JMIR MHEALTH AND UHEALTH Jaana & Paré

Original Paper

Comparison of Mobile Health Technology Use for Self-Tracking

Between Older Adults and the General Adult Population in
Canada: Cross-Sectional Survey

Mirou Jaana1, PhD; Guy Paré2, PhD

1
Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
2
Research Chair in Digital Health, HEC Montreal, Montreal, QC, Canada

Corresponding Author:
Mirou Jaana, PhD
Telfer School of Management
University of Ottawa
55 Laurier Ave East
Ottawa, ON, K1N 6N5
Canada
Phone: 1 16135625800 ext 3400
Email: [email protected]

Abstract
Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially
those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care
they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information
is available on Canadian older adults’ attitudes toward and use of mHealth technologies for self-tracking purposes—an area that
is increasingly important and relevant during the COVID-19 era.
Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim
of this study was to compare older adults’ use of mHealth technologies to that of the general adult population in Canada and to
investigate the factors that affect their use.
Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was
administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted
of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with
and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom
scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies.
Results: Significant differences were observed between the older adults and the general adult population in the use of smart
technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using
smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital
tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated
using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained
over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7%
(428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or
more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers,
respectively). No significant differences were observed between the older adults and the general adult population with regard to
satisfaction with mHealth technologies and their intention to continue using them.
Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data
with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is
deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations
of patients and their caregivers.

(JMIR Mhealth Uhealth 2020;8(11):e24718) doi: 10.2196/24718

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KEYWORDS
mobile health; older adults; self-tracking; wearable technology; smart devices; mobile apps; survey; mobile phone; seniors; elderly

with older age [19-26]. Self-tracking devices in particular (eg,

Introduction smart devices with mobile apps, fitness trackers, blood pressure
Population aging is a phenomenon that is associated with monitors) have gained interest in recent years in light of their
increased prevalence of chronic conditions worldwide [1-3]. In potential for monitoring and motivating individuals to remain
2017, the global number of people 60 years and older was 962 healthy [27-31]. However, their use remains variable and less
million (including 137 million ≥80 years), and this number is widespread among older adults [32], and prior research has
expected to reach 2.1 billion by 2050 [3]. This growing reported risks associated with health information tracking, which
population of older adults leads to an increased demand on the may trigger negative emotions among patients with multiple
health systems for services, which are costly and require chronic conditions and potential emotional draining in this group
significant resources [4]. [33]. With the current COVID-19 crisis, calls for initiatives and
efforts to bridge health information and communication
A recent Commonwealth survey of older adults in 11 countries technologies with the care for older adults have appeared in
investigated the challenges faced by adults aged ≥65 years at various countries as a preparedness mechanism and a mitigating
the social and health care levels [2,5]. The results showed that, approach against the current and future pandemics [7,10,34,35].
across all surveyed countries, older adults, in general, and older However, to date, limited information is available on older
adults with high needs, in particular (ie, multiple chronic adults’ attitudes toward and their use of mHealth technologies
conditions/functional challenges), experience social isolation for self-tracking purposes—an area that reveals to be
and have high rates of emergency visits and general increasingly important during and following this COVID-19
dissatisfaction with the quality of care they receive [2]. The era.
current COVID-19 crisis has further catalyzed this problem.
Older adults represent a group of the population that is at higher This study, which is part of a larger program on digital health
risk of death from severe acute respiratory syndrome associated self-tracking [36], addresses this gap and presents the results of
with coronavirus, thus necessitating social distancing, which a national survey across all provinces in Canada, which assessed
may lead to social isolation [6]. This confinement and social older adults’ familiarity with and use of mHealth technologies
isolation can in turn have negative psychological effects and comprising mobile apps, smart devices, and wearables.
sleeping problems [7,8] and increased risk for early mortality Specifically, we report findings on the pattern of older adults’
[9]. In addition to potential social isolation, COVID-19 may use of mHealth technologies for self-tracking purposes and
have long-term effects on people with preexisting compare it to that of the general adult population. We also
noncommunicable chronic diseases [10]. This is particularly investigate the factors that influence the continued usage of
observed with decrease in physical activity, unhealthy lifestyles mHealth technologies among older adults.
during the COVID-19 crisis, and changes in the management In order to address the objectives of this study, we propose a
of these conditions (eg, reduced outpatient visits, difficulty in research model based on the work of Bhattacherjee [37] and
diagnosing new conditions or recognizing deterioration in the Hong et al [38] and the expectation-confirmation theory [39].
existing ones) [10]. In the present context, this model suggests that an older adult’s
In Canada, wait times for various types of services (eg, doctors, intention to continue using mHealth technologies is mainly
specialists, emergency) have been historically longer compared influenced by his or her level of satisfaction, which is in turn
to some other developed countries [11]. Generally, Canadians affected by the extent to which his or her initial expectations
tend to be more frequent users of health services [11], and toward mHealth technologies are confirmed, in addition to ease
concerns have been growing about the ability of the public of use and perceived usefulness [40]. The latter factors also
health care system to address the increasing needs of an aging have direct links with usage continuance intention [38]. Hence,
population [12]. For instance, the population of Canadian adults this study presents evidence on the extent to which older adults
aged 65 years and older reached 6.5 million in 2019 [13], and use mHealth technologies to self-track their health, compares
this number is expected to increase by 68% over the next 20 their use of mHealth technologies to that of the general adult
years [14]. This is particularly critical, given the high health population, and analyzes the factors that influence the continued
care spending per capita on older adults and large use of services use of these technologies in the older population.
by this group [12].
Methods
Mobile health (mHealth) technologies present an opportunity
to address the challenges associated with population aging and Study Design and Sampling
enable support for older adults in the community. mHealth refers We present in this section the survey that was conducted in
to the use of mobile devices (eg, patient monitoring devices, accordance with the Checklist for Reporting Results of Internet
mobile phones) to detect and monitor physiological changes E-Surveys [41]. A web-based questionnaire was administered
and support medical and public health practice [15]. Prior to a national sample of 4109 Canadian residents, aged 18 years
research has examined the potential role of mHealth or older, and who spoke English or French. The sample was
technologies in providing long-term support for older adults selected from a proprietary web-based panel (AC Nielsen
[16-18] and in monitoring chronic conditions often associated Company), which is one of the largest and most representative

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panels in Canada. To ensure representativeness of the overall adapted from Davis [40] and rated on a 5-point Likert scale
population, the quota method was applied (age and gender) (1=strongly disagree, 5=strongly agree). We also adapted
following a stratification by the geographic region. The ethics measures from Bhattacherjee [37] and Hong et al [38] to assess
approval for the study was granted by the HEC Montréal’s users’ satisfaction (3 items) and confirmation of initial
research ethics committee. The older adult group in the sample expectations (3 items) on a 5-point Likert scale (1=strongly
consisted of all respondents aged 65 years and older and the disagree, 5=strongly agree).
general adult population in the sample consisted of respondents
The survey instrument was first pretested during face-to-face
aged 18-64 years.
interviews with 16 adults who were representative of the
Survey and Data Collection Canadian population in terms of gender, language, and age.
The survey instrument consisted of 3 sections assessing the Some small adjustments were made to the questionnaire
following items: (1) demographic characteristics, health status, following this step. A copy of the final survey instrument may
and comorbidities; (2) familiarity with and use of mHealth be obtained from the authors upon request. Panel members were
technologies (ie, mobile apps, consumer smart devices/wearables invited to participate in the study by email. Once participants
such as vital signs monitors, bathroom scales, fitness trackers, clicked on the URL provided in the email letter, they were
intelligent clothing); and (3) factors influencing the continued screened for the abovementioned eligibility criteria. All
use of mHealth technologies. The latter section also measured respondents read and approved an informed consent form prior
respondents’ satisfaction, ease of use, expectation confirmation, to completing the questionnaire. Survey respondents were able
perceived usefulness, and intention to continue using mHealth to enter the survey at any point during the data collection period,
technologies in the future. ie, from January 11, 2017 to February 2, 2017. In accessing the
web-based questionnaire, respondents were assigned a unique
Sociodemographic variables were measured using standardized identifier and secret code (closed survey) that allowed them
indicators used in other international surveys [42-45]. These access to their data until the survey was done. Those who partly
included gender, age, region, gross family income, education, completed the survey were able to exit the questionnaire and
occupation, and use of mobile phones and digital tablets. Health return at a later time to enter additional data and to review and
status was self-rated by respondents on a 5-point Likert scale change their prior answers. Participants were rewarded gift cards
(1=poor or fair, 5=very good or excellent), which is a common (eg, Amazon, iTunes, Starbucks, magazine subscriptions) for
approach used in prior research [46]. A total of 11 chronic survey completion. Rewards ranged in value from CAD $5 to
conditions were investigated (eg, diabetes, high blood pressure, CAD $75.
cardiovascular disease, lung or respiratory cancer).
Statistical Analysis
Respondents’ familiarity with mHealth technologies was
Data analysis was conducted to explore and better understand
assessed using a combination of items. A general question
the pattern of use of these technologies and self-tracking
measured their familiarity with consumer wearables and smart
behaviors by older adults in the community and compare it to
medical devices on a 5-point Likert scale (1=not much at all
that of the general adult population. Descriptive data analysis
familiar, 5=extremely familiar). Participants were also asked
was performed to present an overview of the older adult group
to indicate the devices that they owned by using descriptive
characteristics and their use of mHealth technologies. Bivariate
terms that referred to 13 devices identified in the literature and
analyses (two-sided t test for continuous variables and chi-square
available in the Canadian market. When participants indicated
for categorical variables) were conducted to assess the
owning a specific device or wearable, they were asked to rate
differences between the 2 groups on these variables. Multinomial
on a (1-7) scale (1=once a month or less, 7=many times a day)
logistic regression tests were used to compare self-trackers
how often they used it in the past 3 months.
(traditional and digital) and nontrackers, and Pearson correlation
Three self-tracking profiles were identified in this study based tests and partial least squares multiple regression analyses were
on the respondents’ indication of their health tracking behavior. used to analyze users’ appreciation of digital self-tracking
Those who regularly tracked one or more aspects of their health devices. Data analyses were performed on SPSS Statistics v25
or well-being by using mHealth technologies, including mobile (IBM Corp) and SmartPLS 2.0 (SmartPLS GmbH).
apps for health, consumer wearables (eg, fitness trackers), and
smart medical devices (eg, blood pressure monitors), were Results
defined as “digital trackers.” Respondents who regularly
monitored one or more aspects of their health and well-being Sample Characteristics
by using manual tools (ie, recording the information in writing) Of the total study population of 4109 participants distributed
were defined as “traditional trackers.” All other respondents across all provinces, 682 (16.6%) were aged 65 years and older
who did not regularly monitor any aspect of their personal health (older adults) and 3427 (83.4%) were aged 18-64 years (general
were considered as “nontrackers.” adult population), which represents the actual distribution of
The factors that are likely to influence the continued usage of the older adults in the Canadian population [13]. Table 1 shows
mHealth technologies were captured. First, measures of that a higher proportion of the older adults live on the east coast
perceived usefulness (7 items) and ease of use (4 items) were of Canada and British Columbia.

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Table 1. Comparison of the characteristics of the older adults with those of the general adult population in this study.
Characteristics Older adult population, n=682, n (%) General population, n=3427, n (%) Total, N=4109, n (%) P value
Gender <.001
Male 400 (58.6) 1718 (50.1) 2118 (51.5)
Female 282 (41.3) 1709 (49.9) 1991 (48.5)

Regiona <.001

Atlantic provinces 56 (8.2) 237 (6.9) 293 (7.1)

Quebec 153 (22.4) 833 (24.3) 986 (24.0)
Ontario 265 (38.9) 1310 (38.2) 1575 (38.3)
Prairies 37 (5.4) 229 (6.7) 266 (6.5)
Alberta 50 (7.3) 387 (11.3) 437 (10.6)
British Columbia and 121 (17.7) 431 (12.6) 552 (13.4)
territories

Highest education levelb,c .09

Primary and secondary school 181 (26.7) 758 (22.5) 939 (23.2)
College/CEGEP 177 (26.1) 972 (28.8) 1149 (28.4)
University undergraduate 207 (30.6) 1093 (32.4) 1300 (32.1)
University graduate 112 (16.5) 549 (16.3) 660 (16.3)
Employment <.001
Full-time 37 (5.4) 1921 (56.1) 1958 (47.6)
Part-time 44 (6.4) 385 (11.2) 429 (10.4)
Retired 587 (86.1) 350 (10.2) 937 (22.8)
Other 14 (2.1) 771 (22.5) 785 (19.1)

Incomed <.001

<$20,000 32 (5.7) 236 (8.1) 268 (7.7)

$20,000-$39,999 123 (22.1) 461 (15.7) 584 (16.7)
$40,000-$59,999 131 (23.5) 482 (16.4) 613 (17.6)
$60,000-$79,999 95 (17.1) 465 (15.9) 560 (16.1)
$80,000-$99,000 74 (13.2) 424 (14.4) 498 (14.3)
≥$100,000 102 (18.3) 863 (29.4) 965 (27.7)

Chronic conditionse <.001

Yes 342 (51.4) 939 (28.0) 1281 (31.9)

No 323 (48.6) 2413 (72.0) 2736 (68.1)

Current health statusb .87

Very poor/poor 63 (9.2) 339 (9.9) 402 (9.8)

Good 345 (50.7) 1724 (50.3) 2070 (50.4)
Very good/excellent 274 (40.2) 1364 (39.8) 1638 (39.9)
Tracking health measures <.001
Manual self-tracking 307 (45.0) 744 (21.7) 1051 (25.6)
Electronic self-tracking 121 (17.8) 1547 (45.1) 1668 (40.6)
No self-tracking 254 (37.2) 1135 (33.1) 1389 (33.8)

a
Atlantic provinces include Nova Scotia, New Brunswick, New Foundland and Labrador, and Prince Edward Island; Prairies include Manitoba and
Saskatchewan; Territories include Nunavut, Yukon, and Northwest territories.

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b
Significant differences were observed between seniors and the general population on all variables except for “Current health status” and the “Highest
level of education”.
c
There were 5 and 55 nonrespondent in the older adult group and the general adult population, respectively.
d
There were 125 and 496 nonrespondents in the older adult group and the general adult population, respectively. All income data are provided in
Canadian dollars (CAD $1=US $1.31).
e
There were 17 and 75 nonrespondents in the older adult group and the general adult population, respectively.

When comparing the older adult population with the general Internet and Smart Technologies
adult population, significant differences were observed in all Table 2 shows significant differences between the older adult
the characteristics, with the exception of education level and population and the general adult population in terms of internet
reported health status; comparable educational levels were noted and smart technology use. Of the 682 older adults, 323 (47.3%)
in the 2 groups and the perceived health status was reported as and 340 (49.8%) reported using a smartphone and a digital
good-to-excellent in both groups. Compared to the general adult tablet, respectively, as compared to 2887 (84.2%) and 2337
population, the older adult population had a larger number of (68.2%) respondents of the 3427 respondents in the general
men, who were retired, and had an annual income below CAD adult population. Among the 463 older adults using
$60K. Of the 682 older adults, 342 (50.1%) indicated having smartphones/digital tablets (out of 682 participating in this
one or more chronic conditions compared to 939 (27.4%) study), only 91 respondents (19.6%) downloaded ≥1 mobile
respondents of the total general adult population of 3427. apps and 314 (67.8%) indicated accessing the internet on a daily
Among the 62.8% (428/682) of the older adults who reported basis versus 45.6% (1406/3082) and 87.9% (2709/3082) in the
self-tracking of their health, 17.7% (121/682) did so general adult population, respectively. When asked about their
electronically (digital trackers) compared to 45.1% (1547/3426) familiarity with smart devices/wearables for health, 82.7% of
in the general adult population. The majority of the older adults the older respondents (383/463) indicated having heard of these
reported tracking their health parameters manually (traditional technologies, but only 32.1% of the older adults (123/383) were
trackers). somewhat familiar or very familiar with them.

Table 2. Comparison of the internet and mobile health technology use of the older adults with that of the general adult population.
Use of internet and mobile health technology Older population General population Total P value
Using a smartphone 682 3427 4109 <.001
Yes, n (%) 323 (47.4) 2887 (84.2) 3210 (78.1)
No, n (%) 359 (52.6) 540 (15.8) 899 (21.9)
Using a digital tablet 682 3426 4109 <.001
Yes, n (%) 340 (49.9) 1997 (58.3) 2337 (56.9)
No, n (%) 342 (50.1) 1429 (41.7) 1772 (43.1)

Accessing internet using smartphone/digital tableta 463 3082 3545 <.001

Never, n (%) 52 (11.2) 89 (2.9) 141 (4.0)

Less than daily, n (%) 97 (21.0) 284 (9.2) 381 (10.7)
Daily, n (%) 314 (67.8) 2709 (87.9) 3023 (85.3)

Downloaded ≥1 mobile apps on smartphone/digital tableta 463 3082 3545 <.001

Yes, n (%) 91 (19.6) 1406 (45.6) 1497 (42.2)

No, n (%) 372 (80.3) 1676 (54.4) 2048 (57.8)
Heard of smart devices/wearables for health 463 3082 3545 .03
Yes, n (%) 383 (82.7) 2667 (86.5) 3050 (86.0)
No, n (%) 80 (17.3) 415 (13.5) 495 (14.0)

Familiarity with smart devices/wearables for healtha 383 2667 3050 <.001

Slightly familiar, n (%) 260 (67.9) 1227 (46.0) 1487 (48.7)

Somewhat familiar, n (%) 103 (26.9) 973 (36.5) 1076 (35.3)
Very familiar, n (%) 20 (5.2) 467 (17.5) 487 (16.0)

a
The total values in the rows indicate the number of respondents for that category, which may be lower than the total number of older adults and the
general adult population.

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Mobile Apps for Health and Well-being 21 respondents (70%) indicated sharing data with family
Table 3 compares the use of mobile apps for health/well-being members, and 4 respondents (13%) reported sharing data with
between the older adult population and the general adult their friends and doctors. Interestingly, 38% of the older adults
population. Among the 91 older adults who downloaded ≥1 (29/77) reported using these mobile apps for 1-2 years as
mobile apps (presented in Table 2), 78 respondents (86%) compared to 22.1% in the general population (269/1219).
indicated having used mobile apps for health/well-being in the However, it is important to note that no significant differences
last 3 months, which is comparable to that of the general were observed between the older adults and the general
population (1257/1406 respondents, ie, 89.4%). No significant population who used mobile apps for health in the factors that
differences were noted in relation to the number of mobile apps affect their use (ie, perceived ease of use, perceived usefulness,
for health used nor in the extent of data sharing between the 2 and expectation confirmation). The overall satisfaction and
groups. Among the 30 older adults that reported sharing data, intention to continue using mobile apps were favorable in both
groups.

Table 3. Comparison of the use and perceptions of mobile apps for health between older adults who indicated downloading these apps and their
counterparts in the general adult population.
Use and perceptions Older population General population Total P value

Mobiles apps for health/well-being used (last 3 months)a 78 1257 1335 .06

1 app, n (%) 40 (51) 514 (40.9) 554 (41.5)

2 apps, n (%) 26 (33) 406 (32.3) 432 (32.4)
≥3 apps, n (%) 12 (15) 337 (26.8) 349 (26.1)

Duration of use of mobile health/well-being appsa 77 1219 1296 .007

<1 year, n (%) 39 (51) 790 (64.8) 829 (64.0)

1-2 years, n (%) 29 (38) 269 (22.1) 298 (23.0)
>2 years, n (%) 9 (12) 160 (13.1) 169 (13.0)
a 77 1238 1315 .50
Sharing of health/well-being data from apps
Yes, n (%) 30 (39) 436 (35.2) 466 (35.4)
No, n (%) 47 (61) 802 (64.8) 849 (64.6)
b 3.79 (1.67-5) 3.78 (1-5) 3.70 (1-5) .89
Satisfaction with mobile apps, mean (min-max)

Ease of use, mean (min-max)b 4.00 (1.5-5) 3.95 (1-5) 3.95 (1-5) .55

Expectation confirmation, mean (min-max)b 3.74 (1.67-5) 3.60 (1-5) 3.61 (1-5) .12

Perceived usefulness, mean (min-max)b 3.59 (1.25-5) 3.56 (1-5) 3.56 (1-5) .78

Intention to continue using mobile apps, mean (min-max)b 3.97 (1-5) 3.91 (1-5) 3.92 (1-5) .61

a
The total values in the rows indicate the number of respondents for that category, which may be lower than the total number of older adults and the
general adult population.
b
The means represent the average of 4 questions that constitute each scale (satisfaction with mobile apps, ease of use, expectation confirmation, perceived
usefulness, and intention to continue using mobile apps). Continuous variables were measured on a 5-point Likert scale.

remaining 78.6% (302/383) indicated not having smart

Smart Devices/Wearables for Health devices/wearables. The majority of the older adults had only 1
Among the 383 older adults in the sample who had heard of device as opposed to the general adult population with more
smart devices/wearables (as presented in Table 2), 47 respondents indicating having 2 or more devices (see Table 4),
respondents (12.2%) reported having ≥1 smart devices and and the most common type of smart devices/wearables used
indicated currently using them, while another 35 respondents was bracelet/wristband watches.
(9.1%) reported having these devices but not using them; the

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Table 4. Comparison of the use of smart devices/wearables for health between older adults who own these devices and their counterparts in the general
adult population.
Use and perceptions Older population General population Total P value

Having ≥1 smart device/wearables for health, n (%)a 384 2667 3051 <.001

Yes, and use them 47 (12.2) 533 (20.0) 580 (19.0)

Yes, and stopped using them 24 (6.3) 236 (8.9) 260 (8.5)
Yes, and never used them 11 (2.8) 164 (6.1) 175 (5.7)
No 302 (78.6) 1734 (65.0) 2036 (66.7)
a 47 531 578 .049
Number of smart devices or wearables owned, n (%)
1 39 (83) 368 (69.3) 407 (70.4)
≥2 8 (17) 163 (30.7) 171 (29.6)
a 45 530 575 .19
Duration of use of smart devices/wearables, n (%)
<1 year 19 (42) 297 (56.0) 316 (55.0)
1-2 years 18 (40) 153 (28.9) 171 (29.7)
>2 years 8 (18) 80 (15.1) 88 (15.3)
Use of smart devices/wearables in partnership with 46 533 579 .17
health care provider, n (%)a
Yes 3 (7) 73 (13.7) 76 (13.1)
No 43 (94) 460 (86.3) 503 (86.9)
Satisfaction with smart devices/wearables, mean (min- 4.08 (2-5) 4.07 (1-5) 4.08 (1-5) .98
max)b

Ease of use, mean (min-max)b 4.20 (2-5) 4.21 (1-5) 4.21 (1-5) .92

Expectation confirmation, mean (min-max)b 3.78 (1.67-5) 3.89 (1-5) 3.88 (1-5) .31

Perceived usefulness, mean (min-max)b 3.66 (1.50-5) 3.82 (1-5) 3.80 (1-5) .15

Intention to continue using smart devices/wearables, mean 4.22 (1-5) 4.26 (1-5) 4.25 (1-5) .75
b
(min-max)

a
The total values in the rows indicate the number of respondents for that category, which may be lower than the total number of older adults and the
general adult population.
b
The means represent the average of 4 questions that constitute each scale (satisfaction with mobile apps, ease of use, expectation confirmation, perceived
usefulness, and intention to continue using mobile apps). Continuous variables were measured on a 5-point Likert scale.

When asked about the types of devices used, the answers also respondents perceived these devices as relatively useful. About
varied between the 2 groups. The most commonly reported 6 out of 10 users said that they maintained or improved their
devices were bracelets/wristbands. The adults in both the groups health status by using digital self-tracking devices.
who reported using smart devices/wearables did not differ Approximately 66% (31/47) of the older adult users of smart
significantly in relation to the duration of use of these devices/wearables reported they were more informed or more
technologies and the extent of use in partnership with a health knowledgeable about their health condition due to the use of
care provider, which was relatively low among the respondents, these devices. For their part, 53% (25/47) of the older adult
that is, 7% of the older adults (3/46) and 13.7% (73/530) of the users said they felt more confident taking care of their health
general adult population. As in the case of mobile app use for or more autonomous in the management of their condition.
health, no significant differences were observed in the factors Interestingly, feeling less anxious about one’s own health and
that affect the use of smart devices/wearables (ie, perceived having more informed discussions with a doctor were not
ease of use, perceived usefulness, and expectation confirmation) perceived as major benefits among the older adult group.
between the older adult and the general adult population. The
overall satisfaction with and the intention to continue using
Perception of Smart Devices and Self-tracking
these smart devices/wearables were high. The older adults who Behaviors Among Older Adults
used wearables and smart devices reported being very satisfied Cronbach alpha was used to assess the reliability of the measures
(mean 4.1 on the 5-point Likert scale), perceived their devices related to satisfaction and use of mHealth technologies, which
to be user-friendly (mean 4.2), and had a firm intention to were included in this study. The results (see Table 5) show that
continue using them in the future (mean 4.2). Importantly, all the measures exceed the .70 threshold of statistical

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significance [47]. The validity of the variables was also variable and its respective items (diagonal) was greater than the
supported; the square root of the variance shared by each intercorrelations between the variables.

Table 5. Variance shared by the variables considered in this study.a

Variables Number of Cronbach α Perceived Perceived ease of Confirmation of User Intention to
items usefulness use expectations satisfaction continue
usage
Perceived usefulness 4 .86 0.82 0.42b 0.79b 0.70b 0.71b
Perceived ease of use 4 .88 0.84 0.65b 0.62b 0.45b
Confirmation of expecta- 3 .70 0.83 0.78b 0.63b
tions
User satisfaction 3 .88 0.89 0.74b
Intention to continue usage 3 .93 0.90

a
The diagonal (italicized values in the table) refers to the square root of the variance shared by each variable and its respective items. The values off
the diagonal refer to the intercorrelations between the variables. The values in the lower part of the table are a mirror of those in the upper part above
the diagonal.
b
The correlation was significant at P<.01.

Partial least squares regression analyses that were performed variable. These results indicate that expectation confirmation
to test the associations between satisfaction, initial expectations, is strongly related to ease of use, perceived usefulness, and user
and intention to continue using smart devices/wearables (Figure satisfaction, which in turn affect the older adults’ intentions to
1) showed that all relationships but one were supported, and continue using these mHealth technologies.
the model explained 60% of the variance in the dependent
Figure 1. Results of the partial least squares regression analyses that were performed to test the associations between satisfaction, initial expectations,
and intention to continue using smart devices/wearables. * P<.05; **P<.01; ***P<.005; ns: nonsignificant.

Last, a multinomial logistic regression, including digital trackers, and nontrackers) in terms of gender, education
sociodemographic and health status variables, was performed level, occupation, and perceived health condition. However,
to calculate the odds ratios describing the odds of tracking one’s significant differences were observed in terms of region (P=.005
own health using traditional or digital devices compared with and P=.03 for traditional trackers and digital trackers,
the odds of nontracking (reference category) among the older respectively, in Alberta) and chronic conditions (P<.001 and
adult group. The traditional .05 criterion of statistical P=.003 for traditional trackers and digital trackers, respectively).
significance was employed for all tests. Addition of the Older adults living in the province of Alberta were 4.9 times
predictors to a model that contained only the intercept more likely to be in the digital self-tracking group than the older
significantly improved the fit between model and data; adults living in other Canadian regions. Compared with older
χ234(n=682)=49.46, Nagelkerke R2=0.11, P<.01. adults living with no chronic condition, older adults with chronic
conditions were 0.4 times less likely to be digital self-trackers.
As indicated in Table 6, our analyses showed no statistically
significant differences between the groups (traditional trackers,

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Table 6. Multinomial logistic regression resultsa.

Characteristics Traditional trackers, n=307 Digital trackers, n=121

ORb (95% CI) P value ORb (95% CI) P value

Intercept N/A c <.001 N/A <.001

Gender
Female 1.176 (0.761-1.817) .47 1.144 (0.656-1.996) .63
Region
Atlantic provinces 1.342 (0.582-3.094) .49 1.098 (0.379-3.183) .86
Quebec 1.896 (0.983-3.658) .06 1.322 (0.585-2.988) .50
Ontario 1.503 (0.828-2.729) .18 1.001 (0.478-2.096) >.99
Prairies 1.270 (0.487-3.309) .62 0.793 (0.220-2.861) .72
Alberta 6.053 (1.719-21.312) .005 4.914 (1.221-19.775) .03
Education
Primary and secondary school 1.064 (0.539-2.102) .66 0.623 (0.274-1.616) .37
College/CEGEP 1.371 (0.686-2.738) .37 0.623 (0.541-2.960) .59
University undergraduate 1.270 (0.675-2.392) .46 0.832 (0.571-2.675) .59
Occupation
Full-time employment 1.078 (0.181-6.422) .93 0.633 (0.099-4.438) .67
Part-time employment 1.972 (0.342-11.375) .45 0.799 (0.118-5.404) .82
Retired 1.596 (0.333-7.649) .56 0.699 (0.139-3.525) .66
Perceived health condition
Very poor/ poor 0.524 (0.240-1.14) .10 0.734 (0.275-1.955) .54
Fair or good 1.094 (0.692-1.730 .70 1.249 (0.697-2.240) .45
≥1 chronic disease(s) 0.439 (0.281-0.686) <.001 0.431 (0.245-0.758) .003

a
Reference category: nontrackers (n=254).
b
OR: odds ratio.
c
N/A: not applicable.

indicated accessing the internet on a daily basis. A large number

Discussion of Canadian older adults in the community have already acquired
Study Relevance these technologies, which presents an opportunity to leverage
them beyond basic communication use to support their
This study investigates older adults’ use of mHealth technologies well-being by enhancing social connectedness and improving
in comparison to that of the general adult population and the management of their health conditions [48,49].
assesses the pattern of use of these technologies for self-tracking
purposes. The surveyed older adult population differed Despite the comparable good-to-excellent health status reported
significantly from the general population in relation to the by older adults and the general adult population, the prevalence
sociodemographic variables. This stresses the importance of of chronic conditions was significantly higher among the older
having a closer examination of older adults’ use of mHealth adult group compared to that among the general adult population
technologies for self-tracking purposes separately from the (P<.001), which necessitates close monitoring and management
general adult population, which would inform future research, of their health and conditions. Therefore, it is important to
practice, and policy efforts in this area. leverage existing technologies that can support their health and
well-being needs in the community and potentially connect
Principal Findings them with caregivers and health care providers. This is
Although there were significant differences between older adults particularly relevant in relation to wearables (eg, wristbands,
and the general adult population in the use of internet and smart pedometers) and mobile apps that allow users to store and
technology, a considerable number of older adults reported monitor health-related data. Prior research has discussed the
using them. Specifically, 47.3% (323/682) and 49.8% (340/682) important role of technology to support the ability of older adults
of the older population (65 years and older) reported using a to remain at home, improve their quality of life and health
smartphone or a digital tablet, respectively, and 67.8% (314/463) outcomes, and enhance family caregivers’ and health care

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professionals’ access to relevant information [16,50]. This is in It is also important to note that a low proportion of respondents
line with the findings of this study that showed a high among the older adults and in the general population, that is,
satisfaction rate with mHealth technologies and favorable 39% (30/77) and 35.2% (436/1238), respectively, indicated
conditions for their use. either sharing data from mobile apps or using smart
devices/wearables in partnership with health care providers.
Nevertheless, this study demonstrates that the potential of
Hence, it appears to be a disconnect between the actual needs
mHealth technologies for self-tracking purposes has not been
and willingness of the older adults in the community to use
fully captured yet in the context of older adults. Although 62.8%
mHealth technologies and the ability and readiness of health
(428/682) of the older adults reported tracking their health
care providers to leverage these tools to support the care
measures, the majority did so manually, which may compromise
provided for these individuals. Despite previous efforts to
the process, given the risk of losing information and the
explore the factors that affect health information technology
difficulty in sharing it with health care providers and caregivers.
adoption by older adults in the community [26], we have very
This considerable number of older adults tracking their health
limited information about the facilitators and barriers that play
measures is indicative of the need and interest among this group
a role in bridging this disconnect and enabling more optimal
to monitor their health. In the absence of the widespread use of
use of mHealth technologies for older adults’ care.
personal health records, older adults do not have options for
tracking and monitoring their health status but through their The partial least squares regression analyses confirmed that
own initiative; as such, many seem to resort to the traditional expectation confirmation is strongly related to ease of use,
manual recording of their health. This may be an indication of perceived usefulness, and user satisfaction. Hence, it is critical
limited knowledge that they may have on mHealth technologies to adequately manage older adults’ initial expectations to ensure
and how they work or a lack of funding and incentives to acquire greater adherence and continued usage of wearables and smart
and use these technologies (ie, from the health care providers, devices. These initial expectations may be considered as the
government, and caregivers). Surprisingly though, older adults anchor for the subsequent behavior of older adults, and their
with one or more chronic conditions appeared to be mostly acceptance and the use of these technologies, and which may
nontrackers, which raises concerns as to the extent to which be shaped by the environment in which they live. Caregivers
mHealth technologies are indeed benefitting the older adults and family members, peers, as well as health care providers can
most in need of them. play a significant role in shaping these initial expectations and
the subsequent benefits that older adults may reap out of using
In light of these findings, it is critical to develop strategies to
these technologies. Interestingly, the results of this study show
enhance older adults’ awareness and knowledge of the existing
that older adults living in Alberta were 4.9 times more likely to
mHealth technologies available at their disposal and how to use
be in the digital self-tracking group compared to older adults
them and encourage family physicians and allied health
in other regions. Alberta is a province known to attract young
professionals to communicate about these options with them.
families and is known for its highest rate of workforce growth.
In addition, it is equally important to understand older adults’
This may have implications for older adults living in this
priorities and self-tracking needs in order to offer technologies
province who are surrounded by a younger population heavily
suitable to address these needs [32]. This is particularly relevant
immersed in technology and who may have expectations in
in light of recent studies in other countries showing that older
relation to the role of mHealth technologies in the care for their
adults’ acceptance of mobile apps can be improved by informing
older persons.
them about the potential benefits of these technologies [51] and
that older adults agree to share collected data through in-home A culture shift in the provision of care to Canadian older adults
monitoring and sensors with professional caregivers and demand living in the community is deemed necessary in order to keep
participation in decisions about technology [52]. up with the development of mHealth technologies and the
changing demographics and expectations of patients and their
Interestingly, the majority of the mobile apps downloaded by
caregivers. This is particularly important in light of the results
the surveyed older adults consisted of apps used for health and
in this study that show that older adults living with chronic
well-being, reflecting a “targeted” use of these technologies by
conditions are 0.4 times less likely to be digital self-trackers.
older adults. Around half of the older adults who reported mobile
This is a “missed opportunity” at the community level as the
app use in the past 3 months specified using 2 or more of these
individuals who may benefit most from mHealth technologies
apps. This is indicative of the perceived benefits of these
(ie, older adults with chronic conditions) do not seem to be
technologies by older adults and can also reveal a level of
actually using them. Given this state, how can we make this
comfort and interest in the use of these mobile apps over time.
leap and paradigm shift? Evidently, this shift cannot come along
Once older adults start using mobile apps for health, their
without paralleled changes at the health system level in relation
interest and willingness to use more than one mobile app over
to existing policies, reimbursement modalities, and the structure
a long period of time was confirmed (Table 3 shows higher
of health care services delivery. In order to optimize the use of
proportion of older adults reporting >1-year use compared to
mHealth technologies to support older persons in the
the general population). Future studies should investigate the
community, who need and are capable of using them, it is
motivating factors that facilitate their embracement of mHealth
important that health care providers integrate data gathered
technologies to develop strategies that would enable a broader
through these smart devices in the delivery of care to them.
range of older adults to benefit from them.
With the recent COVID-19 crisis, we have seen a rapid uptake
of virtual care worldwide, which has been catalyzed by a dire
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need to provide “remote care” to a vulnerable population (ie, mHealth technologies. This necessitates a particular focus on
older adults) and a facilitated reimbursement approach. For older adults in future studies in order to better understand the
example, as of May 1, 2020, the Ministry of Health and needs and perceived facilitators and barriers for the use of these
Long-Term Care in the province of Ontario, one of the largest technologies this group. However, interestingly, both groups
health jurisdictions in Canada, implemented new temporary fee considered in this study demonstrated similarities in terms of
schedule codes that cover virtual assessments and provision of limited current use of mobile apps and wearable devices for
services [53]. Despite this agile adaptation during the time of sharing data in partnership with health care providers. This calls
crisis, it is equally important to develop long-term plans to for future research, which extends to the whole population, to
leverage technologies to support the care for Canadian older better understand the underlying reasons and challenges in this
adults, which may require reforms at the health system level. area and study the feasibility and readiness of health care
providers to leverage these tools to support the care that they
Before the COVID-19 crisis, we had started to witness
provided to their patients.
unconventional changes in this area in some Canadian provinces
with initiatives that allowed patients to leverage wearables and Last, it is important to note some limitations associated with
smart devices to support their health. Alberta, for example, had the study design and breadth of data. The data set used in this
released a personal health record initiative allowing patients to study is from a single country, thereby limiting the
collect and store their own health data by using wearables and generalizability of the findings. In addition, the web-based
smart medical devices and manage authorizations for accessing survey was completed by respondents who had access to the
these data. Other provinces, including Quebec, Nova Scotia, internet, which may preclude representativeness of potential
and Saskatchewan, are following this lead with health respondents with no internet access. Given the cross-sectional
information portals giving patients more access and control over nature of the survey, a full assessment of the predictors of older
their health data. These initiatives are promising; however, they adults’ use of mHealth technologies as well as an evaluation of
have to be paralleled and supported by changes at the policy the variation in their behaviors over time, especially in relation
and reimbursement levels to close the loop and encourage health to changes in their health conditions, was not feasible.
care providers to endorse new technologies as integrated Furthermore, given the exploratory nature of the study and the
components in the delivery of health services for older adults focus on mobile apps and smart devices/wearables, limited data
and enablers for improved quality of care. were collected on the functional ability of the older adults, their
level of independence and health condition, and other
It is worth noting that the consistent high satisfaction of older
sociodemographic characteristics that may play a role in shaping
adults with mobile apps and smart devices/wearables and their
their use of these technologies. Future studies should take these
intention to continue using them is a positive indication of the
factors into account to better understand the variation in the use
evolving expectations of the older adult population and a
of mHealth technologies by older adults in the community and
potential game changer for the future of care for older adults.
determine the optimal conditions in which these technologies
The results of this study confirm that once mobile apps and
can best benefit them.
smart devices/wearables are used, the perceived ease of use and
usefulness of these technologies do not vary by age of the users. Conclusion
As the older adult population continues to grow to include The burden of population aging and the associated chronic
people currently still in the workforce and using technology in conditions is observed worldwide. Mobile technologies present
their daily lives (eg, mobile apps, smart devices), the demand an opportunity to address the challenges faced by older adults
for more connectedness with health care providers and better in relation to their health and the care that they receive. This
response from the health care system in a networked society study shows that a considerable number of older adults are
will likely increase. familiar with and use these technologies. Importantly, older
Limitations and Future Research adults who use mHealth technologies are highly satisfied with
them and plan to continue using them in the future.
This study presents contributions to an underresearched area
Understanding why older adults who are familiar with mHealth
on older adults and mHealth technology use. These findings are
technologies are not using them would inform progress in this
the first step toward understanding the behaviors and attitudes
area. In particular, leveraging these mHealth technologies for
of older adults toward these technologies. By unveiling the
older adults who need and may benefit from them, in partnership
actual prevalence of mHealth technology use among the
with family physicians and allied health care professionals
Canadian older adult population and exploring their familiarity
remains very limited at present. The current development and
and satisfaction with these technologies, we set the stage for
deployment of various personal health record initiatives in
future research to investigate the optimal environment and
Canada appear as a promising avenue to facilitate bidirectional
predictors for their effective use [54].
health information exchanges between health care providers
At present, there are still significant differences between older and patients, including older adults.
adults and the general adult population in relation to the use of

Conflicts of Interest
None declared.

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Abbreviations
mHealth: mobile health

Edited by L Buis; submitted 01.10.20; peer-reviewed by H Gewald, B Chaudhry; comments to author 18.10.20; revised version received
23.10.20; accepted 23.10.20; published 27.11.20
Please cite as:
Jaana M, Paré G
Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada:
Cross-Sectional Survey
JMIR Mhealth Uhealth 2020;8(11):e24718
URL: http://mhealth.jmir.org/2020/11/e24718/
doi: 10.2196/24718
PMID: 33104517

©Mirou Jaana, Guy Paré. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 27.11.2020. This is an
open-access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information,
a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

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