Applying Cognitive and Cultural Frameworks to mHealth

Application Design for Elderly Users

Mia Forbes, Joyram Chakraborty and Johannes A. Badejo

Department of Computer and Information Science, Towson University, Towson, MD, U.S.A.

Keywords: Cognitive Theories, Conceptual Models, Usability, Perceived Usefulness, Perceived Ease of Use,

User-Centered Design, Interaction Design, mHealth.

Abstract: Information and communication technologies and mobile health applications are becoming more pervasive in

healthcare. Although these technologies aim to be harmoniously ubiquitous, there are important design factors

that user experience practitioners must consider for optimal utilization for elderly users. User’s perceived

usefulness is the driving factor for technology adoption. Incorporating cognitive and conceptual design

principles such as information processing, mental models, external cognition, and emotional interaction based

upon sociocultural determinants can improve the usefulness of mobile Health tools amongst elderly users.

Data was obtained from a small sample (n=30) aged 75 years or older who use telehealth and mobile health

apps. Findings show that users have a low perceived ease of use and usefulness of these applications based

on the lack of sociocultural elements incorporated into the interface design. This paper aims to analyze the

impact cognitive theories and conceptual frameworks have on mobile health design for elderly users, while

bridging the gap of an existing digital divide. A qualitative study was conducted involving empirical research

to define a correlational relationship between technology dissonance and elderly users for the purpose of

identifying a thematic analysis.

1 INTRODUCTION

Mobile health (mHealth) applications have

progressed in their original performance during the

plight of a worldwide health emergency, with an

expectation of rapid adaptability and acceptance.

From an imperceptive standpoint, mHealth apps are

beneficial based on system functionality, permitting

users accessibility to medical personnel and resources

remotely (i.e., mHealth apps); however, considering

usability factors are equally important. There’s a

digital divide as it relates to technology adoption

amongst older users. As the elderly population is

continuously increasing, User Experience (UX)

designers and researchers can pursue and create

iterative designs that are tailored to this fast-growing

population with the aim and focus on inclusivity. It is

crucial that cultural society address issues regarding

the impact of advances in technology on the daily life

of the elderly (Li, & Perkins, 2007).

UX designers must conceptualize a design

framework that overcome barriers leading to

technology resistance, such as: socio-cultural

determinants, cognitive theories, and conceptual

frameworks. By closing the digital divide gap and

making access to technologies equitable, favorable

outcomes are within reach as digitally connected

living has potential implications for poverty

alleviation, improved education, social well-being,

and health (Aruleba & Matarirano, 2022).

As UX researchers are analyzing the inclination

of technology acceptance, findings show that user

resistance does not rely solely based on technical

unfamiliarity. Compared to ‘middle aged’ which

they define as people between 55 and 64 years of age,

young seniors (65–74 years) are only 63% as likely to

use the Internet, while old seniors (75+) are only 30%

as likely (Friemel, 2016). Besides the lack of

technical devices to access the Internet for some, the

main reasons for not using the Internet were found to

be either motivational indifference (perceived

uselessness of the information on the Internet or little

relevance for one’s life), or deficient knowledge

(Friemel, 2016). This paper focuses on how to

homologize user expectations and interface design

within human computer interaction (HCI) by

discovering inclusivity and sustainability gaps within

telehealth applications to identify design

Forbes, M., Chakraborty, J. and Badejo, J.

Applying Cognitive and Cultural Frameworks to mHealth Application Design for Elderly Users.

DOI: 10.5220/0012321600003660

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 19th International Joint Conference on Computer Vision, Imaging and Computer Graphics Theory and Applications (VISIGRAPP 2024) - Volume 1: GRAPP, HUCAPP

and IVAPP, pages 435-443

ISBN: 978-989-758-679-8; ISSN: 2184-4321

435

opportunities that provide representation to the aging

population.

This paper aims to further examine the following:

• Whether interface designs including

cognitive theories increase perceived ease of

use of telehealth applications within the

elderly community.

• Whether interface designs including

conceptual frameworks based on

sociocultural determinants increase

perceived usefulness in telehealth

applications within the elderly community.

Using empirical research, data was obtained and

analyzed from a sample (n=30) to identify existing

challenges with mHealth apps from users within the

aging community. Based on findings, a qualitative

study was conducted by reviewing existing peer-

reviewed literature to identify a thematic analysis to

correlate cognitive theories, conceptual models, and

user interface (UI) design to improve mHealth

adoption.

2 METHODOLOGIES

In this study, a qualitative approach was undertaken

using an exploratory model consisting of surveys,

interviews, and observations to determine a thematic

analysis in order to define a correlational relationship

between technology dissonance and elderly users. A

systematic literature review was conducted to identify

a thematic analysis.

Data collection was conducted at a residential

senior retirement community in the North East United

States region. Figure 1 displays the survey used with

the purpose of identifying inclusion and exclusion

criteria, as the target audience for preliminary data set

were elderly users with no information and

technology background.

Figure 1: Survey questions used to conduct preliminary

findings.

Qualifying participants resulted as (n=30). Over

20 participants indicated they had some level of

college education. Provided that, it’s myopic to

consider an existing level of education with ease of

use and technology adoption. However, from an HCI

purview it can be advantageous to use that

information to further asses and build upon cognitive

aspects such as information processing to create a

more intuitive UI. Furthermore, it was also important

to analyze the responses from question #5 as it relates

to users being tech savvy. For instance, it was

observed that users who considered themselves “tech

savvy” equated that to owning some technical device

(e.g., smartphone, laptop, etc.,) However, it was

discovered that while these users owned technology

devices, by watching these users interact with specific

devices (e.g., computers, laptops, smartphones, etc.,),

the utilization were surface level capacities. For

example, security features that allow users to save log

in credentials to mitigate user input for future use was

scarcely used because they did not know it existed or

they didn’t understand what it was. In addition, some

users were not aware of speech-based interaction

styles for text messages or note taking – hence,

further bridging the gap between what tech savvy

means to one demographic vs another.

Following the survey intake, an interview was

conducted in a semi-structured format, asking open-

ended questions, to allow participants to discuss their

thoughts surrounding mHealth. During this dialogue,

both verbal and non-verbal mechanisms such as hand

gestures and movement, range of voice octaves, facial

expressions, etc., were observed. It was important to

observe these mechanisms as it also ties into UX

evaluation. For example, when participants use a

range of forceful hand gestures during the

conversation, it can be resonated as a pain point

within the technology. Figure 2 displays the

consensus of responses that were documented from

participants.

Figure 2: Participant responses from focus group.

2.1 Literature Search Criterion

Using an exploratory method, secondary research was

conducted via a systematic literature review (n=82)

including: peer reviewed scholarly articles, literature

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436

reviews and case studies. The following inclusion

criteria was used:

1. Publication written in English

2. Scholarly peer-reviewed journal article

3. Published in academic journals or text

4. Full text

5. Aging/elderly/senior population

Figure 3: Quality Criterion Assessment.

Figure 4: Qualitative Research Criterion.

Literature that included youths and adolescent age

groups and users with sufficient technology

background were excluded. Literature was analyzed

to define a correlational relationship regarding

cognitive theories such as: mental models,

information processing, external cognition and

emotional interaction aspects based on sociocultural

factors within the aging community being

incorporated into mHealth interfaces. The following

sections summarize cognitive theories and conceptual

frameworks to be embodied as it applying user-

centered design approaches.

3 SOCIAL INFLUENCES AND

MHEALTH

Sociocultural factors have an influence on the

adoption rate of mHealth applications within the

aging population. The function of mHealth services

facilitates health care for elderly users and brings

multiple benefits such as, providing prompting

medication alerts, self-monitoring of biometrics

indicators, support for telemedicine consultations,

health care cost savings, and so on (Cao et al., 2020).

Despite the potential benefits and opportunities for

elderly people to use mHealth apps, they are found to

be less innovative toward it and encounter various

challenges and difficulties when they are using (Cao

et al., 2020).

Based on internal factors, targeted audiences’

culture and values are guiding factors in how resistant

they will be to mHealth. To further illustrate, older

adults’ views and values of what it means to age

successfully may shape their evaluations of

preventive services (Butler et al., 2011). Models of

successful aging often favor a biomedical or

psychosocial perspective; models with a psychosocial

perspective emphasize satisfaction with one’s current

and past life, social engagement, and personal growth

(Butler et al., 2011). Literature details a study that

was conducted with older adults aged 65 years or

older that highlighted their initial perception of

technology. Participants reported they were bored

with digital technologies because sometimes the

technology was very complex and easily broken (Li

& Luximon, 2016). Direct manipulation and

exploring interaction types may be advantageous for

improved perceived usefulness and perceived ease of

use. By paying close attention to how people actually

exploit real environments, and describing those

phenomena in appropriate theoretical terms, we can

see how to go beyond the simple replication of

felicitous features of the real world (Hollan et al.,

2000). An important research issue for the field of

human-computer interaction is how to move beyond

current direct-manipulation interfaces (Hollan et al.,

2000).

Elderly customs surround a sense of community

and collectiveness. Figure 5 displays the correlation

of both internal and external socio-cultural

determinants that influence technology adoption.

Rather than operating in different silos, this

community embraces more collaborative and shared

practices. Such as, when there is a positive and high

adoption within users of the community, projected

users will be more prone to assimilation opposed to

natural resistance. Higher adoption rates amongst this

group can be achieved as professionals and

individuals within the community begin to adapt to

the changes and demonstrate advantages, as they have

a positive perception of usefulness and usage.

Community health workers and volunteers see

themselves as agents of change who accompany the

members of the community as they change their lives

(Mohajer & Singh, 2018). They use their local

knowledge to explain health in simple terms and can

address traditional false beliefs (Mohajer & Singh,

2018). Expressing the benefits of technology

utilization in simplistic methods are in alignment with

older user’s mental capacity and values as new

concepts are approaching them.

It must be remembered, during the plight of

COVID-19 technology was forced upon users as the

main source of continuing healthcare services.

Approaching the adoption of mHealth apps should be

Applying Cognitive and Cultural Frameworks to mHealth Application Design for Elderly Users

437

built upon a user-centered foundation that

incorporates user needs at the core to reduce

dissonance and anxiety disassociated with utilization

during the pandemic.

Figure 5: Socio-cultural factors related to technology

adoption.

3.1 Social Interaction

Communication and being social are fundamental

aspects of everyday life. The various ways people

socialize and interact with other beings can be

reflective of the type of culture they were emersed in

and traditional upbringing. For instance, younger

adults tend to use telecommunication devices to

socialize via non-verbal modes while older adults are

more vocal, using verbal communication modes.

They prefer the richness of face-to-face

communications and authenticity. In today’s

technologically advanced world, social networks

have the potential to exclude loneliness in one's life,

but the current social media platforms which cater to

the biggest number of users do not take into

consideration the needs of seniors around the world

(Embarak et al., 2021).

In an effort to combat the issue of loneliness and

social isolation among the elderly community,

creating UI designs within telehealth applications that

encompass direct manipulation interaction styles not

only provide a benefit by allowing the user to be in

full control, additionally it is creating a

communication mode between user and the

device/technology (Embarak et al., 2021). Human

beings are inherently social; people will always need

to collaborate, coordinate, and communicate with one

another, and the diverse range of applications, web-

based services, and technologies that have emerged

are enabling them to do so in more extensive and

diverse ways (Preece et al., 1994).

UX practitioners can begin building upon a

conceptual framework for UI design. Conceptual

models not only aid in being an effective

communicative tool between designer and user, but it

also allows a sense of transparency and trust to build

with an aim of decreasing technology rejection within

this population.

4 COGNITIVE THEORIES

Elderly adults’ cognitive abilities may be affected

with age, resulting in a decline in visual, auditorial or

dexterity function. Coupled with their physical

abilities, cognition also embodies user learning styles,

attention span, perception and their memory. UI

designs that embed interaction styles such as a

metamorphic approach would be instrumental. Using

interface metaphors can result in a higher adoption of

mHealth tools as it can aid in reducing their cognitive

load along with creating a sense of independency

while using this technology. Using metaphors can be

an effective way to communicate an abstract concept

or procedure to users, as long as the metaphor is used

accurately (Card, 2018).

Conceptually illustrating system functions in a

relatable way can reduce the cognitive load and strain

of learning new technology. Metaphors rely on a

user’s familiarity with another concept, as well as

human affordances, to help users understand the

actions they can perform with their data based on the

form it takes (Card, 2018). Metaphors can provide

cues to users how to understand products: to orient

and personify as they provide us with the means to

understand our complex digital devices (Saffer,

2005).

Metaphors aren’t particularly about language, but

rather about thought “in the way that we

conceptualize one domain in terms of the other” -

helping us to conceive and understand abstract

concepts like time, usually by making reference to

more concrete objects (Saffer, 2005). Using cognitive

theories to provide a conceptual framework in UI

design, centered around the user, can improve the

perception of ICTs in the elderly community. When

designers and researchers apply a user-centered

approach, these factors can be used as a fundamental

basis for a conceptual model design inclusive of

cognitive factors such as: mental models, information

processing, external cognition and emotional

interaction.

4.1 Mental Models

A principle of the modern theory of mental models is

that a model has the same structure as the situation

that it represents (Johnson-Laird, 2004). Users will

begin to form their own mental model surrounding a

concept based on how often they interact with such.

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One can reasonably assume that elderly users may

have limited interaction with ICTs if there’s no

requirement to use them to perform daily tasks.

Characteristics of mHealth app users suggest they

tend to be younger, white, have an educational level

greater than high school, have a higher income, are

employed, have insurance coverage, live in urban

areas, are not current smokers, are more often obese,

and report excellent health (Smahel et al., 2019).

With this in mind, elderly users are not identified

as primary users of these ICTs which can result is a

limited mental model. Provided that, with technology

advances being rolled out with UIs that do not

incorporate sociocultural and cognitive elements of

elderly users, they can be overwhelmed with these

tools. Therefore, inadvertently creating a negative

mental model. There is accordingly a many-to-one

mapping from possibilities in the world to their

mental model (Johnson-Laird, 2004).

4.2 Information Processing

Human Information Processing (HIP) Theory

describes the flow of information from the world, into

the human mind, and back into the world (Card,

2018). Perception is critical as it pertains to

information processing, guiding the user to initially

rely on the representation of what is being presented

to them. Contextual perception is also a key factor as

well. For instance, if UX practitioners are deploying

new technology using technical jargon amongst the

elderly population without the proper education

background, this advancement may be processed as

unfamiliar and overwhelming. The way information

is displayed can also greatly influence how easy or

difficult it is to attend to appropriate pieces of

information (Preece et al., 1994).

While the information presented of mHealth apps

may demonstrate needed benefits, their contextual

perception can be a barrier. Some users demonstrate

that they were too old to learn new things while others

complained that they had bad memories and less

patience to learn new technologies (Li & Luximon,

2016). On the other hand, others state that they had

the confidence to learn new technology only when the

technology was simple enough (Li & Luximon,

2016). Perception refers to how information is

acquired from their environment via the different

sense organs – eyes, ears, fingers – and transformed

into experiences of objects, events, sounds and tastes

(Preece et al., 1994). Vision is the most dominant

sense for sighted persons; with respect to interaction

design it is important to present information in a way

that can be readily perceived in the manner intended

(Preece et al., 1994).

Education background also relates to how users

process information given. Users with a certain level

of digital literacy may process UI design with more

ease that novice users.

4.2.1 Digital Literacy and Education

Uncontrollable factors and challenges such as

technical resources are one aspect of technology

barriers; however, learning challenges are also

critically important. Changes in cognitive,

psychomotor, and affective areas of behavior

influence learning as each component is affected by

the normal aging process (Best, 2001). It must be

remembered that learning new concepts can be

overwhelming for people who are not braced for such

impact of change. To emphasize, consider the

contextual difference of individuals learning in a

college classroom in contrast to individuals learning

on their own without sufficient guidance. In an

academic setting, individuals are prepared to learn

new ideas and concepts, as intended. On the other

hand, individuals who are learning new concepts and

ideas based on society and the direction that

civilization is moving towards may face more

challenges. UI design aspects that include and display

an inviting and simplified approach will engage

elderly users. Nevertheless, UX practitioners should

be cognizant of creating a UI design that is ‘too’

simple in respect to the sensitivities related to lack of

education.

4.3 External Cognition

One of the main benefits of incorporating cognitive

factors such as external cognition is reducing end

user’s memory load. External cognition is concerned

with explaining the cognitive processes involved

when we interact with different external

representations (Hartson, R & Pyla, 2012). For

example, users would be able to understand how to

directly manipulate a file by dragging it to the

embedded trash can icon, representing the action of

deletion. This is an example of a mirrored realization,

just as a person in the real world would physically

pick up an item, walk to the trash can to dispose of it.

A main goal of this framework is to explicate the

cognitive benefits of using different representation

for different cognitive activities and the processes

involved (Hartson, R & Pyla, 2012). The main goals

include:

• Externalizing to reduce memory load

Applying Cognitive and Cultural Frameworks to mHealth Application Design for Elderly Users

439

• Computational offloading

• Annotating and cognitive tracing

(Hartson, R & Pyla, 2012).

Distributed cognition is important in UI design as

we move to a more ubiquitous culture. The theory of

distributed cognition, like any cognitive theory, seeks

to understand the organization of cognitive systems;

it extends the reach of what is considered cognitive

beyond the individual to encompass interactions

between people and with resources and materials in

the environment (Hollan et al., 2000). Distributed

cognition looks for cognitive processes, wherever

they may occur, on the basis of the functional

relationships of elements that participate together in

the process (Hollan et al., 2000). When the UI design

for mHealth can illustrate a parallel design to the

physical world and allow interaction between those

artifacts (i.e., clicking on a letter icon to send a

message to a healthcare professional) and the user can

increase the information processing of performing

specific tasks.

4.4 Emotional Interaction

Applying emotional design aspects that elicit a desire

to engage with mHealth tools must be considered.

Given the cultural, or higher-level nature of these

designs – people needing to learn about design in

order to associate it with e.g., values, actions or

functions – it should be understood that design

cognition and experience is always dependent on

social processes (Saariluoma, 2020). Reliability and

functionality are fundamental considerations of UX,

yet emotional aspects including desirability and

satisfaction also influence users’ perceptions of their

experience and should also be captured in a

comprehensive evaluation (Richardson et al., 2021).

When designers apply factors that relate what

features and aspects elicit desirable emotions by

researching these elements by communicating with

the targeted audience, perception can be positively

impacted. Desirable speaks to the attractiveness and

appealing nature of the app design (Richardson et al.,

2021). Guidelines to promote attractive designs and

techniques for emotional engagement were adapted to

create the criteria for this principle (Richardson et al.,

2021).

Emotions influence both the way that users

perceive a technology and how they interact with it,

(Dupré & Sinclair, 2021) which can impact PU within

the initial stages of its introduction. For example,

literature show that users’ satisfaction in using a

computer laptop for work-related tasks was better

predicted by amusement than by utility (Dupré &

Sinclair, 2021). Thus, the more that users feel positive

and experience intense emotions, the greater the

probability that they will use the technology again

(Dupré & Sinclair, 2021).

Considering the discussed cognitive aspects of

user design, this information is imperative to use as a

foundation in creating conceptual models of UI

design.

5 CONCEPTUAL MODELS

Conceptual models in interaction design serve as a

useful communicative tool for both designers and end

users. This modeling tool is an interconnecting piece

that enables UI practitioners and researchers to

communicate and connect with end users via a

framework they can process. A framework that is

effective at taking account of the nature of the

technology as well as the social context of use is

essential (Wolff-Piggott et al., 2018). In addition, a

sociotechnical approach asserts that an understanding

of existing ways of working is important – this

implies that the actual conditions under which work

is carried out (Wolff-Piggott et al., 2018).

Figure 6 illustrates a high-level conceptual model

for a future telehealth/mHealth prototype, intended to

be used in subsequent usability testing related to this

study. The model is intended to use a range of

graphical representations built upon external

cognition as they relate to system functionality, with

the aim of creating a more intuitive user interface for

the aging population. Applying cognitive theories can

significantly reduce overload when approaching

technology advances, particularly within

demographics with respective dissonance. Therefore,

a more systematic approach is needed for evaluating

the merits of different kinds of graphical

representations, one that is theoretically-driven and

which accounts for the cognitive processing when

people interact with them (Scaife & Rogers, 1996).

Furthermore, the basis of the conceptual model

illustrated in figure 6 will be used to simulate real-

world interactions between patient and healthcare

personnel. For example, creating a parallel interface

aims to increase expectation management, ensuring

that system features and functionality are in

alignment with both internal user expectations and

their thought process in addition to external real-

world interactions. For example, using a pharmacy

illustration to represent medication management, one

can reasonably predict that a cognitive association of

actions such as: refilling prescriptions, monitoring

medications, reviewing prescriptions, etc., with an

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440

aim of mitigating ambiguity. Also, system-user

dialogue is also an important feature in collaboration

with incorporating external cognition into a UI that is

parallel to real-world scenarios. The value of this is to

focus our attention more on the cognitive processing

involved when interacting with graphical

representations, the properties of the internal and

external structures and the cognitive benefits of

different graphical representations (Scaife & Rogers,

1996).

Figure 6: Telehealth (mHealth) Conceptual Model.

6 DIGITAL INCLUSION

As technology is predominately growing amongst the

middle-to-high socioeconomic areas, accessibility

challenges still exist within the lower-class and rural

locations. Factors related to available resources

within the environment, must be considered to create

a conducive environment for ICT implementation and

use (Ratshidi et al., 2022). Therefore, UX

practitioners have the opportunity to combine more

theoretical and practical approaches to technology

adoption of telehealth applications via mHealth and

ICTs. Implementing mHealth technologies across

cultures, critically where medical resources are less

accessible, would be logical. Although this may be,

this is an opportunity to reduce the usability gaps to

create and forecast an optimal and positive user

experience for inclusivity and sustainability for all

users who are also not readily accepting to

technology.

7 KEY FINDINGS

Findings show that participants (n=30) were

antipathetic towards the idea of connecting with

healthcare professionals online and via computer

applications. The core of these feelings was due to

lack of sociocultural aspects being incorporated into

the design. One can conclude that as this generation

values in-person connections, UIs will need to mirror

a sense of connection that reflects the physical realm

as close as possible for patient-provider relationships.

In addition, it was found that users were able to

navigate through certain applications with little help,

identifying that technology adoption goes beyond

instructing how to use technology, but rather socio-

cultural aspects of embracing new non-traditional

concepts.

8 DISCUSSIONS

With attention to the aging population’s growth,

coupled with cognitive aspects, mHealth technology

should be designed using cognitive frameworks as its

basis during development phases, particularly

surrounding design aspects reflective of an invisible

computer. Most compelling evidence, participant

responses from the focus group in this study suggests

a hypothesis of current UI designs leave some users

feeling ambivalent. Older users are aware of the vast

growth of technology; so undoubtedly, they attempt

to grow and adapt to the change. Hundreds of

thousands of mHealth apps are available in the

marketplace; yet, few have been tested for UX, and

fewer still have been successfully integrated into

healthcare systems (Kirkscey, 2021). The systemic

development and UX evaluation of an mHealth app

for older adults developed in a case study conducted

by (Kirkscey, 2021) emphasize the need for

researchers to consider several stakeholders. The

healthcare system creates an interconnected web that

must integrate contextual awareness as an essential

element of the test plan (Kirkscey, 2021). Notably,

patients, physicians, and healthcare personnel in the

previously mentioned case study emphasizes the need

to consider the embodied contexts of the older adults

as they navigate the sociocultural and economic

features of using technology deployed from a

healthcare system (Kirkscey, 2021).

While there are existing studies that highlight the

development process of mHealth applications, there’s

limited research accentuating user requirements in

both UI development and UX evaluation from a

cognitive perspective. In existing user-centered

design approaches, the goal is to derive what the users

need to do and their objectives based on the gathered

context and then set a clear statement of user

requirements for the solution designs

(Nimmanterdwong et al., 2022). These requirements

Applying Cognitive and Cultural Frameworks to mHealth Application Design for Elderly Users

441

are often created along with other requirements of the

product such as the requirements of the system stating

that the system needs to be able to do a certain task

because it will help users accomplish their goals

(Nimmanterdwong et al., 2022). Currently, mHealth

applications tend to underscore system requirements

leaving a narrowed focus on achieving user needs on

a multitude of cognitive levels in conjunction with

contextual factors – point often overlooked. During

a case study represented by (Kirkscey, 2021) of a

mHealth app for older adults, it highlights

performative phenomenology assists in defining the

relationships and contextualizing the needs not only

of the patient but also of the caregivers, healthcare

providers, IT workers, and external stakeholders

involved in the process. This emphasizes the

importance of coupling multifaceted aspects of both

user and system requirements within UI design –

noting that one is no more important than the other

for optimal utilization. Through this process of

discovery, researchers may also expose and even shift

some power relationships by giving voice to patients

or research participants in different and more forceful

ways (Kirkscey, 2021). Giving user’s a voice early in

the design can have a significant impact on usability,

as it provides these users with a sense of ownership

tied to the application and UI development opposed

to forcibly adapting to what has been created for

them. Involving users early in the process proves vital

in crafting a health care technology that matches

actual older adult user needs, with elderly friendly

user interfaces (Nimmanterdwong et al., 2022).

9 CONCLUSION AND FUTURE

WORKS

Findings in this study aim to create future

development of mHealth UIs encompassing

traditional elements of healthcare by using cognitive

frameworks such as external cognitional and

emotional interaction, to a name a few, in creating a

parallel simulation of real-world interactions within

technology. Adapting face-to-face intervention and

its contents into a suitable mobile experience for

middle-aged and older patients is key

(Nimmanterdwong et al., 2022). For example,

simulating an UI that mirrors social interactions that

traditionally take place in-person may decrease the

dissonance that older users feel while engaging with

telemedicine., via virtual social agents. Human–

computer interaction applications increasingly deploy

intelligent agents to support the social aspects of the

interaction (Van Erp & Toet ,2015). Social agents

(either embodied or virtual) already employ vision

and audition to communicate social signals but

generally lack touch capabilities (Van Erp & Toet

,2015). Designing these applications while using an

iterative and user-centered design approach may

display an increasing adoption rate of mHealth. For

any interesting real-world domain of design, there

cannot be any global synthesis function that maps

requirements into a structure (Card, 2018). Design, as

all designers know, is not a simple top-down or

bottom-up process of synthesizing a design solution

from requirements; rather an open process, in the

sense that the design problem is constantly being

redefined (Card, 2018). It’s important to note that

mHealth applications were reintroduced in the plight

of a global pandemic, yet this paper serves as a basis

to continually redefine the UI of these applications

that go beyond patients simply reaching their

healthcare team, but rather creating a sense of

inclusiveness.

With the assistance of design processes derived

from Card’s work noted in “The psychology of

Human-Computer Interaction”, future work aims to

achieve a more inclusive mHealth design that

includes a multifaceted cognitive frameworks and

models. There’s limited research on creating

inclusive technology that encompasses such

cognitive aspects. It is expected that future UX

designers and researchers continue to investigate

inclusive UI design aspects that includes as many

users as possible. However, collecting data from

overlooked groups within technology assimilation

must be initiated if this gap intends to decrease. ICT

infrastructure plays a pivotal role in the elderly’s

healthcare (Fotoyi, 2021). As an agent of change, ICT

enables the provision of proactive, personalized

healthcare to the elderly living at home (Fotoyi,

2021). Stressing the importance of mHealth

applications via ICTs within the aging population will

continue to keep the goal of universal usability at the

forefront for UX designers and researchers.

9.1 Limitations

While this study was conducted with a small sample

size (n=30) for preliminary findings, these key

findings were able to identify important usability

concerns that are still not widely incorporated into

UX design. Participants in this study primarily

focused on elderly users in the United States in an

urban region. Further cross-cultural studies will need

to be conducted to determine a direct correlation

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between American elderly users compared to this

demographic in other regions.

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