International Journal of Audiology 2014; 53: S38–S42
Original Article
Exploring the relationship between technology use, hearing help-seeking, and hearing aid outcomes in older adults Heidi Stieglitz Ham*,†, Paul Bunn*,†, Carly Meyer*,†, Asad Khan* & Louise Hickson*,† *HEARing
CRC, Melbourne, Australia, and †Communication Disability Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
Abstract Objective: The objective of this study was to explore technology use and its relationship to help-seeking for hearing impairment (HI) and success with hearing aids among older adults. Previous research had suggested a link between higher levels of technology use and hearing aid success. Design: General technology use was evaluated using a purposefully developed 25-item questionnaire. Twelve items related to everyday technology use (e.g. DVD player) and 13 related to advanced technology use (e.g. Bluetooth). Study sample: Four groups of older adults with HI participated in the study: (1) non-consulters (n ⫽ 49), (2) consulters (n ⫽ 62), (3) unsuccessful hearing aid owners (n ⫽ 61), and (4) successful hearing aid owners (n ⫽ 79). Results: Preliminary analyses revealed a main effect in the use of everyday and advanced technology across the four participant groups. However, it was found that age and living arrangements accounted for most of the variance in reported everyday technology use (p ⫽ .030; p ⫽ .029, respectively) and age and gender accounted for the variance in reported advanced technology use (p ⬍.001; p ⫽ .040, respectively). For everyday technology, an increase in age and living alone were associated with decreased technology use and for advanced technology use, age and female gender were associated with decreased technology use. Conclusions: Although we hypothesized that technology use would be less amongst non-consulters and unsuccessful hearing aid owners, our findings did not support this prediction. Technology use did not vary by group membership once the covariates of age, gender, and living arrangements were accounted for.
Key Words: Hearing aids; help-seeking; outcomes; older adults; hearing impairment; technology Due to increasing longevity, chronic health problems amongst older adults in our community are on the rise. One of the more common chronic health problems experienced by older adults is hearing impairment (HI) with a prevalence of 60–70% in adults 70 years or older (Chia et al, 2007; Cruickshanks et al, 1998; Davis, 1989). Despite these high levels of HI in the population, studies have reported poor take up of hearing health care services including hearing aid fitting (Gopinath et al, 2011; Schneider et al, 2010). One possible reason for this, explored in this study, is whether or not the positioning of hearing aids as a ‘high technology solution’ to hearing and communication difficulties is in fact a barrier to hearing help-seeking and hearing aid use for older adults. Technology use statistics have been recorded across Australia since 1996 and indicate that, although there is a growing number of older Australians using computers and the internet, technology use remains relatively low amongst older adults (Australian Bureau of Statistics, 1996a, 2003b; Madden & Savage, 2000). Figures from 2009 show that 81% of Australians aged between 15 and 44 years access the internet, compared to only 29% of Australians aged 65 years and older (Australian Bureau of Statistics, 2009c). Similar figures are reported in other developed countries. For example, a British government survey (National Archives, 2001) reported that
only 14% of older adults had internet access compared with 49% of other households; and only 36% of older adults owned a mobile phone compared with 82% of other households. Older adults were far more likely to use everyday technologies (e.g. microwave, washing machine) than more advanced forms of technology (e.g. mobile phones, computers) (The National Archives, 2001). Factors influencing technology use in older adults have been studied and point to the mediating effects of age and gender on technology use. For example, in Greece, a sample of 300 adults between 65 and 85 years of age were asked to report on their use of everyday technology items (e.g. TV, wireless phone). Of the 300 participants, 134 were men and nearly 80% were aged between 65 and 74 years. Statistical analysis revealed a gender difference; women were more likely than men to use everyday technology. Some age stratification was also evident with decreasing rates in the old-old compared to the young-old. Specifically, 80% of participants between 65 and 74 years of age used everyday technology compared to 20% of participants between 75 and 84 years of age, and fewer than 10% of adults aged 85 years and older (Roupa et al, 2010). The only previous study of the relationship between HI and technology use in older adults was conducted by Gonsalves and Pichora-Fuller (2008). A questionnaire about the extent of use
Correspondence: Louise Hickson, Communication Disability Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, Australia. E-mail: [email protected] (Received 11 September 2013; accepted 16 September 2013) ISSN 1499-2027 print/ISSN 1708-8186 online © 2014 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society DOI: 10.3109/14992027.2013.847287
Technology use, help-seeking and hearing aids
Methods
Abbreviations ANOVA ANCOVA dB HA HI HTL IOI-HA TEQ WEA
Analysis of variance Analysis of covariance Decibel Hearing aids Hearing impairment Hearing threshold level International outcome inventory for hearing aids Technology experiences questionnaire Worse ear average
of 16 technologies (e.g. radio, answering machine, internet) was completed by 135 adults aged between 65 and 87 years (Mean ⫽ 74.3, SD ⫽ 5.2). Interestingly, participants with uncorrected HI (n ⫽ 25) used the internet and email considerably less than participants with normal hearing (n ⫽ 82). There were no differences in technology use between participants with corrected HI (i.e. they wore hearing aids) (n ⫽ 28) and those with normal hearing (Gonsalves & Pichora-Fuller, 2008). Participants with uncorrected HI also appeared to use computers, faxes, and automatic teller machines (ATMs) less than other participant groups. The authors concluded that “there seems to be a connection between use of general communication and information technologies and the use of hearing aids” (p.154). Accordingly, as the program of research described in this special issue aimed to understand barriers and facilitators to help-seeking for HI and successful use of hearing aids, we undertook a study of older adults’ technology use in this context. Given that Gonsalves and Pichora-Fuller (2008) found that those with HI who did not own hearing aids did not use technology to the same extent as those with normal hearing or those who wore hearing aids, we hypothesized that technology use would be less amongst older adults who had not sought help for their hearing difficulties (compared to those who had sought help) and amongst those who were successful hearing aid users (compared to those who were not successful).
Participants The study sample consisted of a subset of 251 adults, aged between 60 and 95 years, who were participants in a larger study investigating barriers and facilitators to hearing rehabilitation in older adults (Hickson et al, this issue; Meyer et al, this issue). Participants were placed into one of four groups based on the followed criteria: (1) those with HI who had not sought help for their hearing problems (non-consulters; n ⫽ 49); (2) those who had consulted a health professional about their HI but chose not to obtain hearing aids (consulters; n ⫽ 62); (3) those fitted with hearing aids in the past two years but were unsuccessful in using them (unsuccessful hearing aid owners; n ⫽ 61); and (4) those fitted with hearing aids in the past two years and were successfully using them (successful hearing aid owners; n ⫽ 79). HI was defined as a pure-tone average (0.5, 1, 2, and 4 kHz or 2, 3, or 4 kHz) of greater than 25 dB HTL in at least one ear. Hearing aid success was defined using two items from the international outcome inventory – hearing aids (Cox et al, 2002) as a minimum of one hour of daily hearing aid use and at least moderate benefit from hearing aids in the situation the individual most wanted to hear better (Hickson et al, this issue; Meyer et al, this issue). Demographic information relevant to this study is presented in Table 1. The mean age of the participants was 72 years (SD ⫽ 7; range ⫽ 60 to 95) with 64% of the sample being male. Just over half the sample (54%) had tertiary qualifications. The majority of participants were retired (82%) and 75% lived with either a spouse, family member, or a friend. Fifty-five percent of participants received a pension and were thus eligible for free hearing rehabilitation services including hearing aids.
Materials A 25-item technology experiences questionnaire (TEQ) was developed to assess participants’ experiences with various types of technology. The TEQ was based on results of a pilot study involving 49 adults with HI (M ⫽ 74 years, range ⫽ 62–90 years; 16 females, 33 males). As part of the pilot study, participants were asked the
Table 1. Demographic information of group members (N ⫽ 251). Variable Gender Female: n (%) Male: n (%) Age in years (SD) Education Primary/secondary: n (%) Tertiary: n (%) Employment status Retired/house duties: n (%) Employed (full-time/part-time): n (%) Living status Alone: n (%) Spouse/family member/friend: n (%) Pension type Pension: n (%) No pension: n (%) HA ⫽ Hearing aids
S39
Non-consulters (n ⫽ 49)
Consulters (n ⫽ 62)
Unsuccessful HA owners (n ⫽ 61)
Successful HA owners (n ⫽ 79)
24 (49%) 25 (51%) 73 (7.5)
21 (34%) 41 (66%) 70 (6.6)
17 (28%) 44 (72%) 75 (6.8)
29 (37%) 50 (63%) 70 (6.2)
25 (51%) 24 (49%)
24 (39%) 38 (61%)
31 (51%) 30 (49%)
35 (44%) 44 (56%)
38 (78%) 11 (22%)
43 (69%) 19 (31%)
55 (90%) 6 (10%)
70 (89%) 9 (11%)
16 (33%) 33 (67%)
14 (23%) 48 (77%)
18 (30%) 43 (70%)
14 (18%) 65 (82%)
20 (41%) 29 (59%)
20 (32%) 42 (68%)
50 (82%) 11 (18%)
49 (62%) 30 (38%)
S40
H. S. Ham et al.
following open-ended question: “We’re interested in your experiences with technology. Can you think of any technology you use?” A list of technologies was compiled (see Table 2) and categorized into one of the following technology groups to form the basis of the questionnaire: TV (five items), telephone (one item), mobile phone (three items), computer (seven items), digital camera (three items), and general technologies (e.g. iPod, ATM) (six items). The 25 items on the TEQ were then classified as either everyday or advanced technology, in accordance with definitions used in previous studies (National Archives, 2001; Gonsalves & Pichora-Fuller, 2008; Roupa, 2010). Everyday technology included common technologies encountered and used more frequently and often included older technologies (e.g. mobile phone and answering machine). Advanced technology, on the other hand, included technologies that were more complex and required more skill in their use (e.g. use of advanced applications on a mobile phone, and downloading and editing images from a digital camera). Each participant was asked how often they used each technology. The responses (never, seldom, monthly, weekly) on the 25 TEQ items were scored (never ⫽ 0, seldom ⫽ 1, monthly ⫽ 2, weekly ⫽ 3) to create composite scores that were collated for each participant. Higher composite scores on the TEQ items were Table 2. Technology experiences questionnaire items as functions of technology type. Type of technology TV 1. VCR 2. DVD player 3. Pay TV (e.g. foxtelTM, IQTM) 4. Digital TV/Set top box/Hard drive recorder/ TIVOTM 5. Universal remote control Phone 1. Answering machine/voicemail (Telstra 101TM, mobile) Mobile phone 1. Calls 2. Text/SMS 3. Advanced (apps., e-mail, internet, GPS) Computer 1. Basic software (e.g. Office, solitaire, etc.) 2. Internet browsing 3. E-mail 4. Specialist programs (e.g. myobTM, ItunesTM etc) 5. Social networking (FacebookTM, TwitterTM, blogger) 6. SkypeTM/web cam 7. Gaming Digital camera 1. Taking photos 2. Downloading images/printing 3. Editing images General 1. GPS/sat nav 2. IpodTM/mp3 3. ATM 4. Bluetooth 5. Home alarm system 6. Home A/C system
Everyday
Advanced
√ √ √ √ √ √
√
consistent with more experience with technology whereas lower scores were associated with less experience.
Procedure Ethical clearance was granted through the University of Queensland Behavioural and Social Sciences Ethical Review Committee. Prior to the assessment appointment, participants were sent a number of questionnaires in the mail (including the TEQ) which they were asked to complete and to bring with them to the appointment. When the participant attended the assessment appointment, a standard audiological test battery was carried out and further questionnaires and assessments were administered (for details of other measures see Meyer et al and Hickson et al, this issue).
Statistical analysis Prior to analysis, the variables: age, gender, education status, employment status, pension type, living arrangement, group membership, and the TEQ data, were examined for completeness and the data was cleaned as appropriate for analysis. The participants’ composite scores on the TEQ for everyday and advanced technology were assessed for normality. Analysis of skewness on advanced technology indicated skewness of .106, mildly positive, and unlikely to violate assumptions associated with ANOVA. Skewness on everyday technology was .005 and nearly normally distributed. A 2 ⫻ 4 mixed design ANOVA was conducted using technology (everyday and advanced) as the within-subjects factor and group (i.e. HI participant groups) as the between-group factor to assess differences in the use of technology across the four groups. After a Group ⫻ Technology interaction was not identified, a mixed design ANOVA was not necessary and thus two one-way ANOVAs were conducted for everyday and advanced technology. Next, variables for age (in years), gender (male, female), education status (primary/secondary, tertiary), living status (alone, spouse/family member/friend), employment status (employed, retired), pension type (pension, no pension) were co-varied in two ANCOVAs, one for everyday technology and one for advanced technology.
√ √
Results
√ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
The ANOVA revealed a significant main effect for technology [F (1,179) ⫽ 184.35, p ⬍ .001, partial eta squared ⫽ .507] suggesting that the two types of technology were used differently, however, the Group ⫻ Technology interaction was not significant [F (3,179) ⫽ .1.021, p ⫽ .385]. Since an interaction was not identified, two separate ANOVAs were conducted for everyday and advanced technology factors. One-way ANOVAs revealed significant group effects for both everyday [F (3, 190) ⫽ 2.74, p ⫽ .045] and advanced technology [F (3, 221) ⫽ 3.20, p ⫽ .024]. This finding supported our initial hypothesis that there would be significant differences across the groups in the use of everyday and advanced technologies (see Table 3). Interestingly, for both everyday and advanced technology, the mean composite scores on the TEQ for the consulter and successful hearing aid owner groups were higher than those for non-consulters and unsuccessful hearing aid owners. However, post-hoc Tukey tests indicated that only one comparison trended towards statistical significance; namely, that non-consulters used everyday technology less than consulters (p ⫽ .053).
Technology use, help-seeking and hearing aids Table 3. Means, standard deviations, and ranges of TEQ composite scores for participants, by group, for use of everyday and advanced technology. Everyday technology
Advanced technology
Group
Mean
SD
Range
Mean
SD
Range
Non-consulters Consulters Unsuccessful HA owners Successful HA owners
17.9 21.5 18.4 19.7
(6.8) (6.4) (6.5) (6.9)
4–32 8–33 3–39 1–39
10.4 14.1 10.2 14.3
(8.7) (8.6) (7.4) (8.0)
0–32 0–31 0–30 0–31
Subsequent ANCOVAs that included the covariates of age, gender, education, employment status, pension status, and living arrangements across the four participant groups revealed that there were no significant differences between groups in everyday technology or advanced technology use [F (3,184) ⫽ .921, p ⫽ .432 and F (3,215) ⫽ 1.16, p ⫽ .324]. However, the covariates age and living arrangement had a significant effect on everyday technology use [F (1,184) ⫽ 4.06, p ⫽ .045, partial eta squared ⫽ .022; F (1,184) ⫽ 4.98, p ⫽ .027, partial eta squared ⫽ .026, respectively]. Increasing age and living alone (versus living with a spouse, family member, or friend) were associated with decreased technology use. In the ANCOVA for advanced technology scores, age, and gender showed significant effects on technology use in older adults [F (1,215) ⫽ 15.153, p ⬍.001, partial eta squared ⫽ .066 and F (1,215) ⫽ 4.45, p ⫽ .036, partial eta squared ⫽ .020 respectively]. An increase in age and female gender were associated with decreased technology use in older adults.
Discussion This study considered the use of both everyday and advanced technology and compared the frequency of technology use across four groups of older adults with HI who differed in terms of their helpseeking behaviour and hearing aid outcomes. The hypothesis that technology use would be less amongst non-consulters and unsuccessful hearing aid owners, compared to consulters and successful hearing aid owners, was not supported. Factors that did influence technology use amongst older adults were age, gender, and whether participants lived alone or with others. Both age and gender have previously been reported as influencing technology use in older adults. One of the largest studies in this area is the MOBILATE survey (Tacken et al 2005) of 3950 participants aged 55 years and older from European Union member states (Finland, Hungary, East and West Germany, Italy, Netherlands). Adults aged 75 years and older who were surveyed were less likely to use new technology than younger older adults (55–74 years); and women were less likely to use new technology than men. Likewise, Czaja et al (2006) reported on attitude to computer use in a sample of 1,204 participants and found that age and gender significantly influenced attitudes. Women had higher levels of anxiety about computer use, lower computer self-efficacy, poorer attitude towards computers, and less interest in computers than men. They also found that older people (61–90 years) used fewer types of technology than younger and middle-aged adults. The finding in the present study that people who lived alone were less likely to use technology has not previously been reported in the literature and is counterintuitive in some respects as one might
S41
assume that a person living alone may need to use more technology to communicate and socialize with family and friends. The reasons for this finding are not known but it may be that older adults living alone do not use technology as much as those who live with others because of difficulties with access. For example, some older adults may need assistance to set up new technologies such as computers.
Conclusions In conclusion, the results of this study indicate that the use of both everyday and advanced forms of technology is not a factor contributing to the uptake and use of hearing aids by older adults. Thus, our results indicate that audiologists do not need to enquire about clients’ technology use during discussions about hearing rehabilitation options. It would be more appropriate to focus on other factors identified in this special issue as being important, such as attitude to hearing aids, family support, and self-efficacy (see Meyer et al, this issue; Hickson et al, this issue). Declaration of interest: The authors alone are responsible for the content and writing of this paper. The authors report no declarations of interest This research was funded by the HEARing Cooperative Research Centre, established under the Cooperative Research Centres Program – an Australian Government Initiative.
References Australian Bureau of Statistics. 1996a. Household use of information technology [online]. Available: http://www.abs.gov.au/AUSSTATS/[email protected]/a llprimarymainfeatures/56738B8C47A766CFCA25722E001BFE4B?op endocument [accessed 24 August, 2011]. Australian Bureau of Statistics. 2003b. Household use of information technology [online]. Available: http://www.abs.gov.au/AUSSTATS/abs@. nsf/allprimarymainfeatures/869A172088191248CA2570D8001B83E2? opendocument [Accessed 24 August, 2011]. Australian Bureau of Statistics. 2009c. Household use of information technology [online]. Available: http://www.abs.gov.au/AUSSTATS/[email protected]/ allprimarymainfeatures/ACC2D18CC958BC7BCA2568A9001393AE? opendocument [Accessed 24 August, 2011]. Chia E.M., Wang J.J., Rochtchina E., Cumming R.R., Newall P. et al. 2007. Hearing impairment and health-related quality of life: The Blue Mountains Hearing Study. Ear Hear, 28, 187–195. Cox R.M., Stephens D. & Kramer S.E. 2002. Translations of the International Outcome Inventory of Hearing Aids (IOI-HA). Int J Audiol, 41, 3–26. Cruickshanks K.J., Wiley T.L., Tweed T.S., Klein B.E.K., Klein R. et al. 1998. Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin: The epidemiology of hearing loss study. Am J Epidemiol, 148, 879–886. Czaja S.J., Fisk A.D., Hertzog C., Rogers W.A., Charness N. et al. 2006. Factors predicting the use of technology: Findings from the Centre for Research and Education on Aging and Technology Enhancement (CREATE). Psychol Aging, 21, 333–352. Davis A. 1989. The prevalence of hearing impairment and reported hearing disability among adults in Great Britain. Int J Epidemiol, 18, 911–917. Gonsalves C. & Pichora-Fuller M.K. 2008. The effect of hearing loss and hearing aids on the use of information and communication technologies by community-living older adults. Canadian Journal on Aging, 27, 145–157. Gopinath B., Schneider J., Hartley D., Teber E., McMahon C.M. et al. 2011. Incidence and predictors of hearing aid use and ownership
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among older adults with hearing loss. Annals of Epidemiology, 21(7), 497–506. Hickson L., Meyer C., Lovelock K., Lampert M., Khan A. et al. (this issue). An investigation of factors that influence hearing aid success in older adults. Madden G. & Savage S.J. 2000. Some economic and social aspects of residential internet use in Australia. Journal of Media Economics, 13, 171–185. Meyer C., Hickson L., Lovelock K., Lampert M., Khan A. et al. (this issue). An investigation of factors that influence help-seeking for hearing impairment in older adults. Roupa Z., Nikas M., Gerasimou E., Zafeiri V., Giasyrani L. et al. 2010. The use of technology by the elderly. Health Science Journal, 4, 118–126.
Schneider J. M., Gopinath B., Karpa M. J., McMahon C.M., Rochtchina E. et al. 2010. Hearing loss impacts on the use of community and informal supports. Age Ageing, 39, 458–464. cgibin/imdb/p2SV.pl?Function ⫽ getSurvey&SDDS ⫽ 4505&lang ⫽ en&db ⫽ imdb&adm ⫽ 8&dis ⫽ 2#b2.htm. [accessed 15 June, 2011]. Tacken M., Marcellini F., Mollenkopf H., Ruopilla I. & Széman Z. 2005. Use and acceptance of new technology by older people. Findings of the international MOBILATE survey: “Enhancing mobility in later life”. Gerontechnology, 3, 126–137. The National Archives. 2001. National statistics: Living in Britain, supplementary report, people aged 65 and over, housing and consumer durables. [online]. Available: http://webarchive.nationalarchives.gov. uk/20100520011438/http://www.statistics.gov.uk/lib2001/Section3759. html [accessed 15 June, 2011].
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Original Article
Exploring the relationship between technology use, hearing help-seeking, and hearing aid outcomes in older adults Heidi Stieglitz Ham*,†, Paul Bunn*,†, Carly Meyer*,†, Asad Khan* & Louise Hickson*,† *HEARing
CRC, Melbourne, Australia, and †Communication Disability Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
Abstract Objective: The objective of this study was to explore technology use and its relationship to help-seeking for hearing impairment (HI) and success with hearing aids among older adults. Previous research had suggested a link between higher levels of technology use and hearing aid success. Design: General technology use was evaluated using a purposefully developed 25-item questionnaire. Twelve items related to everyday technology use (e.g. DVD player) and 13 related to advanced technology use (e.g. Bluetooth). Study sample: Four groups of older adults with HI participated in the study: (1) non-consulters (n ⫽ 49), (2) consulters (n ⫽ 62), (3) unsuccessful hearing aid owners (n ⫽ 61), and (4) successful hearing aid owners (n ⫽ 79). Results: Preliminary analyses revealed a main effect in the use of everyday and advanced technology across the four participant groups. However, it was found that age and living arrangements accounted for most of the variance in reported everyday technology use (p ⫽ .030; p ⫽ .029, respectively) and age and gender accounted for the variance in reported advanced technology use (p ⬍.001; p ⫽ .040, respectively). For everyday technology, an increase in age and living alone were associated with decreased technology use and for advanced technology use, age and female gender were associated with decreased technology use. Conclusions: Although we hypothesized that technology use would be less amongst non-consulters and unsuccessful hearing aid owners, our findings did not support this prediction. Technology use did not vary by group membership once the covariates of age, gender, and living arrangements were accounted for.
Key Words: Hearing aids; help-seeking; outcomes; older adults; hearing impairment; technology Due to increasing longevity, chronic health problems amongst older adults in our community are on the rise. One of the more common chronic health problems experienced by older adults is hearing impairment (HI) with a prevalence of 60–70% in adults 70 years or older (Chia et al, 2007; Cruickshanks et al, 1998; Davis, 1989). Despite these high levels of HI in the population, studies have reported poor take up of hearing health care services including hearing aid fitting (Gopinath et al, 2011; Schneider et al, 2010). One possible reason for this, explored in this study, is whether or not the positioning of hearing aids as a ‘high technology solution’ to hearing and communication difficulties is in fact a barrier to hearing help-seeking and hearing aid use for older adults. Technology use statistics have been recorded across Australia since 1996 and indicate that, although there is a growing number of older Australians using computers and the internet, technology use remains relatively low amongst older adults (Australian Bureau of Statistics, 1996a, 2003b; Madden & Savage, 2000). Figures from 2009 show that 81% of Australians aged between 15 and 44 years access the internet, compared to only 29% of Australians aged 65 years and older (Australian Bureau of Statistics, 2009c). Similar figures are reported in other developed countries. For example, a British government survey (National Archives, 2001) reported that
only 14% of older adults had internet access compared with 49% of other households; and only 36% of older adults owned a mobile phone compared with 82% of other households. Older adults were far more likely to use everyday technologies (e.g. microwave, washing machine) than more advanced forms of technology (e.g. mobile phones, computers) (The National Archives, 2001). Factors influencing technology use in older adults have been studied and point to the mediating effects of age and gender on technology use. For example, in Greece, a sample of 300 adults between 65 and 85 years of age were asked to report on their use of everyday technology items (e.g. TV, wireless phone). Of the 300 participants, 134 were men and nearly 80% were aged between 65 and 74 years. Statistical analysis revealed a gender difference; women were more likely than men to use everyday technology. Some age stratification was also evident with decreasing rates in the old-old compared to the young-old. Specifically, 80% of participants between 65 and 74 years of age used everyday technology compared to 20% of participants between 75 and 84 years of age, and fewer than 10% of adults aged 85 years and older (Roupa et al, 2010). The only previous study of the relationship between HI and technology use in older adults was conducted by Gonsalves and Pichora-Fuller (2008). A questionnaire about the extent of use
Correspondence: Louise Hickson, Communication Disability Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, Australia. E-mail: [email protected] (Received 11 September 2013; accepted 16 September 2013) ISSN 1499-2027 print/ISSN 1708-8186 online © 2014 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society DOI: 10.3109/14992027.2013.847287
Technology use, help-seeking and hearing aids
Methods
Abbreviations ANOVA ANCOVA dB HA HI HTL IOI-HA TEQ WEA
Analysis of variance Analysis of covariance Decibel Hearing aids Hearing impairment Hearing threshold level International outcome inventory for hearing aids Technology experiences questionnaire Worse ear average
of 16 technologies (e.g. radio, answering machine, internet) was completed by 135 adults aged between 65 and 87 years (Mean ⫽ 74.3, SD ⫽ 5.2). Interestingly, participants with uncorrected HI (n ⫽ 25) used the internet and email considerably less than participants with normal hearing (n ⫽ 82). There were no differences in technology use between participants with corrected HI (i.e. they wore hearing aids) (n ⫽ 28) and those with normal hearing (Gonsalves & Pichora-Fuller, 2008). Participants with uncorrected HI also appeared to use computers, faxes, and automatic teller machines (ATMs) less than other participant groups. The authors concluded that “there seems to be a connection between use of general communication and information technologies and the use of hearing aids” (p.154). Accordingly, as the program of research described in this special issue aimed to understand barriers and facilitators to help-seeking for HI and successful use of hearing aids, we undertook a study of older adults’ technology use in this context. Given that Gonsalves and Pichora-Fuller (2008) found that those with HI who did not own hearing aids did not use technology to the same extent as those with normal hearing or those who wore hearing aids, we hypothesized that technology use would be less amongst older adults who had not sought help for their hearing difficulties (compared to those who had sought help) and amongst those who were successful hearing aid users (compared to those who were not successful).
Participants The study sample consisted of a subset of 251 adults, aged between 60 and 95 years, who were participants in a larger study investigating barriers and facilitators to hearing rehabilitation in older adults (Hickson et al, this issue; Meyer et al, this issue). Participants were placed into one of four groups based on the followed criteria: (1) those with HI who had not sought help for their hearing problems (non-consulters; n ⫽ 49); (2) those who had consulted a health professional about their HI but chose not to obtain hearing aids (consulters; n ⫽ 62); (3) those fitted with hearing aids in the past two years but were unsuccessful in using them (unsuccessful hearing aid owners; n ⫽ 61); and (4) those fitted with hearing aids in the past two years and were successfully using them (successful hearing aid owners; n ⫽ 79). HI was defined as a pure-tone average (0.5, 1, 2, and 4 kHz or 2, 3, or 4 kHz) of greater than 25 dB HTL in at least one ear. Hearing aid success was defined using two items from the international outcome inventory – hearing aids (Cox et al, 2002) as a minimum of one hour of daily hearing aid use and at least moderate benefit from hearing aids in the situation the individual most wanted to hear better (Hickson et al, this issue; Meyer et al, this issue). Demographic information relevant to this study is presented in Table 1. The mean age of the participants was 72 years (SD ⫽ 7; range ⫽ 60 to 95) with 64% of the sample being male. Just over half the sample (54%) had tertiary qualifications. The majority of participants were retired (82%) and 75% lived with either a spouse, family member, or a friend. Fifty-five percent of participants received a pension and were thus eligible for free hearing rehabilitation services including hearing aids.
Materials A 25-item technology experiences questionnaire (TEQ) was developed to assess participants’ experiences with various types of technology. The TEQ was based on results of a pilot study involving 49 adults with HI (M ⫽ 74 years, range ⫽ 62–90 years; 16 females, 33 males). As part of the pilot study, participants were asked the
Table 1. Demographic information of group members (N ⫽ 251). Variable Gender Female: n (%) Male: n (%) Age in years (SD) Education Primary/secondary: n (%) Tertiary: n (%) Employment status Retired/house duties: n (%) Employed (full-time/part-time): n (%) Living status Alone: n (%) Spouse/family member/friend: n (%) Pension type Pension: n (%) No pension: n (%) HA ⫽ Hearing aids
S39
Non-consulters (n ⫽ 49)
Consulters (n ⫽ 62)
Unsuccessful HA owners (n ⫽ 61)
Successful HA owners (n ⫽ 79)
24 (49%) 25 (51%) 73 (7.5)
21 (34%) 41 (66%) 70 (6.6)
17 (28%) 44 (72%) 75 (6.8)
29 (37%) 50 (63%) 70 (6.2)
25 (51%) 24 (49%)
24 (39%) 38 (61%)
31 (51%) 30 (49%)
35 (44%) 44 (56%)
38 (78%) 11 (22%)
43 (69%) 19 (31%)
55 (90%) 6 (10%)
70 (89%) 9 (11%)
16 (33%) 33 (67%)
14 (23%) 48 (77%)
18 (30%) 43 (70%)
14 (18%) 65 (82%)
20 (41%) 29 (59%)
20 (32%) 42 (68%)
50 (82%) 11 (18%)
49 (62%) 30 (38%)
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following open-ended question: “We’re interested in your experiences with technology. Can you think of any technology you use?” A list of technologies was compiled (see Table 2) and categorized into one of the following technology groups to form the basis of the questionnaire: TV (five items), telephone (one item), mobile phone (three items), computer (seven items), digital camera (three items), and general technologies (e.g. iPod, ATM) (six items). The 25 items on the TEQ were then classified as either everyday or advanced technology, in accordance with definitions used in previous studies (National Archives, 2001; Gonsalves & Pichora-Fuller, 2008; Roupa, 2010). Everyday technology included common technologies encountered and used more frequently and often included older technologies (e.g. mobile phone and answering machine). Advanced technology, on the other hand, included technologies that were more complex and required more skill in their use (e.g. use of advanced applications on a mobile phone, and downloading and editing images from a digital camera). Each participant was asked how often they used each technology. The responses (never, seldom, monthly, weekly) on the 25 TEQ items were scored (never ⫽ 0, seldom ⫽ 1, monthly ⫽ 2, weekly ⫽ 3) to create composite scores that were collated for each participant. Higher composite scores on the TEQ items were Table 2. Technology experiences questionnaire items as functions of technology type. Type of technology TV 1. VCR 2. DVD player 3. Pay TV (e.g. foxtelTM, IQTM) 4. Digital TV/Set top box/Hard drive recorder/ TIVOTM 5. Universal remote control Phone 1. Answering machine/voicemail (Telstra 101TM, mobile) Mobile phone 1. Calls 2. Text/SMS 3. Advanced (apps., e-mail, internet, GPS) Computer 1. Basic software (e.g. Office, solitaire, etc.) 2. Internet browsing 3. E-mail 4. Specialist programs (e.g. myobTM, ItunesTM etc) 5. Social networking (FacebookTM, TwitterTM, blogger) 6. SkypeTM/web cam 7. Gaming Digital camera 1. Taking photos 2. Downloading images/printing 3. Editing images General 1. GPS/sat nav 2. IpodTM/mp3 3. ATM 4. Bluetooth 5. Home alarm system 6. Home A/C system
Everyday
Advanced
√ √ √ √ √ √
√
consistent with more experience with technology whereas lower scores were associated with less experience.
Procedure Ethical clearance was granted through the University of Queensland Behavioural and Social Sciences Ethical Review Committee. Prior to the assessment appointment, participants were sent a number of questionnaires in the mail (including the TEQ) which they were asked to complete and to bring with them to the appointment. When the participant attended the assessment appointment, a standard audiological test battery was carried out and further questionnaires and assessments were administered (for details of other measures see Meyer et al and Hickson et al, this issue).
Statistical analysis Prior to analysis, the variables: age, gender, education status, employment status, pension type, living arrangement, group membership, and the TEQ data, were examined for completeness and the data was cleaned as appropriate for analysis. The participants’ composite scores on the TEQ for everyday and advanced technology were assessed for normality. Analysis of skewness on advanced technology indicated skewness of .106, mildly positive, and unlikely to violate assumptions associated with ANOVA. Skewness on everyday technology was .005 and nearly normally distributed. A 2 ⫻ 4 mixed design ANOVA was conducted using technology (everyday and advanced) as the within-subjects factor and group (i.e. HI participant groups) as the between-group factor to assess differences in the use of technology across the four groups. After a Group ⫻ Technology interaction was not identified, a mixed design ANOVA was not necessary and thus two one-way ANOVAs were conducted for everyday and advanced technology. Next, variables for age (in years), gender (male, female), education status (primary/secondary, tertiary), living status (alone, spouse/family member/friend), employment status (employed, retired), pension type (pension, no pension) were co-varied in two ANCOVAs, one for everyday technology and one for advanced technology.
√ √
Results
√ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √
The ANOVA revealed a significant main effect for technology [F (1,179) ⫽ 184.35, p ⬍ .001, partial eta squared ⫽ .507] suggesting that the two types of technology were used differently, however, the Group ⫻ Technology interaction was not significant [F (3,179) ⫽ .1.021, p ⫽ .385]. Since an interaction was not identified, two separate ANOVAs were conducted for everyday and advanced technology factors. One-way ANOVAs revealed significant group effects for both everyday [F (3, 190) ⫽ 2.74, p ⫽ .045] and advanced technology [F (3, 221) ⫽ 3.20, p ⫽ .024]. This finding supported our initial hypothesis that there would be significant differences across the groups in the use of everyday and advanced technologies (see Table 3). Interestingly, for both everyday and advanced technology, the mean composite scores on the TEQ for the consulter and successful hearing aid owner groups were higher than those for non-consulters and unsuccessful hearing aid owners. However, post-hoc Tukey tests indicated that only one comparison trended towards statistical significance; namely, that non-consulters used everyday technology less than consulters (p ⫽ .053).
Technology use, help-seeking and hearing aids Table 3. Means, standard deviations, and ranges of TEQ composite scores for participants, by group, for use of everyday and advanced technology. Everyday technology
Advanced technology
Group
Mean
SD
Range
Mean
SD
Range
Non-consulters Consulters Unsuccessful HA owners Successful HA owners
17.9 21.5 18.4 19.7
(6.8) (6.4) (6.5) (6.9)
4–32 8–33 3–39 1–39
10.4 14.1 10.2 14.3
(8.7) (8.6) (7.4) (8.0)
0–32 0–31 0–30 0–31
Subsequent ANCOVAs that included the covariates of age, gender, education, employment status, pension status, and living arrangements across the four participant groups revealed that there were no significant differences between groups in everyday technology or advanced technology use [F (3,184) ⫽ .921, p ⫽ .432 and F (3,215) ⫽ 1.16, p ⫽ .324]. However, the covariates age and living arrangement had a significant effect on everyday technology use [F (1,184) ⫽ 4.06, p ⫽ .045, partial eta squared ⫽ .022; F (1,184) ⫽ 4.98, p ⫽ .027, partial eta squared ⫽ .026, respectively]. Increasing age and living alone (versus living with a spouse, family member, or friend) were associated with decreased technology use. In the ANCOVA for advanced technology scores, age, and gender showed significant effects on technology use in older adults [F (1,215) ⫽ 15.153, p ⬍.001, partial eta squared ⫽ .066 and F (1,215) ⫽ 4.45, p ⫽ .036, partial eta squared ⫽ .020 respectively]. An increase in age and female gender were associated with decreased technology use in older adults.
Discussion This study considered the use of both everyday and advanced technology and compared the frequency of technology use across four groups of older adults with HI who differed in terms of their helpseeking behaviour and hearing aid outcomes. The hypothesis that technology use would be less amongst non-consulters and unsuccessful hearing aid owners, compared to consulters and successful hearing aid owners, was not supported. Factors that did influence technology use amongst older adults were age, gender, and whether participants lived alone or with others. Both age and gender have previously been reported as influencing technology use in older adults. One of the largest studies in this area is the MOBILATE survey (Tacken et al 2005) of 3950 participants aged 55 years and older from European Union member states (Finland, Hungary, East and West Germany, Italy, Netherlands). Adults aged 75 years and older who were surveyed were less likely to use new technology than younger older adults (55–74 years); and women were less likely to use new technology than men. Likewise, Czaja et al (2006) reported on attitude to computer use in a sample of 1,204 participants and found that age and gender significantly influenced attitudes. Women had higher levels of anxiety about computer use, lower computer self-efficacy, poorer attitude towards computers, and less interest in computers than men. They also found that older people (61–90 years) used fewer types of technology than younger and middle-aged adults. The finding in the present study that people who lived alone were less likely to use technology has not previously been reported in the literature and is counterintuitive in some respects as one might
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assume that a person living alone may need to use more technology to communicate and socialize with family and friends. The reasons for this finding are not known but it may be that older adults living alone do not use technology as much as those who live with others because of difficulties with access. For example, some older adults may need assistance to set up new technologies such as computers.
Conclusions In conclusion, the results of this study indicate that the use of both everyday and advanced forms of technology is not a factor contributing to the uptake and use of hearing aids by older adults. Thus, our results indicate that audiologists do not need to enquire about clients’ technology use during discussions about hearing rehabilitation options. It would be more appropriate to focus on other factors identified in this special issue as being important, such as attitude to hearing aids, family support, and self-efficacy (see Meyer et al, this issue; Hickson et al, this issue). Declaration of interest: The authors alone are responsible for the content and writing of this paper. The authors report no declarations of interest This research was funded by the HEARing Cooperative Research Centre, established under the Cooperative Research Centres Program – an Australian Government Initiative.
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