Phase three
Conducting Primary Research with Stakeholders
This week, due to difficulties with accessing elderly participants within clinical settings, I decided instead to gather insights through personal connections spread across Florida, Hawaii, New Jersey, and a psychiatrist based in Pennsylvania. Through interviews and love and break-up letters, I obtained a better understanding of how I can facilitate mental health discussions among the elderly through the use of technology.
Why I Chose These Methods
Interviews: I opted for interviews because they allow for conversations flexible enough to accommodate the sensitivities around mental health. This method provides direct insight into the lived experiences of the elderly, which surveys or observational studies cannot always do.
Love/Breakup Letters: This method gave me access to seniors’ unfiltered emotions and attitudes towards technology in the context of their mental health care—insights often toned down in face-to-face interviews. Participants were asked to write "love letters" to aspects of mental health and technology they appreciated, as well as "breakup letters" to aspects they found problematic or disliked.
How I Conducted the Research
I conducted the interviews primarily over the phone, with two in-person sessions with those who live in New Jersey. For the love and breakup letters, I sent instructions via email and text message and followed up regularly to ensure participants understood the exercise and felt supported throughout the process.
Insights and Surprises
Each participant shared unique insights, though common themes emerged, particularly around the importance of routines, spirituality, and social interactions for well-being. It was also interesting to see how misconceptions about the elderly’s relationship with technology differed from their actual desires and abilities to engage with it. My grandmother Nancy, who grew up in the era of typewriters, is a great example. She went from resisting new technology to embracing it, eventually mastering it and even encouraging others from her age group to do the same.
The letters also painted a clear picture of the nuanced relationships the elderly have with technology. They like how easy it makes it to connect with others yet are often overwhelmed by the complexity and impersonal nature of digital interactions. This highlights an important area for improvement in tech design: simplifying interfaces and interactions to enhance usability for the elderly while keeping the human element they value.
These insights emphasize the importance of designing digital tools that simplify and enhance the lives of elderly users.
Note to my Stakeholders
A heartfelt thank you to all who have participated and contributed to this important phase of my research. Your openness and insights are helping shape my research and design decisions.
This project is inspired by my great-grandfather, who, at 96 years old, remains strong and resilient. He has witnessed transformations in society, from the inequalities of his youth as a Puerto Rican to the different world we live in today. His reluctance to discuss mental health has prompted me to reflect on generational shifts in how we understand and address it, highlighting the influence of historical and cultural contexts on our perceptions and conversations.
Interview Questions for the Elderly Community
Introductory Questions
Could you share a little about your daily routine and what brings you joy or satisfaction?
What are some common misconceptions people have about being your age?
A: People think they can’t move forward or grow, but they can.
G: Misconceptions about being dysfunctional, out of touch, or unable to learn.
P: People, especially younger ones, make sarcastic or ignorant comments about aging.
N: Older people have wisdom and experience, and they can still contribute actively.
How do you generally communicate with your family and friends about personal matters, including mental health?
A: Just tells them (but outside perspective says she avoids discussing personal matters).
G: Through one-on-one conversations by phone or in person.
L: Rarely communicates; trusts his wife or mother.
P: Depends on the situation, typically via phone.
N: Confides in close friends, her husband, and through prayer.
Mental Health-Specific Questions
Can you tell me about a time when you felt really supported by those around you regarding your mental well-being?
A: Doesn’t remember.
G: Loss of her mother.
L: Brain surgery; support came from his wife and close contacts.
P: Doesn’t recall a specific time.
N: The suicide of her brother; close friends and prayer helped her through.
Are there aspects of mental health care or discussions that you find challenging or uncomfortable?
A: Claims no discomfort (though avoids the topic).
G: None.
L: Doesn’t trust people with personal matters.
P: Finds therapy helpful but has no significant discomfort.
N: Focuses on understanding others’ challenges through research and prayer.
What changes would make you feel more comfortable discussing your mental health with others, including healthcare providers?
A: Assured confidentiality.
G: Feels there’s no guaranteed confidentiality.
L: Trust is the key issue.
P: No specific opinion.
N: Has no problems discussing it with doctors.
Technology Integration Questions
How often do you use technology such as smartphones, tablets, or computers? What do you primarily use them for?
A: Uses her phone daily (2–4 hours) for Facebook, Amazon, and basic tasks.
G: Daily for communication and other tasks.
L: Occasionally uses his phone for YouTube and Google searches.
P: Basic use of his phone for communication and YouTube.
N: Uses a smartphone and laptop daily for communication, genealogy, and indexing projects.
Have you ever used technology to manage your health before, like reminders for medication, virtual doctor’s appointments, or health tracking apps? What was that experience like?
A: Relies on doctor reminders but doesn’t use apps.
G: Finds required digital check-ins forced and not particularly beneficial.
L: Used telehealth reluctantly; trusts his doctor but dislikes the process.
P: Hasn’t used health technology.
N: Uses Kaiser Permanente’s online tools and finds phone/zoom appointments helpful.
What do you think about using technology to talk to health professionals or counselors about your mental health?
A: Prefers in-person interactions.
G: Prefers direct human interaction.
L: Favors in-person communication.
P: Sees the convenience of virtual appointments.
N: Comfortable with it but still values in-person meetings.
Are there features in the technology you use that make it easier or harder for you to use them effectively? Could you describe them?
A: Finds too many buttons, passwords, and options overwhelming.
G: Systems should be simpler and less frustrating.
L: No major issues.
P: Basic features are sufficient for his needs.
N: Comfortable with technology due to prior training.
What features would you find most helpful if I could design a technology solution that helps you discuss and manage your mental health?
A: I don’t know.
G: Simplicity is key. If you have a mental health issue, it should not be complicated or frustrating. Follow-up is essential to ensure problems are being addressed.
L: I don’t know because I don’t use it—my wife does all that.
P: I don’t know.
N: Great question, but I don’t know. I worry that technology, rather than an understanding, caring, compassionate person, can’t give the same help.
In what ways do you think technology could make it easier for you to maintain contact with family, friends, and healthcare providers regarding your mental health?
A: It’s at your fingertips, so you don’t have to leave the house.
G: Sometimes it’s not as easy because not everyone has the technology or knows how to use it.
L: Make it easier to understand and access.
P: Because you don’t always have time to see everyone, it’s easy to call.
N: I already use emails, texts, and FaceTime to keep in touch. I just got off an hour-long call with Ian in Virginia, and I love his calls. My mental health is more dependent on having a life—something worthwhile to do, having friends over, being among people. I use technology for those who are far away.
Closing Questions
What advice would you give to younger generations about maintaining mental health?
A: Eat well, take vitamins, meditate, and address problems directly.
G: Speak up and seek help when needed.
L: Avoid drugs and alcohol; they impact mental health.
P: Talking to others helps put life into perspective.
N: Stay active, focus on happiness, and believe in something bigger than yourself.
Is there anything else you wish to share that we haven’t covered, especially about mental health and wellbeing?
A: Fresh air, sunshine, and positivity are essential.
G: Stresses the importance of confidentiality in mental health care.
L: Believes faith and self-care are crucial.
P: Nothing additional to share.
N: Advocates for finding the good in life and staying active.
Interview Questions for a Healthcare Provider
Trenton: What has been your experience with implementing telehealth services, particularly before and during the pandemic?
Doctor: Even before the pandemic, my business partner was big on telehealth because so many people don't have access to care due to various barriers such as lack of transportation, time constraints, or being at work. We implemented telehealth before the pandemic, which equipped us well to handle the increased demand during it.
Trenton: How have telehealth services impacted your ability to reach and treat your clients, especially the elderly?
Doctor: We've used a platform called DOXY and have seen an increase in the number of clients we can service. With senior citizens, many don’t drive, and are in facilities or in remote areas, or maybe they are injured, so we are connecting with those with mobility issues.
Trenton: How does insurance coverage affect telehealth services, particularly for mental health care?
Doctor: Most insurances reimburse the same way as if the sessions were in person, but some give a lower rate for telehealth which is frustrating for the provider because it is still the same amount of the provider’s time, although this is a small number of insurances that do this.
Trenton: Can you describe some barriers your clients face when accessing mental health care?
Doctor: There is limited resources for seniors, and I have had many clients upset and complaining because their loved ones have dementia and don’t know how to access resources.
Trenton: What challenges do elderly clients face with using technology for telehealth?
Doctor: Elderly clients have a tough time because they aren’t as great with technology. Some don’t charge their devices, can't figure out how to get into the virtual waiting room, or prefer phone calls because they can't navigate the technology. For those with conditions like Parkinson's and those in assisted living facilities, I sometimes drive to visit them because they can’t handle technology well.
Trenton: From a generational perspective, how do you perceive the attitude toward mental health among seniors?
Doctor: There's a big stigma on mental health with the senior population because they grew up in a time where it wasn’t allowed to have emotion, where the advice was to 'get over it, keep it moving.' Now, with social media and the internet, there are a lot more discussions about mental health which is sometimes overwhelming for them. They didn’t even recognize conditions like depression because 'that’s just the way it was.'
Trenton: What would make telehealth more accessible and effective for seniors who struggle with technology?
Doctor: Targeting facilities with nurses and social workers who can help seniors with technology is essential. They are not good with technology and are very isolated. For example, one lady broke her back, and she doesn’t know how to use Netflix and is very depressed. My suggestion is to have services where someone can come out and set up the technology for them and provide in-person instruction, or at least offer this as an option if they can't manage it on their own.