JMIR Publications

ABSTRACT

Background:

Digital Cognitive Training(DCT) has been found to be more effective than traditional paper-and-pencil training in enhancing overall cognitive function. However, a significant barrier to its long-term implementation is that older adults with mild cognitive impairment(MCI) don’t continue to use it, or even drop-off in usage, after initial engagement. Such short-term engagement may limit the potential benefits of DCT, as sustained use is required to achieve more significant cognitive improvements. Exploring the reasons for the shift in the discontinuous usage behavior is crucial for promoting successful DCT implementation and maximizing its positive effects.

Objective:

This study aims were to explore the intrinsic reasons for the transition from initial acceptance to discontinuous usage behavior among older adults with MCI throughout the DCT process, employing the Extended Model of IT Continuance(ECM-ITC).

Methods:

We employed a qualitative research methodology, conducting 38 semi-structured interviews before and after the use of DCT(three times per week, each session lasting 30 minutes, over one month) with 19 older adults with MCI, aged 60 and above, and 4 family members between January and March 2024. Thematic analysis and deductive framework analysis were used to identify reasons for discontinuous usage of the DCT , mapped to the ECM-ITC.

Results:

Most participants failed to complete the standard dosage of DCT. Data analysis revealed the reasons for the shift to discontinuous usage. Despite their need to improve cognitive function, participants found the cognitive training confusing and discovered that DCT did not align with their preferred method of training upon actual use. The disparity between their vague expectations and the reality, combined with the contradiction between the “delayed gratification” of DCT and their desire for “immediate gratification”, made it difficult for them to discern the usefulness of DCT. Participants also viewed DCT as an additional financial burden and tended to avoid training under family pressure. They relied on motivational measures, which further weakened their intention to continue DCT , ultimately leading to the inability to develop discontinuous usage behavior.

Conclusions:

Continuous usage behavior differs from initial acceptance as it evolves dynamically with user experience over time. To encourage older adults with MCI to persistently engage with DCT, it is essential not only to thoroughly consider their genuine preferences and the potential disruptions DCT may bring to their lives but also to bridge the gap between expectations and actual experiences. While ensuring that older adults receive appropriate external incentives and encouragement, it is equally important to foster their intrinsic motivation, thereby gradually cultivating the habit of sustained DCT usage.