technology, and more than half of the articles described combinations of types of technology. Technology ... implementation of new technologies. Our research ...
FACTORS INFLUENCING TECHNOLOGY ACCEPTANCE BY COMMUNITY DWELLING OLDER ADULTS: PRELIMINARY RESULTS OF A SYSTEMATIC LITERATURE REVIEW S.T.M. Peek 1, E.J.M. Wouters 2, J. van Hoof 2, K.G. Luijkx 3, H.J.M. Vrijhoef 4 1. Introduction In the last decade much effort has been put in the development of technology to support active and healthy ageing at home. At the same time, questions have been raised on the readiness of community dwelling older adults to accept and use these technologies [1-3]. In order to improve the implementation of ambient assisted living technology it is crucial to understand which factors influence technology acceptance. For this purpose, a systematic literature review was conducted, the first of its kind to target this specific issue: acceptance of technology by older adults who are living independently. In this extended abstract preliminary results are presented and discussed.
2. Methods Seven major scientific databases (including MEDLINE, Scopus and CINAHL) were searched using a combination of 150 different keywords (including synonyms) such as “living independently”, “ageing in place”, “assistive technology“, “ehealth”, ”utilization” and “adoption”. This led to 4,692 search results. After the removal of duplicate results, a total of 2841 unique articles were identified. These articles were assessed to see if they matched formulated inclusion and exclusion criteria (Figure 1). The most important inclusion criteria were: articles had to be peer-reviewed, describing community dwelling older adults who were at least 60 years old, and aimed at investigating factors that influence the acceptance or use of electronic technology developed to support ageing in place. Using these criteria initially 15 articles were included. Three researchers read these articles and extracted factors influencing acceptance by means of a data extraction form. In addition, references of the articles were checked for other articles eligible for this review (snowball method). This led to the inclusion of one extra article [19], bringing the total number of articles included in this review to 16.
1
Fontys University of Applied Sciences & Tilburg University Fontys University of Applied Sciences 3 Tilburg University 4 National University of Singapore 2
541
Figure 1. Flow diagram of the article selection process
3. Results Results show that the majority of the reviewed articles were based on qualitative research methods (interviews, focus groups); 12 articles used this type of method (see Table 1). Three articles were based on a combination of qualitative and quantitative research methods (surveys, analysis of log files) and one article was based on quantitative methods alone. Articles described acceptance of different types of technology, and more than half of the articles described combinations of types of technology. Technology that provides safety and security (e.g. ,monitoring technology and personal alarms) was the most prominent type of technology, followed by technology to promote health (e.g., health monitoring) and technology to provide interaction (e.g., video telephony). Technology that supports older adults in their Activities of Daily Living (ADL, e.g., electronic memory aids) was less prominently included. Results also show that the majority of the articles (11) solely describe acceptance of technology at the pre-implementation stage: technology was shown or explained to older adults and they were asked whether they would be willing to use it sometime in the future. Evaluation of acceptance at the post-implementation stage (3 articles) or a combination of evaluation at the pre- and post-implementation stage (2 articles) was far less common. 542
Table 1. Characteristics of the 16 reviewed articles Method Article Qualitative [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19]
X X X X X X X X X X X X X X X
Technology type
Quantitative N
X
X X X
65 18 333 32 13 14 14 35 9 15 5 23 6 100 7 14 11 1406
ADL
Health X X X X
X X
X X
Safety / Security X X X X X X X X X X X X X X
Implementation stage Interaction Pre Post X X X
X X X
X
X X X X X X X X X X X X X
X
X
X X X
In summary: the major part of the articles contain qualitative data of technology acceptance at the pre-implementation stage. Therefore, the focus in this extended abstract lies on these articles [4-15, 18]. Seven types of factors influencing preimplementation acceptance were identified: benefits expected of the use of technology (e.g., feeling safe/secure, enabling independent living and benefits for significant others); concerns regarding the use of technology (e.g., cost, obtrusiveness, privacy implications); the need for use of technology (e.g., perceived personal need, preference for living independently); presence of alternatives to technology (e.g., satisfaction with current technology or assistance of caregivers); facilitators for the use of technology (e.g., technical support ); personal characteristics of the older adult (e.g., perception of personal health, fit with cognitive impairments), and the social environment of the older adult (e.g., perception of use by others, influence of professional caregivers). Analysis of quantitative and post-implementation data is currently in progress. While reviewing all 16 articles it was observed that only one article [8] referred to established technology acceptance models [20-21]
5 6
A second group of 15 older adults that did not meet our inclusion criteria was excluded from the review. A second group of 16 family members and friends was excluded from the review.
543
4. Discussion It is clear that technology acceptance of community dwelling older adults is influenced by a multitude of factors. These factors should play a paramount role in the design and implementation of new technologies. Our research provides insight into key preimplementation acceptance factors. Additionally health professionals need to be aware of the identified factors and their influence on acceptance in the post-implementation phase. Knowledge of these factors provides opportunities for matching communication and promotion of technology as well as adequate support of end-users. At the moment only a small number of studies focus on post-implementation acceptance. Future research in this field should fill this gap. Also, longitudinal research is necessary to be able to compare pre-implementation factors to post-implementation factors. For instance: do pre-implementation concerns (such as cost, privacy implications) evolve into actual barriers of technology use in the post-implementation stage? Furthermore, more quantitative research is required to test whether factors described in qualitative research apply to larger groups of community dwelling older adults. In this pursuit established models of technology acceptance [20-21] cannot be ignored. A full manuscript of this systematic literature review is currently in preparation.
References [1] [2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
McLean, A. (2011). Ethical frontiers of ICT and older users: cultural, pragmatic and ethical issues. Ethics and Information Technology, 13(4), 313-326. Kang, H.G., Mahoney D., Hoeing H.M., Hirth V., Bonato P., Hajjar I., & Lipsitz L.A. (2010). In situ monitoring of health in older adults: Technologies and issues. Journal Of The American Geriatrics Society, 58(8), 1579-1586. Cohen-Mansfield, J., & Biddison, J. (2007). The scope and future trends of gerontechnology: Consumers' opinions and literature survey. Journal of Technology in Human Services, 25(3), 1-19 Lorenzen-Huber, L., Boutain, M., Camp, L. J., Shankar, K., & Connelly, K. H. (2011). Privacy, Technology, and Aging: A Proposed Framework. Ageing International, 36(2), 232-252. van Hoof, J., Kort, H. S. M., Rutten, P. G. S., & Duijnstee, M. S. H. (2011). Ageing-inplace with the use of ambient intelligence technology: perspectives of older users. International Journal Of Medical Informatics, 80(5), 310-331. Lai, C. K., Chung, J. C., Leung, N. K., Wong, J. C., & Mak, D. P. (2010). A survey of older hong kong people's perceptions of telecommunication technologies and telecare devices. Journal Of Telemedicine And Telecare, 16(8), 441-446. Steggell, C. D., Hooker, K., Bowman, S., Choun, S., & Kim, S. J. (2010). The role of technology for healthy aging among Korean and Hispanic women in the United States: A pilot study. Gerontechnology, 9, 443-449. Steele, R., Lo, A., Secombe, C., & Wong, Y. K. (2009). Elderly persons' perception and acceptance of using wireless sensor networks to assist healthcare. International Journal Of Medical Informatics, 78(12), 788-801. Courtney, K. L., Demiris, G., Rantz, M., & Skubic, M. (2008). Needing smart home technologies: the perspectives of older adults in continuing care retirement communities. Informatics In Primary Care, 16(3), 195-201.
544
[10] Demiris, G., Hensel, B. K., Skubic, M., & Rantz, M. (2008). Senior residents' perceived
[11] [12]
[13]
[14]
[15]
[16] [17]
[18]
[19] [20]
[21]
need of and preferences for "smart home" sensor technologies. International Journal Of Technology Assessment In Health Care, 24(1), 120-124. Horton, K. (2008). Falls in older people: the place of telemonitoring in rehabilitation. Journal Of Rehabilitation Research And Development, 45(8), 1183-1194. Mahmood, A., Yamamoto, T., Lee, M., & Steggell, C. (2008). Perceptions and use of gerotechnology: implications for aging in place. Journal of Housing for the Elderly, 22(1-2), 104-126. Mihailidis, A., Cockburn, A., Longley, C., & Boger, J. (2008). The acceptability of home monitoring technology among community-dwelling older adults and baby boomers. Assistive Technology, 20(1), 1-12. Wild, K., Boise, L., Lundell, J., & Foucek, A. (2008). Unobtrusive in-home monitoring of cognitive and physical health: Reactions and perceptions of older adults. Journal of Applied Gerontology, 27(2), 181-200. Cohen-Mansfield, J., Creedon, M. A., Malone, T. B., Kirkpatrick Iii, M. J., Dutra, L. A., & Herman, R. P. (2005). Electronic memory aids for community-dwelling elderly persons: Attitudes, preferences, and potential utilization. Journal of Applied Gerontology, 24(1), 3-20. Porter, E. J. (2005). Wearing and using personal emergency response system buttons. Journal Of Gerontological Nursing, 31(10), 26-33. Ezumi, H., Ochiai, N., Oda, M., Saito, S., Ago, M., Fukuma, N., & Takenami, S. (2003). Peer support via video-telephony among frail elderly people living at home. Journal Of Telemedicine And Telecare, 9(1), 30-34. Porter, E. J., & Ganong, L. H. (2002). Considering the use of a personal emergency response system: an experience of frail, older women. Journal Of Long Term Home Health Care, 3(4), 192-198. Zimmer, Z., & Chappell, N. L. (1999). Receptivity to new technology among older adults. Disability And Rehabilitation, 21(5-6), 222-230. Davis, F. D., Bagozzi, R. P., & Warshaw, P. R. (1989), User Acceptance of Computer Technology: A Comparison of Two Theoretical Models. Management Science, 35, 9821003. Venkatesh, V., Morris, M.G., Davis, F.D., & Davis, G.B. (2003). User Acceptance of Information Technology: Toward a Unified View. MIS Quarterly, 27, 425-478.
545
