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Mar 8, 2010 - one for those aged 65–74 years was held in Stonehaven, approximately 20 miles south of the city, and the fourth. (for those aged 55–64 years) ...
www.ietdl.org Published in IET Intelligent Transport Systems Received on 23rd November 2009 Revised on 8th March 2010 doi: 10.1049/iet-its.2009.0106

Special Issue – selected papers from the 16th World Congress on ITS ISSN 1751-956X

New technology and quality of life for older people: exploring health and transport dimensions in the UK context K. Pangbourne P.T. Aditjandra J.D. Nelson Centre for Transport Research, School of Geosciences, University of Aberdeen, St Mary’s, Elphinstone Road, Aberdeen AB24 3UF, UK E-mail: [email protected]

Abstract: The aim of this study is to explore issues of inclusion and quality of life (QoL) for older people in relation to their experiences of and attitudes towards using information and communication technologies (ICT) in meeting their transport and healthcare needs. The objectives of the research were to use focus groups and supplementary questionnaires to collect rich qualitative data from older people in order to inform policy-relevant work on designing more user-friendly and user-targeted intelligent transport systems (ITS). The authors trace the complex relationships between individual attitudes and needs in accessing the services provided by the three relevant policy sectors of transport, healthcare and communications technologies. This study observed that older cohorts show a slight tendency to be less comfortable with ICT, and therefore to integrate it less into daily life. Moreover, the data reveal that the differences between individuals occur through interactions between knowledge and their practices, combined with factors relating to an individual’s physical and mental experience of ageing. The trend of an ageing demographic and increased longevity makes normalising ICT in older people’s lifestyles a policy imperative, so that the development of ITS recognises the particular needs of older people, avoids unintentional exclusion, and enhances QoL. Our recommendations focus on using ITS to facilitate access to healthcare, as that was the main concern of the participants. The authors suggest a conceptual representation of the ideal relationship between ICT, accessibility of services and mobility of individuals that gives policy-makers and service providers a better understanding of the desired outcome of working together.

1

Introduction

This study formed a part of the inclusive digital economy (IDE) project funded by UK Engineering and Physical Sciences Research Council programme which aimed to explore means of bridging the digital inclusion gap for older people through a better understanding of their needs. The objective of the study is to improve understanding of the relationship between older people and new technology in the form of information and communication technology (ICT) and intelligent transport systems (ITS) in the context of their healthcare and transport needs. Drawing on discussions by the IDE cluster [1], digital economy is defined as all transactions and social relations that utilise bits rather than atoms [2] through the use of ICT. 318 & The Institution of Engineering and Technology 2010

Examples are: purchasing goods and services via electronic networks; pervasive access to (electronic) information; Internet and mobile communications between government, its partners and citizens and between businesses and customers. Digital economy also includes non-financial exchanges such as social networking and cultural exchange through the Internet. The contribution made by this project is qualitative and user focused, complementing the technical design expertise of other members of the cluster (e.g. computer scientists and ergonomists). In the context of an ageing population that will place more demands on public transport and healthcare services, the purpose of this paper is to inform policy and provide insights useful in designing more user-friendly and user-targeted ITS as a specialised element within the digital economy. IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318– 327 doi: 10.1049/iet-its.2009.0106

www.ietdl.org Section 2 of this paper is a literature review that contextualises ICT in relation to the quality of life (QoL) of older people. The principal focus is on older people’s need for healthcare, social inclusion and mobility/access to services. ICT has potential to enable ‘virtual mobility’ where older people can access more services, including healthcare, without the need for physical travel. However, this requires older people to have access and ability to use available ICTs, which suggests that social inclusion requires digital inclusion. Finally, ITSs are considered as a niche application that may contribute to the QoL of older people. Section 3 describes the methodology used, whereas Section 4 presents project findings and discussion. Section 5 presents the conclusions of the research and makes recommendations about how ITS might be utilised to facilitate a more personalised approach to accessing healthcare that contributes to QoL for older people and which also addresses mobility constraints and digital exclusion.

2

Literature review

The literature review guides and contextualises the subsequent focus group work on the experiences and attitudes of older people towards using ICT to facilitate arranging transport. The project particularly emphasises access to healthcare, and maintaining an active, socially included lifestyle (broadly equated to QoL, with the technologies most likely to be relevant to participants in the focus groups. Such examples are mobile phones, Internet use and digital TV services. Attitudes and experience of various real-time information systems such as on-street digital signs, mobile-phone-based short message services (SMS) and Internet-based applications were also explored. Fig. 1 shows the issues to be discussed in the literature review as a nested hierarchy in relation to the QoL of older people in the context of an ageing demographic.

2.1 QoL of older people, digital inclusion and transport QoL (or subjective well-being) is an increasingly important objective in social policy, as it is increasingly recognised

Figure 1 Conceptual approach to understanding the context of ICT in contributing to the QoL for older people in an ageing society IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318 – 327 doi: 10.1049/iet-its.2009.0106

that happiness or contentment is as important as social inclusion and social justice [3]. The European Commission, for example, has made this an explicit policy goal [4]. Halvorsrud and Kalfoss reviewed empirical studies that relate to QoL for older people but found no generally accepted conceptual framework; however, they identified five ‘classic’ components of QoL in the current literature: Physical health, social relationships and support, environment, financial/material circumstances and cognitive beliefs. This suggests a consensus that QoL is a multidimensional concept encompassing the physical, emotional and social domains. Older people additionally identify independence and autonomy as a key element of QoL [5]. Although a subjective and hard to define concept, QoL is underpinned by social inclusion. Digital applications that may enhance older people’s QoL are social networking sites that appeal to an older market, other niche services such as booking holiday travel and products that can be e-delivered, and making services and information for the general population more accessible to those with reduced physical or mental capacity. Digital inclusion is therefore an important element in the 21st-century QoL and as the economy and public service provision increasingly turns to a digital platform, this facet of inclusion becomes an important policy aim. This is only vaguely defined in the literature, but drawing on a range of policy documents and the work of the IDE cluster [1, 6, 7], digital inclusion is about affordable and convenient access to ICT, confidence in content, personal security and ability to use ICT, and motivation to use information that is of personal value, relevant and empowering. The UK statistics show that more than 1/3 of adults have never surfed the web, and nearly 50% of UK homes do not have Internet access [8]. Although various studies show an income-related effect (e.g. only 22% of retirees use the Internet), stated attitudinal reasons why people do not use the Internet, such as ‘don’t want/need to’ (57%) and ‘lack of skills/confidence’ (39%), appear as important as a lack of connectivity (44%) and are a more significant barrier than cost (15%). Indeed, 22% of all adults say they have not used the Internet, have not considered using it and do not think they will [9, 10]. In relation to transport, the QoL for older people has been conceptualised by Banister and Bowling [11] as a composition of mobility patterns, locality and social networks. Their study suggested that transport is important in accessing local services and facilities and in engaging in social activities; these are two of the six components of the respondents’ perception of QoL for the elderly (the others being people’s standard of social comparison, a sense of optimism, having good health and feeling safe). Su and Bell [12] analyse trip chaining among older people and find that although this declines with age, the category ‘old’ (as with ICT above) needs to be disaggregated: trip complexity declines with advancing age, but within that the ‘old – old’ 319

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www.ietdl.org have markedly different travel behaviour to the ‘young – old’. This understanding in turn can direct the focus for ICT interventions supporting digital inclusion exclusively for older people, for example, the enhancements of a flexible transport service targeted at the elderly [13].

2.2 ICT and older people It is important to go beyond the dichotomous stereotype of older people as either users or non-users of ICT, as older technology users are much more diverse than younger and middle-aged users [14, 15]. In a survey of ICT use among the over-60s in England and Wales, Selwyn et al. found that part of the reason for the low usage of ICT in this age group, despite the growing numbers of ‘silver surfers’, is to do with ‘relevance’ [16]. This survey revealed that the most popular use of technology for older people was watching TV or listening to the radio: only 22% reported having used a computer within the last year and that was mostly for word-processing. Internet use levels were low, mostly for e-mails with less than 6% of the sample using more advanced Internet access such as banking, shopping, learning, information search or social networks. Despite the rhetoric of the ‘information society’ and the demonstrable advances made in individualising ITS applications [17], other literature also suggests that many older people are not technophobe but see little relevance in the use of digital technologies in their daily lives. Thus, older people will take part if they get training and when they see that it is personally relevant to use digital technologies [18, 19]. Selwyn [20] recommends that policy-makers should be less technologically deterministic and accept that older adults should not be expected to immediately embrace ICT as essential to their daily lives. Statistics for 2001 and 2003 for mobile phone take up in the UK reveal that there is a reduction in ownership rates with age, but that all age groups are purchasing more mobile phones. The slightly higher rate of increase among the older age groups is probably the result of the lower base: for the age group 55– 64 the percentage increase over 2001 – 2003 is 16%, for 65– 74 it is 23%, and for 75 and over it is 46% [21]. The explosion of information rapidly available to individuals enabled by mobile telephony and the Internet is a spectacular and global ICT phenomenon, but there is also evidence of social fragmentation: individuals become isolated from one another and are confused by proliferating identity-making choices. Furthermore, many people are ‘left baffled by the possibilities of the Internet [which appears] . . . a placeless and obstacle-ridden world without a clear purpose, . . . in which websites appear from nowhere and vanish again without notice, and which seldom exist long enough . . . to find their way about them’ [22]. The absence of ubiquitous uptake, particularly of Internet access, poses questions about the potential for widespread web-delivery of ITSbased consumer information in the UK, but the consumer boom for Internet-capable small mobile devices is 320 & The Institution of Engineering and Technology 2010

encouraging as an alternative platform, as the uptake rates indicated above suggest that older people appear more comfortable with mobile phones than computer-based Internet access [16, 23]. However, Internet-capable mobile devices are more difficult to learn and raise new issues for older people [24]. In the UK, 2008 was the first year in which more than half of the over 65 years who use the Internet reported using it on a daily basis [25], showing that the older people are slowly embracing Internet use. A recent study on the Internet use concluded that before interaction can even become an issue for active consideration, individuals must first become interested in making use of computers, so ‘changing older people’s misconceptions about computers, better informing them about what they are, what they can do and how they can be of real practical use’ are recommended [26]. Yet it is important to not blame older people’s attitudes per se. There is clear evidence that the probability of Internet use decreases with age [27] as does the level of skill and range of activities accessed online [28]. In terms of other types of information access points there is a similar age-related decrease for satellite/multi-channel TVs [29] and ICTbased public information kiosks [30]. The latter is particularly relevant to ITS applications such as tripplanning on the move, indicating that older people may be inadvertently excluded from such innovations. An underlying issue that may contribute to this decline in usage is the problem, referred to above, of age-related physiological changes that include incremental loss of sight, hearing, dexterity and cognitive processing, which disadvantages older people in an increasingly screen and button-based world, particularly those who are not already using ICT. This poses questions for consumer-oriented applications of ITS.

2.3 Potential contribution of ITS to improved QoL in older age There are a number of applications in which ICT, transport services and healthcare come together. For example, using real-time public transport information services (a form of ITS) to make centralised healthcare facilities more accessible by means other than the private car [31]. Telephone and booking service facilities (a form of ICT) have been crucial to the development of flexible transport services, such as demand-responsive transport (DRT) [13], and it is relevant to note that much experience with DRT stems from earlier dial-a-ride services, that were targeted at the disabled and elderly. DRT’s more user-focused approach to transport provision is increasingly making its way into the mainstream. However, more research needs to be done to incorporate public transport timetable data into accessibility models to understand access to healthcare, as those more likely to be dependent on public transport are also those who are more likely to be significant users of healthcare services, such as mothers of young children and older people [32]. The UK Social Exclusion Unit found IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318– 327 doi: 10.1049/iet-its.2009.0106

www.ietdl.org that a third of non-car owners found it difficult to get to hospital, and that patient experience of actually reaching ‘routine’ and non-emergency healthcare was insufficiently understood [33]. The stress that this induces for patients and their carers could result in a vicious cycle of further negative health impacts leading to an increased need for public healthcare. Clearly, there are several intersections between the digital economy and transport, especially for the passenger. ICT is increasingly utilised to optimise the travel experience, both through customer-facing ITS (booking systems and information provision) and ‘back-room’ applications that optimise service and route planning and operation [34], and these can be linked. The use of ICT-generated data on fixed-route journeys can identify where and when time-table slippage occurs, thus assisting route management and service punctuality. ICT is also central to providing waiting passengers with more reliable real-time information, through the use of fixed real-time information service infrastructure on station platforms and bus shelters for example, but also increasingly mobile and personalisable through SMS applications. Developing a national Internet-based journey planner was a hallmark of the UK government’s 10-year plan (2000) and resulted in the transport direct service. The functionality of transport direct and a variety of other journey planners has been explored in a review study [35]. Recent work to develop personalised travel planning through ICT to tailor plans for individuals can also benefit operators by feeding back information on unmet needs of different consumer groups [36]. A study of the use of mobile phones to access public transport information among 100 travellers of various ages (the oldest was 85 years old) showed that older travellers had unmet needs in relation to advance information on certain trip aspects, such as the length of a pedestrian walk. They also wanted global positioning system (GPS) guidance while walking and the location of bus stops as well as real-time information on bus times. The record of behaviour showed that the over 70 years had difficulties with touch screen interfaces and the navigation logic of applications [37]. The recommendations for ‘senior’ preference settings (e.g. larger pictograms) and simplified navigation, and enabling more individualisation are in line with other recent studies on senior-centred design [24]. This study shows that ITS applications such as trip planning on the move can result in unintentional exclusion of older people from innovation. Other research, such as the FP6 EMIRES project, demonstrates potential for combining activity planning (such as attending a job interview) with transport booking in a single transaction involving the interrogation of appropriate databases [38]. This approach should also be applicable in the context of healthcare-related travel.

2.4 Summary Older people generally have a greater need for public services such as transport, health and social care. The increasing IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318 – 327 doi: 10.1049/iet-its.2009.0106

tendency to organise service information and access via ICT risks increasing exclusion for older people, given their reduced levels of new technology adoption [10, 39]. However, some studies suggest that there are likely to be improvements in adoption from the cohort effect [16]. Given that at present using ICT does not seem to offer any particular advantage to older people, progress could be better if a senior-centred design approach was adopted in shaping ICT to meet their needs, helping to counteract negative effects from technology ‘churn’ and poor design features that inhibit use (e.g. small buttons, small print, sound, easier to use menus and better ‘help’ facilities). The risk of experiencing a rise in social exclusion as people enter older age will have a measurable impact on their experience of QoL. Digital inclusion is thus part of the wider concept of social inclusion which for older people is particularly connected to healthcare and transport. This suggests that socially inclusive transport can be enabled by digital inclusion: ‘The concept of social inclusion implies empowerment and involvement of socially “excluded” people in interventions to reduce their isolation from desired activities’ [40]. Similarly, there are opportunities to improve ITS applications to take greater account of the specific needs of older people. However, the unevenness of age-related reduction in physical and mental capacities, combined with varying initial levels of skill at using ICT, as well as attitudes towards it, suggests that more work to understand the different degrees of utility among older people is needed.

3 Focus group and supplemental questionnaire methodology The project reported in this paper utilised a qualitative, inductive approach, based on focus group work informed by the literature review and supplemented with questionnaires to contextualise the participants within the wider population subgroup from which they were drawn. The samples are not representative of the wider population, but focus group work provides rich data on a spectrum of people’s views and how they interact and discuss the issue(s) that are of interest to researchers or policy-makers. The focus groups were designed to have between four and ten participants, with one facilitator and two to three other researchers to record the proceedings. Data collection and analysis were undertaken over a 6-week period in October/ November 2008 in Aberdeen City and Aberdeenshire, Scotland, UK. The participants were recruited through letters sent to members of National Health Service (NHS) Grampian’s community health partnership forums, inviting any member in the target age group(s) to participate in a focus group on a voluntary basis. As a concept, the term ‘older person’ has no common definition. Many studies take 55 years and over, whereas others start at 60 or 65 years. However, it is recognised that 321

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www.ietdl.org many people experience significant life changes from the age of 50. For this study, we included older people from the age of 55 in order to capture something of the transition from employment to retirement, and how this affects the day-to-day use of digital technologies and the need for transport information. A total of four focus groups were organised for two age groups (55 – 64 and 65– 74 years). Two were held in Aberdeen City (one for each age group), one for those aged 65– 74 years was held in Stonehaven, approximately 20 miles south of the city, and the fourth (for those aged 55– 64 years) was held in Inverurie, approximately 20 miles north-west of the city. There were insufficient volunteers to organise a suitable time and venue for the 75+ age group. We believe that this could be because of factors such as the increased likelihood that this age group find it harder to travel and the possibility that this age group is under-represented in the community health partnership forums. To supplement the data obtained from the focus groups, all those who volunteered to participate (more than 50 in total) were also surveyed by means of a questionnaire, whether or not they actually attended a focus group. A total of 48 useable responses were returned, capturing some information about the 75+ age group, and from a wider geographical area than the focus group participants thus drawing information from more rural parts of the case study area currently experiencing uneven provision of ICT, public transport and healthcare accessibility.

4 Empirical findings and discussion The general findings from the focus groups confirm other studies in that the older cohorts show a slight tendency to be less comfortable with ICT, and for ICT to be less fully integrated in daily life. The topics that focus group participants touched upon were quite varied, as participants’ thought processes were influenced by one another as well as by the guidance of the facilitators. Fig. 2 has been designed

to convey the way in which participants conceptualised the headlines issues of particular interest to the project, namely transport, healthcare and ICT. Consequently, a wide variety of topics can be seen to overlap in complex ways, suggesting that many issues of concern to older people as individuals have a cross-cutting nature. We recommend reading Fig. 2 from inside out following the ‘story’ from the individual shown in the darkest shade to the abstract higher level topics on the outer ring, shown in the lightest shade. By centring the diagram on participants’ attitudes and perceptions, we show that the most personal concerns for individuals’ perceptions of their QoL and aspirations relate to feelings of vulnerability, and a desire for individualisation and social contact. This leads outward to more specific concerns that relate to the desire for dialogue with both healthcare and transport providers, at public consultation state, at information stage and at booking stage. Participants are then able to consider in a more general way what they want from real-time information systems, and their current shortcomings, how online booking systems might be personally relevant, and how the two together influence transport to appointments. Discussion on these issues brought participants back to specific issues of concern on sectoral aspects of their experience of ICT, transport and healthcare, although there are again, some overlaps. For example, discussion about the links between transport and health tended to trigger discussion about parking at hospital, a common concern for both patients and escorts, conceptualised as something that causes stress, and in need of closer collaboration between healthcare and transport providers, as well as with local authorities and patient groups. There was a consensus that employing ITS for managing hospital parking might be highly beneficial for patients. Within each ring the placement of each individual topic has been made so as to approximately illustrate overlaps between sectors that emerged in the focus group discussions. Thus, the headline issues themselves represent professionally distinct policy

Figure 2 Topics raised by focus group participants 322 & The Institution of Engineering and Technology 2010

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www.ietdl.org sectors which can be seen as needing to develop a more collaborative approach. A quantifiable context for the respondents was established through questionnaires. Questions sought to establish the breadth of their Internet use. Questions were asked in two ways: firstly from an activity basis – what the respondent uses the Internet for and secondly from an awareness basis – what the respondent knows about potentially relevant content (multiple responses were permitted). A key question about activities using the Internet showed that transport-related activities were prevalent, but emphasise tourism and leisure. Only two respondents indicated that they used all the Internet functions listed (e-mail was dealt with in a separate question), and eight (16%) ticked eight or more. A further 12 respondents (25%) ticked between five and seven categories. Nearly a third of respondents selected no options, but of these two individuals wrote down alternatives: property prices/availability, e-banking, and occasional contact with friends and family. The remaining 14 respondents (29%) ticked between four or less options, the most frequent use being travel related. There were six respondents (13%) who ticked the social networking option, all of whom fell into the ‘five or more’ group and can thus be considered to be more enthusiastic/ skilled users, and that they are quite highly motivated to use ICT. Respondents also mentioned five more uses in the ‘other category’: booking theatre tickets, organising social groups/clubs, playing games, studying and as a reference ‘book’. We have interpreted the data on transport-related Internet activity as being largely for leisure purposes, even for train bookings and information. This is based on local knowledge, as the local railway network is very limited, mainly providing a link out of the region. One of the questions on awareness of content listed a number of websites assessed as having information relevant to the target group. These were chosen on the basis of local knowledge, and using a web search. Selected websites focused on transport, general information aimed at older people and social networking. The results indicated that the breadth of Internet use was relatively limited. With regard to transport, many had heard of the commercial sites of major public transport companies. However, given the level of public investment in journey planning it was disappointing to note the poor awareness of Traveline (nearly two-thirds of respondents had heard of it) and Transport Direct (almost none of the respondents had heard of it). However, these Journey Planners were not particularly designed to address the requirements of older people as different to the general public. With the exception of National Rail Enquiries and the Trainline (both portals for booking rail travel), it appears that respondents were more likely to have heard of a website than to have actually used it. For example, 40% of respondents had heard of, but not used, the websites of the two leading local bus operators, but fewer than a quarter had accessed them. IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318 – 327 doi: 10.1049/iet-its.2009.0106

For many of the questionnaire respondents, using mobile phones and other devices for regular communications and Internet access (a form of ICT) are not routine, with use tending to be occasional and highly selective such as in emergency situations or for making ‘functional’ contacts with family/friends during travel. One participant made a key observation about ICT generally: ‘If you’ve lived for 60– 70 years without – why get one?’. However, in general participants felt that while the cohort to come after them would be more familiar, the speed of technological development always keeps ICT a step or two ahead. However, individual differences in take up of ICT developments were clearly a function of knowledge and practices. Some individuals are sufficiently knowledgeable to adapt daily practices, whereas others will find it less easy to adopt a new technology; however, advantageous others believe it may be to them. The results suggest a spectrum of either sceptical or fearful in some way, whereas those who integrate ICT much more in daily life have a degree of dependence on it. Some even suggest, for example, that use of technology is not advanced enough in some areas of service provision, for example, online booking of healthcare appointments or accessing test results. The literature review shows that ICT take up among older age groups is not a straightforward issue of supplying services, equipment and training, and this is confirmed by the focus groups. The groups themselves were heterogeneous, even within age groups, but there was a discernible shift of emphasis from pro- to anti-ICT between the age groups 55– 64 and 65 –74, despite nearly three-quarters of the respondents having broadband Internet access. This shift is also found in the literature [39]. From the focus group, scepticism about the breadth and depth of ICT benefits was apparent in the 65– 74 group that used ICT the most and that appeared to have the highest level of education. This group made pertinent comments about a tendency for the public sector to try to push citizens too fast and far towards new delivery modes. This approach is argued to be not in the spirit of inclusivity, suiting idealist technocrats and cost-conscious politicians more than citizens. Participants related their feeling of being pushed to make a change unwillingly to the issue of vulnerability. This was a pervasive multi-dimensional theme in all the groups. ICT was represented as making older people vulnerable to identity theft and fraud and was linked to social vulnerability through the impersonality of electronic service provision, increasing isolation rather than countering it for some people. Some participants also referred to how travelling to healthcare appointments is stressful and increases a sense of vulnerability. Many participants were clear that solutions to these issues could include ICT but that the design of systems should take account of older people’s desire for individuality as well as their increased sense of vulnerability in relation to ICT. The suggestion was that using ICT to improve travel to healthcare (for example) should be largely behind-the-scenes by the service provider to reduce stress for service users. 323

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Figure 3 Contingent perceptions of vulnerability connected to transport and ICT About two-thirds of respondents reported accessing Internet from home to find information about travel and to make bookings, but only 5% reported using the Internet to find health information or make health appointments. There were some key observations that shed light on the difficult relationship between social inclusion, QoL, ICT, health and transport. These illustrate how varied individual attitudes are, and how dependent on personal context. These ranged from feelings of fear using buses when feeling unwell or a general social concern for others who are old, alone and unable to cope with new technologies (e.g. Internet appointment bookings). However, some viewed ICT more positively, as essential tools for inclusion and well-being for individuals who have developed disabilities such as chronic arthritis or loss of vision (see Fig. 3). It was clear that some aspects of the digital economy were not likely to enjoy much take up among these older age groups, for a number of reasons. For example, those living in rural areas are less able to access online supermarket shopping either because of distance or because Internet connections are too slow. However, there were areas where ITS applications have clear potential. One relates to healthcare access, for example, in rural areas the DRT model has many strengths for organising complex and highly individual transport to healthcare, but this depends on resolving technical infrastructure issues affecting significant portions of the rural population (such as mobile and Internet ‘notspots’ (a recently coined term that is replacing ‘blackspots’ to indicate a lack of network coverage. Further detail can be seen in this link: http://news.bbc.co.uk/ 1/hi/8068676.stm)). The user-interface needs ageingsensitive design, and to take account of concerns for personal privacy and online security.

5 Conclusions and recommendations To summarise the QoL agenda, equality of opportunity to access social activities, healthcare and lifelong learning/ employment is relevant to all segments of the population, and appropriate transport is often a pivotal enabler. ITS developments need to take this into account, especially in the context of an ageing demographic where increasing numbers seek to maintain active lifestyles into their 80s [41]. Designers of transport systems need to better understand heterogeneous mobility and accessibility requirements among older people, to ‘ensure that specific requirements of this large segment are not being ignored through the promotion of traditional 324 & The Institution of Engineering and Technology 2010

“solutions” and historical assumptions’ [42]. ITS development should therefore focus on addressing specific requirements of individual groups within the population, rather than bolting technology onto traditional transport solutions, as transport planning has developed through a series of overlapping expansions, that have never fully overturned the 1950s paradigm that emphasised accommodating the growth in vehicle numbers and movements. The nuances introduced through an attitude-based perspective, partly influenced by the growth in ITS as well the need to make radical changes to deal with congestion and climate change, are an improvement, but there is, as yet, limited capability in modelling of better information provision: the attitude-based perspective has not made a big impact on formal evaluation, and many of the qualitative aspects of ITS are not fully captured by existing appraisal methods [43]. The policy imperative of an ageing demographic and increased longevity, which will increase demands on care services, makes it important that ICT is generally normalised within the lifestyles of older people. In turn, a more normative role for ICT in the daily lives of older people has implications for ITS, whether that be real-time information services, electronic ticketing or sophisticated DRT and flex-route matching services. Normalising ICT for older people would be assisted by adopting a seniorcentred design focus within a more human-centred design process generally. Older age groups need to be able to read and access the information and services, but services also need to be better matched to a range of requirements. Designing an ITS system around healthcare appointment making, for example, offers the opportunity to identify and meet previously unmet transport needs in ways that minimise stress at times of vulnerability, as well as making more efficient use of transport and health sector resources. Suggestions for technological improvements to better serve people without access to personal transport could include: † A software tool to enable health service providers to set appointment times that account for distance and available transport services between the patient’s home and the clinic. † The health provider makes a transport booking at the same time as the medical appointment. † Information on available transport options is supplied to individual (patient or carer) at time of booking of appointment, but individuals make their own arrangements by a variety of means. † ITS can also be applied to parking management at health care centres, instilling confidence in patients or escorts and thus reducing stress. To facilitate collaboration between service providers we develop an ideal relationship between accessibility, mobility and ICT as an understanding that ICT is both accessible and contributes or substitutes for mobility, and at the same IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318– 327 doi: 10.1049/iet-its.2009.0106

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Figure 4 Conceptual representation of ideal relationship between ICT, accessibility and mobility time essential services are designed to be physically or virtually accessible (Fig. 4). However, achieving this ideal requires that all transport users actively use ICT and the aim for ITS should be to work with other sectors to reach that central zone across the population. Support needs to come from behind the scenes, and useful ‘back-room’ approaches would be for technology providers to work closely with healthcare and transport providers alongside patient groups to develop ICT-based solutions to the difficulties faced by patients, their carers/support network and clinics in achieving a good fit between personal circumstances and operational need. Policy-makers must also be kept informed of the acceptability and feasibility of policy initiatives requiring widespread adoption of ICT solutions. ICT that supports ageing-in-place, and ITS backroom applications that co-ordinate flexible transport solutions are not direct public/economy interfaces, but nevertheless form a part of an economy that is increasingly predicated on electronic platforms, products and services, both commercial and public. Transport telematics can also contribute to making more efficient use of mobility resources, but alternatively ICT can substitute altogether for mobility in some cases, two effects which are both in line with mainstream climate change and transport policies. Developing ITS as an objective should not ignore the individual needs of more vulnerable groups within the wider population. Older people have an increasingly diverse demographic. Increased longevity is creating more older age ‘groups’ with wide variations of technical, cognitive and physical ability. Policy and individual aspiration is to retain as much autonomy as possible. For example, in Aberdeen, UK, the initiative conducted by the NHS and the Regional Transport Partnership for the Aberdeen City and Shire, has resulted in a transport action plan where three core activities of ‘active travel’ promotion, public health impacts of transport and access to healthcare are assessed to address the transport and health issue [44]. One important conclusion of this case study and other work in the area is the scale of opportunity for ICT in general and ITS specifically to contribute to the delivery of meeting both transport and health objectives across the Aberdeen City and Shire region.

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Acknowledgments

The project was funded by the UK Engineering and Physical Sciences Research Council through the Inclusive Digital Economy Cluster ‘An inclusive digital economy supporting IET Intell. Transp. Syst., 2010, Vol. 4, Iss. 4, pp. 318 – 327 doi: 10.1049/iet-its.2009.0106

older and disabled people and other digitally disenfranchised groups’, managed by the Principal Investigator: Professor Alan Newell (University of Dundee) and Co-PIs: Dr Petros Iosifidis (City University, London) and Prof Vicki Hanson (University of Dundee). The authors also thank all the participant/ respondents and acknowledge the endorsement and support of John Gallagher at NHS Grampian; and Derek Halden and Angela Curl of Centre for Transport Research, University of Aberdeen, for their help with the focus group; and Alison Sandison and Jenny Johneton, Department of Geography, University of Aberdeen, for their help with the figures. The paper has benefited from the comments of three anonymous referees.

7

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