Barriers to older adults’ uptake of mobile-based mental health interventions

Background To address increasing demand of mental healthcare treatments for older adults and the need to reduce delivery costs, healthcare providers are turning to mobile applications. The importance of psychological barriers have been highlighted in the uptake of mobile-based mental health interventions and efforts have been made to identify these barriers in order to facilitate initial uptake and acceptance. However, limited research has focused on older adults’ awareness of these applications and factors that might be hindering their use. Objective The purpose of this study was to explore the perceived barriers that older adults experience in the uptake of mobile-based mental health interventions. Methods Semi-structured interviews were conducted with a sample of 10 older adults, 50 years or older (female = 7, mean age = 68 years), who experienced periods of low mood. National Health Service applications were demonstrated to facilitate conversation and explore participants’ understanding of mental health and mobile-based mental health interventions. Thematic analysis was used to analyse the interview transcripts. Results The social ecological model was adopted as an organising framework for the thematic analysis which identified six distinct barriers to older adults’ uptake of mobile-based mental health interventions: mental electronic-health (e-health) awareness, interaction with technology, discontinuation, ‘seeing’ facilitates therapeutic alliance, incongruent role of the general practitioner and privacy and confidentiality. Conclusions Older adults experience a number of barriers to uptake ranging from the individual level to a macro, organisational level. The practical implications of these barriers are discussed such as the need for increased awareness of mobile-based mental health interventions among older adults

Understanding the psychosocial drivers of adoption and use of mobile mental health interventions among older adults

Depression is a major mental health problem in the UK and is particularly problematic within older adults. In addition, tackling the symptoms of depression in older adults is hindered by specific barriers that older adults face in the access of mental health care. Mobile mental health interventions (MMHIs) provide a number of benefits for the delivery of mental health interventions due to their accessibility and thus, are able to overcome a number of barriers to mental health treatment. Existing research has explored ways in which use of MMHIs can be encouraged among a wide variety of demographic groups, including students, adolescents and adults, along with the psychological determinants of future use of MMHIs. However, older adults are seldom included in such research, despite being an age group that could benefit from MMHIs. This thesis aimed to address these gaps by investigating factors which may hinder older adults’ access to such interventions and explore how older adults’ perceptions of MMHIs may be improved. These research objectives were explored using a mixed methods approach. First, this thesis qualitatively explored the psychological barriers that older adults who use technology may experience in the uptake and use of MMHIs. These findings laid the foundation for a series of three quantitative, survey-based studies. The second study took a quantitative approach in investigating the influence of these barriers on their attitudes towards MMHIs, and identified perception of data security, perceived effort expectancy and awareness of mobile mental health as key determinants of attitudes. Next, the Technology Acceptance Model (TAM) was applied to the three identified determinants of attitudes to present an adapted Technology Acceptance Model. In this adapted model, perception of data security was a valuable addition and showed significant associations to attitudes and intention to use MMHIs for older adults. Finally, an experimental study was conducted to compare the effects of different types of information about data security practices on improving older adult’s intentions to use MMHIs, and their attitudes towards them. This thesis has resulted in new knowledge about factors which are important for older adults in the uptake of MMHIs and highlights the role that perceptions of data security, expected effort requirement and awareness of current interventions might play in shaping their uptake by older adults. These findings are discussed in the context of existing literature and the implications for theory, current mental health care delivery and design of MMHIs

Functional privacy concerns of older adults about pervasive health-monitoring systems

Technologies designed to support ageing can be deemed to be ageist in that they often exhibit a benevolent paternalism that tries to ‘protect’ older people. Often this involves gathering extensive data to monitor physical and cognitive decline at the expense of an individual’s privacy, with an underlying, often implicit, assumption that older adults no longer need much privacy. We consider such issues in the context of a project which seeks to promote the well-being of older adults. We conducted interviews with 20 older adults (10 males, 10 females, mean age=73) to ask, under what health and wellbeing circumstances would they wish to protect their privacy? Using thematic analysis, we uncovered six distinct reasons why older adults want to maintain privacy: protection from harm, autonomy, to present a positive social identity, to break free from social norms, to protect others, and to protect their own self-concept. We conclude that privacy is a highly valued resource for older adults and one that enables them to live fulfilling lives. We consider the design implications of our findings, noting that designers should aim to protect privacy from the outset, rather than viewing privacy as a ‘bolt-on’ that would inhibit data collection under specific circumstances. These concerns speak to the ‘paternalism’ agenda, in that older adults should be considered as active agents in the management of their own data disclosures