Developing an eHealth Tutorial for Older Adults to Use Online Health Resources

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Abstract Older adults age 65+ have the lowest health literacy levels of all adult age groups in the United States: only 3% of older Americans have proficient health literacy.1 As information and communication technologies are increasingly used in health care,2,3 the ability to use technology in the health care context has begun to be integrated into recent conceptualization and measurement of health literacy.4-10 Older adults are in double jeopardy in the eHealth era because they tend to have not only low health literacy but also low technology literacy.11,12 Without effective interventions, older adults are likely unable to make use of the technology's full potential to improve health.13,14 In this R21 study, we propose to develop, refine, and pilot test an innovative intervention for improving older adults' eHealth literacy. Key to this intervention is an integrated eHealth tutorial featuring an instructional overlay added onto an actual health information website. Development of this eHealth tutorial is enabled by the Online Tutorial Overlay Presenter (OnTOP), a novel computer program that builds on recent developments in visual recognition technology and enables the development of tutorials that can reduce the demand on learners' cognitive abilities. This project expands our prior work on older adults' learning and use of technology,17-36 design of senior-friendly technology,37-41 novel machine vision algorithms that enable computers to recognize the visual images presented by user interfaces,42-45 our pilot studies on older adults' preferences for design features of a brief eHealth tutorial developed using OnTOP,38, 46 and our recent systematic review of the literature on eHealth literacy interventions for older adults, which found a lack of theory-based interventions with few studies applying high-quality research design.47 Specific Aims are: · Aim 1: To develop a senior-friendly, theory-driven interactive multimedia eHealth tutorial for accessing, assessing, and using reliable health information on the Internet; · Aim 2: To determine the feasibility of older adults using this tutorial to improve their eHealth literacy. To address Specific Aim 1, we will recruit 8-10 older adults to participate in an Advisory Committee and will meet with them monthly throughout the design process to gather design ideas to guide the design of our eHealth tutorial. To address Specific Aim 2, we will conduct a feasibility study using a randomized control group design involving pre- and posttest. We will recruit 100 older adults (age 65+) to participate in this part of the study to ensure sufficient statistical power (.80) to detect an effect size of 0.25 at the .05 level, even after taking into account an attrition rate of 15%. Participants will be randomly assigned to either an intervention group featuring learning with our eHealth tutorial, or a control group featuring learning with an existing NIA tutorial.51 This R21 project is significant because it addresses the important problem of eHealth illiteracy in the older population. This project is innovative because our intervention features the use of state-of-the-art visual recognition technology to enable the development of an integrated eHealth tutorial for older adults.