The use of digital technologies by people with mild-to-moderate dementia during the COVID-19 pandemic: A positive technology perspective.

A growing body of research has shown that people with dementia are using digital technologies to enhance lived experience. The COVID-19 pandemic has brought new digital opportunities and challenges and so provides a unique opportunity to understand how people with dementia have adapted to this new digital landscape. Semi-structured interviews were conducted with 19 people with dementia and analysed thematically. We generated five themes, showing how participants used digital means to combat the stresses of the pandemic by facilitating social connection, self-actualisation, enhanced well-being and by assisting with activities of daily life. These technologies helped to reduce isolation, provide access to support groups, create opportunities for cognitive stimulation and self-development, and engendered a sense of identity at a time of perceived loss. Despite these benefits, participants also reported challenges regarding cognitive fatigue and usability issues. We recommend that training on how to use digital technologies is co-produced with people with dementia and designers engage with the voices of people with dementia throughout the design process. In turn, this could promote the social connectedness, well-being and self-worth of people with dementia.

Exploring digital support for the student transition to university through questionable concepts.

New students face challenges when they make the transition from school to university. Existing digital technologies used during this transition can sometimes increase the stressors associated with change. In order to explore ways forward for technology design in this space, we developed a brochure of questionable concepts. The concepts were grounded in findings of our prior research, yet were also intended to act as provocations to promote discussion in workshops involving 32 first year university students. Our analysis of workshop discussions documents the diverse issues students face around social bonding, their home environment, and their academic performance. Our findings challenge assumptions made in prior work about the ease of transition to university. We demonstrate how questionable concepts can play an important role in prompting 'safe' conversations around stressful life events for adolescents.

Life after lockdown: The experiences of older adults in a contactless digital world.

Introduction: The digital response to the Coronavirus (COVID-19) pandemic and its effects on the lives of older adults has been well-documented, but less is known about how they experienced the post-lockdown re-emergence into a relatively contactless digital society. Methods: We report the findings from a qualitative survey (n = 93) and subsequent interviews (n = 9) with older adults aged 50+, where they describe their struggles with some of the newly implemented digital interactions. These struggles cover a range of settings but include using contactless payments, QR codes and apps to facilitate transactions in cafes, bars, and restaurants. Results: A thematic analysis of our data revealed the intrinsic (e.g. digital literacy) and extrinsic (e.g. malfunctioning technology) factors that limited social inclusion for these participants, and that sometimes even led to moments of public humiliation. Discussion: Our findings shed light on some of the motivational factors that underpin the age-related digital divide, whilst also highlighting the role of self-directed agism in limiting motivations to learn new digital routines.

'Getting back to normality seems as big of a step as going into lockdown': the impact of the COVID-19 pandemic on people with early to middle stage dementia.

People with dementia can experience shrinkage of their social worlds, leading to a loss of independence, control and reduced well-being. We used 'the shrinking world' theory to examine how the COVID 19 pandemic has impacted the lives of people with early to middle stage dementia and what longer-term impacts may result. Interviews were conducted with 19 people with dementia and a thematic analysis generated five themes: the forgotten person with dementia, confusion over government guidance, deterioration of cognitive function, loss of meaning and social isolation, safety of the lockdown bubble. The findings suggest that the pandemic has accelerated the 'shrinking world' effect and created tension in how people with dementia perceive the outside world. Participants felt safe and secure in lockdown but also missed the social interaction, cognitive stimulation and meaningful activities that took place outdoors. As time in lockdown continued, these individuals experienced a loss of confidence and were anxious about their ability to re-engage in the everyday practises that allow them to participate in society. We recommend ways in which the government, communities and organisations might counteract some of the harms posed by this shrinking world.

Framing Effects on Online Security Behavior.

We conducted an incentivized lab experiment examining the effect of gain vs. loss-framed warning messages on online security behavior. We measured the probability of suffering a cyberattack during the experiment as the result of five specific security behaviors: choosing a safe connection, providing minimum information during the sign-up process, choosing a strong password, choosing a trusted vendor, and logging-out. A loss-framed message led to more secure behavior during the experiment. The experiment also measured the effect of trusting beliefs and cybersecurity knowledge. Trusting beliefs had a negative effect on security behavior, while cybersecurity knowledge had a positive effect.

Corrigendum: Technological Change in the Retirement Transition and the Implications for Cybersecurity Vulnerability in Older Adults.

[This corrects the article on p. 623 in vol. 11, PMID: 32425841.].

Technological Change in the Retirement Transition and the Implications for Cybersecurity Vulnerability in Older Adults.

Retirement is a major life transition, which leads to substantial changes across almost all aspects of day-to-day life. Although this transition has previously been seen as the normative marker for entry into older adulthood, its influence on later life has remained relatively unstudied in terms of technology use and cybersecurity behaviours. This is problematic as older adults are at particular risk of becoming victims of cyber-crime. This study aimed to investigate which factors associated with the retirement transition were likely to increase vulnerability to cyber-attack in a sample of 12 United Kingdom based older adults, all of whom had retired within the past 5 years. Semi-structured, one to one interviews were conducted and subsequently analysed using thematic analysis. Six themes were identified referring to areas of loss in: social interaction, finances, day-to-day routine, feelings of competence, sense of purpose, and technology support structures. We discuss the implications of these losses for building cyber-resilience in retirees, with suggestions for future research.

A Revised Model of Trust in Internet-Based Health Information and Advice: Cross-Sectional Questionnaire Study.

BACKGROUND: The internet continues to offer new forms of support for health decision making. Government, charity, and commercial websites increasingly offer a platform for shared personal health experiences, and these are just some of the opportunities that have arisen in a largely unregulated arena. Understanding how people trust and act on this information has always been an important issue and remains so, particularly as the design practices of health websites continue to evolve and raise further concerns regarding their trustworthiness. OBJECTIVE: The aim of this study was to identify the key factors influencing US and UK citizens' trust and intention to act on advice found on health websites and to understand the role of patient experiences. METHODS: A total of 1123 users took part in an online survey (625 from the United States and 498 from the United Kingdom). They were asked to recall their previous visit to a health website. The online survey consisted of an updated general Web trust questionnaire to account for personal experiences plus questions assessing key factors associated with trust in health websites (information corroboration and coping perception) and intention to act. We performed principal component analysis (PCA), then explored the relationship between the factor structure and outcomes by testing the fit to the sampled data using structural equation modeling (SEM). We also explored the model fit across US and UK populations. RESULTS: PCA of the general Web trust questionnaire revealed 4 trust factors: (1) personal experiences, (2) credibility and impartiality, (3) privacy, and (4) familiarity. In the final SEM model, trust was found to have a significant direct effect on intention to act (beta=.59; P<.001), and of the trust factors, only credibility and impartiality had a significant direct effect on trust (beta=.79; P<.001). The impact of personal experiences on trust was mediated through information corroboration (beta=.06; P=.04). Variables specific to electronic health (eHealth; information corroboration and coping) were found to substantially improve the model fit, and differences in information corroboration were found between US and UK samples. The final model accounting for all factors achieved a good fit (goodness-of-fit index [0.95], adjusted goodness-of-fit index [0.93], root mean square error of approximation [0.50], and comparative fit index [0.98]) and explained 65% of the variance in trust and 41% of the variance in intention to act. CONCLUSIONS: Credibility and impartiality continue to be key predictors of trust in eHealth websites. Websites with patient experiences can positively influence trust but only if users first corroborate the information through other sources. The need for corroboration was weaker in the United Kingdom, where website familiarity reduced the need to check information elsewhere. These findings are discussed in relation to existing trust models, patient experiences, and health literacy.

Personality and Social Framing in Privacy Decision-Making: A Study on Cookie Acceptance.

Despite their best intentions, people struggle with the realities of privacy protection and will often sacrifice privacy for convenience in their online activities. Individuals show systematic, personality dependent differences in their privacy decision making, which makes it interesting for those who seek to design 'nudges' designed to manipulate privacy behaviors. We explore such effects in a cookie decision task. Two hundred and ninety participants were given an incidental website review task that masked the true aim of the study. At the task outset, they were asked whether they wanted to accept a cookie in a message that either contained a social framing 'nudge' (they were told that either a majority or a minority of users like themselves had accepted the cookie) or contained no information about social norms (control). At the end of the task, participants were asked to complete a range of personality assessments (impulsivity, risk-taking, willingness to self-disclose and sociability). We found social framing to be an effective behavioral nudge, reducing cookie acceptance in the minority social norm condition. Further, we found personality effects in that those scoring highly on risk-taking and impulsivity were significantly more likely to accept the cookie. Finally, we found that the application of a social nudge could attenuate the personality effects of impulsivity and risk-taking. We explore the implications for those working in the privacy-by-design space.

Reminiscence through the Lens of Social Media.

Reminiscence is used to support and create new social bonds and give meaning to life. Originally perceived as a preoccupation of the aged, we now recognize that reminiscence has value throughout the lifespan. Increasingly, social media can be used to both support and prompt reminiscence, with Facebook's Lookback or Year in Review as recent examples. This work takes prompted reminiscence further, asking what forms and functions of reminiscence are supported by social media. Utilizing the online service MySocialBook, we invited participants to curate content from their personal Facebook account to then be transformed into a printed book. We used that book as a prompt for discussion of the reminiscence function of the curated material, using Westerhof and Bohlmeijer's (2014) reminiscence framework as a starting point. We conclude that this framework is valuable in understanding the role of social media in reminiscence, but note that earlier models, such as Webster's Reminiscence Functions Scale, are also relevant. We contribute to the reminiscence debate by adding a technological lens to the process of life review, whilst concurring with other researchers in this field that a robust conceptual framework is lacking, particularly when considering the forms of reminiscence that are most salient for younger people.

Twitter Influence on UK Vaccination and Antiviral Uptake during the 2009 H1N1 Pandemic.

OBJECTIVE: Information exchange via Twitter and other forms of social media make public health communication more complex as citizens play an increasingly influential role in shaping acceptable or desired health behaviors. Taking the case of the 2009-2010 H1N1 pandemic, we explore in detail the dissemination of H1N1-related advice in the UK through Twitter to see how it was used to discourage or encourage vaccine and antiviral uptake. METHODS: In three stages we conducted (1) an analysis of general content, retweeting patterns, and URL sharing, (2) a discourse analysis of the public evaluation of press releases and (3) a template analysis of conversations around vaccine and antiviral uptake, using Protection Motivation Theory (PMT) as a way of understanding how the public weighed the costs and benefits. RESULTS: Network analysis of retweets showed that information from official sources predominated. Analysing the spread of significant messages through Twitter showed that most content was descriptive but there was some criticism of health authorities. A detailed analysis of responses to press releases revealed some scepticism over the economic beneficiaries of vaccination, that served to undermine public trust. Finally, the conversational analysis showed the influence of peers when weighing up the risks and benefits of medication. CONCLUSION: Most tweets linked to reliable sources, however Twitter was used to discuss both individual and health authority motivations to vaccinate. The PMT framework describes the ways individuals assessed the threat of the H1N1 pandemic, weighing this against the perceived cost of taking medication. These findings offer some valuable insights for social media communication practices in future pandemics.

How do carers of people with multiple sclerosis engage with websites containing the personal experiences of other carers and patients?

The Internet supports the peer-to-peer healthcare and the promotion of shared patient narratives. Websites incorporating these narratives or personal accounts are known to offer support to carers of people with multiple sclerosis, but little is known about how carers make choices about what websites to visit and why. In total, 20 carers viewed a range of websites and online personal accounts about multiple sclerosis and subsequently took part in either a group discussion or an individual interview, followed by 2 weeks and 12 months and later by a telephone interview. Data were subjected to thematic analysis with the aim of understanding more about what drives engagement with the stories of others. We found that carers' interpersonal and coping needs shaped their selection of online narratives, and that they were most likely to engage with online personal accounts that provided a good match in terms of experience and perspective.

Location tracking: views from the older adult population.

BACKGROUND: there has been a rise in the use of social media applications that allow people to see where friends, family and nearby services are located. Yet while uptake has been high for younger people, adoption by older adults is relatively slow, despite the potential health and social benefits. In this paper, we explore the barriers to acceptance of location-based services (LBS) in a community of older adults. OBJECTIVE: to understand attitudes to LBS technologies in older adults. METHODS: eighty-six older adults used LBS for 1-week and completed pre- and post-use questionnaires. Twenty available volunteers from the first study also completed in-depth interviews after their experience using the LBS technology. RESULTS: the pre-use questionnaire identified perceptions of usefulness, individual privacy and visibility as predictive of intentions to use a location-tracking service. Post-use, perceived risk was the only factor to predict intention to use LBS. Interviews with participants revealed that LBS was primarily seen as an assistive technology and that issues of trust and privacy were important. CONCLUSION: the findings from this study suggest older adults struggle to see the benefits of LBS and have a number of privacy concerns likely to inhibit future uptake of location-tracking services and devices.

How do people with asthma use Internet sites containing patient experiences?

OBJECTIVE: To understand how people engage with websites containing patient authored accounts of health and illness. To examine how people with asthma navigate their way through this information and make use of the patient experiences they find. METHODS: Twenty-nine patients with diagnoses ranging from mild to severe asthma were shown a range of websites, some containing patient experiences, and selected two sites to explore further. They discussed their choices in a series of focus groups and interviews. RESULTS: Participants were influenced initially by the design quality of the sites and were subsequently drawn to websites containing patient experiences but only when contributions were from similar people offering 'relevant stories'. The experiences reminded participants of the serious nature of the disease, provided new insights into the condition and an opportunity to reflect upon the role of the disease in their lives. CONCLUSION: For people with asthma websites containing other patients' personal experiences can serve as a useful information resource, refresh their knowledge and ensure their health behaviours are appropriate and up-to-date. PRACTICE IMPLICATIONS: Health professionals should consider referring asthma patients to appropriate websites whilst being aware that online experiences are most engaging when they resonate with the participants own situation.

Perceived threat and corroboration: key factors that improve a predictive model of trust in internet-based health information and advice.

BACKGROUND: How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. OBJECTIVE: The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes. METHODS: Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software. RESULTS: We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ(2) (5) = 10.8 (P = .21), comparative fit index = .99, root mean square error of approximation = .052. The model accounted for 66% of the variance in trust and 49% of the variance in readiness to act on the advice. CONCLUSIONS: Adding variables specific to eHealth enhanced the ability of a model of trust to predict trust and readiness to act on advice.

Exploring patterns of daily physical and sedentary behaviour in community-dwelling older adults.

BACKGROUND: recent evidence suggests that the interaction between periods of sedentary and activity behaviour is important for health; providing distinctive information to assessment of activity alone. This study quantified activity and sedentary behaviour in older, community-dwelling adults. METHODS: fifty-six community-dwelling older adults with an average age 79 (SD) years wore an ActivPAL accelerometer for 7 days and were assessed for a range of motor, cognitive and affective characteristics. Seven variables derived from accelerometry considered to represent four characteristics of habitual behaviour (volume, frequency, intensity and variability) were submitted to principal components factor analysis (PCA). Factor scores were retained and used as dependent variables in regression analysis. RESULTS: three significant orthogonal factors emerged from the PCA, accounting for 80% of the variance in test scores: 'walking behaviour' which accounted for 39% of variance in the model; 'sedentary behaviour' explaining 24.3% of total variance; and 'postural transitions' which accounted for 16.7% of total variance. For the regression analysis, younger age and lower body mass index (BMI) emerged as significant predictors of physical behaviour, explaining 36% of the total variance. For postural transitions, lower BMI was the unique contributor, explaining 15% of total variance. Significant predictors of sedentary behaviours were not identified. CONCLUSIONS: walking, sedentary and transitory behaviours are distinct from each other, and together explain daily function. Further research on a larger sample is indicated to explore the characteristics that explain these behaviours, in particular the interplay between sedentary behaviour and periods of physical activity.

How do patients evaluate and make use of online health information?

Increasing numbers of people are turning to the Internet for health advice despite reports that sites vary in terms of their quality. How do they decide whether or not to trust the advice they find online? A staged model of trust development is proposed and tested here in a longitudinal study in which fifteen women faced with decisions concerning the menopause and hormone replacement therapy (HRT) were observed while searching the Internet for information and advice over four consecutive weeks and then kept diaries over a six-month follow-up period. The women were all resident in the North-East of England and were recruited through advertisements in the local media. The study provided general support for a three-stage model of trust in which participants firstly engaged in rapid heuristic processing of information, efficiently sifting and rejecting general sales sites and portals but sometimes rejecting high-quality content because of poor design. Well-designed sites were then effectively interrogated for credible and personalized content before being designated trustworthy. The women appeared to act much like 'scientists' using web material to generate and test hypotheses and theories about HRT, although their capacity to deal with certain forms of risk information was limited. They subsequently reported integrating online advice with offline advice from friends, family and physicians in order to be fully confident in their final decisions. Women felt that the Internet influenced their decision-making and improved communications with physicians. Personalized stories from like-minded others improved trust perceptions. Despite the use of the Internet the physician was still seen as the primary source of information and advice.

Locked into gambling: anticipatory regret as a motivator for playing the National Lottery.

Four hundred and eighty-five people were asked about their intentions to play the National Lottery in England a week prior to the introduction of a new midweek draw. We predicted that those people who played the Saturday game with a regular set of numbers would be more inclined to play the new midweek game than those who had not established a routine of using the same set of numbers. We further predicted that their motivation to play would derive from a feeling of 'anticipatory regret'--a sense that they would find it intolerable to discover their regular numbers had been drawn when they hadn't purchased a ticket. Results supported both of these predictions, and an interpretation of the data is given in terms of the circumstances most likely to trigger such counterfactual reasoning.