Journal of Biosciences and Medicines, 2014, 2, 1-4
Published Online August 2014 in SciRes. http://www.scirp.org/journal/jbm
http://dx.doi.org/10.4236/jbm.2014.26001
How to cite this paper: Chen, M.-J. (2014) Case Report: Retirees’ Acceptance and Perceived Contribution of Smartphone in
Chronic Disease Management. Journal of Biosciences and Medicines, 2, 1-4. http://dx.doi.org/10.4236/jbm.2014.26001
Case Report: Retirees’ Acceptance and
Perceived Contribution of Smartphone in
Chronic Disease Management
Mei-Ju Chen
Department of Prevention Medicine, Taipei City Hospital, Department of Family Medicine, Heping Fuyou
Branch of Taipei City Hospital, College of Healthcare Administration and Management,
National Taipei University of Nursing and Health Science
Received April 2014
Abstract
Objectives: As smartphones become more popular, so do their applications. However, expecta-
tions of the elderly regarding the contribution of smartphone in controlling chronic diseases re-
main unclear. This research aims to understand senior retirees’ smartphone acceptance, per-
ceived contribution of smartphone application in facilitating chronic disease control and their as-
sociation. Findings from the study provide insights for the development of mobile applications in
chronic disease man agem ent. Methods: convenience sampling was conducted to recruit 110 se-
nior retirees who worked as volunteers in a regional hospital in Taipei. Data was collected
through a structured questionnaire. Descriptive, chi-square and logistic regression statistics were
applied to analyze data. Results: A total of 108 completed questionnaires were collected with a
return rate of 98.2%. Mean age was 65.34 ± 9.59 years old. Of all respondents, 40.7% reported ac-
ceptance of internet-enabled smartphones and 54.6% expected that smartphones would facilitate
chronic disease management in the future. However, a statistically significant 37.3% of those ex-
pecting smartphone to play a role in disease management did not accept smartphones yet. After
controlling for age and education, logistic regression analysis showed that older adults with high-
er smartphone acceptance were more likely to expect use of smartphone in case management (OR
= 7.439, p < 0.001) . Conclusions: The research presented a scope for smartphone application to
control chronic disease in the future. Despite a relatively lower level of smartphone acceptance,
the elderly still expected a positive role for mobile appliances to play in chronic disease manage-
ment.
Keywords
Smartph o ne, Elderly, Chronic Disease Management
1. Introduction
Growing numbers of older adults are accompanied with increasing consumption capacity and influence of the

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elderly population. A notable example is higher use of mobile phones. Technological advances also changed the
way senior home care is delivered. However, product development and marketing still neglects the need of the
elderly, which is different from that of the young generation. Research showed that the elderly were interested in
mobile phone use and applications when such services contributed to a more social, active, meaningful and in-
dependent life [1].
Research observed that many elderly Americans started to use mobile phones despite various limitations and
chall e nge s [2]. Differences existed between older and younger elderly with regards to the motivation for mobile
phone use. An exploratory factor analysis identified usefulness and security as two underlying and correlated
determinants. Specifically, education, ease of use, usefulness, security and short/long-distance travel frequency
were significantly important predictors [3]. A study on digital engagement of elderly people pointed out that
mobile phones were mostly used to stay connected with family members and friends.
In some parts of the world, many elderly people are at risk due to geographic and social isolation in combina-
tion with certain chronic conditions. Information and communications technology (ICT) has brought new di-
mensions to the delivery of healthcare. For example, targeting patients with chronic illness, some project has
developed services interconnecting mobile platforms and computers [4].
A revolutionary mobile health model has evolved from conventional mode of telemedicine, thanks to the la-
test advancement of smartphone technology. It allows users to access fast, pervasive, cheap and powerful mobile
platforms at one end, and enables health systems to deliver services and information at the other, making a mo-
bile healthcare network possible [5]. The new mode of mobile health has become a high potential solution to
address issues from skyrocketing cost, malpractice, manpower shortage, resource constraints, demand for quali-
ty, to physician-patient communication [6].
This research aims to understand senior retirees’ smartphone acceptance, perceived contribution of smart-
phone application in facilitating chronic disease control and their association.
2. Methods
This cross-sectional research adopted convenience sampling method. It recruited 110 senior retirees who worked
as volunteers in a regional hospital in Taipei. The questionnaire obtained personal data including sex, age and
education, whether respondents accepted internet-enabled smartphones and whether they agreed future internet-
enabled smartphones could facilitate chronic disease management. A 5-point Likert scale was used to measure
the extent to which a respondent agreed with the two statements, with 5 representing strong agreement (accep-
tance) and 1 representing strong disagreement (non-acceptance). The Cronbach’s α for the scale was 0.72. De-
scriptive, chi-square and logistic regression statistics were applied to analyze data.
3. Results
Totally 108 questionnaires were completed with a return rate of 98.2%. The majority of volunteers in the hospit-
al were female (more than 90%). The mean age of the sample was 65.34 ± 9.59 years old. Overall, 40.7% re-
ported acceptance of internet-enabled smartphones and 54.6% expected that smartphones would facilitate
chronic disease management in the future. As shown in Table 1, among those with higher acceptance of inter-
net-enabled smartphones 45.5% were high school graduates, 38.6% were college graduates, 50.0% were below
60 years of age, 43.2% between 60 - 70, and 58.1% had chronic diseases. Of those who agreed that inter ne t -
enabled smartphones could facilitate chronic disease management, 44.1% were high school graduates, 35.6%
college graduates, 49.2% between 60 - 70, and 59.6% with chronic conditions. However, a statistically signifi-
cant 37.3% (p < 0.001) of those expecting smartphone to play a role in disease management did not accept
smartphones yet. In Table 2, after controlling for age and education, logistic regression analysis found that older
adults with higher smartphone acceptance were more likely to expect future application of smartphone in case
management (OR = 7.439, p < 0.001).
4. Discussion
Narula (1988) [7] noted that implementation of communication technology had a profound impact on culture
and the way people interacted with each other in a society. New technology first affected an individual’s state of

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Table 1. Demographic characteristics.
Smartphones can facilitate
chronic disease management (N = 108)
Smartphone acceptance (N = 108)
Unlikely
(N) %
Likely (N)
% p Unlikely
(N) % Likely (N) % p
Educatio n 0.009 0.011
Primary school 9 18.80 % 5 8.50% 12 19.00% 2 4.50%
Junior high 15 31.30% 7 11.90% 17 27.00% 5 11.40%
Senior high 10 20.80% 26 44.10% 16 25.40% 20 45.50%
College and above 14 29. 20% 21 35.60% 18 28.60% 17 38.60%
Sex N.P. N.P.
Male 5 10.20 % 4 6.80% 5 7.80% 4 9.10%
Female 44 89.80% 55 93.20% 59 92.20% 40 90.90%
Age (65.34 ± 9.59) 0.005 0.000
<60 12 24.5% 23 39.0% 13 20.3% 22 50.0%
60 - 70 17 34.7% 29 49.2% 27 42.2% 19 43.2%
70 - 80 15 30.6% 4 6.8% 18 28.1% 1 2.3%
>80 5 10.2% 3 5.1% 6 9.4% 2 4.5%
Chronic disease N.P. N.P.
No 20 43.50% 23 40.40% 25 41.70% 18 41.90%
Yes 26 56.50% 34 59.60% 35 58.30% 25 58.10%
Mobile phone acceptance
Unlikely 42 85.7% 22 37.3% 0.000
Likely 7 14.3% 37 62.7%
Note: *p < 0.05, **p < 0.01, ***p < 0.001.
Table 2. Logistic regression analysis.
OR 95% CI
Lowe r Upper
Smartphone
acceptance 7.439 *** 2.707 20.442
Note: Controlling for age and education. Low level of mobile phone acceptance as reference group. *p < 0.05, **p < 0.01, ***p < 0.001.
mind, then the way of thinking and acting, and gradually the sense and perception of human beings (Sprague
and Ruud, 1998) [8]. Chang (1999) [9] held that mobile phones, more than just a tool of communication, high-
lighted the meaning of interpersonal relationships and connectedness, which was highly valued in Chinese cul-
ture. Local research found that the elderly adopted mobile phones for easy communication [10]. In this research,
40.7% of the elderly respondents reported acceptance of internet-enabled smartphones. There was no significant
association between having chronic diseases and expecting future mobile phones to facilitate chronic disease
control. Consistent with existing research findings [2], those with better education reported higher level accep-
tance of smartphones.
In the research respondents aged below 60 years showed higher acceptance of internet-enab led smartphones,
but those between 60 and 70 years constituted the majority expecting smartphones to facilitate disease manage-
ment. Other researchers held the view that the elderly generally showed positive attitudes towards the collection

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of health monitoring information, recognizing the utility of these data sources. Some seniors also mentioned in-
creased social interactions generated in the community setting [11]. However, in the current study 37.3% of the
elderly did not accept smartphones despite their expectations for the possible contribution of future smartphones.
Elderly people are usually favorable towards issues they are aware of. On the other hand when facing novelty
or unfamiliar issues they demonstrate lessened confidence, memory, reasoning, judgment and even eye-hand co-
ordination due to physical and psychological ageing. A new motion or operation without previous knowledge
will create difficulties. As a result, their ability of information processing, logical thinking or postural and spatial
coordination deteriorates. This tendency becomes evident when they operate new products. The elderly tend to
lose confidence in using new gadgets when they have less control of the devices [12].
Nowadays smartphones perform multiple tasks, but the elderly people prefer that mobile phones as simple as
possible because most of them only use phones to make and receive calls. In this sense, mobile phones can be
designed to meet the expectations of this particular group. Most seniors are now aware that they can change
phones to solve usage barriers such as small display or buttons, but from accepting smartphones to seeing them
as a tool to manage disease is an area little studied. The context of the elderly mobile phone users is worth re-
search because it will provide insights in the development of an everyday high-tech, elderly-friendly product.
5. Discussion
The research found that the elderly with higher acceptance of smartphones were more likely to expect smart-
phones to facilitate chronic disease management. While more and more elderly people possess mobile phones,
the extent to which mobile phones integrate into daily life differs. The research presented a scope for future
smartphone application in chronic disease control. Despite a relatively lower level of smartphone acceptance,
the elderly still expected a positive role for mobile appliances to play in chronic disease management. We sug-
gest that future design of mobile phones be informed by the lifestyle and needs of users. We also suggest that
new strategy be adopted to make health management an integral part of overall need assessment.
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