Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study
Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study
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DOI：
10.2196/jmir.8407
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发表时间：
2018-04-01
影响因子：
7.4
通讯作者：
Kort, Helianthe S. M.
中科院分区：
文献类型：
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作者：
van Houwelingen, Cornelis T. M.;Ettema, Roelof G. A.;Kort, Helianthe S. M.
背景：荷兰卫生部制定了关于使用远程医疗的宏伟目标，与目前93%的面对面提供的医疗保健情况相比，这导致了随后的变化。由于大多数护理是向老年人提供的，远程保健的前景提出了这样一个问题：老年人是否准备好接受这种新的护理方式。为了研究这一点，我们创建了一个由6个因素组成的理论框架，这些因素与老年人使用技术的意愿有关。目的：本研究的目的是通过研究社区居住老年人使用视频会议的意愿和在日常生活中使用数字技术的能力作为指标，了解他们接受远程医疗的意愿。方法：采用混合法三角剖分设计。首先，我们进行了一项横断面调查研究，通过多层次路径分析（阶段1）来检验我们的理论框架，以调查老年人使用视频会议的意图。其次，为了更深入地了解老年人对数字技术的实际使用情况，对老年人在家中执行技术任务（例如，在电脑上，手机上）进行了定性观察（阶段2）。结果：第一阶段共有256名65岁及以上的老年人参与了调查研究，其中男性50.0%，中位年龄70岁，Q1-Q3: 67-76岁。使用显著性水平。05，我们发现老年人对视频会议的看法有7个显著的关联。老年人(1)使用视频会议的意愿可以通过他们的预期表现（比值比[OR] 1.26, 95% CI 1.13-1.39）、预期努力（OR 1.23, 95% CI 1.07-1.39）和感知隐私和安全（OR 1.30, 95% CI 1.17-1.43）来预测；(2)工作表现期望由努力期望预测（OR 1.38, 95% CI 1.24-1.52）；(3)努力期望由自我效能感预测（OR 1.55, 95% CI 1.42-1.68）。在第二阶段，共有6名男性和9名女性参与了定性观察研究，年龄在65 - 87岁之间。在主要主题中，确定了5个主题，可以更好地了解老年人在使用数字技术方面的能力和不足：(1)“自我效能和数字素养”，(2)“使用技术的障碍”，(3)“先前的经验和使用频率”，(4)“支持和便利条件的来源”，以及(5)“绩效预期”。这5个主题在所有15项观察中反复出现。结论：绩效预期、努力预期、感知隐私和安全是老年人使用视频会议意愿的直接预测因子。自我效能感似乎在老年人使用科技产品的意图和实际使用中都发挥了作用。通径分析显示，自我效能感与老年人的努力预期显著相关。此外，自我效能感和数字素养似乎在老年人使用数字技术的能力中发挥了重要作用。
Background: The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people's intention to use technology.Objective: The objective of this study was to understand community-dwelling older people's readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators.Methods: A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people's intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people's actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2).Results: In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people's perception of videoconferencing. Older people's (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people's capacities and incapacities in using digital technology: (1) "self-efficacy and digital literacy," (2) "obstacles to using technology," (3) "prior experience and frequency of use," (4) " sources of support and facilitating conditions," and (5) "performance expectancy." These 5 themes recurred in all 15 observations.Conclusions: Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people's intention to use videoconferencing. Self-efficacy appeared to play a role in both older people's intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people's effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people's capacities to make use of digital technology.