The intention to use mHealth applications among Dutch older adults prior and during the COVID pandemic

Abstract

Background: Mobile health (mHealth) applications are widely valued for their potential to increase self-management among older adults and reduce their healthcare demands. However, the intention to use mHealth of Dutch older adults before the COVID-19 pandemic was modest. Healthcare access was considerably reduced during the pandemic and mHealth services substituted for in person health services. As older adults utilize health services more frequently and have been particularly vulnerable to the pandemic, they can be viewed to have especially benefitted from the transition toward mHealth services. Furthermore, one might expect their intention to use these services and reap the potential benefits has increased, especially during the pandemic.

Objective: The aim of this study was to examine whether the intention of Dutch older adults to use medical applications increased during the COVID pandemic and how the explanatory power of the extended Technology Acceptance Model (TAM) developed for this purpose was affected by the onset of the pandemic.

Methods: We conducted a cross-sectional survey using two samples collected before (n = 315) and after (n = 501) the onset of the pandemic. Data was collected using questionnaires which were distributed digitally and on paper, by convenience sampling and snowballing. Participants were 65 years or older, lived independently or in a senior living facility, without cognitive impairment. A controlled analysis was performed to test for significant differences in the intention to use mHealth. The before and after differences in extended TAM variables and their relationship with intention to use (ITU) were analyzed using controlled (multivariate) logistic and linear regression models. These models were also used to explore whether the onset of the pandemic had an effect on ITU not captured by the extended TAM model.

Results: While the two samples differed in ITU (p = 0.017; uncontrolled) there was no statistically significant difference in ITU in the controlled logistic regression analysis (p = 0.107). The scores of the extended TAM variables explaining intention to use were all significantly higher, except for Subjective norm and Feelings of Anxiety. The relationships of these variables with intention to use before and after the onset of the pandemic were similar, except for Social relationships which lost its significance. We found no indications of effects of the pandemic on intention to use not captured by our instrument.

Conclusion: The intention to use mHealth applications of Dutch older adults has not changed since the onset of the pandemic. The extended TAM model has robustly explained intention to use, with only minor differences after the first months of the pandemic. Interventions targeting facilitation and support are likely to promote the uptake of mHealth. Follow-up studies are needed to investigate whether the pandemic has had long term effects on the ITU of the older adult.

Keywords: COVID-19; intention to use; mHealth; medical applications; older adults; pandemic; technology acceptance model.