Participants

We gathered data from two sources of participants. We include reflections on how the intervention has to be modified for remote training based on reflections from clinical psychologists and trainees who worked 25 older adults ranging in age from 60–104 years old. Age of 60 or over and self-referral were the only inclusion criteria for the remote intervention. Training was provided by clinical psychology doctoral students (KG, AK, and MF) and a pre-registered clinical psychologist (IP) supervised by a registered clinical psychologist (MEO). Participants who took part in the groups and wanted training contacted our group through our study website (www.supportoa.ca).

Of the 25 older adults who received the training, 16 (we did not ask for ages for this subset of older adults, and three had male voices) agreed to take part in a semi-structured interview. The reasons for missing interview data include the following: 1 passed away, 1 has Zoom training still in progress at the time of this analysis, 2 were impossible to reach (“no answer”), 2 were pending a callback, and 3 had not yet been contacted at the time of this analysis.

Procedure

Following receipt of ethics approval from the respective University Research Ethics Board we contacted participants who had taken part in the socialization interventions and received phone training. We collected minimal demographic data as this development and refinement work was based on generating an initial understanding of the intervention; future scaling work will include more comprehensive demographic data (for example, on SES and comorbidity). Participants were contacted by a research assistant who inquired about their interest in taking part in an interview. We used the consolidated framework for implementation research (CFIR; Damschroder et al., 2009) to understand the training intervention given its focus on facilitators and barriers to implementation. The CFIR is a comprehensive framework for research implementation, drawing from over 19 theories and models and organized into five domains based on context (intervention, outer setting, inner setting, individual, and process). CFIR was an ideal model for this study given the focus on identifying potential factors (i.e., barriers and facilitators) believed to influence and impact implementation. Using CFIR as a guiding framework focussing on barriers and facilitators related to the intervention based on exterior factors (e.g., lack of access), individual factors (e.g., fear of use), and factors related to the intervention itself (e.g., nature of how intervention was delivered), we used a descriptive qualitative approach (Sofaer, 1999) to collect data from both trainers and participants to understand barriers and facilitators to participation and facilitation. Simultaneously, these methods embrace a participatory community-engaged research approach by working with the community organization to design and develop interventions that meet the needs of their participants (Israel, Eng, Schulz, & Parker, 2012).

Interviews were guided by question prompts with questions related to facilitators and barriers and transcribed verbatim. Two authors (MEO, KH) engaged in the data analysis and used a descriptive thematic analysis approach (Braun, Clarke, Hayfield, & Terry, 2019) with the intention of understanding the patterns and meanings in the data, as described by participants. MEO developed an initial framework which was further revised by KH and subsequently presented to the remaining authorship for revision. We adhered to the principles of rigor in qualitative research as described by Thorne (2016).

Evaluation of remote training intervention

For the subsample of older adults who participated in the evaluation of the training, their responses to the technology training were overwhelmingly positive (although 100% reported positive evaluations, some of these included some external and personal factors that limited their comfort with technology regardless of the training), and we acknowledge it is likely that those who agreed to participate in the evaluation were participants who were more likely to have had a positive experience. All participants wanted help with using the videoconferencing platform of Zoom because this was the platform used by the local community-based organizations, but some were also requesting help using Google Meet and other well-known applications. We grouped the themes from our analysis into barriers and facilitators and describe each of these themes supported by exemplar quotes below.

Intervention adaptations for remote delivery based on trainer reflections

Training began with a brief technology assessment including identifying the ICT infrastructure each older adult had and their prior experience with said infrastructure. Next, we sought to understand their goals for ICT use; for many this was to use Zoom to connect to the community-based organization events (some that preceded our involvement and some that we jointly held). This technology assessment, which occurred over the telephone, was key to the individualized nature of the intervention. Each older adult was provided a different intervention based on their individual needs. Training typically took place over two to three sessions after the initial assessment meeting, each approximately an hour in length. For an older adult who wanted more training, we used cognitive rehabilitation spaced retrieval over 9 sessions to increase their competency for hosting and setting Zoom meetings with friends and family. We had no attrition for the training sessions, but we had one older adult who stated they only needed two sessions of training (they declined further training, but they called back a week later to state that they did indeed need more training to feel competent using the technology

The remote method of training, which began with phone-only contact, necessitated different approaches than would be required in-person. We found that we needed to be very explicit about all steps of procedures, including requiring people to be explicit in describing all steps in their technology interaction, including where they placed their technology. For example, early in the training sessions, we had an incident where an older adult who had purchased a new tablet was placing it in a stand which was pushing on the power button and inadvertently turning the technology off. Task lists involved breaking down each task into the composite steps (e.g., open a web browser, etc.). An example task list is included in the Appendix. When possible, we e-mailed a task list to each older adult to help facilitate the training; regardless of whether the task list was able to be e-mailed and referred to in session, task lists and their creation helped guide each trainer to focus on each small step required in the interaction with ICT and to avoid making assumptions (e.g., asking them to open an e-mail app – when an older adult did not know what an app was).

Telephone training with older adults whose hearing loss was moderate or severe was very challenging, and we found use of videoconferencing helped with communication in the cases of hearing loss due to the ability of visual mouth cues to augment auditory information. We encountered insurmountable barriers with training in use of technology to virtually connect an older adult who reported moderate to severe dual sensory loss. This older adult resided in a communal residence with restricted visitation, so we could not devise a method to physically support her use of the device; consequently, we timed our appointment for training with a scheduled home care visit and engaged with the home care worker, which was moderately successful for a one-time event – joining a virtual music concert. A frequent challenge was the need to install apps on smartphones and tablets, which required the older adult user to know their Apple/Google ID username and password. For some older adults, accessing this information was a barrier to engagement and for others this required additional time to source this information from family members who likely created these accounts on behalf of the older adults.

Peripheral technology sometimes could be needed to increase some older adults’ level of engagement with new technology. For example, a touch-screen interface could be a barrier. At least one person (a tablet user) was comfortable tapping requisite icons and symbols but found using the on-screen keyboard to be discomforting. The individual volunteered with multiple groups, all of whom used Zoom for meetings. Problematically, the platform’s chat function was used frequently by meeting participants; learning to use this function was an important goal for the older adult, but the touch-screen keyboard was perceived as an insurmountable barrier. Consequently, the use of a Bluetooth keyboard proved to be essential to the successful delivery of training. Other examples of peripheral use, hypothetically, would be the use of headphones to facilitate hearing, or using the same to decrease environmental distractors that would otherwise impede training and concentration.

There were also challenges when engaging with older adults using different technologies to that of the trainers. For instance, when assisting with Zoom setup, the layout of the digital environment (e.g., virtual button location) was subject to some variation depending on the computer operating system; this was also an issue based on different types of phones. These unknowns caused some instructional confusion, with the trainer needing to adjust in an ad-hoc manner. In response, a series of triage-type questions were often asked by the trainer before beginning training in an effort to bring both parties into alignment.

Furthermore, having some older adults manage two tasks on their device at once was a challenge. For example, some older adults would struggle if the trainer was phoning them on the same device they were hoping to learn Zoom on. This became another screening question and required some additional, clear instructions to help the older adult understand how to both talk and download an app on their device at the same time.

We also encountered some older adults who were reluctant to try new technology, saw it as an additional chore, and preferred telephone use only. Some participants were afraid they would not be capable of learning how to navigate such a foreign platform. Therefore, as a trainer, it was crucial to use encouragement, break the steps down into manageable chunks, and frequently check in with them to support and encourage them. In terms of fatigue, it varied with some participants, but it was important to check in with them regarding fatigue, validate the older adult’s experience, listen to their feedback, and work the training sessions around their needs and limits. We modified our virtual socialization options for older adults to include telephone-only by purchasing a toll-free line in Zoom, and anecdotally we had success engaging older adults who might have otherwise foregone socialization. This was also the only option for joining virtual community-based or socialization events for those who did not have the necessary ICT infrastructure. For these virtual socialization groups where a large number reported comfort with phone-only options, we have seen those who have the ICT infrastructure more likely to be willing to try the videoconferencing option after experiencing the value of videoconferencing for social connections vs telephone-only.

Limitations

Our evaluation of the technology training is limited in scope: we are missing information from older adults who self-taught to use technology and from older adults who cannot even conceive using technology in this way due to ICT access barriers. Our evaluation in a small sample was itself limited, with little information on background, previous exposure to technology, or attitudes toward technology. Our data are further limited by lack of contextual and demographic information for the older adults who participated in the technology training and the subsequent evaluation. We discuss the importance of this contextual information in our conclusions. Finally, a limitation of our data is lack of long-term follow-up, but we anecdotally refer to the lack of attrition combined with the lack of follow-up requests for help. It is also possible that the technology training and orientation to our training videos held on our website allowed those with the most fear or the least sense of competency to engage in self-training. One benefit to our brief evaluation, however, is the fact that this was completed post-technology training and can therefore be conceived of as a measure of the impact of the technology training for older adults’ daily functioning during the pandemic.

Conclusions

Foremost we demonstrated how training for older adults can facilitate usage of new technology in the era of increased perceived usefulness of new technology due to the COVID-19 pandemic. Our evaluation and clinical experiences are useful for understanding older adults’ views on use of technology for virtual connection to community and socialization, which is key to developing future interventions for subsequent waves of the current and future pandemics. Some of our learning is critical for future technology interventions with older adults – those who have the confidence and competence will self-learn, but those who have ICT access and lack confidence or competence benefit from brief individualized remote training. The most fearful older adults who seem to be a minority (AGEWELL, & STAR Institute, 2020), sometimes colloquially referred to as having “technophobia;” regardless reluctant older adults appear to benefit from tailored support to use to technology to increase a sense of competency and aid in familiarity with its use.

Finally, we are aware of numerous older adults without access to the ICT necessary for videoconferencing. Anecdotally we are seeing increasing numbers of older adults purchase new technology during the pandemic; data supported by a recent study who tracked technology use before and during the pandemic indicate a notable increase in technology use by older adults (AGEWELL, & STAR Institute, 2020). Those without the ICT infrastructure remain vulnerable due to lack of virtual connections, for example, older adults residing in rural and remote locations without broadband Internet or with unreliable cellular data access (O’Connell et al., 2018) as well as those without the financial resources to pay out of pocket for new technology (Yoon et al., 2020). Disparities that have been exacerbated by the pandemic include the use of virtual methods for healthcare (Zhai, 2020) and for access to community and socialization (Gorenko et al., 2020). Pandemic financial supports should include access to technology for those without the means to pay for this necessary technology themselves. The current pandemic highlighted the usefulness of technology for community connections and to maintain socialization, and our learning from this work details how critical exposure to technology is for a sense of competency and independent use of technology. Future work to integrate technology across sociodemographic divides, with a focus on supporting older adults is needed.