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Design principles to Increase Technology Self-efficacy for Older Australians with Mild Cognitive Impairment (MCI) and Older Carers
Snezna Bizilj Schmidt, Nathan D'Cunha, Stephen Isbel, Blooma John, Ram Subramanian
TL;DR
This paper examines technology adoption and sustained use among older Australians with MCI and their carers amid increasing age-related limitations. It reports that frequent technology change lowers perceived self-efficacy, IT literacy, and confidence, and proposes design principles to support self-efficacy.
Problem
Increasing age-related physical and cognitive limitations create pressure on aged-care and health services, while technology may support independent living and service productivity.
Method
The paper proposes high-level technology design principles for supporting self-efficacy, including designing to maximise users’ feelings of self-efficacy.
Results
Frequent technology change lowers perceived IT literacy, technology self-efficacy, and confidence to use technology, while increasing response cost and reducing response efficacy.
Takeaways & Limitations
Design should support and maximise feelings of self-efficacy to help users manage technological change and sustain technology use.
Takeaways & Limitations
The proposed design principles and guidelines are theoretical and have not been validated, and the study used participants from one Australian locale who spoke English.
Abstract
from arXiv · showhide
The number of people with age related physical or cognitive impairments is increasing due to the worlds ageing population. Technology has the potential to support independent living, and to achieve aged and health service efficiencies, however, there are gaps in our understanding of factors that motivate technology adoption and ongoing use by older adults, especially those with cognitive impairments. This study aims to explore motivators and enablers for technology adoption and ongoing use by older Australians with mild cognitive impairment (MCI) and their carers, to identify technology design principles and guidelines that maximise adoption. Semi structured interviews were used to gather data about individual demographics, needs, priorities, lifestyle, challenges, and experiences with technology. Results of inductive, reflective, thematic analysis indicate that a desire for independence, autonomy and quality of life motivate use of technology, and perceived technology self-efficacy and IT literacy are enablers. The Protection Motivation Theory illustrates that constant technology change is a disabler for technology adoption and sustained use, because it lowers perceived technology self-efficacy and IT literacy, and reduces confidence to use technology. Two high-level technology design principles and related guidelines are proposed, grounded in theory and aligned with Banduras four sources of self-efficacy. These design principles and guidelines are intended to increase feelings of self-efficacy and confident use of technology, while also reducing adverse impacts of technological change and encouraging sustained technology adoption by older adults with MCI to support independent living and quality of life.
1 INTRODUCTION & BACKGROUND
Ageing and cognitive impairment increase the need for technologies that support independent living and service efficiency, but existing adoption models do not fully explain use by older adults with MCI. The study therefore examines motivations, changing experiences, and technology change through Protection Motivation Theory.
- Age-related physical and cognitive limitations are increasing, placing additional pressure on aged-care and health services.
- Technology can support healthy ageing, independent living, and more productive healthcare services.
- MCI affects cognitive and affective domains variably, with symptoms that can disrupt memory, decision-making, routines, and daily activities.
- Existing technology-adoption models emphasize usefulness, ease of use, empowerment, control, lifestyle compatibility, cognition, and social context, but do not fully address older adults with cognitive impairment.
- Research must examine initial adoption, experiences over time, changing capabilities, and changing attitudes or needs affecting perceived usefulness and ease of use.
- Protection Motivation Theory frames technology adoption as threat and coping appraisal, including perceived severity, vulnerability, response efficacy, self-efficacy, and response costs.
2 MATERIALS AND METHODS
The qualitative study used individual semi-structured interviews with older Australians with MCI and relevant stakeholders in the Australian Capital Territory. Interview data were transcribed and analysed inductively through reflective thematic coding and author review.
- Participants and recruitment: Participants were Australians over 65 with MCI, family members or carers, and medical or allied health professionals in the Australian Capital Territory.
- Participants and recruitment: Non-random purposeful and convenience sampling recruited participants through clinics, memory services, independent-living villages, and relevant organisations.
- Participants and recruitment: The study interviewed twelve older adults with MCI, six family members or carers, and seven medical or allied health professionals.
- Data collection: Individual face-to-face interviews lasted about 60 minutes on average, were recorded and transcribed verbatim, and examined demographics, needs, priorities, lifestyle, challenges, and technology experiences.
- Data analysis: A bottom-up inductive reflective thematic analysis used semantic and latent coding, iterative review, researcher reflection, and consensus-based theme development.
3 RESULTS
Technology supported independence, autonomy, participation, services, and quality of life for people with MCI and carers, but frequent change created stress, confusion, errors, and reluctance to continue using technology. Participants linked these effects to lower IT literacy, self-efficacy, response efficacy, confidence, and persistence.
- Motivations and benefits: Fear of losing independence and quality of life motivated people with MCI to learn and use technology when non-use was appraised as a threat.
- Effects of technology change: Frequent technology change frustrated people with MCI and carers, while professionals reported that rapid change made transitions harder for people with cognitive decline.
- Effects of technology change: Technology changes caused discomfort, confusion, mistakes, stress, and anxiety by disrupting preferred structure, routine, predictability, and consistency.
- Effects of technology change: Technology change increased response costs and reduced response efficacy, self-efficacy, IT literacy, confidence, self-esteem, and psychological well-being.
- IT literacy and sustained use: Low interest and IT literacy were associated with lower usage, dependence on others, exclusion from activities or services, and difficulty forming technology habits.
- IT literacy and sustained use: People with MCI reported that problems, lost trust, or unexpected operation could lead them to give up rather than persevere with technology.
- Motivations and benefits: Technology supported participation, access to services, caring responsibilities, independence, autonomy, and quality of life despite generally low interest in technological advances.
4 DISCUSSION
For older Australians with MCI and their carers, technology supports independence and quality of life, but constant change lowers confidence, familiarity, and sustained use. The discussion proposes two design principles focused on strengthening self-efficacy and limiting the harms of technological change.
- Technology enables older adults with MCI to remain independent, autonomous, and maintain quality of life, motivating adoption and ongoing use.
- Low self-efficacy makes older adults with MCI less persistent when they experience technology problems.Bandura’s account links perceived self-efficacy to coping behaviours and persistence when obstacles or negative outcomes occur.
- Constant technology change reduces perceived IT literacy, response efficacy, and self-efficacy while increasing response costs.Users must repeatedly expend effort to keep up with modifications before becoming fully familiar and comfortable.
- Lower coping appraisal increases stress, anxiety, and discomfort, reducing confidence, technology use, and development of usage habits.The reported overall effect is lower independence and quality of life.
- Design principles and guidelines: Design principle 1 is to support and maximise feelings of self-efficacy through successful experiences, familiarity, consistency, personalisation, and support for ageing-related changes.Guidelines include affirmative feedback, non-stigmatising language, informative warnings, accessible help, and appropriate training materials.
- Design principles and guidelines: Design principle 2 is to implement technology change in ways that minimise or eliminate negative impacts on perceived self-efficacy and IT literacy.The guidelines are grounded in Bandura’s four sources of self-efficacy and are also reframed around coping strategies for adults with MCI.
5 FUTURE WORK
Future work should test and refine the proposed guidelines across technologies, purposes, populations, and contexts, including different forms and communication channels of technological change.
- Evaluate the proposed design principles and guidelines by building several technology solutions for older adults with MCI.Use target-user feedback to assess effectiveness and iteratively refine the guidelines.
- Examine how changing a solution’s purpose or technology affects the applicability of its design guidelines.
- Investigate whether different categories of technology change have the same effects on perceived self-efficacy and IT literacy.
- Assess whether the method and channel used to communicate technological change significantly affect older adults’ responses.
6 STRENGTHS AND LIMITATIONS
The study’s strengths include its user-focused, role-specific approach and theory-grounded, actionable guidelines, while limitations concern participant scope, interview coverage, language, and unvalidated recommendations.
- Strengths: The study was user-focused, defined participant characteristics clearly, and tailored interview guides to stakeholder roles.
- Strengths: The guidelines address users’ emotional and psychological state alongside technology usefulness and ease of use.They aim to improve self-efficacy, confidence, and self-esteem.
- Strengths: The recommendations are practical, actionable, and grounded in established theory, research, and studies involving older participants with MCI.
- Limitations: The study involved relatively few participants with MCI and carers from one Australian locale, with each person interviewed once and only English-speaking participants included.
- Limitations: The proposed design principles and guidelines are theoretical and have not yet been validated.Broader demographic data are also needed to validate conclusions and examine cultural differences.
7 CONCLUSION
The study links technology adoption and ongoing use among older adults with MCI to independence and quality of life, while identifying frequent technological change as a barrier and proposing self-efficacy-oriented design principles.
- Adoption and ongoing technology use are motivated by need and a desire for independence and quality of life, despite low overall interest in technology.
- Frequent technology changes cause frustration, anxiety, and stress and lower perceived IT literacy, technology self-efficacy, and confidence.
- Within Protection Motivation Theory, technological change increases Response Cost and decreases perceived Self-efficacy, Response Efficacy, and IT literacy.
- Solutions that maximise perceived self-efficacy and IT literacy while minimising negative impacts of change are proposed to support adoption and ongoing use.
- Two design principles and related guidelines are aligned with Bandura’s self-efficacy theory and supported by existing studies and literature.Future work should evaluate, refine, and expand them with target users.
Statement of ethics
The research received ethics approval from the named reviewing body.
- The research received ethics approval from <removed for review process>.
APPENDIX 1 – THEMES AND SUB-THEMES RESULTING FROM INDUCTIVE, REFLECTIVE, THEMATIC ANALYSIS OF INTERVIEW DATA
The interview analysis identified four themes concerning how older adults with MCI and carers select, use, and experience technology. Technology was understood as both an enabler of independence and a potential threat when knowledge, support, or adaptability are limited.
- People have unique needs that depend on their context.
- Simple non-technology strategies can be effective, while technology strategies must satisfy performance and effort expectations.
- People use varied tools and personalised strategies to support independence.
- Technology selection and use depend on social influence, available support, tasks, context, and personal preferences.
- Technology can support independence, but limited knowledge and literacy may cause exclusion, vulnerability, or feeling unvalued.
- Frequent technology change creates stress and anxiety, reduces confidence and self-efficacy, and threatens quality of life.
APPENDIX 2 – THEMES AND SUB-THEMES RESULTING FROM INDUCTIVE, REFLECTIVE, THEMATIC ANALYSIS OF INTERVIEW DATA
The appendix translates interview themes and cognitive considerations into design guidance for adults with MCI. It emphasises stability, familiarity, reduced cognitive effort, intuitive interaction, and careful management of technology change.
- The design guidance is organised around coping strategies for adults with MCI.
- Technology change can frustrate and stress older adults, while inconsistency and unpredictability can cause confusion, anxiety, and reduced confidence.
- Designers should plan solutions holistically because staged releases or added capabilities may create stress, confusion, and lower perceived self-efficacy and literacy.
- Technology change may discourage transition to new products, reduce technology use, and prolong low IT literacy.
- Consistent, simple, meaningful language can reduce cognitive load.
- Interfaces should make important functions easy to find, avoid overloaded layouts, and use clear hierarchies of headings and labels.
- Design should fit existing lifestyles and routines because established habits may be preserved better than habits requiring adaptation.
- Reducing problem-solving demands and using intuitive, familiar interaction patterns can lower cognitive load.