MAKING SENSE OF UBIQUITOUS HEALTH INFORMATION:

A CROSS GENERATIONAL STUDY

D. O. KutzSchool of Library and Information Science

Indiana University-BloomingtonBloomington, Indiana

K. ShankarSchool of Information and Library Studies

University College DublinDublin, Ireland

K.E. ConnellySchool of Informatics and Computing

Indiana University-BloomingtonBloomington, Indiana

STATE OF HEALTHCARE & WELLNESS

• In the United States: “In 2010, no state had a prevalence of obesity less than 20%.” (Center for Disease Control and Prevention, 2010).

• Among youth, obesity, metabolic risk and mental health disorders are on the rise (Kitzrow, 2003).

• United States spends more than twice per capita while maintaining a less-than-expected life expectancy (Anderson & Frogner, 2008).

• Individuals 80 and above are fastest growing segment of the population (State Department, 2007).

TECHNOLOGICAL SOLUTION TO THE PROBLEM?

• Mobile and pervasive technology seen as a way to track and obtain health information as more health management and coordination is offloaded to patients.

• Technologies provide capabilities to share information with others for motivational purposes, education, coordination, and care (Consolvo, et. al., 2004).

• Often serves a persuasive purpose to help people make better choices (Toscos et. al., 2008).

RESEARCH QUESTION

• How do individuals across age groups make sense of how ICT technology is capturing and sharing health related information?

• What are the narratives do individuals construct to understand health technology?

PROTOTYPE DEVELOPMENT

• We developed two hypothetical personal health-monitoring systems

• Prototypes probe individuals’ perceptions towards the collection, sharing, and transmission of health related information

• Draw upon existing research that shows that a person is better able to engage in positive health behaviors when they have the social support of an existing network of peers (Cohen & Janicki-Deverts, 2009; House, Landis, & Umberson, 1988).

STUDY DESIGN

• Survey – demographic information.

• Video skits – used to introduce future technologies.

• Prototypes – serve as probes.

• Interview - semi-structured.

PARTICIPANTS

• Our prototype health tracking systems were presented to three distinct groups of individuals:

• Young adults age 18-25 (n=7).

• Middle age adults 35-50 (n=7).

• Older adults age 65 and above (n=7).

Video Skit: Older Adult

Video Skit: Young Adult

DATA ANALYSIS

• Analyzed all interview transcripts using inductive thematic analysis.

• Look for emergent themes and patterns.

• Authors discussed themes and refined them.

• Subsequent passes through the data were used to code for intergenerational differences among the themes of interest.

• Process was repeated until consensus on findings was reached.

IDENTIFIED THEMES

• Participation and engagement

• Data and information sharing

• Social networking

THEME: PARTICIPATION AND ENGAGEMENT

• Participants would either respond in a passive or active manner when they discussed how they would expect to engage with our system

• Older adults were more likely to take a more passive approach

• Responses from middle aged adults were mixed

• The young adult participants consistently used active language when describing the systems

THEME: PARTICIPATION AND ENGAGEMENT

• Older adults passive in their approach

• “That's a good question to be determined by the people who set up the system.” O16

• "That would be a decision for the system to make." ... “I trust it.” O17

THEME: PARTICIPATION AND ENGAGEMENT

• Middle age adults are cautious

• “If… [employer] is not going to be able to scan our little card and track what we’re doing and see what we’re doing, I would have no problem using a program like that.” M19

THEME: PARTICIPATION AND ENGAGEMENT

• Young adults adults are active

• “Yeah, and I think I would be...As long as I had, you know, the privilege, I guess, to be able to modify that whenever I wanted to, and select if I wanted to share how and whenever I wanted to…if I'm choosing to be a part of this type of program and I was able to just do the select the people that I wanted, or whatever, then I would imagine that I would share that information. Otherwise, I wouldn't be a part of the program.” Y3

THEME: SOCIAL NETWORKING

• Clear distinction identified across generations was the familiarity and expectations from social networking software.

• Young: Strongly identified a social networking component.

• Middle: Associated a social networking component after probing.

• Older: Used different metaphors besides social networking.

THEME: SOCIAL NETWORKING

• Young adults described information sharing using metaphors drawn from social networking technologies (ex: lists, profiles, etc.).

• “Sharing would be to people, maybe that you've already selected.” Y1

THEME: SOCIAL NETWORKING

• Middle aged adults that referred to social networking indicated that these systems were perceived as a diversion.

• “It could just be fun to check some things out, similar to a Facebook type interaction.” (M11)

THEME: SOCIAL NETWORKING

• Older adults’ expectations were far more varied

• Responses informed by technologies they had encountered in their careers, confirming findings in previous research (Morrell, Mayhorn, & Echt, 2004).

• 016 (retired doctor) considered the data to be representative of an entire population: “General population. I would think that this represented. If we multiplied this by 100,000 people, I would guess this would show some descriptive statistic, median or mean.”

THEMES: DATA AND INFORMATION SHARING

• Distinct differences in how the age groups felt about using the prototype to share.

• Young: see value in sharing information.

• Middle: sharing, if only integrated into existing social relationships.

• Older: Sharing did not make sense, but could see some benefit in family cases.

THEMES: DATA AND INFORMATION SHARING

• Young: see value in sharing information.

• “[It] might be the case that you would need to share that information, to either validate what you are saying, or just brag about it even.” And “we are all able to view these to kind of motivate each other.” (Y3)

THEMES: DATA AND INFORMATION SHARING

• Middle: sharing, if only integrated into existing social relationships.

• “I always have a work out partner with me that knows this is what my goal is… and if I start slacking, then I want you to say, ‘are you feeling okay?’” (M9)

THEMES: DATA AND INFORMATION SHARING

• Older: Sharing did not make sense, but could see some benefit in family cases.

• “[D]on't know why somebody would care about this other than my family.” (O17)

INTERPRETATION

• Young and middle aged adults drew upon metaphors from social networking software. These are essential tools to create, expand, and explore newly created social networks.

• Older adults’ explanations informed by their personal experience with technology (particularly work-related).

INTERPRETATION

• Younger adults took an active approach towards managing other people’s perceptions of them.

• Manipulating and crafting how one is represented is a perfectly reasonable strategy to employ: “Because it sounds kind of like things you can almost like play around with, because it gives you option to manipulate data.” (Y4)

INTERPRETATION

• For older adults, the concept of sharing is not related to broadcasting, but sharing information for research purposes or the family unit.

• Reinforce findings that the quality of relationships is preferred over quantity as people age

• information tends to be shared with fewer people, but more deeply (Antonucci, Birditt, & Akiyama, 2009)

SUMMARY

• Designers of new ICTs for health and wellness need to take into account age-related differences not just in usability, but perceived impact, the nature of personal relationships, and privacy concerns

• Generational differences may become more pronounced as populations age

• “Metaphors” inherent in new ICTs are unlikely to resonate uniformly across all generations

REFERENCESAnderson, G. F., & Frogner, B. K. (2008). Health Spending In OECD Countries: Obtaining Value Per Dollar. Health Affairs, 27(6), 1718-1727.

Antonucci, T., Birditt, L., & Akiyama, H. (2009). Convoys of social relations: An interdisciplinary approach. In V. B. Bengtson, D. Gans, N. M. Putney & M. Silverstein (Eds.), Handbook of Theories of Aging (Vol. 2nd). New York: Springer.

Center for Disease Control and Prevention (2010). U.S. Obesity Trends. Retrieved November 6, 2011 from http://www.cdc.gov/obesity/data/trends.html

Cohen, S., & Janicki-Deverts, D. (2009). Can we improve our physical health by altering our social networks? Perspectives on Psychological Science, 4(4), 375-378.

Consolvo, S., Roessler, P., Shelton, B. E., LaMarca, A., Schilit, B., & Bly, S. (2004). Technology for care networks of elders. Pervasive Computing, IEEE, 3(2), 22-29.

House, J., Landis, K., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545

Kitzrow, M. A. (2003). The mental health needs of today's college students: Challenges and recommendations. NASPA Journal, 41(1), 165-179. Morrell, R., Mayhorn, C., & Echt, K. (2004). Why older adults use or do not use the internet. In D. Burdick & S. Kwon (Eds.), Gerotechnology: Research and Practice in Technology and Aging. New York: Springer Publishing.

National Institute on Aging (2009). Why population aging matters: A global perspective. Retrieved June 4, 2011 from http://www.nia.nih.gov/researchinformation/extramuralprograms/behavioralandsocialresearch/globalaging.htm

Toscos, T., Faber, A., Connelly, K., & Upoma, A. (2008). Encouraging physical activity in teens: Can technology help reduce barriers to physical activity in adolescent girls? Paper presented at the In Proceedings of the 2nd International Conference on Pervasive Computing Technologies for Healthcare, Tampere, Finland.

ACKNOWLEDGEMENTS

• We wish to acknowledge the help of Dr. Peter Grogg and Dr. Lesa Huber in recruiting participants, Samantha Mardyla and Allen Shyu in creating the scripts and videos, and the Indiana University Center for Applied Research in Cybersecurity for its financial support.