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Dissertation
A qualitative study utilizing a human factors approach in evaluating the telemedicine user experiences of older adults with visual, hearing, and mobility disabilities
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2024
DOI: 10.25820/etd.007513
Abstract
Introduction: The Coronavirus 2019 (COVID-19) pandemic ushered in a requirement for social distancing and necessitated a shift from in-person care to remote care (telemedicine) to ensure the safety of health care workers, patients, family members, and caregivers. As useful as telemedicine is, older adults with disabilities often experience barriers that can impede their ability to use it. In spite of this, there is a lack of studies (post-pandemic), on the telemedicine user experience of older adults with disabilities. The reasons why some members of this population chose not to use telemedicine are also largely unknown.
Objectives: The objectives of this study were to 1) Understand the user experiences of older adults living with mobility, visual, and hearing impairments) when using a specified telemedicine system to access health care; 2) Evaluate the user experiences of older adults with visual, hearing, and mobility disabilities when using a specified telemedicine system by utilizing a design thinking tool (journey mapping); 3) Determine areas of improvement in the design of a specified telemedicine system, from a human factors perspective, for older adults with hearing, visual, and mobility disabilities; and 4) Determine reasons behind the non-use of telemedicine by non-users.
Methods: This was a qualitative study which used user interviews to obtain data-rich experiences from participants and journey maps to visualize those experiences. User participants had to be at least 60 years old, documented with hearing, mobility, or visual impairment, and must have used telemedicine at least once in the past 2 years (since the COVID-19 pandemic). For non-user participants, they also had to be at least 60 years old, documented with hearing, mobility, or visual impairment, but without the requirement of having used telemedicine. Two theoretical models were used in the study, including the Components of User Experience model (CUE) for users, and the Theory of Planned Behavior (TPB) for non-users. Two interview guides were developed for users and non-users. The interview guide for users followed the continuous discovery habits framework while the interview guide for non-users was developed from the Theory of Planned Behavior (TPB). Two recruitment methods were used in the study. Phase one of the recruitment involved screening the electronic health records of geriatric patients for documented ICD-10 diagnosis codes for mobility, visual, or hearing disabilities, and sending recruitment letters to eligible participants. Phase two involved recruiting participants using an email blast sent out to the entire University of Iowa community. Data was transcribed using Rev.com and uploaded into NVivo, a qualitative data analysis software, for qualitative coding and thematic analysis. A second coder checked coding consistency and helped to improve reliability.
Results: In total, 22 interviews were completed involving 16 users and 6 non-users. For users, five themes were identified a priori based on the Components of User Experience framework, including Human-Technology Interaction (Use Context, User, and Technology Characteristics), Perceptions of Instrumental Qualities (Usability and Impact of Disability on Telemedicine Use), Perceptions of Non-instrumental Qualities (Non-technical Aspects of Telemedicine Use), Emotional User Reactions (Emotions Associated with Telemedicine Use), and Consequences (Use of Telemedicine in the Future). Two additional inductively generated themes for users included Attributes, Expectations, and Overall Evaluation of Provider and Telemedicine Evaluation and Opportunities. For non-users, four themes were identified based on the TPB framework, including, Attitude (Comparing Telemedicine to in-person Visits), Subjective Norm (Influence of External Parties, including Family, Friends, and Providers on Telemedicine Use), Perceived Behavioral Control (Technological Issues Associated with Telemedicine Use), and Actual Behavioral Control (Accessing Support and Resources).
Conclusion: User experiences varied according to their level of satisfaction with their providers as well as the telemedicine system in use. For non-users, several factors influenced their decision to not use telemedicine, including absence of provider recommendation. Telemedicine system designers should include older adults with disabilities as stakeholders when designing telehealth applications. Also, health systems should consider ways to improve telemedicine service delivery to ensure that inclusive, patient-centered care is provided to vulnerable older adult telemedicine users with visual, mobility, and hearing disabilities.
Details
- Title: Subtitle
- A qualitative study utilizing a human factors approach in evaluating the telemedicine user experiences of older adults with visual, hearing, and mobility disabilities
- Creators
- Onyeche Oche
- Contributors
- Korey A. Kennelty (Advisor)Julie Urmie (Committee Member)William Doucette (Committee Member)Priyadarshini Pennathur (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Pharmacy
- Date degree season
- Spring 2024
- DOI
- 10.25820/etd.007513
- Publisher
- University of Iowa
- Number of pages
- xviii, 150 pages
- Copyright
- Copyright 2024 Onyeche Oche
- Language
- English
- Date submitted
- 03/06/2024
- Description illustrations
- Illustrations, tables, graphs, charts
- Description bibliographic
- Includes bibliographical references (pages 110-116).
- Public Abstract (ETD)
Telemedicine has certain benefits, including the promotion of safety, convenience through avoidance of travel, and efficiency of the consultation process, which can increase health care access. On the other hand, it can lead to health care access barriers for certain groups of people lacking the requisite digital literacy, internet access, or technological devices to operate it, including older adults with disabilities. Using a Human Factors perspective (the knowledge of human capabilities and limitations), this study evaluated the telemedicine user experience of older adults with disabilities in order to inform telemedicine design recommendations.
Interviews were used to understand users’ experiences with telemedicine while journey maps were used to visualize those experiences. A small sample of non-users was also interviewed to find out why they chose not to use telemedicine. The results showed that user experiences varied according to their level of satisfaction with their providers as well as the telemedicine system in use. Users reported that it would be easier to use telemedicine if they had improved web accessibility and assistive devices for telemedicine visits. Among non-users, several factors, some of which are modifiable, influenced their decision to not use telemedicine.
Health systems should consider implementing practical interventions to encourage the use of telemedicine among non-users. Telemedicine system designers should also include older adults with disabilities as stakeholders when designing telehealth applications. Finally, health systems should consider ways to improve the delivery of telemedicine services to ensure access for vulnerable older adult telemedicine users with visual, mobility, and hearing disabilities.
- Academic Unit
- Pharmacy
- Record Identifier
- 9984647257602771
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