Factors influencing acceptance of technology for aging in place: A systematic review

(1)

Tilburg University

Factors influencing acceptance of technology for aging in place

Peek, S.T.M.; Wouters, E.J.M.; van Hoof, J.; Luijkx, K.G.; Boeije, H.R.; Vrijhoef, H.J.M.

Published in:

International Journal of Medical Informatics

DOI:

10.1016/j.ijmedinf.2014.01.004

Publication date:

2014

Document Version

Publisher's PDF, also known as Version of record

Link to publication in Tilburg University Research Portal

Citation for published version (APA):

Peek, S. T. M., Wouters, E. J. M., van Hoof, J., Luijkx, K. G., Boeije, H. R., & Vrijhoef, H. J. M. (2014). Factors

influencing acceptance of technology for aging in place: A systematic review. International Journal of Medical

Informatics, 83(4), 235-248. https://doi.org/10.1016/j.ijmedinf.2014.01.004

General rights

Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain

• You may freely distribute the URL identifying the publication in the public portal

Take down policy

If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

(2)

international journal of medical informatics 83 (2014)235–248

jo u r n al ho m e p a g e :w w w . i j m i j o u r n a l . c o m

Review

Factors

inﬂuencing

acceptance

of

technology

for

aging

in

place:

A

systematic

review

Sebastiaan

T.M.

Peek

a,b,∗

_,

_Eveline

_J.M.

_Wouters

a

_,

_Joost

_van

_Hoof

c

_,

_Katrien

_G.

_Luijkx

b

_,

Hennie

R. Boeije

d

_,

_Hubertus

_J.M.

_Vrijhoef

b,e

a_Chair_of_Health_Innovations_and_Technology,_School_for_Allied_Health_Professions,_Fontys_University_of_Applied_Sciences,_The_Netherlands b_Department_of_Tranzo,_School_of_Social_and_Behavioral_Sciences,_Tilburg_University,_The_Netherlands

c_Centre_for_Healthcare_and_Technology,_Fontys_University_of_Applied_Sciences,_The_Netherlands

d_Faculty_of_Social_Sciences,_Department_of_Methodology_and_Statistics,_Utrecht_University,_The_Netherlands e_Saw_Swee_Hock_School_of_Public_Health,_National_University_of_Singapore,_Singapore

a

r

t

i

c

l

e

i

n

f

o

Articlehistory: Received17June2013 Receivedinrevisedform 7January2014 Accepted10January2014 Keywords: Independentliving Aged Technology Review Behavior Assistivetechnology eHealth

a

b

s

t

r

a

c

t

Purpose:Toprovideanoverviewoffactorsinﬂuencingtheacceptanceofelectronic tech-nologiesthatsupportaginginplacebycommunity-dwellingolderadults.Sincetechnology acceptancefactorsﬂuctuateovertime,adistinctionwasmadebetweenfactorsinthe pre-implementationstageandfactorsinthepost-implementationstage.

Methods:Asystematicreviewofmixedstudies.Sevenmajorscientiﬁcdatabases(including MEDLINE,ScopusandCINAHL)weresearched.Inclusioncriteriawereasfollows:(1)original andpeer-reviewed research,(2)qualitative,quantitativeor mixedmethodsresearch,(3) researchinwhichparticipantsarecommunity-dwellingolderadultsaged60yearsorolder, and(4)researchaimedatinvestigatingfactorsthatinﬂuencetheintentiontouseorthe actualuseofelectronictechnologyforaginginplace.Threeresearcherseachreadthearticles andextractedfactors.

Results:Sixteenoutof2841articleswereincluded.Mostarticlesinvestigatedacceptanceof technologythatenhancessafetyorprovidessocialinteraction.Themajorityofdatawas basedonqualitativeresearchinvestigatingfactorsinthepre-implementationstage. Accep-tanceinthisstageisinfluencedby27factors,dividedintosixthemes:concernsregarding technology(e.g.,highcost,privacyimplicationsandusabilityfactors);expectedbenefitsof technology(e.g.,increasedsafetyandperceivedusefulness);needfortechnology(e.g., per-ceivedneedandsubjectivehealthstatus);alternativestotechnology(e.g.,helpbyfamilyor spouse),socialinfluence(e.g.,influenceoffamily,friendsandprofessionalcaregivers);and characteristicsofolderadults(e.g.,desiretoageinplace).Whencomparingtheseresults

∗ _{Corresponding}_author_at:_Dominee_Theodor_{Fliednerstraat}_2,₅₆₃₁_BN_Eindhoven,_The_Netherlands._Tel.:₊₃₁_683991191.

E-mailaddress:s.peek@fontys.nl(S.T.M.Peek).

http://dx.doi.org/10.1016/j.ijmedinf.2014.01.004

(3)

toqualitativeresultsonpost-implementationacceptance,ouranalysisshowedthatsome factorsarepersistentwhilenewfactorsalsoemerge.Quantitativeresultsshowedthata smallnumberofvariableshaveasigniﬁcantinﬂuenceinthepre-implementationstage. Fourteenoutofthesixteenincludedarticlesdidnotuseanexistingtechnologyacceptance frameworkormodel.

Conclusions:Acceptanceoftechnologyinthepre-implementationstageisinﬂuencedby multiplefactors. However, post-implementationresearch on technologyacceptanceby community-dwellingolderadultsisscarceandmostofthefactorsinthisreviewhavenot beentestedbyusingquantitativemethods.Furtherresearchisneededtodetermineifand howthefactorsinthisreviewareinterrelated,andhowtheyrelatetoexistingmodelsof technologyacceptance.

1. Introduction

Themajorityofolderadultsprefertoliveindependentlyfor aslongastheypossiblycan[1–4].Supportingolderadultsto remainintheirownhomesandcommunitiesisalsofavored bypolicy makers and health providers to avoid the costly optionofinstitutionalcare[5]. Researchshowsthatseveral interrelated factors can challenge the independence of olderadults:primarilyfunctionalandcognitiveimpairment,

(4)

237

adultstoacceptanduse thesetechnologies[11–13]. Accep-tance oftechnologies that are electronic or digital may be moredifﬁcultforthecurrentgenerationofseniorswhichdid notgrowupwiththesetypesoftechnologies[14–16].Inan effort to understandolder adults’ usage and non-usage of moderntechnology,researchersoftenturntotwotechnology acceptancemodels,stemmingfromtheﬁeldofinformation systems.

1.1. Technologyacceptancemodels

Technologyacceptanceresearchisdominatedbythe Tech-nologyAcceptanceModel(TAM)[17]andtheUniﬁedTheory ofAcceptanceandUseofTechnology(UTAUT)[18].Thekey variablesinTAMarePerceivedUsefulness(PU)andPerceived EaseofUse(PEOU).Systematicreviewshaveshownthatthese twovariables typicallyexplain40percentofanindividual’s intentiontouseatechnologyinavarietyofcontextsincluding healthcare[19–21],andthatintentiontousemay[22]ormay not[23]predictactualuseoftechnology.UTAUTiscapableof explainingupto70percentofintentiontouseattheexpense ofparsimonybyaddingtwoadditionalvariables(Social Inﬂu-enceandFacilitatingConditions)andfourmoderatingfactors (Gender,Age,ExperienceandVoluntarinessofUse)[18].

Whilebeingpowerfulandrobust,TAMandUTAUThave alsoreceivedcriticismfordisregardingthefactthat technol-ogyacceptancemayfluctuateovertime[24–27].Furthermore, severalstudiesdemonstratethattheinfluenceofPU,PEOU, and other relevant factors is different between the pre-implementation stage (when a technology has not been used yet) and the post-implementation stage (when users haveusedandexperiencedatechnology)[28,29].Acceptance researchisalsocriticizedforbeingtooreliantonTAMand UTAUT, overlooking essential determinants [30,31,26]. In a recentliteraturereview,Chenand Chandiscussed19 stud-iesthatusedTAMorrelatedmodelsandconstructstoexplain technologyacceptancebyolderadults[32].Theyfoundthat specificbiophysical(e.g.,cognitiveandphysicaldecline)and psychosocial (e.g., social isolation, fear of illness) factors relatedtoagingareoverlookedinthecurrentliterature.

ChenandChanalsonotethatthefactorcost(price)of tech-nologyisneglectedinmanystudies,althoughitseemstobe acritical factorin determininganolderadult’s acceptance oftechnology[32].Furthermore,mostresearchhasfocused on communication- and assistive technology in the home domain,neglectingothertypesoftechnology[32].These con-cernsindicatethatmoreresearchisneededtodevelopabetter understandingofacceptanceofvarioustypesoftechnologyby olderadults.

1.2. Researchquestion

Thissystematicreviewofqualitative,quantitative,andmixed methodsstudiesexaminesthefollowingresearchquestions: whichfactorsinﬂuencetheacceptanceofdifferenttypesof technologyforaginginplacebycommunity-dwellingolder adults, and how do these factors differ between the pre-implementationstageandthepost-implementationstage?

Theaimofthis study istoprovide an overviewof fac-torsthatcanfacilitatetheimplementationoftechnologyfor

community-dwellingolderadults,andtoprovidedirections forfurthertechnologyacceptanceresearchwithinthisspeciﬁc group.

Technologyacceptanceinthisstudyisdeﬁnedasthe inten-tion to usea technologyor theactual use ofatechnology

[17]. Technology foraging in placeis deﬁnedas electronic technologythatisdevelopedtosupporttheindependenceof community-dwelling olderadultsbyalleviating or prevent-ingfunctionalorcognitiveimpairment,bylimitingtheimpact ofchronicdiseases,orbyenablingsocialorphysicalactivity. Community-dwellingolderadultsaredeﬁnedasolderadults whoarenotlivinginalong-termcareinstitution.

2. Methods

2.1. Searchstrategy

InJanuary2012,sevendatabases(ACMDigitalLibrary,CINAHL, IEEEXplore,MEDLINE,PsycINFO,ScopusandWebofScience) were searched using acombination of four groups of key-words: (1) “older”,“senior” and synonyms for theseterms; (2)“livingindependently”,“community-dwelling”andsimilar search terms; (3) search terms to ﬁnd electronic technol-ogy that is aimed atsupporting aging in place. Since this typeoftechnologyisstudiedinmanydifferentﬁelds,itwas decided to be broadly inclusive and include search terms suchas“system”,“e-health”,“gerontechnology”, “telemoni-toring”,“smarthome”,“assistivetechnology”,and“robotics”; and (4) search terms that are related to “acceptance” and similar terms such as “use”, “adoption”, “adherence” and “rejection”.Afulllistofall150searchterms,includingoptions and limitsthat were selectedinthe differentdatabases,is available as supplementary material in the online version (http://dx.doi.org/10.1016/j.ijmedinf.2014.01.004).

2.2. Articleselection

Titles,abstractsandfullarticlesweresubsequentlyscreened byoneauthor[SP]applyingtheinclusioncriteriamentioned inTable1.Incaseofdoubt,threeauthors[SP, EWandJvH] discussedtheselection.Inaddition,referencesoftheincluded articleswerecheckedforotherarticleseligibleforthisreview (snowballmethod).

2.3. Dataextraction

Threeauthors [SP,EWandJvH]eachreadall included arti-cles,andseparatelyentereddatausingadataextractionform,

Table1–Inclusioncriteria.

Inclusioncriteria:

•Originalandpeer-reviewedresearchwritteninEnglish; •Qualitative,quantitativeormixedmethodsresearch; •Researchinwhichparticipantsarecommunity-dwellingolder

adultsaged60yearsorolder;and

(5)

whichisavailableassupplementarymaterialintheonline version(http://dx.doi.org/10.1016/j.ijmedinf.2014.01.004).The ﬁrstpartoftheextractionformincludesentriesoninclusion and exclusion criteria, quality assessment, methods used, typeoftechnologystudied andimplementation stage (pre-implementation/post-implementation). Articles were also checkedforworkingdeﬁnitionsofacceptanceandtheuseof existingtechnologyacceptancemodels.

Articles under review used either qualitative methods, quantitativemethodsoracombinationofboth(mixed meth-ods).Inordertoextractfactorsfromalltypesofarticles,the dataextractionformcontainsasectionforfactorsextracted fromqualitativedataandasectionforfactorsextractedfrom quantitativedata.

In the case of qualitative articles and qualitative data from mixed methods articles, factor names and their per-ceivedinfluenceonacceptancewerecodedandsubsequently enteredinthequalitativesectionoftheform.Inthecaseof quantitativearticlesandquantitativedatafrommixed meth-odsarticles, the following informationwas entered in the dataextractionform:variablename,standardizedor unstan-dardized regression coefficients, level of significance, and proportionofvarianceexplained.

2.4. Dataanalysis

Inthefirst stageofthe analysis,the threeauthors[SP, EW andJvH]hadtoreachconsensusoneveryentryinthedata extractionform,foreacharticle.Thiswasdoneinweekly ses-sions, andarticles were discussed inrandom order. Inthe second stage, thematicsynthesis [33]was used to synthe-sizequalitativedataonfactors.Multiplesessionswereheldto groupfactorsderivedfromqualitativearticlesandqualitative datafrommixedmethodsarticlesindescriptivethemesfor acceptanceinthepre-implementationstage,andfor accep-tanceinthepost-implementationstage.Additionally,SP,EW andJvHeachcreatedaconceptualmodeloftherelationships betweenthemes,andsubsequentlyonecombinedmodelwas developed. Inthe final stage, factors derivedfrom qualita-tivearticlesandqualitativedatafrommixedmethodsarticles werecomparedtofactorsinquantitativearticlesand quan-titativedatafrommixedmethodsarticles.Thiswasdoneto determinewhetherfactorspresentinqualitativeresearchare statisticallytestedinquantitativeresearchandtofind signif-icantfactorsinquantitativeresearchthatarenotpresentin qualitativeresearch.

2.5. Qualityassessment

QualitativearticleswerescreenedusingtheCriticalAppraisal SkillsProgram(CASP)[33],whichcontains10criteriaonitems suchasstudydesign,recruitmentstrategy,the relationship betweenresearcherandparticipants,ethicalconsiderations, dataanalysisand explicitnessofthe ﬁndings.Quantitative articleswere screenedusing the HealthEvidence Bulletins Wales checklist [34]. This checklist covers 11 criteria on cross-sectionalstudiesincludingtheappropriatenessof sam-pling,the levelofprotectionagainstbiases and conﬁdence intheuse ofstatisticalmethods.Themixedmethods arti-cleswerescreenedusingtheMixedMethodsAppraisalTool

(MMAT)[35]which,inadditiontospecificcriteriafor qualita-tiveandquantitativeresearch,alsocontainsspecificcriteria ontherelevanceoftheuseofamixedmethodsdesignand theintegrationofdifferenttypesofresults.Itwasdecidednot toexcludearticlesbasedonqualityassessmentbecausethere islittleempiricalevidenceonwhichtobaseexclusion deci-sions inmixedstudies systematicreviews[35–37]. Instead, itwasdecidedtoreportonthequalityofthereviewed arti-clesandtoapplyindependenttriangulation:factorshadtobe presentinatleasttwostudiesinordertobeincludedinthe results.Furthermore,wedecidedthatintheeventofanarticle notmeetingtheminimalscreeningcriteriaofachecklist,we wouldexaminethecontributionofthatarticletoourfindings.

3. Results

The search in seven databases for factors inﬂuencing the acceptanceofelectronictechnologiesthatsupportagingin placebycommunity-dwellingolderadultsgeneratedatotal of4692results.Aftertheremovalofduplicateresults,atotal of2841uniquearticleswereidentiﬁed(Fig.1).Theselection processinitiallyledtotheinclusionof15articles[38–52].The snowball methodadded one article[53], bringing the total numberofarticlesincludedinthisreviewto16.

3.1. Characteristicsofreviewedarticles

The includedarticles were aimed atexploringfactors that influencethe willingnessofolder adultsto usetechnology foraginginplace,aswellastheirperceptionsand expecta-tionsofthistypeoftechnology.AsshowninTable2,articles describedacceptanceofdifferenttypesoftechnology,andsix articlesdescribedcombinationsoftypesoftechnology. Tech-nologythatenhancessafety(e.g.,monitoringtechnologyand personal alarms)was themostprominenttypeof technol-ogy,followedbytechnologythatprovidessocialinteraction (e.g.,videotelephony).Technologythatsupportsolderadults intheirActivitiesofDailyLiving(ADL)orInstrumental Activ-itiesofDailyLiving(IADL)(e.g.,electronicmemoryaids)was lessprevalent.Resultsalsoshowthat12ofthearticlessolely describeacceptanceoftechnologyinthepre-implementation stage.Inthesepre-implementationstudiesresearchers typi-callyusepresentations,vignettesorscenariostoexplainone ormoretypesoftechnologyforaginginplacetothe partici-pants.Inthreestudies,participantswereallowedtointeract with prototypes [38,42,44]. Evaluation of acceptancein the post-implementationstage(onearticle)oracombinationof evaluationinthepre-andpost-implementationstage(three articles)wasfarlesscommon.Elevenofthe16reviewed arti-clesusedqualitativeresearchmethods(usinginterviewsor focus groups),four articlesused a combination of qualita-tiveandquantitativeresearchmethods(mixedmethods),and onearticlewasbasedonquantitativemethodsalone(usinga cross-sectionalsurvey).Convenienceandpurposivesampling wasusedbyallarticleswiththeexceptionofthearticleby Zimmeretal.[53],whichusedstratifiedsampling.Two arti-clesmadeuseofatheoreticalframeworktoguidethesearch orinterpretationoffactorsinfluencingacceptance:Steeleetal.

(6)

i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 3 ( 2 0 1 4 ) 235–248

239

Table2–Characteristicsofthe16reviewedarticles.

Article Technologytype(s) Implementation stage

Method

Firstauthor,year[reference] (I)ADL Safety Interaction Pre Post Type Instrument N Country

Lorenzen-Huberetal.,2011[38] × × × × – Qualitative Focusgroups 65 USA

vanHoofetal.,2011[39] – × × × × Qualitative In-depthinterviews 18 TheNetherlands

Laietal.,2010[40] – × – × – Mixedmethods Face-to-facesurvey 333 Chinad

Steggelletal.,2010[41] × × × × – Qualitative Focusgroups 32 USA

Steeleetal.,2009[42] – × – × – Qualitative Focusgroups 13 Australia

Courtneyetal.,2008[43] – × – × – Qualitative Focusgroups,in-depthinterviews 14 USA

Demirisetal.,2008[44] – × – × – Qualitative Focusgroups 14 USA

Horton,2008[45] – × × × × Qualitative In-depthinterviews 35 England

Mahmoodetal.,2008[46] – × × × – Qualitative Focusgroup 9 USA

Mihailidisetal.,2008[47] × × × × – Mixedmethodsc _In-depth_interviews,_face-to-face_survey ₁₅a _Canada

Wildetal.,2008[48] – × – × – Qualitative Focusgroups 23b _USA

Cohen-Mansﬁeldetal.,2005[49] × – – × – Mixedmethods Face-to-facesurvey 100 USA

Porter,2005[50] – × – – × Qualitative In-depthinterviews 7 USA

Ezumietal.,2003[51] – – × – × Mixedmethodsc _Face-to-face_survey ₂₈ _Japan

Porteretal.,2002[52] – × – × – Qualitative In-depthinterviews 11 USA

Zimmeretal.,1999[53] – × – × – Quantitative Face-to-facesurvey 1406 USA

×,presentinarticle;–,notpresentinarticle.

a _A_second_group_of₁₅_older_adults_that_did_not_meet_our_age_criterion_was_excluded_from_the_review. b _A_second_group_of₁₆_family_members_and_friends_was_excluded_from_the_review.

(7)

Fig.1–Flowdiagramofthearticleselectionprocess.

usedAndersen’sModelofHealthServicesUtilization[54].The majorityoftheincludedresearchwascarriedoutin Anglo-Saxoncountries.

3.2. Qualityofreviewedarticles

Lookingatthequalityofthequalitativearticles,themajority ofthearticlesmetmostofthecriteria.Therewasonecriterion thatwasonlymetbyonearticle[38].Inthiscriterionitwas assessedwhetherresearcherscriticallyexaminedtheirown role,potentialbiasandinﬂuenceintheprocessofconducting thestudy.Acriterionontheconsiderationofethicalissues wasmetbyhalfoftheincludedarticles.

The one quantitative article [53] met all the criteria except for a criterion on the consideration of alternative explanationsforeffects,andacriteriononthevalidationof surveyquestions.

Lookingatthemixedmethodsarticles,thequalityofone article [51] could not be assessed completely because we

considered the researchquestion ofthis articleambiguous and it therefore did notmeetthe screening criteria ofthe MMAT[35].Theothermixedmethodsarticlesmetthe major-ity ofthe criteria, butnone ofthearticles metthe criteria onconsiderationtowardtheinﬂuencebytheresearcher,the validityofquantitativemeasurementsandconsiderationof thelimitationsassociatedwithintegrationofqualitativeand quantitativedata.

3.3. Qualitativeresultsonpre-implementation acceptance

(8)

241

Table3–Pre-implementationacceptancefactors.

Theme Factor Numberofarticles References

Concernsregardingtechnology Highcost 7 [40–42,45,47,49,52]

Privacyimplications 7 [38,41–44,47,48]

Forgettingorlosingtechnology 4 [41,42,48,49]

Falsealarms 3 [44,45,47]

Obtrusiveness 3 [42,44,48]

Burdeningchildren 2 [38,41]

Ineffectiveness 2 [40,52]

Impracticality 2 [47,49]

Loweaseofuse 2 [42,49]

Negativeeffectonhealth 2 [41,42]

Nocontrolovertechnology 2 [42,47]

Stigmatization 2 [42,49]

Beneﬁtsexpectedoftechnology Increasedsafety 6 [38,40,41,44,46,48]

Perceivedusefulness 3 [38,42,47]

Increasedindependence 2 [39,41]

Reducedburdenonfamilycaregivers 2 [38,48]

Needfortechnology Perceivedneed 9 [38,41–45,47,48,52]

Subjectivehealthstatus 2 [43,44]

Alternativestotechnology Helpbyfamilyorspouse 5 [40,42,44,47,52]

Currenttechnology 2 [43,48]

Socialinﬂuence Inﬂuenceoffamilyandfriends 3 [38,43,52]

Inﬂuenceofprofessionalcaregivers 2 [38,43]

Usebypeers 2 [44,52]

Characteristicsofolderadults Desiretoageinplace 6 [38,39,42,46–48]

Culturalbackground 2 [40,41]

Familiaritywithelectronictechnology 2 [42,47]

Housingtype 2 [42,43]

3.4. Concernsregardingtechnology

Community-dwellingolderadultsexpressvariousconcerns whentheyconsidertechnologyforaginginplacethatthey havenotyetused.Oneoftheirmajorconcernsishighcost, whichismentionedinhalfofthearticles.Whenitisdescribed, it has a prominent role: “Costliness was identiﬁed as the

Fig.2–Modelofpre-implementationacceptance.

(9)

Inarelatedconcern,participantsareworried thatother peoplemayperceivethemtobeinpoorhealthorfrail,once theyareseenwearingtechnologythatisspeciﬁctofrailolder adults.Thisfearofstigmatizationcanbeverypowerful,and oneparticipantdescribed wearingapersonalalarmbutton aslikewearinga“badgeofdishonor”(p.31)[50].Whenolder adultsthinkaboutusingpersonalalarmbuttonsorportable healthmonitoringsensors,theyareconcernedthattheymight forgettousethemorlosethem.Inthecaseofhealthorsafety monitoringtechnology,participantsareconcernedaboutfalse alarms:“...ifyou’reintheshowerandyoubendovertopick upyoursoapanditthoughtyou’dfallen—therecouldbefalse alarms... andIdon’twantitsendingfortheambulanceifI’ve onlybumpedmyknee.”(p.793)[42].

3.5. Beneﬁtsexpectedoftechnology

Althoughcommunity-dwellingolderadultsexpress technol-ogyrelatedconcerns,theyalsoexpecttheuseoftechnology foraginginplacetobebeneficial.These expectedbenefits haveapositiveinfluenceontheirpre-implementation accep-tance.Olderadultsmentionthattheywouldusetechnology whentheyperceiveitasuseful,althoughoftenitisnotmade clearwhatconstitutesthisperceivedusefulness:“Ifthething isgood,andit works,thenwegoforit.However,ifwesee somethingthat isuseless,and obtrusive,andischangefor change’ssake,thenno.NotInterested.”(p.796)[42].Inother cases,thebenefitsaremoreconcrete,andthemostfrequently mentionedbenefitisanexpectedincreaseinsafety:“Itwill increasethelifetimebecauseifyougetintoanaccident... youwillbediscoveredsoonerandcangettoemergencyroom beforeitistoolate...”(p.442)[41].Additionally,participants mentionthattheyexpectthattheuseoftechnologyforaging inplacewillincreasetheirindependenceorreducetheburden onfamilycaregivers.

3.6. Needfortechnology

Whetherornotcommunity-dwellingolderadultsarewilling tousetechnologyalsodependsontheirperceived personal needfortechnology.Perceived needisthemostfrequently mentionedfactoroverall,andwhenitispresentthe accep-tanceoftechnologyismorelikely.However,inmostarticles participantsstatethattechnologyforaginginplaceisneeded forahypotheticalotherolderperson,ratherthanfor them-selves:“Idon’tneedthisnow,butperhapsatalaterpoint—I havefriendswho’dbenefitfromthisagreatdeal,Iamnotthere yet...”(p.122)[44].Insomeinstances,anolderadult’s nega-tivesubjectivehealthstatuspositivelyinfluenceshisorher perceivedneedandacceptanceoftechnology;forexample,in thecaseofaparticipantwhorecentlyfell:“Ifyouhadtoldme twomonthsago[aboutthesetechnologies]I’dsaywhoneeds it,butafterwhatIhavebeenthrough,Iseethebenefits.”(p. 122)[44].Inothercases,however,anegativehealthstatusdoes notincreasetheperceivedneedfortechnology:“Onewoman whohadbalanceissuesandahistoryoffallsdescribedher healthconditionandthen statedthatshedidnotneedfall detectiontechnologyatthistime.”(p.199)[43].

3.7. Alternativestotechnology

Available alternatives to technologyfor agingin place can negatively inﬂuence its acceptance. For instance, help by family members or a spouse can reduce the need for technology-basedmonitoring[44].Additionally,certaintypes oftechnologythatarecurrentlyusedcanmakeothertypesof technologyseemredundantintheperceptionofparticipants. Anexample ofthis isthe reducedneedforafall-detection systemwhenapersonalalarmbuttonisavailable[43]. 3.8. Socialinﬂuence

Community-dwelling older adults are also influenced by key figures within theirsocial environmentwhen deciding whetherornottousetechnologyforaginginplace.An exam-pleofthisistheinfluenceoftheirchildren:“Severalnotedthe importanceoftheirchildren’sconcernswhendeterminingif theyneededaserviceoratechnology.”(p.199)[43].Insome cases,thechildren’sinfluencecanbecompelling:“Iamvery compliantaboutthesekindsofthings.Iamnotcompliantwith thethoughtsofmymind,butIamcompliantaboutfollowing directions[frommyadultchildren].”(p.241)[38].

Besideschildren,professionalcaregiversandfriendsand familycanalsopositivelyornegativelyinﬂuenceacceptance. Furthermore,community-dwellingolderadultsareinﬂuenced bytheacceptanceoftechnologybytheirpeers:“EverybodyI’ve talkedtothat’strieditout,theydon’tcareforit...Mygeneral feelingisthatpeopledon’tcareforthem.[Areyouthinking aboutgettingitnow?]Notatthispoint.”(p.195)[52].

3.9. Characteristicsofolderadults

Several characteristics of community-dwellingolder adults canpositivelyornegativelyinﬂuenceacceptanceof aging-in-placetechnology.Oneofthemoreprominentfactorsisthe desiretoageinplace:“Alltherespondentsinthisstudywant tostayintheircurrentdwellingbecauseofattachmenttothe own home,memoriesofthepast,and theirpossessionsin thehome,aswellasthequalityoftheneighborhood.”(p.318)

[39],and“Iwouldchoosehome,Ithinkmostpeoplewould... Nobodychoosestogotoanursinghome.”(p.792)[42].The desiretoageinplacesometimesleadstoacceptanceof tech-nologyforaginginplace,butnotinallcases.Otherfactors arethefamiliarityoftheolderadultwithmodernelectronic technology,andtheﬁtbetweenhousingtypeandcertaintypes oftechnology.Lastly,thereistheissueofwhetherornotthe technologyiscompatiblewiththeolderadult’scultural back-ground:“AuniquelyKoreanvalueemergedinthediscussion ofthesleepmonitor.Dyingwhilesleepingisconsideredvery luckyintheKoreantradition.Participantswereconcernedthat technologymightinterferewiththeirluck.”(p.442)[41]. 3.10. Comparisonwithqualitativeresultson post-implementationacceptance

(10)

243

are still concerned about privacy implications [39,45] and stigmatization [50,51]. Furthermore, many participants are still not sure if they themselves actually need technology foraginginplace,andtheperceivedpersonalneedofthese community-dwelling older adults [39,45] continues to play arole intheir technology acceptance. Lastly,the expected beneﬁt of increased safety [39,50] continues to positively inﬂuenceacceptance.

At the same time, new factors emerge in the post-implementation stage. Some of the older adult’s pre-implementation concerns turn into real life problems; for exampletheoccurrenceoffalsealarms[39,50]:“I’venotbeen verysuccessfulwithit.Idon’tthinkitreallyworkedforme; itkeptgivingthesefalsealarmsandtheybecamequitea nui-sancethatI’dneverbotheredtowearitafterawhile.”(p.1188)

[45].Thisalsohappenswiththeconcernofforgettingorlosing personalalarmbuttonsorothertypesofportabletechnology

[39,45,50]:“...Iwasgoodfortheﬁrstfewmonths,thenIwent awayforafewdays,andIcouldn’thaveitwithmebecauseit wouldn’tworkinmydaughter’shouse.ThenIcamehomeand Isupposeit’slikemostthings,youtryitforawhileandthen youforgetit.”(p.1189)[45].Besidesconcernsbecomingreality, thereisalsotheproblemoftechnologynotworkingincertain locations[50,51],therebyloweringitsacceptance.An exam-pleofthisisportable technologythatdoesnotwork inthe shower.Anotherinhibitoroftechnologyacceptancethatwas notmentionedinthepre-implementationstage,isthe avail-abilityofhomecareasanalternativetotechnologyforaging inplace[39,50].Lastly,thelevelofsatisfactionwiththenew technology[45,51]andtheaffecttowardthenewtechnology asaresultofusingit[39,50]inﬂuencetechnologyacceptance inthepost-implementationstage.

3.11. Comparisonwithquantitativeresultson pre-implementationacceptance

Analysisofquantitativeresultsshowsthatseveralvariables thataresimilartoqualitativefactorshavebeenstatistically testedonpre-implementationdata,usingregressionanalysis. Atthe sametime,asmall numberofvariablesnotpresent inthereviewedqualitativepre-implementationresearchwere alsotested.Inthissection,signiﬁcantresultsarepresented (Table4).

In the study by Cohen-Mansfield et al. [49], the num-ber of concerns regarding using a device (including high cost,loweaseofuse,impracticality,andstigmatization)has asignificant negativeinfluenceon the acceptance of elec-tronicmemoryaids.Furthermore,theimportanceattributed tofunctionsofthedevice,whichresemblesthequalitative fac-torofperceivedusefulness,positivelyinfluencesacceptance. Cohen-Mansfieldetal.[49]alsofoundthatacceptanceof elec-tronicmemoryaidsispositivelyinfluencedbythenumberof differentprescriptionstaken;avariablethatisnotpresentin thereviewedqualitativeresearch.

Lai et al. [40]studied community-dwelling older adults’ acceptanceofavitalsignsmonitoringsystemandtheir accep-tanceofamotionmonitoringsystem. Theyfoundthatthe numberofself-reportedchronicillnesses,whichbears resem-blance tothe qualitativefactor ofsubjective healthstatus, positivelyinﬂuencesacceptanceofavitalsignsmonitoring

system.Atthesametime,thisvariablehasnosignificant influ-enceontheacceptanceofamotionmonitoringsystem.This alsoappliestoage,whichwasfoundtonegativelyinfluence theacceptanceofavitalsignsmonitoringsystem,butnotthe acceptanceofamotionmonitoringsystem.Inadditiontoage, twoothervariablesthatarenotpresentinthereviewed qual-itativeresearchwerestudied:genderandlevelofeducation. Bothnegativelyinfluencetheacceptanceofamotion monitor-ingsystem,butnottheacceptanceofavitalssignsmonitoring system.Laietal.didnotspecifywhetherthemotion monitor-ingsystemwasmoreacceptedbymalesorfemales.

Lastly, in the study by Zimmer and Chappell [53], the acceptance of electronic safety devices is positively influ-enced by two variables that are similar to the qualitative factorofsubjectivehealthstatus:thenumberofself-reported health symptoms and the number ofself-reported dexter-ity problems. The number ofsafety and security concerns (whichcorrespondstoperceived need)alsopositively influ-encesacceptance.Finally,threevariablesthatarenotpresent inthereviewedqualitativeresearchalsoinfluenceacceptance ofelectronicsafetydevices:age(negativeinfluence),levelof education (positiveinfluence),and rural residency(positive influence).

4. Discussion

4.1. Mainﬁndings

(11)

i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 3 ( 2 0 1 4 ) 235–248

Table4–Signiﬁcantpre-implementationvariablesandsimilarqualitativepre-implementationfactors.

Signiﬁcantquantitativevariables Similarqualitativefactors

Ref. Variable Technologystudied Signiﬁcancelevel Theme Factor

[49]a _Number_of_concerns

regardingusingadevice (includinghighcost,low easeofuse,

impracticality,and stigmatization)

Electronicmemoryaids p<.05,Beta=−.17,R2₌_.30 _Concerns_regarding

technology

Highcost,lowease ofuse, impracticality,and stigmatization Importanceattributed tofunctionsofthe device

Electronicmemoryaids p<.05,Beta=.44,R2₌_.30 _Beneﬁts_expected_of

technology

Perceivedusefulness

Numberofdifferent prescriptionstaken

Electronicmemoryaids p<.05,Beta=.25,R2₌_.30 _– _–

[40]b _Number_of_{self-reported}

chronicillnesses

Vitalsignsmonitoringsystem p<.001,B=1.718,R2₌_.22 _Need_for_technology _Subjective_health

status

Motionmonitoringsystem Notsigniﬁcant

Age Vitalsignsmonitoringsystem p<.001,B=−1.284,R2₌_.22 – –

Motionmonitoringsystem Notsigniﬁcant

Gender Vitalsignsmonitoringsystem Notsigniﬁcant – –

Motionmonitoringsystem p<.05,B=−0.785,R2₌_.13

Levelofeducation Motionmonitoringsystem p<.05,B=−0.911,R2₌_.13 _– _–

[53] Numberofself-reported

healthsymptoms

Electronicsafetydevices p<.05,Beta=.06,R2₌_.15 _Need_for_technology _Subjective_health

status Numberofself-reported

dexterityproblems

Electronicsafetydevices p<.05,Beta=.06,R2₌_.15 _Need_for_technology _Subjective_health

status Numberofsafetyand

securityconcerns

Electronicsafetydevices p<.01,Beta=.27,R2₌_.15 _Need_for_technology _Perceived_need

Age Electronicsafetydevices p<.01,Beta=−.08,R2₌_.15 _– _–

Levelofeducation Electronicsafetydevices p<.05,Beta=.06,R2₌_.15 _– _–

Ruralresidency Electronicsafetydevices p<.01,Beta=−.09,R2₌_.15 _– _–

–,notdescribedinqualitativearticles.

(12)

245

articlesdidnotuseanexistingtechnologyacceptance frame-workormodel.

4.2. Strengthsandlimitations

Thisreview’sstrengthsliesinits extensivesearchstrategy, covering databases in the ﬁelds of social sciences, health careand technology.Thissystematicand multidisciplinary approachisalsoreﬂectedin theextractionoffactors from qualitativeresearch,whichwasdonebythreeindependent reviewersfromdifferentbackgrounds(psychology,medicine and engineering). Another strength is the inclusion of all typesofavailableevidence,regardlessofthetypeofresearch method(qualitative,quantitativeormixedmethods).

Onemixedmethodsarticle[51]didnotmeetthe screen-ing criteria of the checklist that was used [35], due to an ambiguousresearchquestion.Howeveritdidcontaindatathat helpedusanswerourresearchquestion.Whenwelookatthe contributionofthisarticletoourdata,itshowsthatthree post-implementationfactorswereextractedfromthisarticle.Each ofthesefactorswerealsomentionedbyoneotherarticle.This indicatesthatthecontributionofthisstudytotheﬁndings wassupportiveratherthandecisive.Thisisinaccordancewith ﬁndingsbyThomasandHarden,whoshowedthatthe contri-butionofstudiesthatwereassessedashavingalowerquality wasmodestcomparedtostudiesthatwereassessedashaving ahighquality[37].

Thisreviewprovidesanoverviewoffactors,butitdoesnot differentiatebetweentypesoftechnology.Furthermore, mod-eratingormediatingrelationshipsbetweenfactorshavenot beeninvestigatedduetoa lackofavailabledata. Thisalso impliesthatthesetypesofrelationshipsare notcoveredin thepresentedmodelofpre-implementationacceptance. 4.3. Relationtootherstudies,reviewsandmodels The majority of the included articles lack a theoretical approach,whichhampersinterpretationandcomparisonof ﬁndingsbetweenstudiesinthisﬁeld.Asimilarproblemhas beenreportedbyauthorsreviewingtechnologyacceptanceof consumerhealthinformationsystems[55]andtelemedicine

[56]. When relating the results of this review to TAM and UTAUT,it appearsthat acceptance oftechnologyforaging in place by community-dwelling older adults in the pre-implementationstageisinﬂuencedbymorefactorsthanjust thekeyconstructsoftheTAMandtheUTAUT.Oneexample ofthisisthefactthatcommunity-dwellingolderadults men-tionmorebeneﬁtsoftechnologyforaginginplacethanjust PerceivedUsefulness.1

However, it is possible that the other beneﬁts that community-dwellingolderadultsmention,suchasincreased safetyandincreasedindependence,areinfactantecedentsto PerceivedUsefulness.Analternativeexplanationisprovided bytheauthorsofthevalue-basedadoptionmodel(VAM)[57], whostatethatTAMisveryusefulinorganizationalcontexts, butnotinthecontextofconsumerswhohavetomaketheir

1 _Davis_[17]_and_Venkatesh_[18]_deﬁne_Perceived_Usefulness_of

PerformanceExpectancyas“Thedegreetowhichanindividual believesthatusingthesystemwillhelphimorhertoattain gainsinjobperformance.”

ownpersonalevaluationofthecostsandbenefitsofusinga technology.Therefore,intheVAMmultiplePerceivedBenefits andmultipletypesofPerceivedSacrificestogetherdetermine thePerceivedValueofatechnologytotheconsumer,whichin turninfluencesanindividual’sintentiontouseatechnology. Perceivedsacrificescanbemonetaryornon-monetary. Exam-plesofnon-monetarycostsaretimecosts,effort costsand psychologicalcosts.InVAM,TAM’sPerceivedEaseofUse con-structisconsideredtobeaPerceivedSacrifice[57].Thetheme “concerns”inthisreviewresemblestheconstructofPerceived Sacrifices.UpuntilnowVAMhasbeenusedsuccessfullyin explainingconsumersacceptanceofmobileinternet[57]and InternetProtocolTeleVision[58].AtthesametimeVenkatesh, ThongandWuhaveproposedandtestedUTAUT2,whichis also aimedatexplaining consumerbehavior,and contains theconstructofPriceValuewhichisdefinedas“acognitive tradeoffbetweenthe perceived benefitsofthe applications andthemonetarycost”[59].Thestudy byCohen-Mansfield etal.[49]thatisincludedinthisreviewprovidessome sta-tisticalsupportfortheroleofcost-benefitevaluations,butto ourknowledgeVAMandUTAUT2havenotbeentestedinthe contextofolderusers.

This reviewalso shows that other mechanisms besides cognitivecost-beneﬁts tradeoffscomeintoplaywhenolder adultsareconsideringtheuseoftechnology.Whetherornot olderadultsfeeltheneedfortechnologytosupporttheiraging inplaceisimportantintheiracceptanceoftechnology,both inthe pre-implementation andpost-implementation stage. Perceived Need playsa similarrole inAndersen’sModelof HealthServicesUtilization[54],whereitisthemost immedi-atepredictorofhealthserviceuse.Thearticlesinthisreview indicatethatmanycommunity-dwellingolderadultsdonot feel the need for supportive technology. This is in accor-dancewithsomeofthestrategiesforcopingwithdeclinethat community-dwellingolderadultsemploy,suchas“tryingto keep one’s’ mind from focusingon oneself and one’s own vulnerability”[60]and “focusing onthe present”[61]. More researchisneeded tounderstandhowolder adults’coping strategiesarerelatedtotheuseofsupportivetechnology, espe-ciallysincethisreviewalsoshowstheambiguousrelationship betweenolderadults’desiretoageinplaceandtheuseof tech-nology designedtosupportthatsamegoal.Perceived Need hasalsoproventobeaninﬂuentialfactorinresearchonthe acceptanceofnon-electronicassistivedevicesaccordingtoa systematicreviewbySteelandGray[62].Otherfactorsinthis reviewarealsosimilartofactorsinourreview,suchasfearof stigmatization,effectiveness,andcost.Additionally,Steeland Graystressthatacceptanceoftechnologycanbeimprovedby trainingusersandmakingsurethattechnologymatchesan individual’sleveloffunctioning,goals,preferencesandneeds

[62].Thesetypesofimplementationfactorshavepossiblynot receivedmuchattention inthereviewedliteraturebecause the majority oftheincluded studies wasperformed atthe pre-implementationstage.

(13)

adultsfromusingtechnologyforaginginplace,suchashelp by a spouse or help by a family member, are also social factors.Additionally, alternative technology that isalready acceptedcanpreventtheuseofnewtechnology.Thisreview alsopointstootherpre-existingconditionsthatcaninfluence acceptance,suchasfamiliaritywithelectronictechnologyand culturalbackground.Thesepre-existing conditionsare also describedinTriandis’TheoryofInterpersonalBehavior[63]. ResearchbyWilsonandLankton[64],thatisbasedon Trian-dis’theory,showsthatpre-existingconditionssuchasageand presenceofchronichealthconditionshaveadirecteffecton e-health use bypatients. Thisispartlyconfirmed by stud-ies inthis reviewthat found significant effectsofage and the number ofchronicillnesson the acceptanceofa vital signs monitoring system [40]and electronic safety devices

[53],butnotontheacceptanceofamotionmonitoringsystem

[40].

4.4. Implicationsforpracticeandresearch

Professional caregivers,productdevelopers,managers, pol-icymakers, and family members who are interested in stimulatingcommunity-dwellingolder adultstostartusing technologyforaginginplace,needtobeawarethat accep-tancedependson alargenumber offactors thatmay vary foreachindividual.Mostofthetime,anolderadultwillhave anumberofspecifictechnology-relatedconcerns,whilethe perceived benefitsofa technologymightbemoreabstract. Therefore,itisnecessarytocommunicateconcretebenefits totheolderadultand,atthesametime,reduce technology-relatedconcernsspecificforthatindividual.Demonstration of the technology, the opportunity to try out the technol-ogyinarisk-freeenvironment,andtrainingorcoachingcan beused for this purpose.It is advisableto involve profes-sional caregivers, family members, and peers who already use thenewtechnologyinthese interventions,sinceolder peoplearesensitivetotheirinfluence.Whenanolderadult doesnotseetheneedforatechnology,itishighlyunlikely that he or she will be inclined to start using it. How-ever, at this time it is uncertain if perceived need can be influenced, and if it is desirable to do so. It is, therefore, recommended to keep track of an older adult’s perceived needfortechnologyinordertocoordinatetheintroduction oftechnology accordingly. It is also advisable tobe sensi-tivetothefactthatcommunity-dwellingolderadultsdonot exclusivelylookattechnologyasameanstoenableagingin place; theyalsoconsider alternatives such ashelp by oth-ersortheuseoftheircurrenttechnology.Infact, available alternativesmightpreventthemfromusingnewtypesof tech-nology.

Meanwhile,severalgapsregardingresearchonthe accep-tanceofelectronictechnologyforaginginplacebycommunity dwellingolderadultscanbeidentiﬁed.First,whiledataon fac-torsinﬂuencingacceptanceinthepre-implementationstage arecomprehensive,resultsregardingacceptanceinthe post-implementation stage are limited by the small number of studies.Inordertosupporttheindependenceof community-dwellingolderadultsforlongperiodsoftime,moreresearch isneededtounderstandwhatdrivescontinuedorsustained useoftechnologyonceithasbeenimplemented.Thisrequires

longitudinalresearchinvestigatingtheinﬂuenceoffactorsin multiplestagesofuse,suchasthoseproposedbyRogers[65]

or Chiu and Eysenbach [66]. Secondly, there isa dearthof quantitative researchin thepre-implementation stage and quantitative research in the post-implementation stage is nonexistent.Morequantitativeresearchisneededto under-standwhichfactorsaremoreinfluentialthanothersandto investigate moderating ormediating relationshipsbetween factors.Thirdly,researchuntilnowhasprimarilyfocusedon technologythatprovidessafetythroughmonitoring,andto alesserextentontechnologythatsupports(I)ADLorsocial interaction. More researchis needed on the acceptanceof othertypesofelectronictechnologyforaginginplace,such as technologyforchronicdisease managementor technol-ogythatstimulatesphysicalactivity.Thisisalsonecessary in orderto gain abetterunderstanding ofwhich core fac-torsareinfluentialinexplainingtheacceptanceofmultiple typesoftechnology,suchasperceivedneed,andwhich fac-torsaremoretechnologyspecific.Lastly,authorsinvestigating technologyacceptancebycommunity-dwellingolderadults are encouragedtomakeuseofexistingtheoriesontheuse of technologyand to developtheoriessuitable to the con-textofcommunity-dwellingolderadults.Inconclusion,more research isneededtocapturethe complexity and timeline of the acceptance process of different types of electronic technologyforaginginplacebycommunity-dwellingolder adults.

Author

contributions

Allauthorshavemadeasubstantial,direct,intellectual con-tributiontothisstudy.Peek:studyconceptanddesign,data analysis and drafting ofthe manuscript. Wouters and van Hoof: analysis and interpretation of data, critical revision ofthemanuscriptforimportantintellectualcontent.Luijkx, Boeije and Vrijhoef: critical revision ofthe manuscriptfor importantintellectualcontent.

Allauthorsprovidedapprovaloftheﬁnalversion.

Competing

interests

Theauthorsdeclaretheyhavenoconﬂictofinterestforthis study.

Acknowledgements

(14)

247

Summarypoints

Whatwasalreadyknownonthetopic:

• Technologymaysupportaginginplace,butquestions have been raised on the readiness of community-dwellingolderadultstousethesetechnologies,andit isunclearwhichfactorsplayaroleintheiracceptance oftechnology.

• Research from other ﬁelds shows that technology acceptance varies between the pre-implementation stageandthepost-implementationstage.

Whatthisstudyadds:

• A comprehensive overview of factors inﬂuencing acceptanceofelectronictechnologyforaginginplace inthepre-implementationstage,basedonqualitative research.

• A comparisonbetween qualitative research on pre-implementation factors and qualitative researchon post-implementationfactors,andacomparisonwith quantitativeresearch.

ﬁndingandretrievingarticles.RienkOverdiep(Fontys Univer-sityofAppliedSciences)isacknowledgedforhismanagerial support.

r

e

f

e

r

e

n

c

e

s

[1] L.L.Barrett,Healthy@home2.0,AARPResearch&Strategic Analysis,Washington,DC,2011.

[2] D.Boldy,L.Grenade,G.Lewin,E.Karol,E.Burton,Older people’sdecisionsregarding‘ageinginplace’:aWestern Australiancasestudy,Australas.J.Ageing30(2011) 136–142.

[3] J.K.Eckert,L.A.Morgan,N.Swamy,Preferencesforreceiptof careamongcommunity-dwellingadults,J.AgingSoc.Policy 16(2004)49–65.

[4] G.Woolhead,M.Calnan,P.Dieppe,W.Tadd,Dignityinolder age:whatdoolderpeopleintheUnitedKingdomthink?Age Ageing33(2004)165–170.

[5] WHO,GlobalAge-friendlyCities:AGuide,WorldHealth Organization,Geneva,Switzerland,2007.

[6] C.M.Perissinotto,I.StijacicCenzer,K.E.Covinsky,Loneliness inolderpersons:apredictoroffunctionaldeclineanddeath, Arch.Intern.Med.172(2012)1078–1083.

[7] M.Luppa,T.Luck,S.Weyerer,H.-H.König,E.Brähler,S.G. Riedel-Heller,Predictionofinstitutionalizationinthe elderly.Asystematicreview,AgeAgeing39(2010)31–38.

[8] J.E.Gaugler,S.Duval,K.A.Anderson,R.L.Kane,Predicting nursinghomeadmissionintheU.S:ameta-analysis,BMC Geriatr.7(2007)13.

[9] A.E.Stuck,J.M.Walthert,T.Nikolaus,C.J.Büla,C.Hohmann, J.C.Beck,Riskfactorsforfunctionalstatusdeclinein community-livingelderlypeople:asystematicliterature review,Soc.Sci.Med.48(1999)445–469.

[10] S.L.Molony,Themeaningofhome:aqualitative meta-synthesis,Res.Gerontol.Nurs.3(2010)291–307.

[11] A.McLean,EthicalfrontiersofICTandolderusers:cultural, pragmaticandethicalissues,EthicsInf.Technol.13(2011) 313–326.

[12] H.G.Kang,D.F.Mahoney,H.Hoenig,V.A.Hirth,P.Bonato,I. Hajjar,L.A.Lipsitz,CenterforIntegrationofMedicineand InnovativeTechnologyWorkingGrouponAdvanced ApproachestoPhysiologicMonitoringfortheAged,Insitu monitoringofhealthinolderadults:technologiesand issues,J.Am.Geriatr.Soc.58(2010)1579–1586.

[13] J.Cohen-Mansﬁeld,J.Biddison,Thescopeandfuturetrends ofgerontechnology:consumers’opinionsandliterature survey,J.Tech.Hum.Serv.25(2007)1–19.

[14] J.L.Fozard,H.-W.Wahl,Ageandcohorteffectsin gerontechnology:areconsideration,Gerontechnology11 (2012)10–21.

[15] C.S.C.Lim,DesigninginclusiveICTproductsforolderusers: takingintoaccountthetechnologygenerationeffect,J.Eng. Des.21(2010)189–206.

[16] K.Zickuhr,Generations2010,PewResearchCenter, Washington,DC,2010.

[17] F.D.Davis,Perceivedusefulness,perceivedeaseofuse,and useracceptanceofinformationtechnology,MISQuart.13 (1989)319–339.

[18] V.Venkatesh,M.G.Morris,G.B.Davis,F.D.Davis,User acceptanceofinformationtechnology:towardauniﬁed view,MISQuart.27(2003)425–478.

[19] R.J.Holden,B.T.Karsh,Thetechnologyacceptancemodel:its pastanditsfutureinhealthcare,J.Biomed.Inform.43 (2010)159–172.

[20] W.R.King,J.He,Ameta-analysisofthetechnology acceptancemodel,Inform.Manage.43(2006)740–755.

[21] P.Legris,J.Ingham,P.Collerette,Whydopeopleuse informationtechnology?Acriticalreviewofthetechnology acceptancemodel,Inform.Manage.40(2003)191–204.

[22] M.Turner,B.Kitchenham,P.Brereton,S.Charters,D. Budgen,Doesthetechnologyacceptancemodelpredict actualuse?Asystematicliteraturereview,Inform.Software Tech.52(2010)463–479.

[23] J.Wu,H.Du,Towardabetterunderstandingofbehavioral intentionandsystemusageconstructs,Eur.J.Inf.Syst.21 (2012)680–698.

[24] C.Liao,P.Palvia,J.-L.Chen,Informationtechnologyadoption behaviorlifecycle:towardaTechnologyContinuance Theory(TCT),Int.J.Inf.Manage.29(2009)309–320.

[25] F.D.Davis,M.G.Morris,Deadoralive?Thedevelopment, trajectoryandfutureoftechnologyadoptionresearch,J. Assoc.Inf.Syst.8(2007)267–286.

[26] S.Y.Yousafzai,G.R.Foxall,J.G.Pallister,Technology acceptance:ameta-analysisoftheTAM:Part2,J.Model. Manag.2(2007)281–304.

[27] K.Zheng,R.Padman,M.P.Johnson,H.S.Diamond, EvaluationofHealthcareITApplications:theuser acceptanceperspective,Soc.Psychol.65(2007)49–78.

[28] A.Bhattacherjee,G.Premkumar,Understandingchangesin beliefandattitudetowardinformationtechnologyusage:a theoreticalmodelandlongitudinaltest,MISQuart.28(2004) 229–254.

[29] E.Karahanna,D.W.Straub,N.L.Chervany,Information technologyadoptionacrosstime:across-sectional comparisonofpre-adoptionandpost-adoptionbeliefs,MIS Quart.23(1999)183–213.

[30] D.G.Bouwhuis,L.M.J.Meesters,A.A.M.Sponselee,Modelsfor theacceptanceoftele-caresolutions:intentionvs

behaviour,Gerontechnology11(2012)45–55.

[31] R.P.Bagozzi,Thelegacyofthetechnologyacceptancemodel andaproposalforaparadigmshift,J.Assoc.Inf.Syst.8 (2007)244–254.

[32] K.Chen,A.H.S.Chan,Areviewoftechnologyacceptanceby olderadults,Gerontechnology10(2011)1–12.

(15)

Availablefrom:http://www.casp-uk.net/wp-content/ uploads/2011/11/CASPQualitativeAppraisalChecklist

14oct10.pdf

[34] HEBW.Questionstoassistwiththecriticalappraisalofan observationalstudye.g.cohort,casecontrol,cross-sectional. HealthEvidenceBulletins–Wales;[2-1-2013].Available from:http://hebw.cf.ac.uk/methodology/appendix8.htm

[35] R.Pace,P.Pluye,G.Bartlett,A.C.Macaulay,J.Salsberg,J. Jagosh,R.Seller,Testingthereliabilityandefﬁciencyofthe pilotMixedMethodsAppraisalTool(MMAT)forsystematic mixedstudiesreview,Int.J.Nurs.Stud.49(2012)47–53.

[36] H.R.Boeije,F.VanWesel,E.Alisic,Makingadifference: towardsamethodforweighingtheevidenceinaqualitative synthesis,J.Eval.Clin.Pract.17(2011)657–663.

[37] J.Thomas,A.Harden,Methodsforthethematicsynthesisof qualitativeresearchinsystematicreviews,BMCMed.Res. Methodol.8(2008)1–10.

[38] L.Lorenzen-Huber,M.Boutain,L.J.Camp,K.Shankar,K.H. Connelly,Privacy,technology,andaging:aproposed framework,AgeingInt.36(2011)232–252.

[39] J.vanHoof,H.S.M.Kort,P.G.S.Rutten,M.S.H.Duijnstee, Ageing-in-placewiththeuseofambientintelligence technology:perspectivesofolderusers,Int.J.Med.Inform. 80(2011)310–331.

[40] C.K.Lai,J.C.Chung,N.K.Leung,J.C.Wong,D.P.Mak,Asurvey ofolderHongKongpeople’sperceptionsof

telecommunicationtechnologiesandtelecaredevices,J. Telemed.Telecare16(2010)441–446.

[41] C.D.Steggell,K.Hooker,S.Bowman,S.Choun,S.J.Kim,The roleoftechnologyforhealthyagingamongKoreanand HispanicwomenintheUnitedStates:apilotstudy, Gerontechnology9(2010)443–449.

[42] R.Steele,A.Lo,C.Secombe,Y.K.Wong,Elderlypersons’ perceptionandacceptanceofusingwirelesssensor networkstoassisthealthcare,Int.J.Med.Inform.78(2009) 788–801.

[43] K.L.Courtney,G.Demiris,M.Rantz,M.Skubic,Needing smarthometechnologies:theperspectivesofolderadultsin continuingcareretirementcommunities,Inform.Prim.Care 16(2008)195–201.

[44] G.Demiris,B.K.Hensel,M.Skubic,M.Rantz,Senior residents’perceivedneedofandpreferencesforsmart homesensortechnologies,Int.J.Technol.Assess.Health Care24(2008)120–124.

[45] K.Horton,Fallsinolderpeople:theplaceoftelemonitoring inrehabilitation,J.Rehabil.Res.Dev.45(2008)1183–1194.

[46] A.Mahmood,T.Yamamoto,M.Lee,C.Steggell,Perceptions anduseofgerotechnology:implicationsforaginginplace,J. Hous.Elderly22(2008)104–126.

[47] A.Mihailidis,A.Cockburn,C.Longley,J.Boger,The acceptabilityofhomemonitoringtechnologyamong community-dwellingolderadultsandbabyboomers,Assist. Technol.20(2008)1–12.

[48] K.Wild,L.Boise,J.Lundell,A.Foucek,Unobtrusivein-home monitoringofcognitiveandphysicalhealth:reactionsand perceptionsofolderadults,J.Appl.Gerontol.27(2008) 181–200.

[49] J.Cohen-Mansﬁeld,M.A.Creedon,T.B.Malone,M.J. KirkpatrickIII,L.A.Dutra,R.P.Herman,Electronicmemory aidsforcommunity-dwellingelderlypersons:attitudes, preferences,andpotentialutilization,J.Appl.Gerontol.24 (2005)3–20.

[50] E.J.Porter,Wearingandusingpersonalemergencyresponse systembuttons,J.Gerontol.Nurs.31(2005)26–33.

[51] H.Ezumi,N.Ochiai,M.Oda,S.Saito,M.Ago,N.Fukuma,S. Takenami,Peersupportviavideo-telephonyamongfrail elderlypeoplelivingathome,J.Telemed.Telecare9(2003) 30–34.

[52] E.J.Porter,L.H.Ganong,Consideringtheuseofapersonal emergencyresponsesystem:anexperienceoffrail,older women,CareManag.J.3(2002)192–198.

[53] Z.Zimmer,N.L.Chappell,Receptivitytonewtechnology amongolderadults,Disabil.Rehabil.21(1999)222–230.

[54] R.M.Andersen,Revisitingthebehavioralmodelandaccess tomedicalcare:doesitmatter?J.HealthSoc.Behav.36 (1995)1–10.

[55] C.K.L.Or,B.-T.Karsh,Asystematicreviewofpatient acceptanceofconsumerhealthinformationtechnology,J. Am.Med.Inform.Assoc.16(2009)550–560.

[56] D.Gammon,L.K.Johannessen,T.Sørensen,R.Wynn,P. Whitten,Anoverviewandanalysisoftheoriesemployedin telemedicinestudies,MethodsInf.Med.3(2008)1–10.

[57] H.-W.Kim,H.C.Chan,S.Gupta,Value-basedadoptionof mobileinternet:anempiricalinvestigation,Decis.Support Syst.43(2007)111–126.

[58] T.-C.Lin,S.Wu,J.S.-C.Hsu,Y.-C.Chou,Theintegrationof value-basedadoptionandexpectation–conﬁrmation models:anexampleofIPTVcontinuanceintention,Decis. SupportSyst.54(2012)63–75.

[59] V.Venkatesh,J.Y.L.Thong,X.Xu,Consumeracceptanceand useofinformationtechnology:extendingtheuniﬁedtheory ofacceptanceanduseoftechnology,MISQuart.36(2012) 157–178.

[60] H.M.Hörder,K.Frändin,M.E.H.Larsson,Self-respectthrough abilitytokeepfearoffrailtyatadistance:successfulageing fromtheperspectiveofcommunity-dwellingolderpeople, Int.J.Qual.Stud.HealthWell-being8(2013)20194.

[61] J.Reichstadt,G.Sengupta,Olderadults’perspectiveson successfulaging:qualitativeinterviews,Am.J.Geriatr. Psychiatry18(2010)567–575.

[62] D.M.Steel,M.A.Gray,Babyboomers’useandperceptionof recommendedassistivetechnology:asystematicreview, Disabil.Rehabil.Assist.Technol.4(2009)129–136.

[63] H.C.Triandis,InterpersonalBehavior,Brooks/Cole Publishing,Monterey,CA,1977.

[64] E.V.Wilson,N.K.Lankton,Predictingpatients’useof provider-deliverede-health:theroleoffacilitating conditions,in:E.V.Wilson(Ed.),Patient-CenteredE-Health, IGIGlobal,Hershey,PA,2009,pp.217–229.

[65] E.M.Rogers,DiffusionofInnovations,5thed.,FreePress, NewYork,2003.

Factors influencing acceptance of technology for aging in place: A systematic review

Tilburg University