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.
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
Proceedings Copyright © 2024 by SCITEPRESS Science and Technology Publications, Lda.
opportunities that provide representation to the aging
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
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
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
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
HUCAPP 2024 - 8th International Conference on Human Computer Interaction Theory and Applications
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.
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.,
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
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
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.
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,
Metaphors aren’t particularly about language, but
rather about thoughtin 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
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.
HUCAPP 2024 - 8th International Conference on Human Computer Interaction Theory and Applications
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
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
Externalizing to reduce memory load
Applying Cognitive and Cultural Frameworks to mHealth Application Design for Elderly Users
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.,
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
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
HUCAPP 2024 - 8th International Conference on Human Computer Interaction Theory and Applications
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,
Figure 6: Telehealth (mHealth) Conceptual Model.
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
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
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
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).
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
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
HUCAPP 2024 - 8th International Conference on Human Computer Interaction Theory and Applications
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Applying Cognitive and Cultural Frameworks to mHealth Application Design for Elderly Users