Older adults' preferences for Internet‐based services: Type and content

The aim of this paper was to report on qualitative survey responses provided by older Australian adults regarding their preferences for Internet‐based services and content.


| INTRODUCTION
The proportion of the Australian population aged 65 years and over is growing rapidly.This cohort comprises 16% of the total Australian population 1 and is projected to increase to approximately 22% by 2066, 2 posing significant challenges to the health-care system, aged care services and national economics.How best to reach and support this ageing population to offset these increasing pressures is a necessary consideration.
One potential means is to create Internet-based mental health and well-being services targeted to meet the needs of older adults.A recent study showed older adults to have a generally positive attitude towards Internet-based health technologies. 3However, to utilise Internet-based services effectively to support the mental health and well-being of this cohort, it is important to understand their perspectives on the type of Internet-based services they would prefer, and what content they feel should be included in order to obtain the greatest benefit.
The aim of this paper was to report on the qualitative survey responses provided by older Australian adults regarding their preferences on what mental health and wellbeing Internet-based services and content would be of most interest to them.

| Measures
This paper reports on two items from data collected as part of a larger study to trial a survey to collect cross-sectional data on the mental and physical health of older Australian adults across multiple timepoints.The survey included sociodemographic items, validated measures and items relating to the mental and physical health and well-being of the respondents.The two items under focus asked participants 'What type of Internet-based mental health and well-being (1) services and (2) content would be of most interest to you?'An open textbox was provided for participants to respond to each question.These two questions were not mandatory.

| Procedure
Following ethics approval from the Federation University Human Research Ethics Committee (Project No.: A13-133), the study was advertised Australia-wide via social and printed media, personal networks and flyers on community notice boards and in aged care residential facilities.The study was open to Australian residents aged 65 years and older and involved the completion of an anonymous survey either online (hosted by Survey Monkey®), by telephone, or by returning a paper-and-pencil questionnaire by post.The survey took approximately 25 minutes to complete.

| Statistical analysis
A total of 168 individuals gave consent to take part in the study, of which 91 older adults provided a response to at least one of the qualitative questions (a response rate of 54%).Two of these participants were excluded from the analysis as they resided outside Australia, leaving a sample of N = 89 older adults.
Responses were analysed using reflexive thematic analysis. 4,5This analytic approach follows a recursive process involving familiarisation and coding of the data, searching for and reviewing themes and writing up the analytic narrative.In some cases, participants provided responses that addressed multiple themes.Where responses did not fit logically into a cohesive theme, they were categorised as 'other'.The analysis was undertaken by an academic researcher with experience in the development and evaluation of Internet-based interventions.Qualitative data were analysed using Microsoft Excel.

Practice Impact
Older adults want a secure, tailor-made Internetbased service that facilitates the creation of new social networks and communication, and provides practical strategies to enhance mental and physical fitness and information on coping with grief and loss.However, further investigation determining how best to increase Internet-based health-related service use is required.Study findings can assist organisations to develop Internetbased services and content as preferred by older adults.

| Internet-based mental health and well-being services
A total of n = 88 participants provided a response regarding their preferred type of Internet-based mental health and well-being services.Of these responses, 15 could not be interpreted (e.g.entered a random sequence of letters), a further nine participants responded with 'do not know' or 'unsure' without providing any contextual detail as to whether they did not understand the question, were not sure what Internet services might be of interest to them, or other unspecified reasoning.
Of the interpretable responses, participants primarily indicated a preference for a Facebook-style service (n = 17), closely followed by an Internet-based service that integrated social interaction (e.g.chat groups) (n = 16).An email-based service that allowed people to connect was also suggested by a small number of participants (n = 4).The importance of the service being for use by 'older adults only' was also a common theme.However, the largest proportion of participants (n = 22) indicated that they were unlikely to use Internet-or social media-based services.Part of this response may be due to concerns expressed over the privacy and trustworthiness of online services.See Table 1 for greater detail.

| Internet-based mental health and well-being content
A total of n = 87 participants provided a response to the type of content they would like incorporated into an Internetbased mental health and well-being service.There were 10 responses that could not be interpreted and a further seven participants who stated they 'do not know' or were 'unsure'.
Participants showed greatest interest in content related to mental fitness (n = 34).For this theme, participants wanted access to practical activities to help keep their brain active and mind agile.The next most common themes to emerge were grief and loss (n = 20), followed by health information (n = 13), of which the latter included topics relating to neurological and physically degenerative conditions, and mental ill health.Socialisation (n = 11) was also identified as a commonly occurring theme, with participants seeking opportunities to connect with peers and health professionals.Similar to mental fitness, physical fitness (n = 10) was identified as a beneficial topic to participants, with both topics often raised in the same response.Another particularly relevant theme to this study was coping with life changes (n = 9) that often come with ageing.See Table 2 for further detail.

| DISCUSSION
The purpose of this paper was to report on themes derived from the qualitative responses given by older Australian adults (≥65 years of age) regarding their preferences on Internet-based services and content.
For Internet-based services, participants identified social media style services (i.e.Facebook) and chat groups that were exclusive to-and catered specifically for the needs of older adults (e.g.design, language)-to be of greatest interest.Responses indicated that participants preferred simply presented sites that are easy to navigate, with a strong preference for jargon-free language, steering clear of more modern, informal means of communication, such as net-or chat-speak.
A preference for in-person or telephone-based services over that of Internet-based services was indicated.Two recent studies conducted in Australia 6 and Canada 7 during the pandemic similarly found older adults preferred inperson or telephone-based services due to their familiarity and comfort with using telephones, and the social interaction afforded to them in-person.Haase et al. 7 also identified a general disinterest and lack of knowledge of computers among older adults to be a barrier to the use of Internet-based services.This finding aligns with a recent scoping review 8 that identified a reduced responsiveness to technological changes among older adults.This is an important consideration for Internet-based services targeting older adults, as they may initially require more support and time to become comfortable and efficient users of any new technology and subsequently gain maximum benefit.Furthermore, the results of the study by Ienca et al. 3 noted that the perceived need for digital health technologies may be less among older adults who are physically and cognitively healthy.This suggests the development of preventative Internet-based services for older adults may also be warranted, which may serve a number of benefits, such as improving their digital literacy by increasing their familiarity with, and use of Internet-based services while they are cognitively agile, and thereby decreasing the potential risk of social isolation and mental ill health as they age.
Interest in using Internet-based services was also somewhat mitigated by mistrust, with concerns of confidentiality and privacy raised, a barrier to the use of Internet-based services among older adults which has been identified in other studies. 3,7,9,10Some participants needed greater assurance that the service was safe to use, with issues such as the use of fake profiles minimised.For Internet-based services that incorporate a social component, allowing older adults to use video-chat technologies may partially alleviate such trust and confidence concerns as seeing the other person would allow them to verify with whom they are speaking.
In respect to content, the main themes of interest were mental and physical fitness, grief and loss, health information and socialisation.The topics showed a clear alignment with the experiences faced by an ageing population.The theme of socialisation closely aligned with the participants' interest in services that offered a means of communication and connection, along with information on how to deal with loneliness and building new social connections.In the development of effective Internet-based services, the importance of understanding the related but distinct concepts of social isolation (objective state) and loneliness (subjective state) has been highlighted. 11Determining what Internet-based services and content may best suit these two groups would benefit from further investigation.Furthermore, we encourage future research to use a co-design approach, involving both older adults and service providers, in developing appropriate Internet-based services and content.Here, key stakeholders can best determine how to integrate these services within the community, particularly within rural areas where services are often scarce, with long waiting lists.

| CONCLUSION
Overall, the responses indicated a preference for tailormade social media style services for older adults that allows them to communicate with their peers and create new social networks.In addition, responses indicated the benefit of including content that provides practical strategies to work on mental and physical fitness, information on coping with grief and loss and general mental health information.However, some mistrust of Internet-based services was expressed.These findings can be used by organisations to develop Internet-based services and content preferred by older adults.