. Technology Use Among Seniors. Pew Research Center. 2017. [2020-06-03].
    1. Internet/Broadband Factsheet. Pew Research Centre. 2019. [2020-09-23].
    1. Czaja SJ. Long-term care services and support systems for older adults: the role of technology. Am Psychol. 2016;71(4):294–301. doi: 10.1037/a0040258.
    1. Mouton A, Cloes M. Web-based interventions to promote physical activity by older adults: promising perspectives for a public health challenge. Arch Public Health. 2013 Jul 2;71(1):16. doi: 10.1186/0778-7367-71-16.
    1. Vegesna A, Tran M, Angelaccio M, Arcona S. Remote patient monitoring via non-invasive digital technologies: a systematic review. Telemed J E Health. 2017 Jan;23(1):3–17. doi: 10.1089/tmj.2016.0051.
    1. Hickie IB, Davenport TA, Burns J. Overview of project synergy: building an online platform to deliver right care, first time. Med J Aust. 2019;211(7):S4–7.
    1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205. doi: 10.1080/16506070903318960.
    1. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010 Oct 13;5(10):e13196. doi: 10.1371/journal.pone.0013196.
    1. Glozier N, Christensen H, Naismith S, Cockayne N, Donkin L, Neal B, Mackinnon A, Hickie I. Internet-delivered cognitive behavioural therapy for adults with mild to moderate depression and high cardiovascular disease risks: a randomised attention-controlled trial. PLoS One. 2013;8(3):e59139. doi: 10.1371/journal.pone.0059139.
    1. Cox D, Ritterband L, Magee J, Clarke W, Gonder-Frederick L. Blood glucose awareness training delivered over the internet. Diabetes Care. 2008 Aug;31(8):1527–8. doi: 10.2337/dc07-1956.
    1. Kraschnewski JL, Stuckey HL, Rovniak LS, Lehman EB, Reddy M, Poger JM, Kephart DK, Coups EJ, Sciamanna CN. Efficacy of a weight-loss website based on positive deviance. A randomized trial. Am J Prev Med. 2011 Dec;41(6):610–4. doi: 10.1016/j.amepre.2011.08.012.
    1. Cunningham JA, Wild TC, Cordingley J, van Mierlo T, Humphreys K. A randomized controlled trial of an internet-based intervention for alcohol abusers. Addiction. 2009 Dec;104(12):2023–32. doi: 10.1111/j.1360-0443.2009.02726.x. doi: 10.1111/j.1360-0443.2009.02726.x.
    1. Christensen H, Batterham PJ, Gosling JA, Ritterband LM, Griffiths KM, Thorndike FP, Glozier N, O'Dea B, Hickie IB, Mackinnon AJ. Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. Lancet Psychiatry. 2016 Apr;3(4):333–41. doi: 10.1016/S2215-0366(15)00536-2.
    1. Irvine AB, Gelatt VA, Seeley JR, Macfarlane P, Gau JM. Web-based intervention to promote physical activity by sedentary older adults: randomized controlled trial. J Med Internet Res. 2013 Feb 5;15(2):e19. doi: 10.2196/jmir.2158.
    1. Cheng VWS, Davenport T, Johnson D, Vella K, Mitchell J, Hickie IB. Naturalistic evaluation of a sport-themed mental health and wellbeing app aimed at men (MindMax), that incorporates applied video games and gamification. Internet Interv. 2020 Apr;20:100306. doi: 10.1016/j.invent.2020.100306.
    1. Hakobyan L, Lumsden J, O'Sullivan D. Older adults with AMD as co-designers of an assistive mobile application. Int J Mob Hum Comput Interact. 2014;6(1):54–70. doi: 10.4018/ijmhci.2014010104.
    1. LaMonica HM, English A, Hickie IB, Ip J, Ireland C, West S, Shaw T, Mowszowski L, Glozier N, Duffy S, Gibson AA, Naismith SL. Examining internet and ehealth practices and preferences: survey study of Australian older adults with subjective memory complaints, mild cognitive impairment, or dementia. J Med Internet Res. 2017 Oct 25;19(10):e358. doi: 10.2196/jmir.7981.
    1. Andrews JA, Brown LJ, Hawley MS, Astell AJ. Older adults' perspectives on using digital technology to maintain good mental health: interactive group study. J Med Internet Res. 2019 Feb 13;21(2):e11694. doi: 10.2196/11694.
    1. Lee C, Coughlin JF. Perspective: older adults' adoption of technology: an integrated approach to identifying determinants and barriers. J Prod Innov Manag. 2014 Jun 3;32(5):747–59. doi: 10.1111/jpim.12176.
    1. Tams S, Thatcher JB, Grover V. Concentration, competence, confidence, and capture: an experimental study of age, interruption-based technostress, and task performance. J Assoc Inf Syst. 2018;19:857–908. doi: 10.17705/1jais.00511.
    1. Heinz M, Martin P, Margrett JA, Yearns M, Franke W, Yang H, Wong J, Chang CK. Perceptions of technology among older adults. J Gerontol Nurs. 2013 Jan;39(1):42–51. doi: 10.3928/00989134-20121204-04.
    1. E‐Mental Health Strategy for Australia. Australian Government Department of Health. 2012. [2020-09-24]. .
    1. Five Year Forward View. NHS England. 2014. [2020-09-24]. .
    1. Bjerkan J, Hedlund M, Hellesø R. Patients' contribution to the development of a web-based plan for integrated care - a participatory design study. Inform Health Soc Care. 2015 Mar;40(2):167–84. doi: 10.3109/17538157.2014.907803.
    1. Davenport T, Milton A, Ospina-Pinillos L, Whittle L, Ricci C, Burns J. Project Synergy research and development cycle: iterative processes of participatory design, user testing, implementation and feasibility testing. Med J Aust. 2019;211(7):S8–11.
    1. LaMonica HM, Davenport TA, Burns J, Cross S, Hodson S, Veitch J, Hickie IB. Technology-enabled mental health service reform for open arms - veterans and families counselling: participatory design study. JMIR Form Res. 2019 Sep 19;3(3):e13662. doi: 10.2196/13662.
    1. Goeman DP, Dickins M, Iliffe S, Pond D, O'Keefe F. Development of a discussion tool to enable well-being by providing choices for people with dementia: a qualitative study incorporating codesign and participatory action research. BMJ Open. 2017 Nov 14;7(11):e017672. doi: 10.1136/bmjopen-2017-017672.
    1. Hwang AS, Truong KN, Cameron JI, Lindqvist E, Nygård L, Mihailidis A. Co-Designing Ambient Assisted Living (AAL) Environments: Unravelling the Situated Context of Informal Dementia Care. Biomed Res Int. 2015 Nov 15;2015(11):720483. doi: 10.1155/2015/720483. doi: 10.1155/2015/720483.
    1. Davenport TA, Ospina-Pinillos L, Ricci C, Milton A, Burns JM, Hickie IB. Fit Uni Life to thrive: an online health and wellbeing prototype for young people. Med J Aus. 2019;211(7):S12–S16.
    1. Ospina-Pinillos L, Davenport TA, Ricci CS, Milton AC, Scott EM, Hickie IB. Developing a mental health eclinic to improve access to and quality of mental health care for young people: using participatory design as research methodologies. J Med Internet Res. 2018 May 28;20(5):e188. doi: 10.2196/jmir.9716.
    1. Davenport TA, LaMonica HM, Whittle L, English A, Iorfino F, Cross S, Hickie IB. Validation of the InnoWell platform: protocol for a clinical trial. JMIR Res Protoc. 2019 May 31;8(5):e13955. doi: 10.2196/13955.
    1. Naismith SL, Norrie LM, Mowszowski L, Hickie IB. The neurobiology of depression in later-life: clinical, neuropsychological, neuroimaging and pathophysiological features. Prog Neurobiol. 2012 Jul;98(1):99–143. doi: 10.1016/j.pneurobio.2012.05.009.
    1. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson El, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet commission. Lancet. 2020 Aug;396(10248):413–46. doi: 10.1016/S0140-6736(20)30367-6. doi: 10.1016/s0140-6736(20)30367-6.
    1. Boise L, Wild K, Mattek N, Ruhl M, Dodge H, Kaye J. Willingness of older adults to share data and privacy concerns after exposure to unobtrusive in-home monitoring. Gerontechnology. 2013;11(3):428–35. doi: 10.4017/gt.2013.11.3.001.00.
    1. Fischer SH, David D, Crotty BH, Dierks M, Safran C. Acceptance and use of health information technology by community-dwelling elders. Int J Med Inform. 2014 Sep;83(9):624–35. doi: 10.1016/j.ijmedinf.2014.06.005.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–74.
    1. Understanding the Digital Behaviours of Older Australians: Summary of National Survey and Qualitative Research. eSafety Commissioner. 2018. [2020-09-24]. .
    1. Ryff CD. In the eye of the beholder: views of psychological well-being among middle-aged and older adults. Psychol Aging. 1989 Jun;4(2):195–201. doi: 10.1037//0882-7974.4.2.195.
    1. National Seniors Productive Ageing Centre . Social Engagement and Wellbeing Among Mature Age Australians. Canberra, Australia: Department of Health and Ageing; 2013.
    1. Promoting Individual, Family, and Community Connectedness to Prevent Suicidal Behavior. Centers for Disease Control and Prevention (CDC) 2008. [2020-09-24]. .
    1. Linardon J, Cuijpers P, Carlbring P, Messer M, Fuller-Tyszkiewicz M. The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials. World Psychiatry. 2019 Oct;18(3):325–36. doi: 10.1002/wps.20673. doi: 10.1002/wps.20673.
    1. Kushlev K, Proulx JD, Dunn EW. Digitally connected, socially disconnected: the effects of relying on technology rather than other people. Comput Hum Behav. 2017 Nov;76:68–74. doi: 10.1016/j.chb.2017.07.001.
    1. Hope A, Schwaba T, Piper A. Understanding Digital and Material Social Communications for Older Adults. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; CHI'14; April 26-May 1, 2014; Toronto, Canada. 2014.
    1. Social Isolation, Loneliness in Older People Pose Health Risks. National Institute on Aging - NIH. [2020-06-09]. .
    1. Brand J, Todhunter S, Jervis J. Digital Australia 2018. 2018. [2020-09-24]. .
    1. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. Lancet Neurol. 2014 Aug;13(8):788–94. doi: 10.1016/S1474-4422(14)70136-X.
    1. Lumsden J, Edwards EA, Lawrence NS, Coyle D, Munafò MR. Gamification of cognitive assessment and cognitive training: a systematic review of applications and efficacy. JMIR Serious Games. 2016 Jul 15;4(2):e11. doi: 10.2196/games.5888.
    1. Savulich G, Thorp E, Piercy T, Peterson KA, Pickard JD, Sahakian BJ. Improvements in attention following cognitive training with the novel 'decoder' game on an iPad. Front Behav Neurosci. 2019;13:2. doi: 10.3389/fnbeh.2019.00002. doi: 10.3389/fnbeh.2019.00002.
    1. Crabb RM, Rafie S, Weingardt KR. Health-related internet use in older primary care patients. Gerontology. 2012;58(2):164–70. doi: 10.1159/000329340.
    1. Kruse RL, Koopman RJ, Wakefield BJ, Wakefield DS, Keplinger LE, Canfield SM, Mehr DR. Internet use by primary care patients: where is the digital divide? Fam Med. 2012 May;44(5):342–7.
    1. Choi NG, Dinitto DM. The digital divide among low-income homebound older adults: internet use patterns, eHealth literacy, and attitudes toward computer/internet use. J Med Internet Res. 2013 May 2;15(5):e93. doi: 10.2196/jmir.2645.
    1. Wisniewski H, Torous J. Digital navigators to implement smartphone and digital tools in care. Acta Psychiatr Scand. 2020 Apr;141(4):350–5. doi: 10.1111/acps.13149.
    1. Wang J, Du Y, Coleman D, Peck M, Myneni S, Kang H, Gong Y. Mobile and connected health technology needs for older adults aging in place: cross-sectional survey study. JMIR Aging. 2019 May 15;2(1):e13864. doi: 10.2196/13864.
    1. Wilkowska W, Ziefle M. Privacy and data security in E-health: requirements from the user's perspective. Health Informatics J. 2012 Sep;18(3):191–201. doi: 10.1177/1460458212442933.
    1. 2019 Healthcare Data Breach Report. HIPAA Journal. 2020. [2020-09-06].

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe