Prudent Trade-off: The Dynamic Evolution Process Of Interaction Behavior Between The Elderly And Mobile Health

BackgroundAs population aging has become an urgent problem to be solved in China and the world,“healthy aging” has been advocated by WHO and is considered as an important strategy to deal with population aging,focusing on maintaining the functional performance of the elderly and improving their internal capabilities.Mobile health(m Health)is defined as medical and public health practice supported by mobile devices,such as mobile phones,patient monitoring devices,personal digital assistants(PDAs),and other wireless devices.Mobile health has been proven to be a feasible means to help the elderly manage their own health,maintain the functional performance,and achieve active health.However,the adoption rate and usage rate of mobile health among the elderly are still at a low level,which prevents them from accessing the benefits of mobile health.Most of the research on the interaction behavior of the elderly and mobile health is based on the theoretical framework to verify the influencing factors of behavioral intention at a single point in time.Few studies have analyzed the dynamic development process of interaction behavior with mobile health from the perspective of the elderly,and explored the strategies involved in the process.Meanwhile there is a lack of researches exploring social-cultural contextual factors in China.AimsThe purpose of this study is to explore the formation and continuation process of the interaction behavior between the elderly and mobile health,analyze the dynamic changes in the psychological and behavioral patterns of the elderly during this process,analyze the main factors affecting the process,and explore the strategies and skilled involves in the process.The finding of this study is expected to provide a reference for the government,health care institutions,and mobile health development companies to build a mobile health interaction behavior promotion program,with the elderly as center.MethodsGrounded theory methodology was used.Through purposive sampling,theoretical sampling,variational sampling,and snowball sampling,a total of 34 elderly people who have never used mobile health,are using mobile health,and have used mobile health before but currently give up using it were recruited to conduct individual in-depth interviews.Finally,the participants came from urban and rural areas including Shanghai,Hefei,Wuhu,Maanshan,Hangzhou,Nanjing,Zhengzhou,Yunnan,and Qinghai,etc.Meanwhile,the participatory observation method was used to collected the observation data of 8 elderly people when interacting with mobile health.All recorded interviews were word for word into electronic documents for collation and preservation,and the observations were collected using field notebooks and saved electronically.Three-level coding and analysis techniques such as questioning and continuous comparison were used for analysis.The analysis process was recorded by writing a memo to help form the categories and construct the relationship between them.Finally,a theoretical framework for the dynamic evolution process of the interaction behavior between the elderly and mobile health was formed.ResultsThe adoption and continuous use of mobile health by the elderly is not achieved overnight.The entire interaction process includes four stages: the awareness stage,the cognitive decision-making stage,the experimental learning stage,and the formal use stage.Throughout the interaction process,under the influence of many factors,the elderly may smoothly move from one stage to the next,and they may also withdraw from the interaction at any time and return to their original lifestyle.In the awareness stage,the elderly realize that mobile health can meet their own needs,but this irritating event may bring changes to their peaceful lives.The elderly judge the meaning of the change through the primary evaluation,and consider the response options in the secondary evaluation.The value orientation of the elderly on the state of life and the views of others on the older age group affect the primary evaluation results,and the general control beliefs and perceived social support of the elderly affect the secondary evaluation results.Based on this,four evaluation results are produced,namely threatcontrollable type,threat-out of control type,challenge-controllable type and challenge-out of control type,and induced corresponding emotional responses.Under the influence of cognition and emotions,the elderly make the coping responses.Part of the elderly will further collect the information of mobile health and enter the cognitive decision-making stage,while others will avoid mobile health and seek alternative solutions to meet their own needs.In the cognitive decision-making stage,the elderly build a cognitive structure related to mobile health in their minds through information acquisition and information internalization,which leads to cognitive re-evaluation of mobile health.At this stage,the influencing factors of cognitive re-evaluation are more specific to smart devices.After weighing the risks against benefits,controllability against out of control,the elderly update the evaluation results and change their emotional responses.Based on this result,the elderly make decisions to adopt,delay adoption,or abandon the adoption of mobile health.In the experimental learning stage,the elderly interact with mobile health for the first time.The early learning pattern mainly revolves around “observation and imitation”.After that,driven by internal and external incentives,the elderly explore the use of mobile health independently to achieve more in-depth interaction.The entire learning process can be divided into positive feedback enhanced learning mode,negative feedback weakened learning mode and abandonment learning mode.In the formal use stage,if the elderly repeatedly experience positive feedback during the interaction with mobile health management services and can effectively cope with the difficulties,they will develop using habits after a period of repeated behavior.Conversely,the elderly may experience psychological burnout and give up their continued interaction with mobile health.When the elderly interact with mobile medical services,they will make behavioral decisions about whether to continue using them based on positive or negative feedback.“Prudent trade-off” is the core category of this research.At every stage,the elderly will measure whether they want to deepen the depth of interaction with mobile health.Whether it is before adopting mobile health for the first time or after trying to use it,if the elderly perceive that the potential risks of using mobile health exceed the benefits,and they are unable to effectively cope with difficulties,they may make the decision to abandon interaction.ConclusionsThis study constructed the dynamic evolution process of the interaction behavior between the elderly and mobile health with “prudent trade-off” as the core category.Based on the characteristics and influencing factors of interaction stages,this study provided feasible suggestions for policymakers,communities,health care institutions,mobile health development companies,and families to help the elderly adopt and use mobile health.