This paper is in the following e-collection/theme issue:
Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers
1College for Public Health and Social Justice, Department of Health Management Policy, Saint Louis University, Saint Louis, MO, United States
2W.A. Franke College of Business, Northern Arizona University, Flagstaff, AZ, United States
3Health Informatics and Information Management, Saint Louis University, Saint Louis, MO, United States
4College of Humanities and Social Sciences, Communications Department, George Mason University, Fairfax, VA, United States
*all authors contributed equally
Cynthia LeRouge, PhD
College for Public Health and Social Justice
Department of Health Management Policy
Saint Louis University
3545 Lafayette Avenue
Saint Louis, MO, 63104
Phone: 1 314 977 8195
Fax: 1 314 977 1674
1,2]. The United States is one of many countries around the world that are experiencing new demands on their health care systems due to a rise in the number of older adults and health conditions associated with aging [3-5]. According to a report by the American Hospital Association and First Consulting Group , baby boomers make up the largest segment of the population in the United States (approximately 78 million Americans based on the 2000 US Census) [7,8]. In 2011, the first members of the baby boom generation reached age 65. As baby boomers reach retirement age, many will have increasing medical needs and thus demand more health care resources than other segments of the population, particularly given the size of this age cohort and that their life expectancies are longer than many past generations . Age is often associated with growing health problems and chronic disease . Approximately 60% of baby boomers have already been diagnosed with at least 1 chronic medical condition. Arthritis, diabetes, heart disease, obesity, osteoporosis, and hypertension are common chronic conditions among baby boomers. These conditions require regular health care checkups, prescription medications, and significant dietary changes . Given the size of the baby boomer cohort, responding to age-related health concerns will likely be a significant challenge for health care systems over the next decade and beyond .
The health care industry must be prepared to accommodate this growing segment of health care consumers. Similar to previous generations, many baby boomers will require extensive health services, training and reinforcement for medical self-management, as well as continued connection to clinicians and contact with their peers and caregivers as they grow older . It is questionable whether the traditional US health care system can handle the level of health care demands imposed by the gray tsunami given the immense size of the baby boomer cohort compared to previous older generations . If empowerment leads to an increase in self-care, patient empowerment efforts aimed at prevention and self-management of chronic disease could play a key role in relaxing some of the demands on the health care system . Given current changes in the health care marketplace and the need to find more cost-efficient ways to manage health conditions, baby boomers will likely be the generation that leads the movement toward patient self-management of chronic disease .
Emerging health information and communication technologies bring the promise of transformations in the delivery of care, empowering patients to make more informed health care decisions, connecting patients directly to providers and other caregivers and personalizing services in response to patients’ unique needs and preferences . Information and communication technologies used by consumers for health purposes are increasingly allowing individuals to conveniently learn about, manage, and monitor their health via electronic devices. The use of consumer health technologies may help stem rising health care costs by improving provider-to-patient communication, health condition monitoring, and health information access by enabling self-care [14,15]. Baby boomers may differ from older cohorts in terms of their exposure to new technologies (e.g, being exposed to new technologies in the workplace). Because baby boomers will be the largest older adult cohort in history, it is important to assess the barriers to consumer health technologies within this population; consumer health technologies will likely continue to be a means of controlling health care costs in the face of growing demands on the health care system (due to its increased use by baby boomers as they begin to face health issues associated with aging).
But, are baby boomers currently embracing or even ready to use modern technologies to manage their health? Although baby boomers may have more technology access and experience than prior generations, it is not clear if this leads to greater readiness to adopt consumer health technologies. For example, researchers have found that although barriers exist for some technologies, older consumers are ready and able to adopt other technologies for health-related tasks [16-19]. Designing and developing consumer health technologies that effectively meet the unique requirements of baby boomers requires understanding which types of consumer health technologies baby boomer consumers are ready to adopt and what barriers exist for the specific technologies where readiness is low. Previous research has not adequately addressed these issues from the perspective of baby boomers.
The purpose of this study is to address the following research goals. First, we examine what consumer health technologies baby boomers are ready to use. Second, we investigate barriers to baby boomers’ use of consumer health technologies. Finally, we seek to understand whether readiness for and barriers to baby boomers’ use of consumer health technologies differ from those for other consumers (younger and older). Gaining a better understanding of these issues will help proponents of consumer health technology better understand how to build and promote systems that bring about benefits to baby boomer consumers. This is especially noteworthy because baby boomers may become a driving force behind the development of consumer health technologies given the demands on the health care system they are predicted to create.
Consumer health technologies attempt to engage health consumers to interact with technology to promote healthy behaviors and informed decision making. The Agency for Healthcare Research and Quality notes consumer health information technology (IT) applications are a key topic and indicate that:
These [consumer health technology] applications have various purposes including assisting with self-management through reminders and educational prompts, delivering real-time data on a patient’s health condition to both patients and providers, facilitating Web-based support groups, and compiling and storing personal health information in an easily accessible format…Moreover, consumer health IT applications that allow gathering and integrating data from various health care sources can serve as a comprehensive resource for patients and their providers. In addition to convenience, consumer health IT applications also can be important in emergency situations to provide critical health information to medical staff. 
Most consumer health technologies are designed to change attitudes or behaviors and provide information. The effectiveness of consumer health technologies requires choosing a receptive audience and an appropriate technology [21-23]. Persuasive technology design can facilitate coaxing the user toward healthy action (motivating factor) and underscore the need to choose a receptive audience and befitting technology [22-24]. A model of the persuasive design process (drawn from demonstrated success in industries including health care) begins with defining the persuasion goal to match a receptive target audience with an appropriate technology (Figure 1 depicts this first stage of the persuasive design process; areas of focus for the current study are shaded) . This type of alignment coincides with modern human-computer interaction design philosophy in which the needs, desires, and limitations of users are investigated and analyzed . If various forms of consumer health technology are to be successful, we must have a fundamental understanding of which technology tools align with baby boomers’ needs, desires, and limitations. Indeed, recent research focused on physical and psychological attributes as 1 of 4 types of patient barriers to eHealth opportunity (the other 3 types include the provision of eHealth opportunity, the support others that may have to use eHealth, and economic barriers) .
Unfortunately, the literature that specifically focuses on adoption of consumer health technologies and its use by baby boomers is limited. Some noted exceptions relate to home monitoring devices. For example, work by Mihailidis and colleagues  found a general willingness of current baby boomers to accept various forms of home monitoring technology (eg, personal emergency response systems, fall detection systems). However, it is important to note that the Mihailidis et al study was largely exploratory and it was limited by a small sample size . In addition, a study of Australian baby boomers found baby boomers were generally open to use assistive technologies for a temporary period after hospital discharge . In both studies, the home monitoring and assistive technologies studied were quite passive as compared to the interactive, multipurpose technologies frequently used in consumer health informatics, such as the Internet and smartphones. We know of no study that specifically explores various common interactive technology tools for consumer health informatics use by baby boomers. It is from this need that we provide our first research question:
Research question 1: What technologies are baby boomers ready to use to promote healthy behaviors and informed decision making?
As part of that foundational understanding of which consumer health technology tools align with baby boomers’ needs, desires, and limitations, we must recognize that baby boomers are different from younger and older consumers in many ways, 2 of which are particularly important to note. First, baby boomers are not the “digital native” youths, who have known these technologies their entire lives, nor are they like their elders, most of whom had little exposure to interactive information technologies in their work lives. Many baby boomers experienced the transition to more of an information technology workforce. There might be some social bias that those who are not digital natives may not be as open to consumer health technologies. However, recent studies indicate that this is not the case. A recent study found baby boomers and older adults were generally open to home monitoring devices and did not have strong preferences with respect to the types and locations of the technology . But, do these similarities extend to more interactive technologies? Unlike their predecessors, many baby boomers are comfortable with interactive technology [29,30]. But, unlike their successors, many baby boomers do not naturally turn to technology as their first choice when communicating, seeking information, or looking for task support for health needs . For example, according to the Pew Research Center’s 2013 update on smartphone ownership , only 39% of those surveyed aged 55-64 years owned a smartphone. This percentage was even lower (18%) for those 65 years or older. Younger consumers reported much higher ownership percentages . For example, 81% of those aged 25-34 years reported owning a smartphone .
The second important difference relates to baby boomers’ increased expectations concerning health care services . Because aging baby boomers have higher levels of education, more disposable income in terms of being in their peak earning years compared to younger and older age cohorts (although overall income and savings may be affected by numerous variables, including life circumstances and the recent economic downturn), and are more active than previous generations, baby boomers are naturally more focused on health care services that ensure their long-term mobility and independence . The higher expectations of baby boomers are reflected in increased demands for innovative and personalized health care services that eliminate barriers to treatment and provide timely and accurate health-related information and services. In addition, many baby boomers are now caring for elderly parents, while trying to maintain an active lifestyle, which further increases their health information and service needs . To further explore how baby boomers’ readiness for various consumer health technology tools compares to other segments of the adult population, we introduce the following research question:
Research question 2: How do the technology tools that baby boomers report they are ready to use for health purposes differ from the technology tools younger adults and older adults report that they are ready to use for health purposes?
Prior research indicates that baby boomers may face a number of barriers in adopting consumer health technologies [34,35]. Innovation diffusion theory  provides a useful theoretical framework for investigating the “internal” barriers particular to the personal decision process of adoptions (in contrast to external factors such as provision of eHealth opportunity and economic barriers). Rogers  posits that potential innovation adopters go through a 5-stage process when deciding whether to adopt and use an innovation: knowledge, persuasion, decision, implementation, and confirmation. The first 2 stages, knowledge and persuasion, are of primary interest to this study and require additional explication (note that the discussion of the stages is based on Rogers  unless otherwise indicated).
In the knowledge stage, the potential adopter becomes aware that an innovation exists. This awareness is followed by the adopter forming an understanding of how the innovation functions. Two important sets of information related to the adopter are important to this stage. First, prior conditions, such as prior experience with similar innovations, problems faced by the adopter, and social system norms, impact the knowledge stage. For example, problems faced by the adopter that may be met by the innovation’s use are likely to influence how the adopter frames knowledge about the innovation. Prior experience with similar innovations may likewise influence knowledge of the innovation. For example, a consumer who has experience with a smartphone will build knowledge of a tablet computer differently than a consumer without such prior experience. Characteristics of the adopter are also important in the knowledge stage. This is particularly important for our research given that age is an essential individual characteristic related to innovation adoption .
In the persuasion stage, the potential adopter forms attitudes related to the innovation and its use. (It is important to note that Rogers defines persuasion as the formation of attitudes rather than a change agent’s activities to influence those attitudes.) Perceptions regarding the innovation’s attribute use are the building blocks of the adopter’s innovation-related attitudes. Generally, the adopter is concerned with advantages and disadvantages of the innovation, given the adopter’s particular situation.
During the decision stage, the adopter makes the choice to adopt or reject an innovation. Note that adoption is the decision to make use of the innovation, not the actual use of the innovation. Use occurs in the implementation stage. Use represents an explicit behavioral change that puts the innovation into practice. Post implementation information seeking intended to reinforce the already-made innovation decision follows the implementation stage. In Rogers’ model, this is known as the confirmation stage. The confirmation stage may result in continuation or reversal of the prior innovation decision.
In this study, we are interested in 2 types of barriers to consumers’ use of technology: knowledge-based barriers and motivation-based barriers. We acknowledge that we are making an implicit assumption that the consumer has material access to the technology. In other words, the consumer has the means to physically possess the technology and necessary network access . Our research model (presented in Figure 1) recognizes these 2 categories of barriers to the adoption and use of consumer health technologies. Knowledge-based barriers concern a lack of knowledge of the technology’s existence, purpose, and operation. Motivation-based barriers relate to beliefs about the benefits of using the technology relative to the drawbacks of using the technology. Knowledge and motivation barriers align with the first 2 stages of Rogers’  innovation-decision process: knowledge and persuasion. During the knowledge stage, consumers become aware of the innovation and begin to understand its uses. In the persuasion stage, consumers form beliefs about the technology and its uses. Individual characteristics, such as age, impact both knowledge of and beliefs about a technology . Therefore, we believe it will be instructive to examine baby boomers’ awareness and perceptions of various consumer health technologies.
We first address barriers related to knowledge. The most fundamental of these is a lack of awareness of the technology and its uses . Awareness may partially explain differences between different age cohorts when it comes to the adoption of the new communication technologies. For example, baby boomers are much more likely to own smartphones, desktop computers, and laptop computers than older cohorts, but they are somewhat less likely to own newer technologies (such as iPads) or use certain applications, such as using a smartphone to send/receive emails or access the Internet, than younger cohorts [30,39,40]. Knowledge barriers beyond awareness also exist. Consumers may be aware of the technology, but lack knowledge of its purpose or its operation. For example, consumers may be aware that kiosks exist, but may not know what they can be used for or how to use them.
The second category of barriers relates to motivations to adopt the technology. These barriers concern beliefs about the costs and benefits of using a technology for a specific purpose. For example, making consumer health technologies available for baby boomers with different cognitive, perceptual, and physical abilities is challenging [35,41] because these differences change the cost-benefit calculus. Moreover, baby boomer perceptions of the usefulness and usability of various consumer health technologies, the efficiency of care delivery, cost, and improvement of quality of life stemming from the use of these technologies may be barriers that inhibit adoption and use [28,35].
In the persuasion stage of the innovation adoption decision, the consumer begins to form beliefs about the technology as it relates to health care information acquisition and use. This is the beginning of an adoption cost-benefit evaluation by the consumer that determines the outcome of the adoption decision . Because our primary interest here is in barriers, we focus on the adoption cost side of the equation. Several adoption costs are of particular interest to consumer health technologies. First, the relative difficulty of using the consumer health technology may serve as a barrier to its use. The relationship between perceived complexity and the use of an innovation is well established [43-46]. In some cases, training may reduce the effort required to use the technology. However, in other cases, the user may already know how to use the technology (ie, is trained), but may feel that the effort required to put the technology into use is too high. These barriers align with the van Dijk and Hacker’s  concept of skills access, which indicates that a lack of digital skills causes a combination of inadequate training and high complexity.
Beliefs regarding the suitability of a technology for health information tasks are also important. When a consumer perceives a technology unsuitable for use (not compatible with particular uses), he or she may be reluctant to adopt that technology. Prior research has demonstrated that compatibility beliefs impact adoption decisions [36,47,48]. In the context of consumer health technologies, it is possible that a consumer has no issues with using a particular technology for non-health care purposes, but believes that the technology is not appropriate to use for health-related tasks. For example, impropriety beliefs may emerge if consumers are particularly concerned about whether the technology is sufficiently secure to protect sensitive health-related information.
Finally, it may be that a consumer believes that a technology is suitable for health-related tasks and that he or she has the ability to use the technology without undue effort, but simply does not enjoy using the technology. For example, many consumers may have the ability to use call centers and believe that call centers are appropriate for health-related tasks. However, these same consumers may not enjoy using call centers . (In fact, our results, presented later, support this contention.) Although perceived enjoyment has not received as much attention as the other beliefs discussed here, there are studies that demonstrate a link between perceived enjoyment and adoption of a technology [50-52].
In response to the aforementioned issues, we pose the following questions:
Research question 3: What knowledge and motivation barriers exist for baby boomers using various forms of technology tools for health purposes?
Research question 4: How do knowledge and motivation barriers that exist for baby boomers using various forms of technology tools for health purposes differ from younger adults and older adults?
Table 1 shows the specific knowledge and motivation belief-based barriers included in this study, along with citations for supporting research.