"I'm still struggling with it, and it scares me": A qualitative analysis of older adults' experiences with digital health portals during and after COVID-19.

Objective: The scaling of digital health platforms, accelerated by the COVID-19 pandemic, has globally reshaped the delivery of healthcare services, presenting both opportunities and challenges. Ensuring equitable access, especially for digitally disadvantaged groups, is a critical concern, and this study explores older adults' perspectives on digital health platforms during and after the COVID-19 pandemic and examines their strategies for coping with the general challenges of the digitalization of health. Methods: A total of 77 older adults (aged at least 65), including both internet users and non-users, participated in 11 focus group sessions in Slovenia between September and December 2022. Hybrid thematic analysis was used to develop an understanding of the challenges confronted by older adults in the digital health landscape. Results: Three key themes emerged from the focus group sessions, which highlight digital inequalities that impact access to digital health platforms and their services: the challenges of digitalized health services, coping with these challenges, and the outcomes of health service digitalization. The "digital health paradox" is evident, in which opportunities are provided for some while access is limited for those unwilling or unable to use digital health platforms. Proxy users, often family or friends, help bridge this gap. Conclusions: Ensuring the availability and viability of traditional health service access is crucial for empowering older adults to choose between digital health platforms and alternatives. Recognizing the importance of traditional approaches is vital, and healthcare providers and policymakers should prioritize inclusivity to ensure a diverse and equitable healthcare system for older adults and vulnerable populations.

Determinants of the intention to use mHealth in the future: Evidence from an intervention study of patients with chronic diseases in Slovenia.

BACKGROUND: Mobile health (mHealth) implementation is crucial for developing sustainable healthcare systems, but it faces the challenge of user acceptance. Extending traditional acceptance models allows for the cognitive, emotional and social aspects of engaging with mHealth to be captured, creating a more comprehensive understanding of users' intentions to use it in the future. User-centred intervention studies based on users' real experiences with mHealth are essential for accurate assessments and for improving upon studies that rely merely on anticipated mHealth use. METHODS: An intervention study was conducted with 103 patients with at least one chronic condition (type 2 diabetes and/or arterial hypertension) who had used an mHealth service for three months. They were recruited through purposive sampling at a community health centre in Slovenia. Path analysis was applied to the survey data collected after a three-month testing period to validate an explanatory model with eight hypotheses. RESULTS: The intensity of mHealth use affected usability, which in turn affected acceptability, the psychosocial impacts of engagement with mHealth and intention for future use. The results showed that the intensity of mHealth use did not affect mHealth acceptability. Likewise, acceptability did not affect the psychosocial impacts of engagement with mHealth or the intention for its future use. Notably, perceptions of the psychosocial impacts of mHealth had no significant effect on the intention for future use. CONCLUSION: Usability and intensity of use play a central role in the post-intervention usage of mHealth, offering valuable insights for policymakers and healthcare providers involved in the delivery of mHealth-based treatment to patients with chronic diseases.

An Assessment of the Structural Validity and Measurement Invariance of the Web-Use Skills Scale for Aging Internet Users.

Research on digital inequality has found that aging adults are often at risk of digital exclusion. Understanding the validity of survey measures assessing Internet skills in this population is critical to providing the high-quality data needed for effective digital inclusion policy interventions. This cross-validation study examines the structural validity and measurement invariance (across age, gender, and education groups) of the Web-Use Skills scale (WUS), which is commonly used as a proxy measure of Internet skills. We tested the 14-item version of the WUS. The scale was translated into the Slovenian language and pretested with older Internet users. Data were collected from two independent samples of Internet users aged 50+ years (N1 = 259 and N2 = 256) drawn from an online opt-in panel in Slovenia. The examination of structural validity confirmed that the WUS adequately reflects the one-factor structure of the web-use skills construct, although in a shorter six-item form. Moreover, the analysis confirmed strict measurement invariance between the two samples and, at least, scalar invariance between age, gender, and education groups. The results support the applicability of WUS in cross-group comparisons of Internet skills in the population of aging Internet users and point to several opportunities for future work.

Predictors of Seniors' Interest in Assistive Applications on Smartphones: Evidence from a Population-Based Survey in Slovenia.

Assistive applications (apps) on smartphones could contribute to a better quality of life for seniors living independently at home. At present, there is a lack of empirical evidence of seniors' acceptance of such apps. The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS) model was recently proposed for studying the interplay between acceptance factors by integrating the personal, social and technological domains of seniors' daily lives. This study aimed to explore how four groups of factors, clustered in accordance with the C-TAILS model, predict seniors' interest in assistive apps, on a representative sample of the Slovenian population aged 55 years or older. The 617 respondents, who were contacted though a telephone survey, answered a questionnaire about their interest in three groups of assistive apps and four groups of potentially associated acceptance factors. Three linear regression models were used to analyse the association between the factors and the seniors' interest in the three types of assistive apps. Smartphone-related dispositional traits were the strongest predictors across all three models. Among mobile phone usage patterns, smartphone use and the breadth of mobile phone features used were significant factors, while the significance of seniors' personal characteristics and socio-economic conditions varied across the models. Hence, awareness that these factors play different roles in the acceptance of different assistive apps is needed in order to design viable interventions for their acceptance among seniors.

A comparison of the usability of a standard and an age-friendly smartphone launcher: experimental evidence from usability testing with older adults.

Age-friendly smartphone launchers are tools designed to enhance smartphone handling among older adults with cognitive and functional limitations. Although evidence exists about the positive effects of age-friendly smartphone launchers on older adults' usability performance in general, little is known about how the design and interface complexity of these launchers affect their interface usability effectiveness and efficiency compared with standard Android smartphone interfaces. Thus, in this study, a randomized crossover experiment involving 50 older smartphone users, aged 60 years and above, was guided by the principles of summative usability testing to assess whether an age-friendly launcher performs better than a standard Android launcher performs and to investigate the relationship between the user interface complexity and usability performance of launchers. The results of usability tests in which each participant solved 10 tasks on both launchers indicate that the two tested launchers had comparable effectiveness (i.e. completeness with which participants achieved the test tasks' goals), whereas the age-friendly launcher marginally outperformed its standard Android counterpart in terms of efficiency (i.e. the amount of time used by participants to solve the test tasks). The results also demonstrate that lower user interface complexity is associated with higher effectiveness and efficiency, suggesting that age-friendly smartphone launchers might lead to higher adoption rates of smartphones among older adults if interface designers could reduce their cognitive complexity by limiting the number of steps and alternative paths for task completion.

Risk factors and scoring system as a prognostic tool for epilepsy after neonatal seizures.

BACKGROUND: Neonatal seizures may cause irreversible changes to the immature brain and. A scoring system for early prognostic information could be a useful clinical tool. The aim of the study was to analyze risk factors for epilepsy after neonatal seizures, to validate Garfinkle's scoring system, and to analyze whether a new scoring system is feasible. METHODS: A retrospective study of 176 newborns (59.1% boys, 40.9% girls, 70.5% term, 29.5% preterm; mean birth weight 2820 g), admitted to the Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, because of neonatal seizures (clinical and/or neurophysiological), was performed. Epilepsy rate between 2 and 12 years of follow-up was 18.1%. Five independent predictors from Garfinkle's study and other known predictors were entered into hierarchical binary logistic regression models and analyzed through four steps to identify independent predictors of epilepsy. We tested whether any of the predictors was an effect modifier. RESULTS: Of five potential predictors from Garfinkle's score, electroencephalograph background findings and etiology were predictive. Etiologies, gestation, mode of delivery, duration of seizures, and other risk factors at birth were found to be independent predictors. Duration of seizures has a different effect on prognosis depending on the gestational age. CONCLUSION: Gestational age determines the association between duration of seizures and epilepsy. Scoring systems to predict development of epilepsy after neonatal seizures need to limit interaction between important predictor variables.