Improving Meaningful Access of Internet Health Information for Older Adults (Florida)

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Summary:

There has been enormous growth in the development of consumer-oriented health information technology (IT) applications designed to support tasks such as the exchange of health information, communication, health decisionmaking, and disease management. Many older adults have less experience with computers and the Internet than other age groups and thus obtaining health information from this source may be challenging for them. Studies have shown that older adults use less-efficient search strategies and have less success finding specific information than do younger adults. Given the aging population and that older adults represent a large segment of the consumer health population, it is important to identify ways to reduce barriers to their access and use of health IT applications.

This study refined a set of tools to help health care consumers, particularly older adults, complete Internet-based health management tasks, and evaluated the usability and efficiency of the tools.

The specific aims of this project were to:

  • Refine, through a user-centered iterative design process, a set of software aiding tools so that they can be used by health consumers, particularly older adults, in the performance of Internet-based health management tasks.
  • Evaluate the feasibility, acceptability, and usability of these tools among adult health consumers and the impact of the use of these tools on the performance of Internet-based health management tasks.

The study had two phases. The first involved adapting four specific tools designed to aid health information-seeking tasks on the Internet. Focus groups with older adults were held to learn about perceived benefits and concerns of the tools. Potential usability problems were identified by a task-analysis study.

In the second phase, a randomized trial was conducted in which the intervention group had access to the adapted tools, while the control group did not. All participants had prior computer and Internet experience and were required to complete two brief Internet search tests, one easy and the other more complex, before they could be part of the study. Participants were randomly assigned to one of four conditions and asked to complete a set of defined information-seeking tasks. Those who used the tools were asked to rate their potential usefulness and usability.

Participants found the tools to be useful and of potential value in aiding their information seeking activities. However, performance was generally lower among those who used the tools than those that did not. Training was conducted immediately before the participants performed the tasks, and the study team hypothesized that the users focused more on how to use the tool itself than on completing the task. While repeated use of the tools over time may lead to improved performance, the study data suggested that the tools as designed may be too complex from a usability standpoint for older adults. All participants, irrespective of task, showed an increase in health knowledge following completion of the tasks, indicating that engaging in Internet information-seeking activities may enhance an individual’s overall health knowledge.

The study team concluded that if the tools become publically available, training and instructional support materials are critical. The project team developed recommendations for the redesign of the tools and hope to see the refined tools evaluated with a larger sample over an extended period of time.

Improving Meaningful Access of Internet Health Information for Older Adults - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018831
  • Project Period: 
    April 2011 – September 2013
  • AHRQ Funding Amount: 
    $231,476
  • PDF Version: 
    (PDF, 305.19 KB)

Summary: There has been enormous growth in the development of consumer-oriented health information technology (IT) applications designed to support the exchange of health information, communication, health decisionmaking, and disease management. These applications are intended to support the delivery and self-management of health care, and ultimately improve health outcomes.

Data suggest that the usability and utility of many of the Internet-available consumer health IT applications— such as health Web sites—are uneven across user groups. This is especially true for older adults, whose age-related cognitive changes can impair their ability to find information on the Internet. Furthermore, many older adults have less experience with and more anxiety about using computers and the Internet than do younger people. Studies have shown that older adults use less-efficient search strategies and have less success finding specific information than do younger adults. For these reasons, finding, using, and discerning the reliability of Internet health information, as well as integrating and interpreting the wealth of information available, may be challenging for older people. Given the aging population and the fact that older adults represent a large segment of the consumer health population, it is important to identify ways to reduce barriers to access and use of health IT applications by older adult consumers when implementing these applications.

This study involves refining and testing four existing cognitive aiding tools that are designed to help individuals filter, integrate, and interpret Internet health information. The refinement process is intended to enhance the usability of the tools to support effective use of health IT applications by older adult consumers. Drs. Sara Czaja and Joseph Sharit and their research team at the University of Miami Miller School of Medicine are collaborating with the Palo Alto Research Corporation to conduct this two-phase study.

In Phase I, the research team conducted an iterative tool-refinement process that began with a detailed task analysis of the tools to inform initial refinement. A series of focus groups involving older adult users and clinicians who work with older adults and underserved populations was conducted to provide a preliminary assessment of the usability of the tools. Findings from the focus groups informed additional refinements to the tools. A second cycle of usability testing of the refined tools was completed in 2012.

In Phase II, the tools will be formally evaluated with a randomized study comparing “aided” to “unaided” adults aged 30-85 years. Both groups will receive general practice on Internet searching, while participants assigned to the aided group will also receive training and practice on each of the four refined cognitive aiding tools. Subsequently, both groups will be assigned scenarios and problem-solving tasks to complete. The aided group will have access to the four tools to assist in completing the tasks; the unaided group will not. The feasibility, acceptability, and usability of the aiding tools and their impact on the performance of Internet-based health management tasks will be evaluated by measuring information-seeking performance, domain knowledge, tool use, and usability of the tools. This project will obtain information on the influence of individual characteristics such as age, cognitive abilities, and health literacy on information-seeking performance and the perceived usability and use of the tools. Ultimately, the tool refinement process and tool evaluation findings will be used to develop a set of tools that are easy to use and support effective use of e-health applications by older adult health care consumers.

Specific Aims:

  • Refine, through a user-centered iterative design process, a set of software aiding tools so that they can be used by health consumers, particularly older adults, in the performance of Internet-based health management tasks. (Achieved)
  • Evaluate the feasibility, acceptability, and usability of these tools among adult health consumers and the impact of the use of these tools on the performance of Internet-based health management tasks. (Ongoing)

2012 Activities: Upon completing the refinement process for the four aiding tools in 2011, the project team began work on evaluating the feasibility, acceptability, and usability of the tools in 2012. The tools were pilot-tested before initiating the randomized trial, which revealed that the data collection protocol and tools were not appropriate for the target population of this study. The study investigators determined it was necessary to revise the data collection protocol and tools to better meet the needs of older adults, while also maintaining the integrity of the study and the quality of the data to be collected. This change resulted in significant delays as the tools and a new data collection protocol were developed and approved by the institutional review board. Dr. Czaja is using a 1-year no-cost extension to extend the project period through September 2013 to provide additional time to conduct the randomized trial, which will open to enrollment in January 2013.

As last reported in the AHRQ Research Reporting System, project progress is mostly on track and budget spending is on target.

Preliminary Impact and Findings: Findings from the focus groups conducted as part of the user-centered iterative design process indicated that the four tools are helpful and that older adults would use them.

Target Population: Adults, Elderly*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

*This target population is one of AHRQ’s priority populations.

Improving Meaningful Access of Internet Health Information for Older Adults - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018831
  • Project Period: 
    April 2011 - September 2012
  • AHRQ Funding Amount: 
    $231,476
  • PDF Version: 
    (PDF, 201.82 KB)

Summary: There has been enormous growth in the development of consumer-oriented health information technology (IT) applications designed to support tasks such as the exchange of health information, communication, health decisionmaking, and disease management. These applications are intended to support the delivery and self-management of health care and ultimately improve health outcomes. Data suggest that the usability and utility of many consumer health IT applications that are available on the Internet, such as health Web sites, are uneven across user groups.

This is especially true for older adults whose age-related cognitive changes can impair their ability to find information on the Internet. Many older adults have less experience with computers and the Internet than other age groups. Finding, using, and discerning the reliability of Internet health information, as well as integrating and interpreting the wealth of information available, may be challenging for older people. In fact, when compared to younger adults, older adults report more anxiety about technology adoption. Studies have shown that older adults use less-efficient search strategies and have less success finding specific information than do younger adults. Given our aging population and the fact that older adults represent a large segment of the consumer health population, it is important to consider and identify ways to reduce barriers to access and use health IT applications by older adult consumers when implementing health IT applications.

This study is refining four existing cognitive aiding tools that are designed to help individuals filter, integrate, and interpret Internet health information. The refinement process is intended to enhance the usability of the tools to support effective use of health IT applications by older adult consumers. Dr. Sara Czaja and her research team at the University of Miami Miller School of Medicine is collaborating with the Palo Alto Research Corporation to conduct this two-phased study.

In Phase I, the research team is conducting an iterative tool-refinement process that began with a detailed task analysis of the tools to inform initial refinement. A series of focus groups involving older adult users and clinicians who work with older adults and underserved populations was conducted to provide a preliminary assessment of the usability of the tools. Findings from the focus groups informed additional refinements to the tools. A second cycle of usability testing of the refined tools will be completed in 2012.

During the second phase of the study, the tools will be formally evaluated with a randomized study comparing "aided" to "unaided" adults 30 to 85 years of age. Both groups will receive general practice on Internet searching, while participants assigned to the "aided" group will also receive training and practice on each of the four refined cognitive aiding tools. Subsequently, both groups will be assigned scenarios and problem-solving tasks to complete. The "aided" group will have access to the four tools to assist in completing the tasks; the "unaided" group will not. The feasibility, acceptability, and usability of the aiding tools and their impact on the performance of Internet-based health management tasks will be evaluated by measuring information-seeking performance, domain knowledge, tool use, and usability of the tools. This project will obtain information on the influence of individual characteristics such as age, cognitive abilities, and health literacy on information-seeking performance and the perceived usability and use of the tools. Ultimately, the tool refinement process and tool evaluation findings will be used to develop a set of tools that are easy to use and support effective use of e-health applications by older adult health care consumers.

Specific Aims:

  • Refine, through a user-centered iterative design process, a set of software aiding tools so that they can be used by health consumers, particularly older adults, in the performance of Internet-based health management tasks. (Ongoing)
  • Evaluate the feasibility, acceptability, and usability of these tools among adult health consumers and the impact of the use of these tools on the performance of Internet-based health management tasks. (Upcoming)

2011 Activities: The four aiding tools have undergone initial testing and refinement, first by a task analysis in which the research team reviewed, evaluated, and modified the tools accordingly. Subsequently, an initial usability assessment was conducted by holding a series of focus groups with older adults, the findings from which led to additional revisions and design changes to the four tools to enhance usability. Final refinements are being made, and the formal evaluation tool study will be initiated in 2012.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track, and project budget spending is roughly on target.s last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and project spending is on target. Dr. Ciemins is using a 1-year no-cost extension to ensure adequate time to complete data collection, medication reviews, and data analysis.

Preliminary Impact and Findings: Findings from the focus groups conducted as part of the usercentered iterative design process indicate that the four tools are helpful and that older adults would use them.

Target Population: Adults, Elderly*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

* This target population is one of AHRQ's priority populations.

Improving Meaningful Access of Internet Health Information for Older Adults - Final Report

Citation:
Czaja S. Improving Meaningful Access of Internet Health Information for Older Adults - Final Report. (Prepared by the University of Miami under Grant No. R21 HS018831). Rockville, MD: Agency for Healthcare Research and Quality, 2013. (PDF, 439.18 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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