Aideen J. Stronge

Older Adults, Computer Training, and the Systems Approach: A Formula for Success.

Adults over the age of 65 are the fastest growing segment of computer users. Due to this increased demand, effective training programs are essential. Although previous research findings illustrate the importance of older adults’ goals, abilities, and experience levels in learning to use computers, these factors are often neglected in the development of computer training courses. We apply a systems approach to help bridge this gap between research and practice to address the disparity between what older adults would like to learn and the content of computer training courses. We review the literature on training older adults to use computers and report data from a set of structured interviews to illustrate the criticality of each step in the systems approach. Lastly, we provide the means to evaluate existing computer training programs and suggest modifications for improvement. Our purpose is not to evaluate specific programs, but to educate developers about an approach that has proven successful. Specifically, we provide suggestions for effective computer training for older adults.

Web-based information search and retrieval : Effects of strategy use and age on search success

Objective: The purpose of this study was to investigate the relationship between strategy use and search success on the World Wide Web (i.e., the Web) for experienced Web users. An additional goal was to extend understanding of how the age of the searcher may influence strategy use. Background: Current investigations of information search and retrieval on the Web have provided an incomplete picture of Web strategy use because participants have not been given the opportunity to demonstrate their knowledge of Web strategies while also searching for information on the Web. Methods: Using both behavioral and knowledge-engineering methods, we investigated searching behavior and system knowledge for 16 younger adults (M = 20.88 years of age) and 16 older adults (M = 67.88 years). Results: Older adults were less successful than younger adults in finding correct answers to the search tasks. Knowledge engineering revealed that the age-related effect resulted from ineffective search strategies and amount of Web experience rather than age per se. Our analysis led to the development of a decision-action diagram representing search behavior for both age groups. Conclusion: Older adults had more difficulty than younger adults when searching for information on the Web. However, this difficulty was related to the selection of inefficient search strategies, which may have been attributable to a lack of knowledge about available Web search strategies. Application: Actual or potential applications of this research include training Web users to search more effectively and suggestions to improve the design of search engines.

Older adults' perceptions of usefulness of personal health records

Electronic personal health records (PHRs) have the potential to both make health information more accessible to patients and function as a decision-support system for patients managing chronic conditions. Age-related changes in cognition may make traditional strategies of integrating and understanding existing (i.e., paper-based) health information more difficult for older adults. The centralized and integrated nature of health information, as well as the long-term tracking capabilities present in many PHRs, may be especially beneficial for older patients’ management of health. However, older adults tend to be late adopters of technology and may be hesitant to adopt a PHR if the benefits are not made clear (perceived usefulness). Toward the design of a useful PHR, a needs analysis was conducted to determine how people currently manage their health information, what they perceive as useful, and to identify any unmet needs. This paper describes two qualitative studies examining the health information needs of both younger and older adults. The first study used a 2-week diary methodology to examine everyday health questions or concerns, while the second study examined maintenance of health information and perceptions of PHRs through the use of a three-part interview. User’s perceptions of the usefulness of PHRs are provided as recommendations for the design of e-health technology, especially those targeted for older adult healthcare consumers. The results suggest that both older and younger adults would deem a PHR useful if it provides memory support in the form of reminders, provides tools to aid in comprehension of one’s health concerns, is interactive and provides automatic functions, and is highly accessible to authorized users, yet one’s information is kept secure and private.

Systematic human factors evaluation of a teledermatology system within the U.S. military.

The benefits of telemedicine systems within the U.S. military have been widely recognized. However, a number of telemedicine systems have encountered resistance and have failed to be adopted and widely used. The purpose of the present project was to use a human factors analysis to characterize the facilitators and impediments to the use of a teledermatology system. More specifically, the goal was to investigate areas such as training, workload distribution, and communication between team members because these topics can be broadly classified as human factors issues. Across different sites, structured interviews were administered to three user groups within the system (i.e., consult managers, primary care managers who are comparable to civilian primary care physicians, and dermatologists). All three user groups reported that system support, speed, personal benefits, and increased education and experience were facilitators to system use; impediments were usability problems and insufficient training. However, each user group also identified unique facilitators and impediments. For example, users at the referring site (consult managers and primary care managers) focused on workload distribution among team members and the importance of onsite support as facilitators. In contrast, key facilitators for physicians (primary care and dermatologists) were effective communication, professional benefits, and increased quality of patient care. Human factors issues are critical for successful telemedicine systems and user issues may vary across user groups. The method reported herein provides guidance for development of new telemedicine systems and evaluation of existing telemedicine systems to increase adoption and usage.

Human factors and ergonomics: bridging psychology and technology in telemedicine applications

The field of human factors strives to optimise the performance, efficiency, and safety of human-machine systems by obtaining a clear understanding of the cognitive, perceptual and motor capabilities and limitations of users and their environment (both the physical environment and organisational climate). Thus, it is a science expressly devoted to many critical components of telemedicine systems. For example, telemedicine system users interact with potentially unfamiliar technology (e.g. digital cameras), individuals (e.g. doctors and patients), and information (e.g. technical instructions for a referring physician). In addition to these issues that users face on a regular basis, organisational issues exist, such as the management and overseeing of the system and the designation of various user roles within the system. Human factors researchers and practitioners employ multiple methods to evaluate psychological, macroergonomic, and usability issues that face users, as well as to provide design recommendations to improve system efficiency. These methods include task analysis, qualitative research methods (e.g. interviews and surveys), usability analysis, and quantitative research methods (e.g. questionnaires and experimental research). If telemedicine systems are to be successful and widely adopted, human factors evaluations and interventions must play a critical role in their development and continued improvement.

How would you describe the world wide web? Analogies of the web from users

Due to the complexity of the World Wide Web, it is difficult to give novices an accurate description. It has been suggested that when learning new things, we use metaphors to link new concepts to our existing knowledge domain (Mati, 1994). Research has shown that people who were taught to use a mental model when learning to operate an unfamiliar system had superior performance to those that did not (Fein, Olson, and Olson, 1992; Kieras and Bovair, 1984). What is an appropriate metaphor for the web? Although television has been the dominant metaphor, Nielsen (1999) suggests that the telephone is by far the best metaphor because both the telephone and the Web involve the interactive exchange of information between two parties. Shneiderman (1997) suggests that the most frequent metaphor for the Web is the presentation of information (e.g., encyclopedia with articles, television with channels). Metaphors usage is encouraged in the design of user interfaces because regardless of the experience level of the user, metaphors can incorporate both attractive and familiar elements for most users (Marx, 1992; Vaananen and Schmidt, 1994). Similarly for novice users, an analogy or metaphor for the Web might be well in helping novice users understand the Web. The purpose of the present study was to evaluate the analogies and explanations of the World Wide Web that current users generate. A paper and pencil survey of 41 college-aged students &I = 20.2 years old) with varying levels of computer and Internet experience was conducted. The survey first assessed their level of computer experience by asking questions related to length of time of computer use and types of activities done on a computer. The Web experience section assessed Internet experience by asking questions related to length of time of Web use as well as type of activities the Web was used for. Participants were then asked explicitly what their representation or analogy of the Web was. Each participant was asked to generate up to three analogies and explain why each analogy was appropriate and how it might be inappropriate. Each analogy was coded on several dimensions that included complexity of analogy (e.g., number of ideas or objects used in analogy and whether they were interactive or independent), categorization of analogy (e.g., content analysis of the structure or fimction the analogy represents), and level of reasoning/quality (e.g., deep conceptual versus surface physical). Responses for analogies varied from the simple (e.g., “library”) to more complex (e.g., “imagine a spider web with a computer at each node, where two or more strands connect”). By far the most common analogy reported by all participants focused cm the Web as an information repository or source. The results are informative because they highlight how users with different experience levels think about the Web and its use. The ultimate goal will be to use the analogies generated by experienced users as part of a training program for novice Web users.

Examining Non-Critical Health Information Seeking: A Needs Analysis for Personal Health Records

Keeping track of health information may be burdensome for older adults who may be more likely to have health concerns and questions than other age groups. The management of their health information may be aided by web-based health information management tools (e.g., personal health records). However, it is currently not known what kinds of health information potential users seek and need or want to manage. The current study examined the health information needs of both older and younger adults, to better understand how e-health technology can aid health information management. Seventeen younger and twenty-four older adults kept a health diary for a two-week period, making one entry for each health concern or question they had and how they solved it.

Methodological Considerations in a Human Factors Assessment of a Teledermatology System

The U.S. military has initiated several telemedicine programs ranging from teledermatology to telemental health. Several advantages of telemedicine programs have been documented including increased patient satisfaction and decreased healthcare costs. However, not all telemedicine programs in the military have been successful (i.e., widely used). This analysis used multiple methods to identify the human factors issues involved in using a teledermatology system. The methods included task analyses, decision-action diagrams, and a questionnaire distributed to subject matter experts (SMEs). In a progressive fashion, each method contributed to development of the next method. Task analyses guided the development of decision-action diagrams. Decision-action diagrams identified critical human factors issues within the system and led to the development of questionnaire items specifically targeting those areas (e.g., workload, errors). The results from this assessment demonstrate how multiple methods can be used to analyze a system, identify human factors issues, and suggest interventions.

Doctor-Patient Communication: Guidelines for Improvements

Effective communication between patients and their healthcare providers is essential to positive health outcomes. Older adults may be at a disadvantage during communication exchanges due to age-related sensory declines and cognitive changes. Understanding the role of these age-related changes may lead to interventions that will ameliorate the disadvantages older adults face in the health communication process. Twenty-four older adults were interviewed to obtain an understanding of the difficulties older adults face during health communication. The findings suggest that older adults do have health communication problems. They are, however, able to generate strategies to solve these problems when problems are presented in hypothetical scenarios. Based on the findings, a brochure was developed to provide strategies and guidelines to help anticipate and resolve health communication problems.

Exploring Communication between Health Care Professionals and Older Adults

The purpose of this study is to understand the communication problems that older adults may encounter when interacting with their health care professionals. In particular, we are interested in the types of communication problems older adults have experienced such as memory, comprehension, and sensory issues. A structured interview consisting of two parts was designed to gather this information. The first part focuses on the specific communication problems participants may have had. The second part of the study involves six scenarios in which a fictitious patient has a communication problem with a health care professional. The goal of the scenarios is to determine the types of strategies, if any, participants recommend using when faced with communication problems with their health care professional. The findings from this study will be used to identify and categorize problems and strategies to inform design solutions to remedy these communication problems.