JMIR Publications

ABSTRACT

Background:

As healthcare systems increasingly rely on telehealth, older adults face technological and structural, among other barriers that limit their comfort and ability with virtual care platforms. To ensure the success of our clinical trial examining the impact pharmacist-led visits, we employed ethnographic methods to capture a more nuanced understanding of the unique and multiple barriers that older adults face in real-life while interacting with virtual care is needed to implement digital health interventions for older adults.

Objective:

Our assessment had two primary objectives: 1) To assess and refine our recruitment strategies and technology troubleshooting approaches for a two-site cluster randomized clinical trial (RCT) aimed at delivering pharmacist video visits for medication management. 2) To document the challenges older adults encounter immediately before and during a video visit, and how these challenges affect their overall experience and future willingness to use virtual care.

Methods:

We applied ethnographic methods, including direct observation and fieldnotes, to shape a technology-focused randomized controlled trial (RCT) for older adults. Our goal was to identify barriers to digital access, usability challenges, and adaptive strategies through in-home observation and interviews. Participants were 20 older community-dwelling veterans (aged 65 and older) engaging in video visits from their home for medication reconciliation with a pharmacist. Data collection included structured fieldnotes from both an ethnographer and clinical pharmacist, and direct in-home observations. Data from fieldnotes and direct observations were systematically analyzed using qualitative rapid analysis.

Results:

Our findings highlight several key insights: 1) Ethnographic methods aided in improving the RCT’s patient-facing approach and feasibility. We uncovered technological and structural barriers and identified challenges such as device navigation and broadband connectivity. 2) Ethnographic methods revealed insights into digital ageism and strategies to enhance digital inclusion for older adults in video telehealth. Ethnographically informed direct engagement with technology helped to challenge internalized ageism among participants, and personalized adaptations were essential for those with limited digital skills. Socio-cultural and environmental factors significantly influenced participants' virtual care success, with family and caregiver involvement proving pivotal.

Conclusions:

The novel application of ethnographic methods to shape an RCT for older adults informed the development and tailoring of recruitment and technology trouble shooting approaches for a subsequent RCT to deliver pharmacist video visits for medication management with older adults. Ethnographic methods allowed us to address one component of digital ageism, with an aim to increase participant engagement with research and technology. Our assessment underscores the importance of real-time, ethnographic and qualitative data gathering to improve RCTs and other trials for improving the health of aging populations, with an emphasis in virtual care. Clinical Trial: NA