How to Popularize Smartphones among Older Adults: A Narrative Review and New Perspectives

1. Introduction

Today, social isolation is a problem for many older  adults. Social isolation can occur due to retirement or the death of a partner  or friend [1,2], and can sometimes lead to  cognitive decline and poor mental and physical health [3,4], and in severe cases, can increase the risk of  death, including suicide [5]. One technology  that may solve these problems is information and communication technology  (ICT). Previous studies have shown that the use of ICT, such as smartphones,  has a positive effect on the cognitive function of older adults [6] and reduces the risk of depression [7,8,9]. Relatedly, smartphones have been shown to  play a beneficial role in disease management including cares of diabetes [10] and Alzheimer's disease [11]. Furthermore, incorporating smartphone use into  the lives of older adults may facilitate activities such as internet-based  banking [12] and shopping [13], enriching the daily lives of older adults with  mobility issues. In this review, we review recent intervention studies aimed at  popularizing smartphone use among older adults, point out the limitations of  these studies, and propose new intervention studies.

2. Factors That Hinder or Promote Smartphone Use among the Elderly

Despite these benefits, it is not easy to spread  ICT to the elderly. According to the "2022 Communication Usage Trend  Survey" by the Ministry of Internal Affairs and Communications in Japan [14], the smartphone ownership rate in Japan is  77.3%, while it is low at 27.3% for those aged 80 and over. In addition, even  if some elderly people have smartphones, they mainly use them for phone and  email functions and do not utilize other functions. In the "Public Opinion  Survey on the Use of Information and Communication Devices in 2020" by the  Cabinet Office in Japan [15], the reasons why  elderly people aged 70 and over do not use smartphones included "I don't  think it's necessary for my life," "I don't know how to use it,"  and "I think I can leave it to my family if necessary." On the other  hand, the number of situations in which smartphones are necessary has increased  significantly compared to before, and is expected to increase further in the  future. In addition, as shown in the 2023 White Paper on the Aging Society [16], more than half of elderly households are  single-person or couple-only, and it is assumed that many elderly people do not  have children or grandchildren nearby to ask them how to use smartphones.

The most common argument for why elderly people  avoid ICT is related to their physical decline. Age-related physical changes  make it difficult to understand and use technology [17].  For example, cognitive decline is associated with poorer performance in daily  activities and may negatively affect the acceptance of new technologies by  elderly people [18,19]. In addition,  depression, which is common among elderly people, may increase negative  emotions and inhibit adaptation to new technologies [20].  When these conditions are combined, elderly people are unable to use ICT well,  feel embarrassed about it, experience lower confidence, and increase anxiety,  which may lead to them avoiding ICT even more [21].  Results from a recent cross-sectional study also show low ICT use, especially  among older adults with multimorbidity [22].

However, physical decline due to aging is not the  only barrier to ICT use among older adults. Rather, previous studies have  argued that the main factors that negatively affect ICT use are lack of  self-efficacy and social capital [23,24]. For  older adults, those with existing social support are more likely to receive  assistance with ICT maintenance and troubleshooting, and therefore tend to use  ICT more [23,25,26]. ICT helps older adults  maintain connections with family, friends, former colleagues, acquaintances,  and new contacts with common interests and needs [27].  ICT also allows older adults to find new hobbies, improve their abilities, and  participate in enjoyable activities without time constraints. In addition,  advising others with acquired knowledge has a significant positive impact on  older adults' self-confidence. The gained confidence translates into  self-efficacy, which encourages further ICT use [27].

3. Healthy Aging and ICT

However, it is not enough to simply increase the  Internet use of older adults. When older adults feel that the end of their life  is approaching, they try to actively engage in relationships that they perceive  as meaningful in their lives [28]. Therefore,  excessive or compulsive ICT use can lead to a decrease in well-being [29]. In addition, ICT use is potentially addictive,  which may weaken social connections in daily life and reduce social and  psychological well-being [30]. Furthermore,  passive ICT use may lead to feelings of inferiority and jealousy, which may  reduce well-being [31]. Previous studies have  shown that the main reasons why older adults drop out of the Internet are a  lack of meaningful content, nothing worth reading or watching, and a lack of  time to use it [32]. Fears of privacy  violations and reduced security, for example, worries about internet fraud and  technology malfunctions, are also major reasons why older people avoid ICT [33,34]. Therefore, it is necessary to give older  people what they want and encourage them to learn it, rather than forcing them  to use ICT that they do not need.

The World Health Organization (WHO) has proposed  healthy aging as an important concept that aims to create an environment and  opportunities to maintain a functional state and ultimately achieve universal  well-being [35]. Healthy aging refers to the  process of developing and maintaining "functional capabilities" to  enable well-being in older people. According to WHO, functional capabilities  are a concept that includes various capabilities necessary for an individual to  engage in valued and meaningful activities, and are composed of internal  capabilities, which are a composite of physical and mental capabilities,  environmental factors, and the interaction between these two elements [35]. The WHO suggests that countries monitor  functional capacity, internal capacity, and environmental factors as indicators  of the progress of healthy aging [36].

It is possible to promote the healthy aging by  making good use of ICT. For example, health is a major concern for older  people, so promoting digital health technologies is an effective way to  popularize ICT to older people [37]. However,  considering the above discussion that it is not only physical and mental health  that inhibits ICT use among older people, promoting healthy aging does not  necessarily promote the spread of ICT. If what many older people want from ICT  is health, then one effective way to popularize ICT to them is to use health as  an opportunity, but conversely, it is not surprising that healthier older  people do not need health information as much and therefore do not become more  interested in ICT. Consistent with this speculation, previous research has  shown that older adults with better self-care have lower preference attitudes  toward smart health services [38]. However, if  the aim is to popularize ICT through the circulation of self-efficacy and  social capital, it is significant to have healthy older people enter the ICT  circulation.

4. Review of Previous Intervention Studies and Future Study Perspectives

Compared to the studies highlighting the benefits  of ICT, there is less evidence that ICT training improves ICT proficiency among  older adults. However, there is evidence that group-based ICT training is  effective in promoting skills and digital literacy [39,40,41].  In one study by Zhao et al. [41], 344 older  participants were assigned to either an intervention group or a wait-list  control group in a randomized controlled trial. The authors believe that  previous studies had high dropout rates because the training was not systematic  and therefore participants did not feel the benefits. Therefore, this  intervention study was the first to help participants acquire smartphone  functions under a systematic program. The intervention group, who received a  smartphone training program once a week for 20 weeks, was shown to improve  smartphone competency and quality of life. However, even if the training in  these studies was effective for some older adults, it is unlikely that it was  as effective for many other older adults. This is because, as mentioned above,  older adults have individual differences in what they want from ICT, and a  uniform approach that ignores their autonomy and preferences would discourage  them. This is also reflected in the low effect sizes of some indicators shown  in this study.

Therefore, recent studies have argued for a move  away from a one-size-fits-all approach to individualized approaches to  education and learning [42,43,44]. In one of  these studies, a qualitative study conducted by Betts et al. [42] with 17 older adults revealed that older adults  are interested in acquiring more skills and, at the same time, want to acquire  knowledge through personalized, one-on-one learning sessions. Arthanat et al. [43] conducted a two-year randomized controlled  trial in which 83 older adults were divided into an intervention group and a  control group, followed by one-on-one ICT training between coaches and  participants at six-month intervals to promote access to and use of digital  resources. As a result, older adults in the intervention group were more  engaged in various leisure, health management, and daily activities than older  adults in the control group. They also showed a significant increase in  technology acceptance and maintained a sense of independence. Meanwhile, in a  study of older adults living alone by Fields et al. [44],  83 participants were randomly assigned to an intervention group or a waiting  list group, with the intervention group provided with tablets, broadband, and  one-on-one training. Volunteer coaches provided iPad lessons in participants'  homes for a total of eight sessions each week, and assessed self-reported  loneliness, social support, technology use, and confidence at baseline and  follow-up. As a result, while there was no change in loneliness in the  intervention group, there was a slight significant improvement in social  support and confidence in technology, and a significant increase in technology  use. Furthermore, in interviews, many participants stated that their confidence  in technology had increased. These results indicate that one-on-one, careful instruction  over time is more effective than uniform instruction.

Considering these trends, future intervention  studies on ICT training should not be uniform, such as gathering participants  in a large classroom and conducting lectures, but should be individualized with  one-on-one instruction according to the participants' needs if researchers want  maximum results from an intervention. However, if social implementation is  taken into consideration, it must naturally be feasible in terms of  cost-effectiveness or time-of-day effectiveness. If training is designed to be  too costly and time-consuming to meet individual needs, it will be that much  more difficult to continue the business. It seems that existing research has  not seriously addressed this issue. It is necessary to be able to perform  adequately in terms of cost and time while taking advantage of the benefits of  individual education. Therefore, we propose incorporating into the research  model the improvement in self-efficacy and knowledge about ICT functions that  comes from advising others on acquired knowledge, as confirmed in the review  paper by Chen and Schlz [27].

Self-determination theory asserts that  self-efficacy is a determining factor for intrinsically motivating people [45]. In addition, previous cross-sectional analyses  have shown that intrinsic motivation may affect ICT use and life satisfaction  among older adults [46,47]. Among these, Wang  et al. [46] analyzed the influencing factors  of technology adoption using questionnaire response data administered to 286  participants aged 46 years or older, and found that physiological limitations  and anxiety of aging had a significantly negative effect, while knowledge,  intrinsic motivation, and usage expectancy had a significant positive effect on  behavioral intention. On the other hand, many studies have confirmed that  helping others increases self-efficacy. For example, Barlow & Hainsworth [48] conducted semi-structured telephone interviews  at two time points, before and after training, to explore the motivations of 22  older volunteers when they undertook training to become lay leaders in an  arthritis self-management program. The results revealed that volunteering was  motivated by three primary needs: to fill the void in life left by retirement,  to feel useful members of society by helping others, and to find a peer group.  The results suggest that volunteering among older adults helps to offset the  losses associated with retirement and declining health.

Cognitive scientists offer a different explanation  for the learning effect of teaching: they argue that learning is enhanced when  people are placed in a situation where they must understand information and  make it understandable to others [49,50]. For  example, in an experiment by Nestojko et al. [49],  56 university students were randomly divided into two groups and asked to read  and memorize a text about a war. Prior to the experiment, the two groups were  instructed to either study as if they had a test coming up (Group 1) or study  as if they were going to teach other students (Group 2). As a result of the  experiment, Group 2 was able to recall the content more accurately than Group  1. The authors of the paper argue that the difference in results may be because  people naturally try to summarize the main points of things when they think  they must teach others. Similar results were obtained in a study by Koh et al. [50] involving 124 university student participants,  with the authors arguing that recalling previously memorized information in a  form that others can understand may help strengthen memories.

There is already a substantial body of research  showing the effects of the spread of ICT. However, there is still insufficient  research on how to popularize ICT among the elderly. Considering the existence  of publication bias, which means that experiments that produce significant  results are more likely to be published as papers, it can be assumed that it  will be more difficult to change the elderly's attitude toward ICT and  popularize it. This suggests the limitations of the method used in previous research,  in which a coach teaches a student unilaterally (even if it is one-on-one  instruction). Therefore, the author recommend that future research verify the  hypothesis that the experience of teaching other participants the smartphone  functions they have acquired will increase their interest and knowledge in  smartphones, and as a result, their own proficiency will also improve.

5. A Proposal for New Intervention Study Design

For example, we will design the study as follows.  The study will be a randomized controlled trial (RCT). Assuming that two  measurements will be taken in total for the intervention and control groups,  the effect size (partial eta squared value) will be a moderate 0.06, and the  significance level will be 5% with a power of 80%. The sample size required to  test interactions using repeated measures ANOVA will be calculated as 68 people  (34 people in each group) using G*Power 3.1.9.7. Considering the possibility of  dropouts, 80 people (40 people in each group) will be planned as study  subjects. Participants must be healthy men and women aged 65 or older who have  never used a smartphone or have only used the calling function. First, both the  intervention and control groups will gather at a designated venue and answer a  common questionnaire asking about smartphone knowledge, usage, and well-being  defined as physical and mental health. The questionnaire will be created with  reference to the indicators of Zhao et al. [41], Arthanat et al. [43], and Fields et al. [44].  After that, both the intervention and control groups will undergo training  aimed at acquiring various smartphone functions (communication with family,  health management, household finances, schedule management, online seminars,  entertainment, flashlight function, emergency call function, etc.). The  instructors will be professional instructors who are familiar with smartphone  functions. In this case, participants will be asked in advance about their  preferences and will be taught in order of their interest in the functions they  are most interested in. This measure is based on the findings of previous  research that older people are less interested in ICT functions [32] and the intrinsic motivation theory that says  that the more you are interested in something, the higher your mastery will be [45]. In addition, participants in the intervention  group will continue to take the course from the second time onwards and will  also serve as coaches for participants in the control group. Specifically, they  will train other participants as primary coaches under the supervision of a  professional instructor. The intervention group coach will also answer  questions from participants in the control group. During this time, the  professional coach does not interfere, but instead provide feedback to both the  intervention and control group participants after the primary coaching was  completed, such as making up for shortcomings. This is to prevent the primary  coach from losing motivation to learn other smartphone functions by instilling  a sense of shame in them for not being able to coach well. Both the  intervention and control groups are allowed to use smartphones freely after the  training, and every three months (i.e. 3, 6, 9, and 12 months after the  training), they gather at a designated venue to answer the same questionnaire  and receive training. It is expected that the act of teaching other  participants increases self-efficacy for participants in the intervention group  compared to participants in the control group, and they become proficient more  quickly.

The advantage of this method is that the participants themselves can take on some of the role of coach, saving on the costs and time required for one-on-one instruction. If it is proven that the act of teaching elderly people creates a spiral of mutual help among elderly people through increased self-efficacy, it will become easier for organizations that have been hesitant to enter the market in the past because it was not cost-benefit-based to do so, and it will likely become easier to provide ICT education to the elderly. See Table 1 and Figure 1.

6. Discussion

In this paper, we reviewed the advantages and disadvantages of ICT adoption by the elderly, the promoting and inhibiting factors in ICT adoption, and recent intervention studies, and made suggestions for future intervention studies. While research on ICT use by the elderly is accumulating, there are few studies that clarify how to encourage ICT use by the elderly, and the effectiveness has not been fully verified. Previous research suggests that one-on-one instruction is more effective than a uniform method, but at the same time, it also suggests that there are limitations to the effectiveness if participants simply passively receive training. In this study, we discussed the possibility that elderly people can become more effectively familiar with smartphone functions by increasing their self-efficacy through the act of learning smartphone functions and teaching them to other participants in an environment where they can obtain rich social capital, such as one-on-one instruction, and proposed future research.

Of course, there are several other barriers that must be overcome to implement this in society. The positive spiral of elderly people teaching each other, as proposed in this study, is not only more effective but also less costly than traditional one-on-one instruction. However, even so, the role that ordinary elderly people can play is only a supporting role, and it is unlikely that personnel who can provide one-on-one guidance in a more specialized position will be completely unnecessary. In addition, in situations where elderly people teach each other, a person in charge is needed to guarantee their identity and accept complaints so that they do not become anxious. Issues that need to be considered include who should take on such roles and who should provide resources such as operating capital, equipment, and personnel. Currently, governments and non-profit organizations (NPOs) introduce and match senior volunteers, either paid or unpaid, but they only play a passive role of introducing elderly people who are willing to volunteer to those who need them, and there is no training with an awareness of the positive spiral proposed in this study. Despite this, the number of people who want to provide volunteer work is small compared to the number of people who want to receive volunteer work, and as a result, NPO management is not only unable to match them well, but is also forced to sacrifice budgets for other projects to cover operating costs (from an interview survey conducted by the author at a certain NPO). Despite these limitations, demonstrating that a positive spiral consisting of social capital and self-efficacy promotes the mastery of ICT functions among the elderly should be of great significance as a first step toward social implementation.

7. Conclusions

In this review, we considered the advantages and disadvantages of promoting smartphones to the elderly, and looked back at recent intervention studies to confirm that individualized instruction is more effective in helping elderly people acquire skills than uniform education, and that the challenges of the former are cost and time, but previous research has not seriously addressed this issue. Therefore, this review proposed future research to clarify how to promote the widespread use of smartphones effectively, and at low cost by involving elderly people in teaching other elderly people, creating a positive spiral that combines self-efficacy and social capital among the elderly.