CAN WE IMPROVE THE ACCEPTANCE OF E-HEALTHCARE

SERVICES BY ELDERLY PEOPLE?

Mariona Estrada, Raquel Navarro-Prieto

Fundació Barcelona Media, Innovation Center, Spain

Elena Parra, Angélica Ñañez

Fundació Barcelona Media, Innovation Center, Spain

Keywords: Elderly people, e-Healthcare services, User Centred Design, Social aspects, Cognitive and psychomotor

aspects.

Abstract: The goal of this position paper is to provide a methodological framework for the development of healthcare

information and communication technologies for elderly people. This methodological approach is based on

three complementary areas: user centred design; variables in the e-healthcare acceptance by elderly people

(social, cognitive and psychomotor aspects); and the methodologies that will allow us to gather critical

knowledge about all these aspects. In order to gather information about all these aspects we need to use a

multidisciplinary approach that will bring together observational studies about user requirements in real

context; experimental methodologies that will gather the impact of psychomotor and cognitive aspects that

are relevant to elderly people; and technology specialists that will provide input about ideal technological

solutions for the needs of this specific group.

1 INTRODUCTION

Many studies have found evidences about how e-

healthcare services (electronic medical reports,

home telecare, virtual communities and networks of

social support, etc.) can be very helpful and positive

for elderly people quality of life. Unfortunately, also

many studies have shown that the use of ICT by

elderly people is still very low in most of the

European countries.

In this field there are still many open questions:

What are the specifics needs of the elderly people

concerning healthcare new technologies? Are these

technologies adapted to their needs? How can we

create personalized e-healthcare systems that allow

both security and autonomy for elderly people? And,

regarding their autonomy, how we can improve the

cross-platform interaction (computers, digital TV,

mobile devices, etc.) and the way the users can

interact within them?

Previous research has studied very specific

applications in specific contexts and therefore at

present we do not have a comprehensive view of

how to increase elders’ acceptance of ICT services.

Recently, some researchers (Harper et al., 2009)

had shown the impact of social variables in the

acceptance by elderly people of the ICT: how the

age or the retirement are crucial factors to

understand the use of ICT, for instance. But we need

to include also the cognitive and psychomotor

aspects of this target group that affect the use and

acceptance of the e-healthcare tools.

The goal of this position paper is to provide a

methodological framework for the development of

healthcare information and communication

technologies for elderly people. This methodological

approach is based in three complementary areas:

user centred design; variables in the e-healthcare

acceptance by elderly people (social, cognitive and

psychomotor aspects); and the methodologies that

will allow us to gather critical knowledge about all

these aspects. In the following sections we will

develop these points.

477

Estrada M., Navarro-Prieto R., Parra E. and Ñañez A. (2010).

CAN WE IMPROVE THE ACCEPTANCE OF E-HEALTHCARE SERVICES BY ELDERLY PEOPLE?.

In Proceedings of the Third International Conference on Health Informatics, pages 477-480

DOI: 10.5220/0002759604770480

 SciTePress

2 BACKGROUND

2.1 Elderly People and ICT Use

The incursion of the new ICT in many aspects of our

lives has changed the way we work, communicate or

take care of our health among a lot of other things.

In this paper we will focus only in those processes

that affect the interaction between technologically

mediated healthcare tools and elderly people.

Nowadays, most of the information about health

(medicine, social care, etc) is provided

electronically. In this sense, it’s very important to

guaranty the full access of elderly people to their

health information.

Social care is also very important for this group,

especially for elderly people with chronically

diseases or mobility diseases. Through the new

technologies they can keep the contact to their

relatives, to health assistance or to virtual

communities and networks of social support.

Nevertheless, the age is still an important factor

to determine the use of ICT tools in general and e-

healthcare tools in particular. For instance, in 2007

in Spain 92% of the population between 16 and 34

years used Internet. In contrast, only 8% of the

people between 65 and 74 years used the net (Plan

Avanza 2008, Ministerio de Industria, Turismo y

Comercio de España).

We can see that elderly people are not using e-

healthcare services. In this sense, we need to

improve the acceptance of these services from the

beginning, knowing their actual technological needs.

2.2 Principal Technological needs for

Elderly People

According to the information gathered in previous

research (Eggermont et al., 2006), elderly people

feel that ICT services could provide them more

social support and help them to fight the loneliness.

They want to keep the contact with their relatives,

friends and associations if their mobility decrease

and they have to spend a lot of time at home.

However, they don’t want to lose face-to-face

communication with the doctor or the other medical

assistance.

They want accessible technological services,

designed according to their physic limitations and

previous knowledge. Besides, the accessibility

includes more economical services and tools suited

to their incomes.

Elderly people also want secure and reliable e-

healthcare services to guarantee their intimacy. For

instance, they want to have control over their

medical information and they don’t feel confident

when the information is circulating on Internet. They

like to feel safe and informed about their health. The

new technologies must guaranty the needed

assistance but also intimacy and autonomy.

In spite of this detected needs, the access to e-

healthcare systems is still very low. As we can read

in the survey “The attitudes, expectations and needs

of elderly people in relation to e-health applications:

results from a European survey.” (Stroetmann et al.,

2002): “older people get, the more they depend on

medical and social care, and the more they tend to

live alone, without a family member to look after

them. Policy measures relating to infrastructure as

well as training, education and awareness activities

will be required to avoid a medical divide between

those senior citizens who have access to advanced

medical advice and services and those who do not.”

Elderly people need e-healthcare services but

there are some problems to accept and use them. We

claim that we need a methodological framework

based in a user centered design to create services

widely acceptable by elderly user. Following, we are

going to summarize this methodological approach.

3 METHODOLOGICAL

APPROACH

Our approach is based in the User Centred Design

(UCD) premises, taking into account the specific

characteristics of the target group (elderly people)

and the kind of technological services (e-healthcare).

3.1 User Centred Design

The main objective of this methodology is to

incorporate the end user point of view in the final

design of one product or service, adapting the

products and services to the real needs and interests

of the users.

Following Alison Black (2008), the first premise

of the UCD says that the best designed products and

services are those that include the comprehension of

end users needs in the first steps of the product

development. In this sense, UCD is a continuous and

transversal process to the development, going

beyond the concepts of usability and ergonomics.

Summarizing, UCD involves, among others, four

basic principles for the researcher/designer:

- Contact directly with the users starting from

the initial phases of the design, trying to

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understand their needs and habits in real

contexts.

- Observe the users directly in their context,

participating like one of them (context

immersion) and gathering the observational

data.

- Design prototypes and evaluate them

iteratively in order to gather the user

feedback. Incorporate this feedback to

improve the prototypes.

- Gather information from the higher number

of users profiles because the service could be

used by more than one user profile.

In the UCD process we have to take into account the

variables of the target users and develop a

multidisciplinary approach.

3.2 What Impact the Acceptance of

e-Health Services by Elderly People?

According to our previous studies with this

population group and the reviewed literature, we are

going to explain briefly which are the main aspects

affecting the acceptance of e-healthcare services by

elderly people.

Psychosocial Aspects: The social and familiar

situations are very important when setting out ICT

solutions for elderly people. The most important

factors that we have to take into account are:

- Family and social network: some elders don’t

have enough social contact with their

relatives or friends and it could produce a

feeling of isolation.

- Work: probably they did not need to use the

new ICT in their jobs so the metaphors

associated with the use of the computers are

not familiar to them.

Cognitive Aspects: There are important variables

that affect the interaction between elderly people and

technologies:

- Attention: for this kind of user is more difficult

to focus the attention. In this sense, the

interfaces have to avoid graphics or other

irrelevant elements for the task.

- Memory: the learning process for any computer

application is significantly more difficult in

elders compared with adult and young

people. The memory deficit seems to be one

of the main reasons. Nevertheless, the level

of previous knowledge in ICT use could

minimize this negative effect. In other words,

elders can learn as fast as adults and young if

they have a lot of previous experience (Czaja

and Sharit, 1993).

- Perception and vision: the research in this

field has state that vision loss affects the

interaction between elder people and ICT

applications (Jacko et al., 2000).

Psychomotor and Physiologic Aspects: The most

important variables that could affect the design of

ICT services for elderly people are:

- Speech and audition: is important to adapt

frequencies in the audio interfaces and the

speech applications to elderly people

characteristics.

- Psychomotor aspects: there is a reduction of

the skills, especially in small movements, so

the elders could have problems to use the

mouse and the computer or mobile devices

keyboards (Worden et al., 1997; Chadwick-

Dias et al., 2003).

- Subjective perception of the relation between

software functionality/complexity and the

utility and ease of use: Wu and Van Slyke

(2005) state that elderly people could be more

impact for the interface complexity that

young people. This impact can affect the

feeling of ease of use.

There are other aspects affected by the age of the

users that they are not took into account for the

moment in the ICT applications for elderly people

such as symbolization, logical thinking, error

management and autonomy. In other to gather

information about all these aspects we need to use a

multidisciplinary approach that will bring together

observational studies about user requirements in real

context; experimental methodologies that will gather

the impact of psychomotor and cognitive aspects

that are relevant to elderly people; and technology

specialists that will provide input about ideal

technological solutions for the needs of this specific

group.

3.3 Methodological Approach

Our hypothesis is that actual situation, in which most

of the elderly people are excluded of the e-

healthcare services, is produced because the

cognitive, psychosocial and psychomotor

particularities of elders are not taken into account in

the provided services.

Therefore, we propose a reconsideration

including these aspects that normally are being

leaved out. Following, we present our

methodological approach.

CAN WE IMPROVE THE ACCEPTANCE OF E-HEALTHCARE SERVICES BY ELDERLY PEOPLE?

479

First, the research in the field of e-healthcare

services needs to be a multidisciplinary effort in

order to define and measure the elder’s acceptance

to e-healthcare services from a holistic perspective,

including investigation in to the cognitive processes

and socio-cultural aspects in an iterative manner. It

should include a social science observational

approach to help with the creation of the hypothesis.

In addition, a collaborative approach, between a

technology development research and an

experimental approach would allow us to test these

hypotheses and the creation of new research

questions.

We argue it would be necessary to understand:

- Methodologies that will allow us to gather

knowledge about all these aspects in a

replicable manner.

- The relationship between the cognitive,

psychomotor and social aspects.

- The contribution of each of them to improve the

acceptance of e-healthcare services by elderly

people.

Second, this research should also evolve as new

media formats (interactive TV, mobile devices) and

possibilities for interacting are advance from the

technological perspective.

The following figure summarizes our

methodological approach to enable user-centred e-

healthcare services:

Figure 1: Enabling user-centred e-healthcare services.

4 CONCLUSIONS

The aim of our approach is achieve a better

acceptance of the e-healthcare services by elderly

people including their needs and knowledge in the

design process. These services must be a habitual

tool in their lives allowing a high autonomy and

security in normal situations such as medical

information or health care provision.

Our claim is that in order to reach that good

future research need to integrate UCD into the

development of new e-health services. In particular,

we have found that most of the previous research

focuses on one element of the user needs. For the

creation of future services we have to put together

all the elder people needs and study the relationship

between them.

REFERENCES

Black, A., 2008. The basics of user-centred design.

[Online] Design Council. Available at: http://

www.designcouncil.org.uk/en/About-Design-Techniques

/User-centred-design [Accessed 18 July 2009].

Chadwick-Dias, A., McNulty, M. and Tullis, T., 2003.

Web usability and age: How design changes can

improve performance. In CUU, Proceedings of the

2003 Conference on Universal Usability. Vancouver,

Canada, 2003, ACM: New York.

Czaja, S.J. and Sharit, J., 1993. Age differences in the

performance of computer based work. Psychology and

Aging, 8, pp. 59-67.

Eggermont, S.; Vandebosch, H. and Steyaert, S., 2006.

Towards the Desired Future of Elderly and ICT:

Policy recommendations based on a dialogue with

senior citizens. Poiesis & Praxis, 4(3), pp. 199-217.

Harper, R., Sellen, A. and Lindley, S., 2009. Desiring to

be in touch in a changing communications landscape:

attitudes of older adults. In CHI'09, Proceedings of the

International Conference on Human Factors in

Computing Systems. Boston, USA, April 2009. ACM:

New York.

Jacko, J.A., Barreto, A.B., Marmet, G.J., Chu, J.Y.M,

Bautsch, H.S and Scott, I.U., 2000. Low vision: the

role of visual acuity in the efficiency of cursor

movement. In ASSETS, Proceedings of the fourth

international ACM conference on Assistive

Technologies. Arlington, USA, 2000, ACM: New

York.

Plan Avanza (Ministerio de Industria y Turismo de

España). La sociedad de la información en España,

2009 http://www.planavanza.es/NR/rdonlyres/

A38D435F-CEC9-455B-9B017E47C385FDF1/0/Sien

España.pdf

Stroetmann, V., Hüsing, T., Kubitschke, L. and

Stroetmann, K., 2002. The attitudes, expectations and

needs of elderly people in relation to e-health

applications: results from a European survey. Journal

of Telemedicine and Telecare, 8, pp. 82-84.

Worden, A., Walker, N., Bharat, K. and Hudson, S., 1997.

Making computers easier for older adults to use: Area

cursors and sticky icons. In CHI, Proceedings of the

SIGCHI conference on Human Factors in Computing

Systems. Atlanta, USA, 1997, ACM: New York.

Wu, Y. and Van Slyke, C., 2005. Interface complexity and

elderly users: Revisited. In SAIS, Proceedings of the

2005 Southern Association of Information Systems

Conference. Savannah, USA, 25-26 February 2005.

HEALTHINF 2010 - International Conference on Health Informatics

480