What are the determinants of older people adopting communicative e-health services: a meta-ethnography.
Aged
Digital Technology
Information Technology
Qualitative Research
Social Support
Telemedicine
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
11 Jan 2024
11 Jan 2024
Historique:
received:
24
03
2023
accepted:
23
11
2023
medline:
12
1
2024
pubmed:
12
1
2024
entrez:
11
1
2024
Statut:
epublish
Résumé
Gradually, society has shifted more services online, with COVID-19 highlighting digital inequalities in access to services such as healthcare. Older adults can experience such digital inequalities, yet this group is also more likely to need medical appointments, compared to younger people. With the growing digitalisation of healthcare, it is increasingly important to understand how older people can best use communicative e-health services to interact with healthcare services. This is especially if older adults are to access, and actively interact with health professionals/clinicians due to their general health decline. This review aims to synthesise older adults' experiences and perceptions of communicative e-health services and, in turn, identify barriers and facilitators to using communicative e-health services. A meta-ethnography was conducted to qualitatively synthesise literature on older adults' experiences of using communicative e-health services. A systematic search, with terms relating to 'older adults', 'e-health', 'technology', and 'communication', was conducted on six international databases between January 2014 and May 2022. The search yielded a total of 10 empirical studies for synthesis. The synthesis resulted in 10 themes that may impact older adults' perceptions and/or experiences of using communicative e-health services. These were: 1) health barriers, 2) support networks, 3) application interface/design, 4) digital literacy, 5) lack of awareness, 6) online security, 7) access to digital devices and the internet, 8) relationship with healthcare provider(s), 9) in-person preference and 10) convenience. These themes interlink with each other. The findings suggest older adults' experiences and perceptions of communicative e-health services are generally negative, with many reporting various barriers to engaging with online services. However, many of these negative experiences are related to limited support networks and low digital literacy, along with complicated application interfaces. This supports previous literature identifying barriers and facilitators in which older adults experience general technology adoption and suggests a greater emphasis is needed on providing support networks to increase the adoption and usage of communicative e-health services.
Sections du résumé
BACKGROUND
BACKGROUND
Gradually, society has shifted more services online, with COVID-19 highlighting digital inequalities in access to services such as healthcare. Older adults can experience such digital inequalities, yet this group is also more likely to need medical appointments, compared to younger people. With the growing digitalisation of healthcare, it is increasingly important to understand how older people can best use communicative e-health services to interact with healthcare services. This is especially if older adults are to access, and actively interact with health professionals/clinicians due to their general health decline. This review aims to synthesise older adults' experiences and perceptions of communicative e-health services and, in turn, identify barriers and facilitators to using communicative e-health services.
METHODS
METHODS
A meta-ethnography was conducted to qualitatively synthesise literature on older adults' experiences of using communicative e-health services. A systematic search, with terms relating to 'older adults', 'e-health', 'technology', and 'communication', was conducted on six international databases between January 2014 and May 2022. The search yielded a total of 10 empirical studies for synthesis.
RESULTS
RESULTS
The synthesis resulted in 10 themes that may impact older adults' perceptions and/or experiences of using communicative e-health services. These were: 1) health barriers, 2) support networks, 3) application interface/design, 4) digital literacy, 5) lack of awareness, 6) online security, 7) access to digital devices and the internet, 8) relationship with healthcare provider(s), 9) in-person preference and 10) convenience. These themes interlink with each other.
CONCLUSION
CONCLUSIONS
The findings suggest older adults' experiences and perceptions of communicative e-health services are generally negative, with many reporting various barriers to engaging with online services. However, many of these negative experiences are related to limited support networks and low digital literacy, along with complicated application interfaces. This supports previous literature identifying barriers and facilitators in which older adults experience general technology adoption and suggests a greater emphasis is needed on providing support networks to increase the adoption and usage of communicative e-health services.
Identifiants
pubmed: 38212713
doi: 10.1186/s12913-023-10372-3
pii: 10.1186/s12913-023-10372-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
60Informations de copyright
© 2024. The Author(s).
Références
Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957–62.
doi: 10.1093/jamia/ocaa067
pubmed: 32311034
pmcid: 7188147
Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med. 2011;8(1):e1000387.
doi: 10.1371/journal.pmed.1000387
pubmed: 21267058
pmcid: 3022523
Norman CD, Skinner HA. eHEALS: the eHealth literacy scale. J Med Internet Res. 2006;8(4):e507.
doi: 10.2196/jmir.8.4.e27
Watts G. COVID-19 and the digital divide in the UK. The Lancet Digital Health. 2020;2(8):e395–6.
doi: 10.1016/S2589-7500(20)30169-2
pubmed: 32835198
pmcid: 7384786
Mold F, Hendy J, Lai Y-L, de Lusignan S. Electronic consultation in primary care between providers and patients: systematic review. JMIR Med Inform. 2019;7(4):e13042.
doi: 10.2196/13042
pubmed: 31793888
pmcid: 6918214
Schifeling CH, Shanbhag P, Johnson A, Atwater RC, Koljack C, Parnes BL, et al. Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis. JMIR aging. 2020;3(2):e23176.
doi: 10.2196/23176
pubmed: 33048821
pmcid: 7674139
Tebeje TH, Klein J. Applications of e-health to support person-centered health care at the time of COVID-19 pandemic. Telemedicine and e-health. 2021;27(2):150–8.
doi: 10.1089/tmj.2020.0201
pubmed: 32746750
Ware P, Bartlett SJ, Paré G, Symeonidis I, Tannenbaum C, Bartlett G, et al. Using eHealth Technologies: Interests, Preferences, and Concerns of Older Adults. Interact J Med Res. 2017;6(1):e3.
doi: 10.2196/ijmr.4447
pubmed: 28336506
pmcid: 5383803
Nymberg VM, Bolmsjö BB, Wolff M, Calling S, Gerward S, Sandberg M. “Having to learn this so late in our lives…” Swedish elderly patients’ beliefs, experiences, attitudes and expectations of e-health in primary health care. Scand J Prim Health Care. 2019;37(1):41–52.
Tappen RM, Cooley ME, Luckmann R, Panday S. Digital Health Information Disparities in Older Adults: a Mixed Methods Study. J Racial Ethn Health Disparities. 2022;9(1):82–92.
doi: 10.1007/s40615-020-00931-3
pubmed: 33415705
Cajita MI, Hodgson NA, Lam KW, Yoo S, Han H-R. Facilitators of and Barriers to mHealth Adoption in Older Adults With Heart Failure. Comput Inform Nurs. 2018;36(8):376–82.
pubmed: 29742549
pmcid: 6086749
Hoque R, Sorwar G. Understanding factors influencing the adoption of mHealth by the elderly: An extension of the UTAUT model. Int J Med Informatics. 2017;101:75–84.
doi: 10.1016/j.ijmedinf.2017.02.002
Pan J, Dong H, Bryan-Kinns N. Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation. JMIR aging. 2021;4(4):e30420.
doi: 10.2196/30420
pubmed: 34807836
pmcid: 8663706
Liddy C, Blazkho V, Mill K. Challenges of self-management when living with multiple chronic conditions: systematic review of the qualitative literature. Can Fam Physician. 2014;60(12):1123–33.
pubmed: 25642490
pmcid: 4264810
Moyle W, Jones C, Murfield J, Liu F. “For me at 90, it’s going to be difficult”: feasibility of using iPad video-conferencing with older adults in long-term aged care. Aging Ment Health. 2020;24(2):349–52.
Fox G, Connolly R. Mobile health technology adoption across generations: Narrowing the digital divide. Inf Syst J. 2018;28(6):995–1019.
doi: 10.1111/isj.12179
Lefler LL, Rhoads SJ, Harris M, Funderburg AE, Lubin SA, Martel ID, et al. Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study. JMIR Aging. 2018;1(2):e12178.
doi: 10.2196/12178
pubmed: 31518257
pmcid: 6715011
Kalicki AV, Moody KA, Franzosa E, Gliatto PM, Ornstein KA. Barriers to telehealth access among homebound older adults. J Am Geriatr Soc. 2021;69(9):2404–11.
doi: 10.1111/jgs.17163
pubmed: 33848360
pmcid: 8250614
Turnbull ML, Jin Y, Yau AHY, Lai MSY, Cheung MYC, Kwan WYW, et al. mHealth in hyper-connected Hong Kong: examining attitudes and access to mobile devices and health information among older Chinese residents. MHealth. 2021;7:43.
doi: 10.21037/mhealth-20-123
pubmed: 34345620
pmcid: 8326963
Cornelis TMvH, Ettema RGA, Antonietti MGEF, Kort HSM. Understanding older people’s readiness for receiving telehealth: mixed-method study. J Med Internet Res. 2018;20(4):e123.
Kapadia V, Ariani A, Li J, Ray PK. Emerging ICT implementation issues in aged care. Int J Med Informatics. 2015;84(11):892–900.
doi: 10.1016/j.ijmedinf.2015.07.002
Curtis K, Price K. Factors that influence older people’s engagement with digital health technology. Nurs Older People. 2017;29(10):27–30.
Portz JD, Fruhauf C, Bull S, Boxer RS, Bekelman DB, Casillas A, et al. “Call a Teenager… That’s What I Do!” - Grandchildren Help Older Adults Use New Technologies: Qualitative Study. JMIR aging. 2019;2(1):e13713.
Silver MP. Patient perspectives on online health information and communication with doctors: a qualitative study of patients 50 years old and over. J Med Internet Res. 2015;17(1):e19.
doi: 10.2196/jmir.3588
pubmed: 25586865
pmcid: 4319073
Rasi P, Lindberg J, Airola E. Older service users’ experiences of learning to use eHealth applications in sparsely populated healthcare settings in Northern Sweden and Finland. Educ Gerontol. 2021;47(1):25–35.
Bujnowska-Fedak MM, Mastalerz-Migas A. Usage of medical internet and e-health services by the elderly. Adv Exp Med Biol. 2015;834:75–80.
doi: 10.1007/5584_2014_74
pubmed: 25315621
Bujnowska-Fedak MM, Pirogowicz I. Support for e-health services among elderly primary care patients. Telemed J E Health. 2014;20(8):696–704.
doi: 10.1089/tmj.2013.0318
pubmed: 24359252
pmcid: 4106384
Mak SS. Mobile health technology use in vulnerable populations. Los Angeles: University of California; 2019.
Noblit GW, Hare RD. Meta-ethnography: Synthesizing qualitative studies. Newbury Park, California: Sage; 1988.
Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, et al. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017;100(4):616–35.
doi: 10.1016/j.pec.2016.10.019
pubmed: 28029572
Shin J-W, Kim EY, Son Y-J. Home-dwelling older adults’ experiences of living with both frailty and multimorbidity: A meta-ethnography. Geriatr Nurs. 2022;47:191–200.
doi: 10.1016/j.gerinurse.2022.07.015
pubmed: 35940037
Lindberg J, Bhatt R, Ferm A. Older people and rural eHealth: perceptions of caring relations and their effects on engagement in digital primary health care. Scand J Caring Sci. 2021;35(4):1322–31.
doi: 10.1111/scs.12953
pubmed: 33448031
pmcid: 9290949
Joanna Briggs Institute. Critical appraisal tools. JBI. 2020. Available from: https://jbi.global/critical-appraisal-tools .
Jakobsson E, Nygård L, Malinowsky C, Kottorp A. Experiences from using eHealth in contact with health care among older adults with cognitive impairment. Scand J Caring Sci. 2019;33(2):380–9.
doi: 10.1111/scs.12634
pubmed: 30628736
Ten BL. common pitfalls to avoid when conducting qualitative research. Br J Midwifery. 2006;14(9):530–1.
doi: 10.12968/bjom.2006.14.9.21794
Palaganas EC, Sanchez MC, Molintas VP, Caricativo RD. Reflexivity in qualitative research: A journey of learning. Qual Rep. 2017;22(2):426–38.
France EF, Cunningham M, Ring N, Uny I, Duncan EAS, Jepson RG, et al. Improving reporting of meta-ethnography: the eMERGe reporting guidance. BMC Med Res Methodol. 2019;19(1):1–13.
doi: 10.1186/s12874-018-0600-0
Feast A, Orrell M, Charlesworth G, Poland F, Featherstone K, Melunsky N, et al. Using meta-ethnography to synthesise relevant studies: Capturing the bigger picture in dementia with challenging behaviour within families. methods.sagepub.com. SAGE Publications Ltd; 2018. [cited 2023 Nov 29]. Available from: https://methods.sagepub.com/case/meta-ethnography-synthesize-relevant-studies-dementia-challenging-behavior .
Britten N, Campbell R, Pope C, Donovan J, Morgan M, Pill R. Using meta ethnography to synthesise qualitative research: a worked example. J Health Serv Res Policy. 2002;7(4):209–15.
doi: 10.1258/135581902320432732
pubmed: 12425780
Sattar R, Lawton R, Panagioti M, Johnson J. Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis. BMC Health Serv Res. 2021;21(1):50.
doi: 10.1186/s12913-020-06049-w
pubmed: 33419430
pmcid: 7796630
Iyer S, Mehta P, Weith J, Hoang-Gia D, Moore J, Carlson C, et al. Converting a Geriatrics Clinic to Virtual Visits during COVID-19: A Case Study. J Prim Care Community Health. 2021;12:21501327211000236.
Johnson A, Shukla N, Halley M, Nava V, Budaraju J, Zhang L, et al. Barriers and facilitators to mobile health and active surveillance use among older adults with skin disease. Health Expect. 2021;24(5):1582–92.
doi: 10.1111/hex.13229
pubmed: 34190397
pmcid: 8483196
Mao A, Tam L, Xu A, Osborn K, Sheffrin M, Gould C, et al. Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment. JMIR aging. 2022;5(2):e34326.
doi: 10.2196/34326
pubmed: 35438648
pmcid: 9066341
Vergouw JW, Smits-Pelser H, Kars MC, van Houwelingen T, van Os-Medendorp H, Kort H, et al. Needs, barriers and facilitators of older adults towards eHealth in general practice: a qualitative study. Primary Health Care Res Development. 2020;21:e54.
doi: 10.1017/S1463423620000547
Loza CA, Baez G, Valverdi R, Pisula P, Salas Apaza J, Discacciati V, et al. A qualitative study on the elderly and accessibility to health services during the COVID-19 lockdown in Buenos Aires, Argentina - Part 2. Medwave. 2021;21(4):e8192.
pubmed: 34086668
Watt JA, Fahim C, Straus SE, Goodarzi Z. Barriers and facilitators to virtual care in a geriatric medicine clinic: a semistructured interview study of patient, caregiver and healthcare provider perspectives. Age Ageing. 2022;51(1):afab218.
Rochmawati E, Kamilah F, Iskandar AC. Acceptance of e-health technology among older people: A qualitative study. Nurs Health sci. 2022;24(2):437–46.
Luijkx K, Peek S, Wouters E. “Grandma, you should do it—It’s cool” Older Adults and the Role of Family Members in Their Acceptance of Technology. Int J Environ Res Public Health. 2015;12(12):15470–85.
doi: 10.3390/ijerph121214999
pubmed: 26690188
pmcid: 4690935
Dodgson JE. Reflexivity in qualitative research. J Hum Lact. 2019;35(2):220–2.
doi: 10.1177/0890334419830990
pubmed: 30849272