Research Problem/Purpose
The integration of technology into the healthcare sector both at the care provider level and now the integration and adoption of systems that directly involve the patient or the population remains one of the major revolutions that has been seen yet in the sector. Technology has not only enhanced the adoption of the much needed reforms but it has provided a better platform for the patient-centered care approaches by increasing the level of contact between the care provider and the patient. Previously, the physical distance between the patient and the care provider was and has been an impediment to patient-centered care approaches especially for the less disadvantaged groups such as those in the rural and remote areas. However, with internet and technological frameworks having been highly improved over the past decade, these physical barriers have been eliminated significantly.
Choi & DiNitto (2013) in their research sought to establish the patterns and trends in internet use, Ehealth literacy adoption, reasons for discontinued utilization of internet as well as the attitudes of population towards computers, technology and internet among the low income individuals receiving care at home. The researchers based their study on the identification that across ages, there are variations in the utilization of internet and technology and therefore, they set out to determine how these variations emerge or evolve over time. In this regard, the researchers set out to compare the trends across the themes identified as they appear between person aged beyond 60 years within low income societies and their younger counterparts aged below 60 years within the same setting. The focus on older adults within low income households was based on the idea that this group is essentially a high risk group based on the socioeconomic patterns that dictate their lifestyle as well as the increasing frailties with an advancing age. Technically, it is important to recognize that the adoption of technologies as well as other reforms within the healthcare sector had targeted to improve the health of the high risk groups by increasing access to healthcare.
Review of the Literature
Choi & DiNitto (2013) in their article, they have not set out a specific section for literature review. However, to compensate for this, they have provided a thorough background and introduction section which also provides for review of relevant literature. This decision to eliminate a specific section for the review of literature has not in any way affected the quality of the research nor influenced the study results in any way that would be regarded as unconventional. The development of the review of literature alongside the background of the study has afforded the reader an opportunity to transit easily from the objectives and purpose to the actual clinical value of this study. Within the literature review, the researchers have explored three major themes; on one hand are the patterns and trends in utilization of online health resources by the populations and the differences in utilization across the age groups.
On the other hand, the researchers have focused on the issue of impact of socioeconomic status of individuals in accessing and utilizing these healthcare technologies especially in the long term. In their third theme, the researchers explore the attitudes of people especially along age groups to determine how these attitudes influence the utilization of the internet and online health resources to improve their health status. In order to make the review of literature section, the researchers limited their literature search to the years between 2002 and 2013 with only two sources being outside this period (1992 and 1998). The two older sources wee however useful in providing an overview of the evolution of technology over the past two decades. Technology is a time sensitive issue and this could be the reason why the researchers limited the search to this period.
Theoretical Framework
Choi & DiNitto (2013) does not utilize any specific theoretical framework for this study. However, there is significant evidence to imply that the study could be based on Orem’s Self-care Theory. The theory provides a framework on which the healthcare provider on the nurse can assist the patient to achieve optimal comfort and wellness by being involved actively in the management of various aspects of their health. The theory is based on the ideal that patients have needs which are referred to as deficits. These deficits are essentially what the patient should seek to accomplish with the help of the healthcare provider within the nursing process. The lacking theoretical framework does not affect the results or findings but would have been an important addition to the study. However, with the review of literature and background section having been described well, the reader can significantly make correlations that would point to an intention towards improving self-efficacy.
Variables/Hypotheses/Questions/Assumptions
The research was based on set of four research questions that sought to establish; (1) the rates of internet use, past usage and cases of never use among the older adults as compared to their younger counterparts (2) the frequency of use of the internet, perceptions with the use of internet and difficulties in use of internet across the two groups (3) the reasons for discontinued usage of the internet, and (4) the level of willingness and comfort in using online health resources. In this case, the hypothesis four hypotheses each based on the research question was set out with general indications that the younger adults are more likely to utilize internet, have better perceptions and attitudes towards internet and are less likely to discontinue the use of internet the long term as compared to their older counterparts.
Methodology
The researchers resulted to using a quantitative research design based on a telephone and face to face interviews. A total of 980 participants were included all who had been ascertained as residents of Texas receiving home-delivered food or meals. Up to 78% of this group were aged 60 years and above while the remaining 22% were aged below 60 years of age. The researchers intended to make comparisons across the selected themes based on the age-factor on measures of internet use, internet use trends and patterns, eHealth literacy, attitudes and willingness for utilization of internet or computers, the impact of socio-demographics as well as the impact on health, disabilities and mental health. This was essentially a probability sample with indications that a majority of participants in the younger age group are more likely to utilize internet as well as indicate willingness and a positive attitude towards utilization of the same.
The eHealth Literacy Scale (eHEALS) and the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were the tools used to correct the data from the surveys. Each of these two instruments has been utilized in the past in similar settings and their validity and reliability has never been put to question. The study was approved by the Institutional Review Board of University of Texas at Austin’s to protect the integrity of participants. The participants were subjected to a cognitive assessment to determine their capability to participate in the survey.
Data Analysis
The researchers utilized OLS logistic regression models to develop correlations based on SPSS v.20 which is a conventional tool for data analysis especially when the data is in presented in large volumes and there is need to make correlations across various themes. The results were then tabulated so that they could be easier to read by eliminating the technicalities. In their findings, Choi & DiNitto (2013) indicate that up to 86% of the participants in the younger group and 95%of the participants in the older group had some internet connection at their residence. The rests indicated that they rely on internet that is available at their apartments, at their friends or in their work places where there is wireless internet. Apparently, there were statistically significant differences in the utilization of internet with the older group more likely to connect to the internet at their home than the younger counterparts. However, in both groups, more than 50% were likely to use the internet on a daily basis, 20% would use it after a couple of days, 115 would use it once in a week and the rest would use it less frequently than a weekly.
Summary and conclusions
This study is suitably designed to provide valuable evidence that can be utilized for Evidence-Based best practices that targeting this high risk group of older adults in low income settings and mainly those who have been discharged from hospitals or have been diagnosed with various chronic illnesses. The researchers have dwelt on a topic that impact on the lives of a group whose health status is at risk of deterioration. Within the current healthcare setting, patient outcomes are based on factors such as self-care and self-management and within this perspective helping the patients in managing their general health, their mental health issues as well as developing viable social connections. Therefore, thus study meets the needs of an aggregate within the demands of the contemporary healthcare setting and therefore it can be generalized for application to a patient education program that seeks to improve self-efficacy using internet technology.
References
Choi, N. G., & DiNitto, D. M. (2013). The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use. Journal of medical Internet research, 15(5), e93.
