Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study

Abstract

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.

Keywords: TAM; UTAUT; community-dwelling people; digital literacy; observations; older adults; path analysis; self-efficacy; technology; videoconferencing.

Figure 1

Theoretical framework. This framework displays the factors associated with older people’s intention to use technology. Each hypothesis is based on prior research, as shown. H=hypothesis.

Figure 2

Older people’s (n=256) intention to use videoconferencing and associated factors. Unstandardized regression coefficients are shown, derived from the path analysis. Estimates were pooled from the results of the analysis of 5 imputed datasets using Rubin’s rules. *Significant association, using a significance level of .05 (dotted-line indicates nonsignificance).

Figure 3

Understanding older people’s intention to and actual use of technology. A mixed-method framework of a multilevel regression path analysis (n=256) and qualitative observations (n=15). *Significant (alpha .05) associations; unstandardized regression coefficients are shown. The letter “a” denotes that this “Internet—actual use gap” was based on prior research.