Work 62 (2019) 443–457 443

DOI:10.3233/WOR-192878
IOS Press

Predicting technology usage by health

information need of older adults:
Implications for eHealth technology
Sabine Theisa,∗ , Dajana Schäfera , Christina Bröhla , Katharina Schäfera , Peter Raschea ,
Mattias Willea , Christopher Brandla , Nicole Jochemsb , Verena Nitscha and Alexander Mertensa
a Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Aachen, Germany
b Institute for Multimedia and Interactive Systems (IMIS), University of Lübeck, Lübeck, Germany

Received 30 October 2018

Accepted 17 January 2019

Abstract.
BACKGROUND: Information and communication technology increasingly addresses the information needs patients have
regarding their personal health. While an understanding of older adults’ needs is crucial for developing successful eHealth
technology, user research results hardly apply to different systems.
OBJECTIVE: The present study aims at: (1) describing and analysing the context of digital health systems in a general
manner, (2) investigating if information need of older adults influences their technology usage to show the relevance of the
concept for a general context analysis and (3) testing which demographic variables intervene with their health information
need.
METHODS: Survey data from a longitudinal study with older adults (N = 551) were reported descriptively. After showing a
significant relationship during chi-square tests, we quantified the ones between general health information need and technology
usage, as well as between general health information need and the demographic variables age, education, chronic diseases
and gender by means of (multiple) linear regression models.
RESULTS: We predicted older adults’ technology usage based on their health information need. The results confirmed this
relationship. Higher information need led to a more frequent usage of apps installed on the tablet personal computer (PC), to
a frequent use of smartwatches and to the possession of a computer or laptop. Users’ education has a higher impact on health
information need than amount of chronic diseases, gender and age.
CONCLUSIONS: Information need emerged as a useful object for investigation of context and user requirement analysis
across different systems: it predicted technology usage so that design recommendations derived from the descriptive gained
in importance.

Keywords: Information-seeking behavior, technology usage, requirement analysis, human factors, digital health, user study,
usability

1. Introduction adults has increased. This is because western pop-

In times of demographic change, the need for inno-
vative and comprehensive care concepts for older
∗ Address for correspondence: Sabine Theis, Human Factors
Engineering and Ergonomics in Healthcare, Chair and Institute
of Industrial Engineering and Ergonomics, RWTH Aachen Uni-
versity, Bergdriesch 27, 52062 Aachen, Germany. Tel.: +49 241
80 99469; E-mail: s.theis@iaw.rwth-aachen.de.
ulations are not only getting progressively older, but
also because the incidence and prevalence of illnesses
and the resulting limitations can greatly reduce the
quality of life for patients [1]. The application of digi-
tal information and communication technology (ICT)
and related services in existing and future health
services represents an extremely promising oppor-
tunity. Digital health has the potential to address the

1051-9815/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved
444 S. Theis et al. / Predicting technology usage by health information need of older adults
challenges posed by the societal age shift in Germany,
but also in other western countries [2]. The decou-
pling of medical care from the local and temporal
availability of medical personnel, which is associated
with digital health systems, makes it possible to pro-
vide patient-specific and cost-efficient services and
therapies. Through digital monitoring and appropri-
ate support systems, elderly people’s wish to remain
longer and more independent in their home envi-
ronment can be accommodated. Unfortunately, the
nationwide distribution of so-called eHealth systems
is the exception in Germany and other European
countries. Legal and organizational obstacles as well
as a lack of knowledge about the requirements of
older adults regarding the design of eHealth and
eHealth services could be identified as obstacles in
post-hoc analysis of facilitators and enablers of digi-
tal health systems [3]. Existing systems and services
often lack acceptance and adherence due to usability
issues. One effective mean to support the acceptance
and usability of digital health information systems is
the user-centered design process [4, 5].
1.1. User research and generalizability
User-Centered Design (UCD) processes involve
users in the design of technology by identifying
usability goals, user characteristics, environment,
tasks and the user interaction with a product, ser-
vice or process through different steps of an iterative
process [5]. UCD serves to develop a specific techni-
cal system according to the individual needs of users
[6–9]. User research is one pre-requisite for UCD
and methods depend on the type of technology to be
developed, accessible resources, and the evaluation
and application environment. User research results
are also made available within the framework of clas-
sical research. Here, with each new technology, a new
research question arises. However, by its nature, con-
text and requirement analysis are rarely generalizable
across applications and users.
Besides this research-related issue, in applied set-
tings the problem arises that UCD evaluation of every
new product requires resources. In addition, context
and requirements analysis outcomes rarely involve
alternatives to technology or the interaction of tech-
nical and non-technical information sources in their
effects on users. When the product decision is to
develop a smartphone app, according requirement
analysis will ask e.g. what the users goals are and
will consider how to support them with the app. It is
unlikely that a book or a human will be the solution.
Although there are user requirements that are of
a general nature, these are given little attention.
Research activities instead concentrate on user needs
for one specific system. We consider user research
results as “general” if they hold either across mul-
tiple systems or across multiple users. Such general
context and requirement description could identify
opportunities for digital health information systems
and initiate their development. It could furthermore
identify the potential for new types of applications
and reveal potentials for increasing user acceptance
and adherence. Developers and health system com-
panies could use a general description of the needs of
older adults to make more informed product devel-
opment decisions and they could use it as starting
point for detailed context- and requirement analysis,
especially if this involves demographic factors of the
target group.
1.2. Information need as part of user centered
development
Information technology helps the user to find, use
and transfer information. Looking at the information
a user needs to fulfill her or his goal, has implications
for different kind of technologies, which are able to
transfer this required information. User’s information
need (IN) becomes a concept describing a proportion
of user requirements across systems while a user’s
information seeking behavior (ISB) describes the cur-
rent context of information acquisition. ISB usually
represents the consequence of a previously existing
need for information.
To give an example, imagine the case of a patient
receiving a medical diagnosis. Consequently, this
patient may now develop a need to seek additional
information to his or her diagnosis. Accordingly, to
satisfy this need, the patient will want to employ
information sources or information retrieval systems
such as a search engine for the internet, using a com-
puter, a smartphone or other compatible devices. The
patient either can find required information or not.
The source could lead to either a success or a failure
of the information search. In the case of success, the
patient will use the gathered information so that the
initial IN will be satisfied or not. Success or failure
of one information source influences the use of other
sources.
Accordingly, we want to investigate the potential
of the concepts health information need (HIN) and
health information seeking behavior (HISB) for a
general context and requirement analysis for digital
 S. Theis et al. / Predicting technology usage by health information need of older adults
health systems. To the best of our knowledge, the rela-
tion between information need (IN) and technology
use is lacking so far, even if it is oftentimes implicitly
assumed by studies.
2. Related work
One of the first studies of its kind investigated the
IN of urban residents [10] to identify how it could
be better addressed by public institutions in a city.
Nevertheless, it was criticized due to a lack of defini-
tion of the concept “information need”. Wilson [11]
therefore defined and modeled the concepts of IN and
ISB. He defines information, as “facts, advice or opin-
ions”. For him, IN is a subjective need for information
or knowledge perceived by a user.
Various theoretical models exist to describe IN and
ISB [12–17]. One developed in the health information
context is Wilson’s model of ISB [18–20], depicted
in Fig. 1.
Perceiving the need for certain information ini-
tiates an ISB. In order to obtain the required
information, the user approaches one or multiple
information sources. On the one hand, these can
be systems with the primary task of providing
information, such as libraries, information retrieval
Fig. 1. Wilson’s information seeking behavior model [18].
445
systems or similar ones. On the other hand, these
can be systems that focus on non-informatory tasks
and provide information as a secondary task. One
example for such a system would be a real estate
organization. Its primary goal is to sell houses. How-
ever, if one searches for suitable areas to live in a
city, this organization would be a good information
source to approach. Alternatively, the user may seek
information from people, rather than from systems.
This reciprocal process is considered an informa-
tion exchange. Regardless of the source that the user
approaches, as the previous example of a patient illus-
trates, the ISB could lead either to success or to
failure. Information usage might include perception,
inspection and storage but most importantly an eval-
uation with regard to the perceived need. After using
the information, the user can be satisfied or dissatis-
fied with the information at hand. Being subjective in
nature, IN is not directly obvious and the researcher
has to derive it from a person’s behavior or report.
Various intervening factors of IN and ISB exist
– as they do for human behavior in general. Those
intervening factors can be personal characteristics
of physiological, cognitive [21, 22] or emotional
kind [23]. In a study about the information-seeking
behavior of cancer patients, the authors found hearing
loss, a lack of medical knowledge, verbal limitations
446 S. Theis et al. / Predicting technology usage by health information need of older adults
and nervousness to determine information-seeking
during the consultation with the doctor. In addi-
tion, demographic variables, educational variables,
social/interpersonal variables, economic variables
and source characteristics may play a role. Harris
[24] found out that medical terminology was a barrier
to information exchanges with doctors. Furthermore,
Bettmann and Park [25] detected that more educated
people feel less need to search for more information,
while Harris [26] proposed that the more knowledge-
able the individual, the easier they would find it to
encode information, thereby making further infor-
mation acquisition easier. Finally, Moormann and
Matulich [27] found that high knowledge levels did
indeed facilitate information acquisition. Connell and
Crawford [28] found that the amount of health infor-
mation received by urban residents from all sources
declined with age, this was less the case for older rural
women while they also made use of a larger variety
of sources. An age difference of information obtained
was also apparent between younger and older men:
younger men searched less than older men.
Intervening factors were later included in the
revised model of IN [29]. Besides personal char-
acteristics of psychological, cognitive or emotional
kind, demographic, educational, social/interpersonal
and economic variables were mentioned. But not only
user characteristic are expected to influence IN and
seeking behavior, also source characteristics have to
be taken into account. Moreover, Wilson’s revised
model now also takes into account how information-
seeking behavior can occur, ranging from passive
attention to more active and ongoing search. Addi-
tionally, the construct of self-efficacy that can affect
how successfully information sources are used, is also
considered. However, different stress-coping mecha-
nisms can also arise when e.g. getting an unpleasant
medical diagnosis [30]. Some people may show an
avoidant behavior while others may be more likely to
focus on the possible threat.
IN and seeking behavior was investigated for
numerous application contexts. Greysen et al. have
investigated how functional impairment affects inter-
net use among older adults and found that this had
negative implications for meaningful use of patient
portals [31]. Yagil et al. also found that using every-
day technologies generated stress for older adults,
which also suggested a potential barrier to patient
portal adoption and use [32]. Ancker et al. have inves-
tigated how disadvantaged populations use patient
portals, based on system access logs of more than
74,000 patients at a Federally Qualified Health Center
in New York City [33]. They found good adoption of
the system by low-income participants, but small per-
sistent racial disparities in both the likelihood to be
offered an access code and the likelihood to actually
use the system. Thus, income itself did not appear to
be a limiting factor in adoption of patient portals,
but may have a modifying influence in combina-
tion with other demographic factors. However, these
results may not be generalized to rural populations.
In a qualitative study dealing with eHealth users in
rural Nebraska, Fruehling reports that usability and
clarity were important in the development of such sys-
tems, and noted that security and privacy issues were
a major concern with this population [34]. Finally,
it has to be considered that IN is not a fundamental
need like the ones proposed by [35]; instead Wil-
son considers IN as supporting the needs listed in
Maslow’s theory of human motivation. Wilson noted
that research on the topic of IN and ISB, can stand
on its own as an area of applied research where the
motive for the investigation is pragmatically related
to system design and development. That is why we
consider it as suitable for user studies for eHealth
system development.
3. Research purpose
Related work shows that IN and technology usage
are assumed to relate in some way. However, while
the investigations of HIN primarily focus on specific
diseases and contexts [36–40], a description of HIN
and HISB of older adults is lacking within the evi-
dence literature. In order to close this knowledge gap,
we want to address the following research questions
(RQ):
(RQ1) How large is older adults’ general and topic
specific HIN?
(RQ2) How do older adults acquire and use infor-
mation on their personal health and on health
topics in general?
The second challenge the present study aims to
address is a perceived lack of generalizability in user
centered development research of health information
and communication technology (ICT). While it is not
our aim to generalize our results to different popu-
lations, different contexts, or to different times, we
intend to describe the context and user requirements
not only for one eHealth system, but also to as many
eHealth systems as possible. While concepts such as
user goals or activities would be just as suitable here
 S. Theis et al. / Predicting technology usage by health information need of older adults
[19], present work will concentrate on the subject of
health information. Since information transfer is an
integral part of health information and communica-
tion technology, we consider information needs and
information search behavior to be suitable for gener-
ating general context and user requirements. In order
to document the potential of these constructs (HIN,
HISB) to this purpose, empirical evidence for their
relation has yet to be made. In order to address this
knowledge gap and in order to test Wilson’s Model
on ISB we ask:
(RQ3) What demographic factors influence HIN
and seeking behavior?
(RQ4) Is there a relationship between HIN/HISB
and technology usage?
4. Method
The aim of the study was to describe the HIN
of older adults as the starting point and motiva-
tion for investigating ergonomic aspects of personal
health data access [41–43]. An Institutional Review
Board was obtained prior to the start of the study. A
detailed description of the study method and descrip-
tive results can be found in Mertens, Rasche, Theis,
Bröhl, Wille (2017) [44]. In contrast to the mentioned
article, the present paper does not deal with all the-
matic blocks of the initial survey in its descriptive
documentation, but only with those of the HIN and
HISB. The focus is also placed on the relationships
between mentioned concepts and their determination
of influencing factors.
4.1. Sample
The mean age of the participants (N = 551) was
69.17 years (SD = 5.79) and ranged from 60–90 years.
The gender ratio of the sample was balanced includ-
ing 51.3% males and 48.7% females. 441 participants
(80%) were already retired, while 109 (19.8%) were
still working.
4.2. Procedure
The 15-page paper-based questionnaire was sent
via conventional mail to N = 5,000 adults aged 60
years and older in June 2016. The addresses to
which the questionnaires were sent were rented
from Deutsche Post. This company has more
than 46 million private addresses from registration
447
authorities, which are provided with individual
characteristics of people. From these 46 million
addresses, 5,000 addresses of people older than
60 years with an equally distributed gender ratio
were randomly selected. Of the 5,000 addresses the
paper-based questionnaire was sent to, 586 partici-
pants responded. 35 participants had to be excluded
because they were younger than 60 years, resulting
in a final sample size of N = 551 and a response rate
of 11%. By investigating elderly’s HIN and ISB,
we assessed general HIN and trust in information
sources (TV, magazines, internet, doctor and phar-
macist, family and friends or other). Subsequently,
questions on topic-related IN (diagnosis, therapy,
interdependency of medicine) had to be answered.
This section closed with a question on information
sources participants use to access (personal) health
information and with a question on characteristics
of HISB considered as relevant in Wilson’s model
on ISB. Returned surveys were digitalized through
Remark Office software.
4.3. Statistical analysis
SPSS 24 served to conduct the statistical analy-
sis of the data resulting from survey digitization with
the help of Remark software. Initially we computed
descriptive results for all HIN and HISB items (RQ1
and RQ2). A chi-square test of independence was
performed to examine the relation between HIN and
HISB and demographic variables (RQ3). The chi-
square test was followed by a multiple linear regres-
sion involving all demographic variables showing a
significant relation with HIN during chi-square tests.
To investigate the relation between HIN and tech-
nology usage (RQ4) we computed the point-biserial
correlation coefficient between HIN and technology
usage items. Each item on technology usage that
showed a significant relation with HIN, was included
into a simple linear regression with HIN.
5. Results
5.1. General and topical HIN of older adults
General HIN was measured by one item asking
participants how satisfied they are with health infor-
mation at their disposal. Thematic HIN was measured
by satisfaction regarding information on a certain
topic. The answer scale ranged from one to five
where one stands for very satisfied and five for
448 S. Theis et al. / Predicting technology usage by health information need of older adults
very dissatisfied. High satisfaction represents a low
HIN. Older adults in Germany are satisfied with the
information they get about (personal) health. 64%
(N = 334) claim to be ‘very satisfied’ and ‘satisfied’
while 27.6% (N = 129) consider their satisfaction
with the health information they get as ‘neutral’.
Only 36 participants are not satisfied or very unsat-
isfied. The health topics where older adults have the
highest HIN are information on health billings from
doctors and health insurances (n = 516, M = 3.05,
SD = 0.93). Besides billing transparency, older adults
require information about medical diagnosis (n = 540,
M = 2.27, SD = 0.75), information about the meaning
of examination results (n = 535, M = 2.37, SD = 0.72)
as well as on information on therapy and treatment
options (n = 530, M = 2.66, SD = 0.83).
5.2. HISB of older adults
Descriptive results suggest that older adults in Ger-
many get information about health primarily from
their doctor and pharmacist or from TV. The internet
is the least used information source when it comes
to searching and finding health-related information.
In total, 45.6% of N = 551 valid answers find health
information on TV, 45.6% (n = 251) find health infor-
mation in magazines, while 37.4% (n = 206) look on
the internet. Doctors and pharmacists are the primary
source for 47.9% (n = 264), while friends and fam-
ily are consulted by 38.8% (n = 214). Participants
trust their doctor and pharmacist the most (n = 539,
M = 1.96, SD = 0.67,), while their trust in magazines
and newspapers is the lowest (n = 492, M = 3.30,
SD = 0.80,) on a scale ranging from one (very high)
to five (very low).
Older adults primarily share their information with
family and friends (89.7%, n = 494) and with their
doctor or their pharmacist (73.5%, n = 403). Just over
a quarter (25.2%, n = 139) of older adults in Germany
share health-related information with acquaintances
Table 1
HIN of older adults (1 = very satisfied, 5 = very unsatisfied)
Education Satisfaction with health information (HIN, N = 520)
Very satisfied Satisfied
None 0 0
Lower second. education 4(8%) 21(40%)
Second. education 2(2%) 42(49%)
Vocational training 12(7%) 109(67%)
A-Levels 0(0%) 17(57%)
University degree 9(5%) 109(62%)
Other 1(8%) 8(66%)
χ2 (24) = 209,385, p < 0.000; Phi = 0.635; Cramer-V = 0.317; Contingency coefficient = 0.536.
and 11.8% (n = 65) share it with health insurance
companies. A negligible number of participants share
health-related information on social networks, with
self-help groups, or with people they do not know at
all. From N = 551 valid answers only twenty people
do not share health-related information at all.
In Germany, older adults describe their search
for information about health in general or their per-
sonal health as active and incidental. On a scale with
1 = ‘fully agree’ and 5 = ‘fully disagree’, the average
rating of the statement that their information search is
active is M = 2.7 (SD = 1.3, n = 387) while it is M = 2.7
(SD = 1.22, n = 424) for the statement that their infor-
mation search is causal. The least agreement is with
the statement ‘I search regularly for health informa-
tion’ with a rating of M = 3.3 (SD = 1.9, n = 361).
5.3. Relation between HIN / HISB and
demographic variables
A chi-square test (s. Table 1) found a significant
association between the general HIN and the educa-
tional level. People with lower educational level are
less satisfied with the information they have regarding
their personal health.
The participant without education was satisfied the
least with the information about medical billing (see
Table 2). Differences between all other levels of edu-
cational attainments were non-significant. Another
significant association could be identified regarding
the satisfaction with information about the experience
that others have with their health and their educa-
tion (see Table 2). Older adults with a lower level of
education were less satisfied with the available infor-
mation than older adults that are more educated. As
there was also significant association between the sat-
isfaction concerning information about (interaction
of) medications and the number of chronic diseases.
Our results suggest that people with a higher amount
of chronic diseases are much more satisfied with the
Neutral Dissatisfied Very dissatisfied Total
0 0 1 (100%) 1
18(35%) 9(17%) 0(0%) 52
36(42%) 5(6%) 1(1%) 86
34(21%) 8(5%) 1(1%) 164
12(40%) 1(3%) 0(0%) 30
49(28%) 8(5%) 0(0%) 175
2(17%) 1(8%) 0(0%) 12
 S. Theis et al. / Predicting technology usage by health information need of older adults 449

Table 2
Chi-square test statistics of associated variables (crosstabs)
Associated variables: HIN (general and thematic) χ2 DF p
General HIN × education 209.38 24 <0.001
HIN on billing information × education 60.48 24 <0.001
HIN on experiences of others × education 52.46 20 <0.001
HIN on medication interactions × no. chronic diseases 47.93 24 <0.001
HIN on course of disease × education 36.44 24 <0.05
HIN on therapeutic options × gender 12.05 4 <0.05
HIN on meaning of examination results × gender 11.08 4 <0.05
Associated variables HISB: trust in sources
Internet trustworthiness × postal codes west/east 12.08 4 <0.05
Trustworthiness doctor/pharmacist × education 59.25 18 <0.001
Associated variables HISB: information sharing
With family/friends × age group 15.2 6 <0.05
With acquaintance × living situation 9.76 4 <0.05
With health fund × age group 23.97 6 0.001
With doctor/pharmacist × postal code (west/east) 5.52 1 <0.05
Associated variables HISB: search characteristics
Activity of search × gender 11.56 4 <0.05
Persistence of search × number chronic diseases 47.93 24 <0.01

kind of information they get than people with no or
less chronic diseases. The same applies to informa-
tion about the course of diseases. Finally, we found
women are more satisfied with the information they
get than men. This is the opposite for the understand-
ing older adults have about their medical diagnosis.
Women indicated that understanding the meaning
of a diagnosis is very easy while more men than
women indicated a neutral position to this ease of
understanding.
5.3.1. Trust in health information sources
Surprisingly, people in the eastern part of Ger-
many rate the internet as slightly less trustworthy than
people in the western part. Similarly, we found a sig-
nificant association between the trustworthiness in
doctor/pharmacist and their education. Older adults
with university degree rate this information source as
less trustworthy while people with lower educational
level trust this source more.
5.3.2. Health information sharing
The older the participants, the less they share
health-related information with friends and family.
In nearly all age groups, the number of people who
share their information was higher than the number
of people who do not. Furthermore, results reveal that
people who live in a supervised community for older
adults share health information with acquaintances.
There was also a significant association between shar-
ing health information with health insurance and age
group. The amount of older adults who do not share
health information is in all cases higher than the
amount who do not share their health information
with their health fund. The only exception here is
the age group of the 85 to 90 year old adults. Here,
more people share information about their health with
their health insurance. Older adults in the east of Ger-
many share health information less with their doctor
or pharmacist than in the western part.
5.3.3. Health information search characteristics
Significantly, more women than men describe their
search for health information as active. Finally, yet
importantly, results indicate that the major part of
older adults without a chronic disease reports that
they do not regularly search health information while
the people with two or more chronic diseases report
the opposite.
5.4. Relation between HIN and technology usage
There was a significant negative relationship
between HIN and the possession of a computer or
laptop rs = –0.11, T 95%, BCa CI [–0.19, –0.01],
p = 0.02. Hence, based on the point biserial cor-
relation, we conclude that the possession of a
laptop or computer accounts to 0.11% to the IN
represented by the satisfaction with available health
information. We additionally found a significant
negative correlation between HIN and frequency
of using a smartwatch, rs = –0.30, T 95%, BCa CI
[–0.51, –0.10], p = 0.04. That means, the lower the
satisfaction with available health information, the
450 S. Theis et al. / Predicting technology usage by health information need of older adults

Table 3
Demographic descriptor variables for the prediction of older adults HIN
Predictor variables Statistical measures (N = 514)
B SE B ß
Step 1 (Constant) 2.333 0.052
University vs. lower secondary education 0.294 0.110 0.123
University vs. secondary education 0.213 0.091 0.111
University vs. vocational training –0.083 0.075 –0.054
University vs. A-levels 0.133 0.137 0.044
University vs. others –0.083 0.207 –0.018
University vs. no education 2.667 0.695 0.164
Step 2 (Constant) 1.281 0.382
University vs. lower secondary education 0.250 0.111 0.105
University vs. secondary education 0.178 0.091 0.093
University vs. vocational training –0.116 0.076 –0.076
University vs. A-levels 0.124 0.137 0.041
University vs. others –0.052 0.206 –0.011
University vs. no education 2.633 0.693 0.162
Gender 0.139 0.061 0.097
Age 0.013 0.005 0.102
Amount of chronic diseases –0.004 0.026 –0.006
R2 = 0.25 for Step 1, R2 = 0.28 for Step 2, ∗ p < 0.001, ∗ p < 0.02∗∗ .

Fig. 2. HIN of older adults depending on education.

more frequently older adults use smartwatches. Fur-
thermore, a significant negative relationship could be
identified between HIN and older adults’ frequency
of app usage on tablet PCs, rs = –0.15, T 95%, BCa
CI [–0.29, 0.01], p = 0.04 as well as between HIN
and amount of health apps older adults have installed
on their tablet PC, rs = –0.17, T 95%, BCa CI [–0.34,
0.01], p = 0.04. This indicates that lower satisfaction
with health information available corresponds with
a higher amount of health apps installed on older
adults’ tablet PC. This corresponds with the relation
between IN and frequency of app usage.
 S. Theis et al. / Predicting technology usage by health information need of older adults
5.5. Predicting HIN by age, gender, chronic
diseases and education
In a second step, in order to investigate the influ-
ences on the general need for health information
more closely, variables significantly correlating with
general HIN were examined by a multiple linear
regression with forced choice method. We choose
this method as we have good theoretical reasons for
including the chosen demographic predictors. And
like Studenmund and Cassidy, (1987) we consider
stepwise techniques as influenced by random varia-
tion in the data.
After transforming each educational level vari-
able into a dichotomous category in relation to the
educational level variable “university”. Dummy cod-
ing was conducted, as multiple linear regression
requires interval or ratio scaled variables (Field,
2018). While qualitative educational variables have
a rank order, their distances are not equal which
makes them an ordinal variable [45]. Whether or
not participants attended the university was cho-
sen as reference category, as sample sizes are very
unequal in the groups. As it can become problem-
atic to use very small groups as the reference (like
no education), we choose just the largest category as
the reference.
Multiple regression shows that demographic vari-
ables (amount of chronic diseases, age, gender and
educational level) explain together 25%*, 28% of the
variance in HIN. A regression was found to be statis-
tically significant (R2 = 0.25 for Step 1, R2 = 0.28
for Step 2, ∗ p < 0.001, ∗ p < 0.02∗∗ ), with an R2
of 0.28 (Table 3).
The first dummy variable (university vs. lower
secondary education) shows that the mean IN dif-
fers significantly between participants with university
degree and lower secondary education (p = 0.03).
That means satisfaction with health information
decreases as a person changes from having a
university degree to having a lower secondary edu-
cation degree 0.10 (regression coefficient B of
university vs. lower secondary education) –1.28
(constant) = –0.17). It is important to consider that
a decrease of satisfaction with health information
represents an increase of IN. This means that IN
increases significantly more in adults with lower
secondary education compared to those with uni-
versity degree. Computing the significant (p = 0.05)
difference in the group means of satisfaction with
health information for the group with secondary
education (regression coefficient B of university
451
vs. secondary education HIN (regression coeffi-
cient) = 0.17–1.28 = –1.12), the change of satisfaction
with health information decreases by 1.12 points as
a person changes from having a university degree to
a person with secondary education degree. For the
dummy variable of university vs. vocational training
and university vs. A-level the change in HIN is the
same for a person changing from university degree
to vocational training or to A-level. Only the differ-
ence in the group means for the university group and
the participant with no education achievements was
significant (p < 0.001). Change of HIN (University vs.
no education = 0.01–1.28 = –1.27) increases (because
satisfaction with information decreases) when a per-
son changes from having a university degree to having
no educational achievement.
Within the model, participant’s satisfaction with
health information increases by 0.01 points per
additional chronic disease (p = 0.89), 0.01 points
by each year of age (p = 0.02); male’s satisfaction
with health information was 0.13 points higher than
females (p = 0.02). All together age, gender, number
of chronic diseases, and educational level were sig-
nificant predictors for older adult’s satisfaction with
health information
Participants’ satisfaction with health information
is equal to 1.28 (constant) + 0.25 (university vs.
lower secondary education) + 0.18 (university vs. sec-
ondary education) + 0.112 (university vs. vocational
training) + 0.12 (university vs. A-levels) –0.05 (uni-
versity vs. others) + 2.63 (university vs. no education)
+ 0.14 (gender) + 0.01 (age) + (–0.01) (amount of
chronic diseases) = 4.68.
Based on the standardized ß value, which is an indi-
cator for a predictor’s influence on the output variable,
we learn that education in general influences older
adults IN the most.
University vs. no education (standardized ß = 0.69)
indicates that as educational level changes from
a university degree to no education, satisfaction
with health information increases by 0.69 standard
deviations. The standard deviation for HIN is 0.77
(standardized ß 0.69 × 0.77 SD HIN). Therefore,
changing the educational level from university degree
to no education (the biggest difference in education
you could have) would increase the satisfaction of a
person with the information they have by 0.53 points
on a 5-Point Likert scale. Consider that an increase of
satisfaction with health information corresponds to a
decrease in IN.
Changing the educational level from university
degree to other educational levels, would increase
452 S. Theis et al. / Predicting technology usage by health information need of older adults
the satisfaction of a person with the information they
have by 0.16 points on a 5-Point Likert scale (stan-
dardized ß = 0.21 × 0.77 SD HIN = 0.16). Changing
a person’s educational level from university degree
to A-levels would increase the satisfaction with
health information by 0.11 on a 5-Point Likert scale
(standardized ß 0.14 × 0.71 SD HIN = 0.11). This
value would be 0.09 when changing it to lower sec-
ondary education (standardized ß 0.11 × 0.77 SD
HIN = 0.09), 0.07 when changing it to secondary edu-
cation (standardized ß 0.091 × 0.771 SD HIN = 0.07)
and 0.06 for vocational training (0.078 (standardized
ß) × 0.77 = 0.06).
The standardized ß value of gender (0.01) indi-
cates that as the gender changes from men to women,
satisfaction with health information would increase
by 0.05 points on a 5-Point Likert scale (0.06
(standardized ß) × 0.77 (SD HIN) = 0.05). With each
additional number of chronic disease, the satisfaction
with health information need increases about 0.02
points on a 5-Point Likert scale (0.03 (standardized
ß) × 0.77 (SD HIN) = 0.02, while per year of age the
satisfaction with health information increases by 0.01
points on a 5-Point Likert scale (standardized beta
0.005 × 0.771 = 0.01).
If we look at the predictors of the second model
[18] then the highest correlation exists between edu-
cational level and satisfaction with health information
(r = –0.14, p = 0.001). The amount of chronic dis-
eases (r = 0.03, p = 0.28) is not significantly related
to IN, while age (r = 0.97, p = 0.01) and gender
(r = 0.10, p = 0.01) positively correlate with satisfac-
tion with health information. As the correlation of
educational level and IN is negative, this denotes
that less educated older adults are more satis-
fied with the health information they have at their
disposal and thus have a lower need for informa-
tion. Despite the significance of this correlation,
the coefficient is quite small, though it looks like
the predictors are measuring different things and
that there is little collinearity. As out of all pre-
dictor variables, educational level correlates best
with the outcome variable, it is likely that educa-
tional level will best predict IN. For all predictors
the difference between the regression beta coeffi-
cient and the standardized beta varies between 0.047
(age), 0.56 (educational level) and 0.038 (gender).
Although educational level is the most important
predictor, its results are the least generalizable. A
difference of 0.08 between the R2 and the adjusted
R2 of the model indicate that if the model was
derived from the population rather than a sample it
would account for approximately 8% less variance in
the outcome.
5.6. Predicting technology usage with HIN
Simple linear regression was carried out to
investigate the relationship between HIN as pre-
dictor (5-Point Likert scale) and possession of a
computer/laptop (dichotomous) as output variable,
between HIN and frequency of using a smartwatch
and between HIN and frequency of using apps
on a tablet PC. All according scatterplots showed
that there was a strong positive linear relationship
between the pairs of variables, which was confirmed
by preceding correlation analysis documented in
chapter 5.5.
Simple linear regression showed a significant rela-
tionship between older adults’ health HIN and the
possession of a computer or laptop (p = 0.01). The
slope coefficient for HIN was –0.07 so that the score
for possessing a computer or laptop changed by –0.07
from 1 (=possessing a laptop) to 0 (=not possessing
a laptop) when increasing the score for satisfaction
with health information on a 5-Point Likert scale
value by one point (1 = very satisfied/very low HIN
to 5 = very dissatisfied/very high HIN). The R2 value
was 0.12, indicating that the model explains 12% of
the variation in HIN of older adults.
Simple linear regression showed a significant rela-
tionship between older adults health HIN and the
frequency of using a smartwatch (p = 0.01). The slope
coefficient for HIN was –0.32 so that the usage fre-
quency decreased 0.32 points from 4 (=daily) to 1
(=never), when increasing the score for satisfaction
with health information on a 5-Point Likert scale
value by one point. (1 = very satisfied/very low HIN
to 5 = very dissatisfied/very high HIN). The R2 value
was 0.18, indicating that the model explains 18% of
the variation in older adults’ frequency of using a
smartwatch.
Simple linear regression also showed a significant
relationship between older adults health HIN and the
frequency apps on a tablet PC (p = 0.01). The slope
coefficient for HIN was –0.45 so that the usage fre-
quency decreased 0.45 points from 4 (=daily) to 1
(=never), when increasing the score for satisfaction
with health information on a 5-Point Likert scale
value by one point (1 = very satisfied/very low HIN
to 5 = very dissatisfied/very high HIN). The R2 value
was 0.21 so the model can explain 21% of the vari-
ation in older adults’ frequency of using an app on a
tablet PC.
 S. Theis et al. / Predicting technology usage by health information need of older adults
6. Conclusion
In summary, results of a large-scale survey with
adults older than 60 years in Germany suggest that
older adults are mainly satisfied with the informa-
tion they get about health in general as well as about
their personal health. Consequently, in addition to
usability and legal hurdles, a lack of HIN might
also contribute to a lack of digital health system
usage [3]. HIN was quantified according to Wilson
[20] as satisfaction with available information. To
the best of our knowledge, the need for information
has not been investigated in general and independent
of technology in other studies, so that a comparison
is challenging. General HIN revealed no significant
correlation to social desirability (r = –0.05, n = 504,
p = 0.30), but with computer literacy – although to
a lesser extent (CLS, r = –0.15, n = 445, p = 0.01).
The less elderly people are familiar with the use
of computers, the higher the need for health-related
information. Here we can already see the connec-
tion between the handling and the attitude toward
technology and the HIN.
According to described findings, the answer to
RQ1, how large is older adults’ general and topic
specific health information need? is that the general
HIN of older adults is low. Thematic HIN include a
comparably great need for information on doctors’
and health insurance companies’ bills, diagnoses, the
importance of examination results and information on
therapy and treatment options. Reason for the low IN
could be attributed to the fact that all expressed needs
are sufficiently addressed by doctors as it counts
among a component of their core tasks (diagnosis). A
further explanation for low HIN could lie in the over-
idealized role the doctor has particularly for older
patients [46] by which decisions are placed in the
hands of the doctor and any action is initiated by
him. This interpretation aligns with previous results
about older adult treatment behaviors, which indicate
that as people age, they are less inclined toward self-
directed forms of health management [47–49]. Since
these studies do not include longitudinal results, it
could also be that the older elders show a different
behavior (e.g. questioning authority less) than the
younger people. Based on our results in answer to
RQ1 we thus conclude that digital information sys-
tems purely geared towards the communication of
health-related information – such as information on
the Internet - do not meet the requirement of older
adults as the usage of personal sources already deliv-
ers satisfactory health information. Changes in the
453
treatment process as well as (billing) legal adapta-
tions, for example, could be sufficient in this case. For
the design of eHealth systems, the following recom-
mendations for action result from the research results
to answer the first research question:
• eHealth technology should provide patients with
insight into treatment costs and processes.
• eHealth technology should facilitate a compari-
son of therapy and treatment options.
• eHealth technology should document treatment
results and provide the patient with interpre-
tation aids as well as reliable and trustworthy
additional information.
As answer to RQ2: how do older adults acquire
and use information on their personal health and on
health topics in general? – the descriptive results iden-
tified doctors and pharmacists as the primary source
of health information while only 37% of the partic-
ipants access the internet. Since television serves as
a source of information for almost the same amount
of older people, our findings contradict the statement
that older people prefer people as sources of infor-
mation to things like [50]. Trust is shaped according
to the use of the source: older people mostly trust the
doctor or pharmacist. When exchanging information,
however, friends and family take priority, followed by
the doctor and pharmacist. Nearly every participant
shared information. The results with regard to the
important role of friends and families in the exchange
of information suggest that the bi-directionality of
the information channels is more strongly perceived
or practiced here than with the doctor or pharmacist.
Participants describe their HISB as causal, active and
not regular. Wilson [29] describes these characteris-
tics as closely related to the interaction with sources.
In addition to a pure description of the HISB through
the characteristics mentioned above and with regard
to technology development, it would also be neces-
sary to consider the preferred characteristics in the
future. As older adults consider professional medical
sources as most trustworthy, involving these actors in
the introduction and application of digital health tech-
nology might increase the acceptance and adherence
of digital health systems. For the design of eHealth
system it therefore should be considered that:
• Digital health systems should be applied in coop-
eration with the doctor, supporting his core tasks
and facilitating communication with him.
• Older adults need health information irregularly
and casually. The long-term use of digital health
454 S. Theis et al. / Predicting technology usage by health information need of older adults
systems should therefore require as little activity,
effort and attention of the user as possible.
In order to find out what demographic factors influ-
ence HIN and seeking behavior? (RQ3) chi-square
tests were conducted. According results support the
theoretically stated relation between demographic
variables, HIN and HISB. It is not surprising that both
objectives strongly relate to educational attainment.
Furthermore, the understanding of health informa-
tion and level of activity in information seeking was
revealed to differ depending on gender. In addition,
the occurrence of chronic diseases plays a major role
for the information search continuity. Particularly
unexpected the trust in information sources as well
as the information sharing with the doctor seem to
be influenced by the political history. In the areas of
the former GDR, the mistrust for the internet seemed
to be higher. In addition, older adults coming from
those areas share personal health information to a
smaller extent with the doctor or pharmacist. Further
investigations into this aspect are necessary. Sharing
information about one’s own health relates demon-
strably to age. The older people get, the less they
share information with family and friends. However,
it seems reasonable to assume that this is not only
due to the willingness and motivation, but also to
mortality of family members and friends.
A more in-depth investigation by means of mul-
tiple linear regression analysis confirmed a relation
between age, educational level and gender. In line
with previous research [25–27] education of a per-
son had the strongest impact on HIN. Lower educated
people have a higher HIN. With increasing age, the IN
of a person declines. The HIN of men is lower than the
one of women. The initial relation between amount
of chronic diseases and general HIN was not con-
firmed. These results allow the following guidance
for eHealth system design:
• eHealth systems should have adjustable or even
adaptive levels of information complexity as the
depth of required and needed information can be
highly divergent
• eHealth systems for very old people should dras-
tically decrease the amount of information and
required interaction by the user
• Personal experiences through social, societal
and political history should be taken into account
in the user-oriented design of eHealth systems
Results to answer RQ4 (Is there a relation-
ship between HIN/HISB and technology usage?)
empirically demonstrated a relationship between
HIN and older adults’ technology usage. Dissatisfac-
tion with available health information relates to the
possession of a computer or laptop, and to a higher
frequency of using a smartwatch (n = 6) as well as to a
higher frequency of using health apps on a tablet PC.
However, it has to be considered that the significant
correlation of mentioned variables does not necessar-
ily imply causation. This fact indicates the theoretical
relationship stated by Wilson [20] that an informa-
tion source’s failure to deliver desired information
influences the usage of other sources. Although the
results do not allow for the conclusion that the source
of health information most frequently consulted by
older people - the doctor or pharmacist - does not
provide the desired information and that the result-
ing need is the cause of the use of technology, it does
suggest this assumption. With a more detailed investi-
gation of this relationship, the question arises whether
the information which the doctor cannot supply are
at his/her disposal or not. It is conceivable that the
doctor will not have access to this information or that
the resources and contextual conditions will be an
obstacle to the transfer of this information. In par-
ticular, the relation between the HIN and the use of
smartwatches suggests that the required information
is about personal behavior or vital functions, which,
at least in an outpatient context, are very difficult to
acquire for the doctor himself.
• Providing information not available through
other sources can encourage to use an eHealth
technology
• eHealth should provide the physician and the
patient with objective health-relevant data from
patients daily lives in real life settings
6.1. Limitations
Described results have to be interpreted with regard
to internal validity, imprecision of measurement and
other limitations. Internal validity of the present study
is particularly influenced by the application of a non-
standardized and self-formulated questionnaire.
Results of HINs influence on smartwatch and tablet
PCs have to be interpreted for a comparably small
number of people who actually used smartwatches
(n = 6). These results suggest that especially tablet
PCs, Smartwatches and Computers serve to provide
older adults with health relevant information. Over-
all, it has to be stated the proportion of variance
explained by the model is relatively low at about
 S. Theis et al. / Predicting technology usage by health information need of older adults
7.6%. The use of technology thus appears to be
characterized by many influencing variables that are
not taken into account in our model. Among other
things, the understanding of the term information may
have contributed to this. Another reason might have
been the fact that the examination of the HIN con-
stituted a peripheral topic within a larger study on
older adults technology usage. Considering a subset
of all variables mentioned in Wilson’s model kept the
questionnaire short and concise. Identified influence
of HIN on the use of technology are a motivation
and a first step to further validate and refine Wilson’s
model.
When interpreting the results, it should also be con-
sidered that we are dealing with a snapshot of people
in Germany who were older than 60 years in 2016.
This generation did not grow up with digital tech-
nology, and technology usage of people who grew
up without digital tools differ from those of digital
natives [51]. For cancer survivors it has already been
documented that older cancer survivors were less
likely to seek out information compared with their
younger counterparts and more likely to seek infor-
mation from friends, family, or books than from the
Internet [52]. Recurring observations of the present
type are thus required. In order to address this prob-
lem, a repetition of the study is planned in the coming
years.
Finally, the self-selected sample must be pointed
out. Although the randomized selection of question-
naire addressees from the Federal German region was
taken into account, each participant decided on his or
her own collaboration. Generalizability of the results
is to be assessed against this background.
6.2. Summary
The shown influence of HIN on technology usage
provides empirical evidence that IN is a feasible con-
struct to describe the context of eHealth systems
across applications and to investigate general user
research results.
This study describes the health-related informa-
tion needs of older adults in Germany, as well as
their theoretically assumed influences. The results
could be used to formulate practical design guidelines
for eHealth systems, so that user characteristics and
needs can be better-accommodated in future digital
work systems in the health sector. Thereby, this work
contributes to a more efficient, effective and satisfac-
tory use of digital work systems. It is very interesting
that the recommendations are very different from the
455
use of technology often see in health currently – a
much more collaborative approach among the doc-
tors, pharmacists, family and friends, and the older
adult. We suspect the reason for this is that the user’s
perspective is still too rarely taken into account when
deciding on the use of a particular technology. In
addition, collaborative approaches are accompanied
by a distribution of responsibility and competence. If
these are in the hands of medical experts, a depen-
dency gap arises that is more conducive to profit
maximization than to patient autonomy and personal
responsibility. In doing so, collaborative approaches
supported by technology could represent exactly the
relief for health systems that are so often demanded.
However, implications and recommendations derived
from the HIN only partially represent user needs and
contextual aspects. Their use alone does not yet lead
to generalizable context and requirements analysis
results. Further efforts and approaches in this direc-
tion remain necessary. The aim of this work, however,
was to clarify the significance and benefits of general
requirements analyses and to demonstrate a way to
address this challenge.
Acknowledgments
This publication is part of the research project
“TECH4AGE,” financed by the Federal Ministry of
Education and Research (BMBF, under Grant No:
16SV7111) and promoted by VDI/VDE Innovation
+ Technik GmbH.
Conflict of interest
None to report.
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