The Relationship Between Individual Coping and the Need to Have and Seek Health Information Among Older Adults: Exploratory Mixed Methods Study.

BACKGROUND: The need to have and seek information shapes the context of computing systems. When it comes to health, individual coping influences human behavior. Therefore, the relationship between individual coping and the need to have and seek health information plays a crucial role in the development of digital health systems. OBJECTIVE: This study aims to examine the relationship between individual coping and the need to have and seek health information among older adults. METHODS: Questionnaires and semistructured interviews investigated the health information need (HIN) and health information-seeking behavior (HISB) in relation to the individual coping strategies of 26 older Germans. RESULTS: The mean age of the interviewed group was 71 years (SD 7). Quantitatively, a trend was found for a negative correlation between the avoidance-oriented coping and HIN (rs=-0.37895; bias-corrected and accelerated bootstrap 95% BCa CI -0.730 to 0.092; P=.05). The qualitative results supported this finding. For some participants, information and exchange was part of dealing with their health situation, whereas others wanted to learn as little as possible to avoid a decline in their health status. The older adults acquired, collected, and exchanged paper-based health data to augment clinical information sources and support information exchange with professionals. CONCLUSIONS: Individual coping strategies are relevant for the design of digital health systems. They can support older adults in coping with their health situation, although it remains unclear how systems must be designed for people with an avoidance coping strategy to achieve the same acceptance.

Predicting technology usage by health information need of older adults: Implications for eHealth technology.

BACKGROUND: Information and communication technology increasingly addresses the information needs patients have regarding their personal health. While an understanding of older adults' needs is crucial for developing successful eHealth technology, user research results hardly apply to different systems. OBJECTIVE: The present study aims at: (1) describing and analysing the context of digital health systems in a general manner, (2) investigating if information need of older adults influences their technology usage to show the relevance of the concept for a general context analysis and (3) testing which demographic variables intervene with their health information need. METHODS: Survey data from a longitudinal study with older adults (N = 551) were reported descriptively. After showing a significant relationship during chi-square tests, we quantified the ones between general health information need and technology usage, as well as between general health information need and the demographic variables age, education, chronic diseases and gender by means of (multiple) linear regression models. RESULTS: We predicted older adults' technology usage based on their health information need. The results confirmed this relationship. Higher information need led to a more frequent usage of apps installed on the tablet personal computer (PC), to a frequent use of smartwatches and to the possession of a computer or laptop. Users' education has a higher impact on health information need than amount of chronic diseases, gender and age. CONCLUSIONS: Information need emerged as a useful object for investigation of context and user requirement analysis across different systems: it predicted technology usage so that design recommendations derived from the descriptive gained in importance.

Survey-based personas for a target-group-specific consideration of elderly end users of information and communication systems in the German health-care sector.

BACKGROUND: In many countries, including Germany, older people are increasing in numbers, while fewer caregivers are available. A way to address the problem is to develop new medical assistance and monitoring systems that are operated by the elderly on their own, e.g. in-home aftercare systems. OBJECTIVE: The development of a set of eight data-based personas in terms of a best practice approach is presented. METHOD: "Personas" are an integral method of the user-centered design approach. They address the problem of incomplete knowledge of individual user behaviour by introducing archetypal user groups. Thus, personas can be used at an early stage of development to raise the awareness of developers to the needs, skills, and abilities of the elderly. Personas are also a cost-effective method and quickly and easily accessible. In order to guarantee representativeness the development of personas needs to occur based on a robust data set of a certain user group. RESULTS: This article presents the data-driven development of eight personas. The applied data set results from a nationwide questionnaire study on the elderly's use of information and communication technology, out of elderly people in Germany. The results will be presented in terms of best practice. CONCLUSION: To conclude, survey-based personas of older end users can play an important role in the research and development of innovative devices. APPLICATION: The personas presented in this paper can be used in research and development to raise awareness of the needs and demands of end users.

Task-Data Taxonomy for Health Data Visualizations: Web-Based Survey With Experts and Older Adults.

BACKGROUND: Increasingly, eHealth involves health data visualizations to enable users to better understand their health situation. Selecting efficient and ergonomic visualizations requires knowledge about the task that the user wants to carry out and the type of data to be displayed. Taxonomies of abstract tasks and data types bundle this knowledge in a general manner. Task-data taxonomies exist for visualization tasks and data. They also exist for eHealth tasks. However, there is currently no joint task taxonomy available for health data visualizations incorporating the perspective of the prospective users. One of the most prominent prospective user groups of eHealth are older adults, but their perspective is rarely considered when constructing tasks lists. OBJECTIVE: The aim of this study was to construct a task-data taxonomy for health data visualizations based on the opinion of older adults as prospective users of eHealth systems. eHealth experts served as a control group against the bias of lacking background knowledge. The resulting taxonomy would then be used as an orientation in system requirement analysis and empirical evaluation and to facilitate a common understanding and language in eHealth data visualization. METHODS: Answers from 98 participants (51 older adults and 47 eHealth experts) given in an online survey were quantitatively analyzed, compared between groups, and synthesized into a task-data taxonomy for health data visualizations. RESULTS: Consultation, diagnosis, mentoring, and monitoring were confirmed as relevant abstract tasks in eHealth. Experts and older adults disagreed on the importance of mentoring (χ24=14.1, P=.002) and monitoring (χ24=22.1, P<.001). The answers to the open questions validated the findings from the closed questions and added therapy, communication, cooperation, and quality management to the aforementioned tasks. Here, group differences in normalized code counts were identified for "monitoring" between the expert group (mean 0.18, SD 0.23) and the group of older adults (mean 0.08, SD 0.15; t96=2431, P=.02). Time-dependent data was most relevant across all eHealth tasks. Finally, visualization tasks and data types were assigned to eHealth tasks by both experimental groups. CONCLUSIONS: We empirically developed a task-data taxonomy for health data visualizations with prospective users. This provides a general framework for theoretical concession and for the prioritization of user-centered system design and evaluation. At the same time, the functionality dimension of the taxonomy for telemedicine-chosen as the basis for the construction of present taxonomy-was confirmed.

Prevalence of Health App Use Among Older Adults in Germany: National Survey.

BACKGROUND: Health apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services. OBJECTIVE: The aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany. METHODS: A nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status. RESULTS: In total, 16.5% (95/576) used health apps, whereas 37.5% (216/576) indicated only using general apps, and 46.0% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis. CONCLUSIONS: Health apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users' demographics were revealed.

The "Aachen fall prevention App" - a Smartphone application app for the self-assessment of elderly patients at risk for ground level falls.

BACKGROUND: Fall incidents are a major problem for patients and healthcare. The "Aachen Fall Prevention App" (AFPA) represents the first mobile Health (mHealth) application (app) empowering older patients (persons 50+ years) to self-assess and monitor their individual fall risk. Self-assessment is based on the "Aachen Fall Prevention Scale," which consists of three steps. First, patients answer ten standardized yes-no questions (positive criterion ≥ 5 "Yes" responses). Second, a ten-second test of free standing without compensatory movement is performed (positive criterion: compensatory movement). Finally, during the third step, patients rate their subjective fall risk on a 10-point Likert scale, based on the results of steps one and two. The purpose of this app is (1) to offer a low-threshold service through which individuals can independently monitor their individual fall risk and (2) to collect data about how a patient-centered mHealth app for fall risk assessment is used in the field. RESULTS: The results represent the first year of an ongoing field study. From December 2015 to December 2016, 197 persons downloaded the AFPA (iOS™ and Android™; free of charge). N = 111 of these persons voluntarily shared their data and thereby participated in the field study. Data from a final number of n = 79 persons were analyzed due to exclusion criteria (age, missing objective fall risk, missing self-assessment). The objective fall risk and the self-assessed subjective risk measured by the AFPA showed a significant positive relationship. CONCLUSIONS: The "Aachen Fall Prevention App" (AFPA) is an mHealth app released for iOS and Android. This field study revealed the AFPA as a promising tool to raise older adults' awareness of their individual fall risk by means of a low-threshold patient-driven fall risk assessment tool.

[Thought styles in nursing]. / Denkstile in der Pflege.

Proceeding from the occupation with the question whether the tension that nursing staffs experience in correspondence with the conflict of theory and practical orientation can be made transparent the authors found no sufficient explanations in the current theories of professionalism. The theory of thought styles and thought collectives (Denkstile und Denkkollektive) of Ludwig Fleck offers a perspective that takes a look at the inside of nursing, at the nursing staffs. From the analysis of the works of Fleck three styles, or thought collectives have been determined, that can be met in nursing. The thought style that corresponds with the pre-professional phase of a nursing career is characterised by a mainly caritative understanding of nursing. The thought style that comes with professional nursing is based on standardised knowledge by experience without scientific foundation. The thought style that is related to a professionalism of nursing connects scientific insights, nursing knowledge by experience and hermeneutic understanding of cases. The consideration of the current situation in nursing shows two problems that can be explained from the perspective of the thought styles: disturbances in communication because of terms that are interpreted differently by different thought styles and resistance against the consequences of some processes of development relating to professional-political aspects of nursing (making nursing academical and more professional). The resulting strategies of action include a further development of a thought style of a professionalism of nursing to be able to deal with needing of care and the reflection of conflict situations on the background of thought collectives.