JMIR Publications

ABSTRACT

Background:

Self-rated health is associated with information communication technology (ICT) use among older adults. Foreign-born, older Asian Americans are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the Technology Acceptance Model (TAM) for low-income, older Asian Americans, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of smartphone and ICT use. However, the association of health in technology acceptance has not been explored among older Asian Americans.

Objective:

This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of smartphones and ICTs among low-income, older Asian Americans.

Methods:

This cross-sectional survey included Asian Americans aged 62 and older living in affordable senior housing (N=392). Using hierarchical multiple regression, we explored the association of self-rated health with dependent variables (smartphone use and ICT use), and TAM mediators (PU and PEOU), while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association of age and subjective cognitive decline with the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines revealing that the relationship between subjective cognitive decline, smartphone use, and ICT use varied in three age segments, which led to updating our analysis to estimate differences in smartphone and ICT use among age categories, with and without subjective cognitive decline.

Results:

Self-rated health was not significantly associated with smartphone use, ICT use, PU, or PEOU. However, the interaction terms of subjective cognitive decline and age significantly improved model fit for smartphone use (ΔR2=.016; P =.02) and ICT use (ΔR2=.011; P =.04). In reviewing scatterplots, we determined that in the youngest age group (62 to 74), smartphone use and ICT use increased with subjective cognitive decline, whereas in the older age groups (75 to 84, and 85+), smartphone use and ICT use decreased with subjective cognitive decline, more so in the oldest age category. Using contrast analysis, among participants with subjective cognitive decline, smartphone use and ICT use significantly decreased in the middle- and older- age group as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant.

Conclusions:

This study contributes to the understanding of the complex relationship between health and ICT acceptance among low income, older Asian Americans and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. Clinical Trial: N/A