The results are reported in two sections. First, participants’ performance and compliance rate in their usage for everyday health monitoring were examined in five domains (i.e., general computer skills and usage, overall perceived health, nutritional consumption, physical activity, and cognitive fatigue). Second, themes that emerged from the focus group discussion are also presented.
3.1. Older Adults’ Abilities and Compliance Rate in Health Monitoring
After the ten-day period, further statistical analysis was conducted to evaluate older adults’ abilities and the compliance rate in their usage for everyday health monitoring. Participants of this study reported an average rating of 2.88 on a 5-point scale on their confidence in computer skills, meaning that participants were somewhat uncertain about their skills in using a computer (Table 4
). However, about a third of the participants stated they were somewhat confident in computer skills. In terms of computer usage, participants reported their computer usage ranged from once a month to every day to several times a day. Half of the sample indicated they used computers every day.
With regard to the compliance rate over the ten-day period, two users completed the 21 health diary questions every day (100% compliance rate) and two other users completed the health diary questions less than 50% over the 10-day period. Specifically, all users completed the health diary questions on Day 1 (100% compliance rate); however, the compliance rate dropped to 75% on Day 2, and the lowest compliance rate of 62.5% was reported on Day 3, 5, 6, and 10 (Figure 1
). In addition, individual compliance rates can be found in Table 5
Based on the compliance rate, two groups were created: a high compliance rate group (90% and above) and a low compliance rate group (below 90%). Mean differences in computer skills, computer usage, and health at baseline between the two groups were examined through t-tests. However, no significant differences in the three variables were noted: t(6) = 0.27, p = 0.80 for computer skills, t(6) = 1.22, p = 0.27 for computer usage, or t(6) = 0.91, p = 0.40 for health at baseline.
3.2. Three Themes from a Focus Group
The ten-day pilot test was successful in that all participants who started the pilot test completed the ten-day testing period. This study also yielded interesting findings regarding older adult user experience with computer-based communication activities. Three total themes emerged from the focus group transcript: accessibility, awareness, and safety and intrusion.
This theme dealt with the accessibility from a number of different perspectives including environmental inclusion (e.g., rural environments) and financial accessibility (e.g., inexpensive technology will be used by more individuals). Participants were intrigued that Skype was free and felt it offered an additional benefit over cell phones. One participant noted, “A program that is free will be used.” In addition, one participant suggested that a “fee scale” for healthcare services in which telehealth visits conducted using computer-based communication tools were cheaper than face-to-face visits could be advantageous. Another participant commented, “If it’s [telehealth visits] lower [cost] than the actual visit, that’s convenient.” However, one participant went on to mention, “I thought professionals, if they wanted to use it for this type of thing [for telehealthcare], would need very good grade cameras.”
Participants also felt that the check-in, daily diary, and Skype tasks were relatively easy to complete and use. A participant mentioned, “I did find out that the computer doesn’t bite…if you use it right.” This sentiment seemed to illustrate the anxiety or hesitation that is sometimes associated with computers. Overall, after using computers over a ten-day period, participants seemed to possess more self-assurance. Although all participants did have their own computers, most individuals were only using their computers for basic tasks (e.g., playing games or checking email periodically). Only one participant had ever used Skype before. It was also apparent to the researchers that participants were much more at ease with the communication tools than they were at the beginning of the study. For example, researchers noted significant hesitancy and anxiety (e.g., concern that they might not complete the communication task successfully) on the day the programs were installed on participant computers. Participants also later stated how relatively easy the check-in task was to complete on the computer by indicating that it was “very simple and easy.” Another participant stated, “No, I didn’t have any trouble with the check-in.”
Increased flexibility for check-in time periods was suggested by several participants. For example, one participant noted, “Our problem is from 10 a.m.–12 p.m.…we didn’t always get that
.” Other participants noted conflicting appointments or schedules that interfered with the check-in time frame. Furthermore, some participants felt the daily health diary could be more tailored to individual needs. For example, one participant responded, “I think that as the system would be refined…questions would vary over time
.” Some participants seemed to note the importance of thinking about individual differences. The participant went on to explain:
“Not criticizing your question, but…if you carried this thing a step further and it was being used by professionals, your questions wouldn’t be of such a general nature and ultimately the questions would have to be refined to the person.”
In regard to how detailed the daily health diary should be, one participant noted that some daily healthy diary questions may need to be more specific:
“Some will have quite the detailed questionnaire and others will have a relatively simple one. There is a lot of relativity as you move to one person to the other.”
Participants also appreciated that the computer-based communication activities were relatively easy and quick to complete. Participants commented that the daily health diary took the longest and ranged anywhere from three to ten minutes to complete.
Although participants in this study were not living in a rural area, several individuals discussed the benefits for rural populations. One participant noted, “I think it would pertain more to people who are maybe more than maybe 100 miles away.” Another participant commented, “And weather is important because in rural Iowa, winter weather snowy roads…this would be advantageous.”
This theme was related to increased awareness of food and drink consumption, as well as increased awareness technology terms and opportunities for using technology. Participants appeared to be more aware of their own health when using the daily health diary as some questions asked about fruit and vegetable servings as well as liquid intake. For example, one participant noted, “It just reminded us to eat a little better.” Similarly, an additional participant mentioned, “Your two fruits, two vegetables and 3 to 5 glasses or cups of water reminded us.” Another participant noted, “…It did make me very much aware of the fluid intake.”
One of the challenges associated with the computer-based communication activities were that “you had to remember to do it every day.” For some, this requirement was challenging. Some participants reported difficulty remembering to complete the check-in, daily diary, and Skype tasks each day. Several participants noted they “forgot.” However, one participant seemed to indicate that the tasks could soon become part of a routine. He stated, “If I just did it when I got up in the morning, there are all those things that you do routinely.”
Participants also seemed to be more aware of available technology that might be useful to them and felt they became more knowledgeable about computer terms. One participant noted that “She…our daughter…was Skyping her husband in Washington, D.C. If they had said we were ‘Skyping,’ we would have thought, ‘what on earth are they doing?’ But we knew the language…” Participants reported feeling satisfied that they were more knowledgeable about computer terminology (such as Skype) and were more aware of how such technology functioned. Skype also offered increased opportunities for socialization. A participant noted “I’ve made contact with relatives that I haven’t seen for years. It’s just like they’re sitting across the table from you the way we sit and talk.”
3.2.3. Safety and Intrusion
This theme included discussion on increased safety due to technology tools as well as discussion on privacy and intrusion due to technology use. Participants mentioned that the computer-based communication tools would be helpful for safety reasons, particularly when professional staff members were away or unavailable. One participant mentioned that “[Staff members] need to keep in contact with me so [staff members] don’t find me at the bottom of the stairs in a mess.” An additional participant seemed to echo similar points when he indicated that “all the emergencies occur on weekends.”
Participants seemed to acknowledge that check-in devices are important to ensuring the safety or older adults, especially those who reside alone or with little to no professional medical staff. One participant went on to further explain how useful check-in tasks are when he explained,
“But, uh, any kind of signal that we came up with [at the independent living apartment complex] …either people didn’t want us to be checking on them or they figured it wasn’t a good enough plan and we’ve never done anything. And, generally speaking, we know what the next-door neighbor’s doing or some person we are in touch with. But it failed once. I mean we lost somebody over a weekend…”
Another participant mentioned how beneficial a camera could be if one were to use Skype as part of telehealthcare. The participant said, “It seemed to me that the Skype would add a lot to that…just seeing the individual, more than the telephone.”
Initially, participants were less eager to use Skype to communicate with research assistants at the University. However, at the end of the research project participants thoroughly enjoyed the added benefit of being able to see the person they were communicating with during conversation. One participant noted, “I thought it was fun interacting with these students. I thought that was interesting.” Another participant stated, “They [researcher assistants] weren’t being intrusive.” At the conclusion of the study, participants were eager to have the Skype software left on their computers for continued use. One participant noted, “You can take anything you want out of my computer, but leave Skype!”