Digital health bother and burden in older age: a creative play exploration

Abstract

Precarity in older age, living with uncertainty, insecurity, or vulnerability, is characterised by anxiety about the anticipated impact of transformative changes such as the digitalization of society. Narratives about the resilience of older persons imply the transfer of responsibility for health and wellbeing to individuals and families is warranted. However, concerns about the bother of accessing supports can impede use of health and wellbeing resources including digital health tools. The terms ‘bother’ and ‘burden’, although different, are often conflated or used conjointly. This research sought to explore differences in the conceptualisation of these terms, to inform digital health implementation. Language philosophers posit that the meaning of a word only truly exists in the social context within which it is used. To elicit the latent real-world meaning of the terms bother and burden, Lego Serious Play® (LSP) workshops, conducted in Ireland and Belgium, explored each term separately. A group-based methodology, LSP enables constructive reflection and facilitates the expression of complex concepts in a creative way, using Lego® bricks as metaphors. Participants over 70 years of age (n=15 in Belgium; n=8 in Ireland) were guided through a sequence of Lego® building and descriptive activities. Final models, described in participants own words, were video recorded. A thematic analysis of recordings followed transcription and translation of content from Dutch to English. Findings suggest that unmet expectations about what technology ‘should’ be able to do, and the unpredictability of the technology-use journey, are elements of bother and burden respectively. Furthermore, while inadequate digital proficiency is experienced as a bother, the anticipation of exclusion, as society and healthcare becomes more digitalised, is experienced as burden. Reduced face-to-face interpersonal engagement further exacerbates these experiences. Additional research is needed about the relationship between bother, burden, and precarity of older age within digitalised health and care delivery systems