Designing and evaluating information and
communication technology-based interventions?
Be aware of the needs of older people
Hanna Allemann and Arianna Poli
The self-archived postprint version of this journal article is available at Linköping
University Institutional Repository (DiVA):
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-163622
N.B.: When citing this work, cite the original publication.
Allemann, H., Poli, A., (2020), Designing and evaluating information and communication technology-based interventions? Be aware of the needs of older people, European Journal of Cardiovascular Nursing, , 1474515119897398. https://doi.org/10.1177/1474515119897398
Original publication available at:
https://doi.org/10.1177/1474515119897398
Copyright: SAGE Publications (UK and US)
Designing and evaluating ICT-based interventions? Be aware of the needs of
older people
Allemann, H. & Poli, A.
Across Europe, life expectancy is increasing and, along with this, so is the prevalence of chronic conditions including cardiovascular disease (CVD) which is a major cause of morbidity and reduced quality of life, especially among older people 1. Overall, these changes are generating growing demand for care, which challenge the healthcare systems.
The use of information and communications technology (ICT) has been seen as a solution to providing good quality care, while simultaneously making the healthcare systems more efficient and sustainable in the long term 2. Ever more research is being conducted into the design and evaluation of new ICT-based interventions. Such ICT-ICT-based interventions are meant to be used for providing a broad range of services such as booking medical appointments online, managing e-prescriptions, engaging in online health education and promotion (e.g. for self-care), receiving remote monitoring and checking your medical journal.
These changes in healthcare provision involve all medical fields, including cardiology. ICT-based interventions have the potential to support the health and wellbeing of patients with CVD3 by providing tele-monitoring 4, supporting lifestyle changes 5 and treating depression 6. Informal carers of older people could also benefit indirectly from the improved situation of the older person for whom they are caring and directly from tailored ICT-based interventions 7.
However, the effectiveness, the acceptance and the use of ICT-based interventions by older people can be reduced by some key aspects. Firstly, when designing and developing ICT-based interventions, it is crucial to consider that health-related limitations can hinder the engagement of older people with the intervention 8. Secondly, although the number of older persons using ICTs has been increasing over the last years, some of them are non-users or have little experience with the use of ICTs 9.
Health-related challenges to ICT-based interventions for older people with CVD
Older people with CVD can suffer from sensory, physical and cognitive limitations that can hinder the use of ICTs. Sensory abilities, such as eyesight and hearing can decline. Physical strength and control of the hands and bodily movement can decrease. There can also be a negative effect on cognitive functions such as memory, attention and ability to process written material 8.
All these limitations should be considered when designing ICT-based interventions for older people with CVD. For example, designers can choose to incorporate reminders into ICT-based interventions, to integrate the possibility to return to information when needed, or to implement self-explanatory features (e.g. guiding the user with the help of an avatar) in order to support those whose cognitive function has declined. Loss of power and control of the body require considering what features to incorporate into ICT-based interventions, e.g. using a computer mouse or touchscreen can represent a barrier for some. Other important considerations concern the opportunity to personalise the interface of the ICT-based interventions, e.g. making it possible to enlarge fonts, adjust colours for contrast, use vocal feedback or allow the modification of content.
Older people and the use of ICTs
Although the number of older people using ICTs has increased in the recent years, some of them are non-users or have limited experience with the use of ICTs9. Providing healthcare services by the means of ICTs can represent a disadvantage for those older people who are not familiar with the use of ICTs. Individual characteristics, personal attitudes and contextual aspects are associated with the use of ICTs among older people. Older people with a lower level of education and lower income are less likely to be digitally engaged, have lower digital skills and perform a more limited range of activities using ICTs 10. In addition, older people living alone and those who live in rural areas are less likely to be users compared to those who live in urban areas 9, presumably because of a lack of encouragement and help from family members or partners and poor infrastructure, respectively. Health status is a relevant predictor and both physical and cognitive impairment reduces the use of technology among older people 8, 10. Older people who are non-users are more likely to demonstrate a lack of motivation and interest in using ICTs11. Furthermore, they tend to demonstrate poorer perceived usefulness of ICTs, higher anxiety and lower self-efficacy towards the use of ICTs compared to their digitally engaged counterparts 8. Beyond individual characteristics and attitudes, contextual aspects such as dedicated public policies that foster and facilitate the use of ICTs among older people (e.g. free training, free internet access in public spaces), well-developed infrastructure and low costs for internet access can favour the use of ICTs among older people 9 (Table 1).
Table 1. Main aspects related to use and non-use of ICTs among older people.
Individual characteristics Personal attitudes Contextual aspects
Socioeconomic status Interest in ICTs Dedicated policies
Health status ICT-related self-efficacy and anxiety Quality of the infrastructure Living area
Take home messages
Older people with CVD do indeed represent a heterogeneous group with a broad range of different needs and preferences. The awareness of this heterogeneity should guide the design and evaluation of new ICT-based interventions.
When designing interventions, the possible impact of sensory, cognitive and physical decline can be reduced by including facilitatory features, which support the interactions between the users and the ICTs. The existing digital inequalities among older people should be considered. This includes considering if alternatives to ICT-based interventions should be available to the users. Moreover, in order to acknowledge future users’ interests and needs, the design and evaluation of interventions should involve samples of older people that reflect the target population of interest 12. For example, this can mean involving older people from different age groups, with different attitudes to ICTs and with different cognitive and physical abilities.
ICT-based interventions in healthcare should not prevent older people from accessing healthcare services, rather they should facilitate their use by this group. This means to develop inclusive ICT-based interventions that are able to overcome barriers, capitalise on older people’s capabilities and facilitate broad and effective implementation.
Declaration of conflicting interests
The Author(s) declare(s) that there is no conflict of interest. Funding
This work was supported by the Supporting Self-Care by Information and Communication Technology (ICT) for Older People with Long-Term Conditions (ICT4Self-care) research programme (2015-2018) funded by the Swedish National Science Council and the Swedish Research Council for Health, Working Life and Welfare (VR-FORTE) [ref. 2014-4100].
References
1. Timmis A, Townsend N, Gale C, et al. European Society of Cardiology: Cardiovascular Disease Statistics 2017. European heart journal 2018; 39: 508-579. 2017/12/01. DOI:
10.1093/eurheartj/ehx628.
2. Czaja SJ. The Potential Role of Technology in Supporting Older Adults. Public Policy &
Aging Report 2017; 27: 44-48. DOI: 10.1093/ppar/prx006.
3. Widmer RJ, Collins NM, Collins CS, et al. Digital health interventions for the prevention of cardiovascular disease: A systematic review and meta-analysis. Mayo Clinic Proceedings 2015; 90: 469-480. Article. DOI: 10.1016/j.mayocp.2014.12.026.
4. Brons M, Koudstaal S and Asselbergs FW. Algorithms used in telemonitoring programmes for patients with chronic heart failure: A systematic review. European journal of
cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2018; 17: 580-588. 2018/06/30. DOI: 10.1177/1474515118786838.
5. Deka P, Pozehl B, Norman JF, et al. Feasibility of using the Fitbit((R)) Charge HR in validating self-reported exercise diaries in a community setting in patients with heart failure.
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2018; 17: 605-611. 2018/03/17. DOI:
10.1177/1474515118766037.
6. Neher M, Nygardh A, Nilsen P, et al. Implementing internet-delivered cognitive behavioural therapy for patients with cardiovascular disease and psychological distress: a scoping review. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular
Nursing of the European Society of Cardiology 2019; 18: 346-357. 2019/02/24. DOI:
10.1177/1474515119833251.
7. Carretero S, Stewart J and Centeno C. Information and communication technologies for informal carers and paid assistants: benefits from micro-, meso-, and macro-levels. European
journal of ageing 2015; 12: 163-173. 2015/09/09. DOI: 10.1007/s10433-015-0333-4.
8. Czaja SJ, Boot WR, Charness N, et al. Designing for older adults. Principles and creative
human factors approaches. Third ed. Boca Raton, Florida.: Taylor&Francis Group, 2019.
9. Konig R, Seifert A and Doh M. Internet use among older Europeans: an analysis based on SHARE data. Universal Access in the Information Society 2018; 17: 621-633. Article. DOI:
10.1007/s10209-018-0609-5.
10. Hunsaker A and Hargittai E. A review of Internet use among older adults. New Media &
Society 2018; 20: 3937-3954. DOI: 10.1177/1461444818787348.
11. Friemel TN. The digital divide has grown old: Determinants of a digital divide among seniors. New media & society 2016; 18: 313-331.
12. Poli A, Kelfve S and Motel-Klingebiel A. A research tool for measuring non-participation of older people in research on digital health. BMC public health 2019; 19: 1487. 2019/11/11. DOI: 10.1186/s12889-019-7830-x.
