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Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities: Conceptual Framework

Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities:... Background: The COVID-19 pandemic caused widespread societal disruption, with governmental stay-at-home orders resulting in people connecting more via technology rather than in person. This shift had major impacts on older adult residents staying in retirement homes and residential care facilities, where they may lack the technology literacy needed to stay connected. The enTECH Computer Club from the University of Waterloo in Ontario, Canada created a knowledge translation toolkit to support organizations interested in starting technology literacy programs (TLPs) by providing guidance and practical tips. Objective: This paper aimed to present a framework for implementing TLPs in retirement homes and residential care facilities through expanding on the knowledge translation toolkit and the framework for person-centered care. Methods: Major concepts relating to the creation of a TLP in retirement homes and residential care facilities were extracted from the enTECH knowledge translation toolkit. The domains from the framework for person-centered care were modified to fit a TLP context. The concepts identified from the toolkit were sorted into the three framework categories: “structure,” “process,” and “outcome.” Information from the knowledge translation toolkit were extracted into the three categories and synthesized to form foundational principles and potential actions. Results: All 13 domains from the framework for person-centered care were redefined to shift the focus on TLP implementation, with 7 domains under “structure,” 4 domains under “process,” and 2 domains under “outcome.” Domains in the “structure” category focus on developing an organizational infrastructure to deliver a successful TLP; 10 foundational principles and 25 potential actions were identified for this category. Domains in the “process” category focus on outlining procedures taken by stakeholders involved to ensure a smooth transition from conceptualization into action; 12 foundational principles and 9 potential actions were identified for this category. Domains in the “outcome” category focus on evaluating the TLP to consider making any improvements to better serve the needs of older adults and staff; 6 foundational principles and 6 potential actions were identified for this category. Conclusions: Several domains and their foundational principles and potential actions from the TLP framework were found to be consistent with existing literatures that encourage taking active steps to increase technology literacy in older adults. Although there may be some limitations to the components of the framework with the current state of the pandemic, starting TLPs in the https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 1 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al community can yield positive outcomes that will be beneficial to both older adult participants and the organization in the long term. (JMIR Aging 2022;5(3):e34997) doi: 10.2196/34997 KEYWORDS older adult; technology; retirement home; long-term care; social connections; technology literacy program; retirement; elderly; literacy; implementation; concept; framework; knowledge translation members have also developed a knowledge translation toolkit Introduction in consultation with the University of Waterloo faculty [15]. The toolkit serves as a starting point for LTC homes to Older adults’ ability to stay socially connected has become more implement technology programming, consolidating much of challenging as a result of the COVID-19 global pandemic. The the club’s work. World Health Organization and public health agencies in North America have advised all individuals to follow physical The purpose of this paper is to describe a framework to guide distancing measures and limit gatherings to minimize the implementation of technology programming in residential transmission of COVID-19 [1-3]. Older adults (individuals who care facilities and retirement home settings, using the framework are 65 years of age or older) are identified as a group at greater for person-centered care by Santana et al [16] as a template. To risk for severe illness from COVID-19, compared to the general complement the toolkit by Nagallo et al [15], we aimed to public [4]. Throughout the course of the pandemic, long-term develop a comprehensive framework with which a technology care (LTC) visitor restrictions have been implemented to protect program can be started. Additionally, we wish to frame the the health of residents and staff members in these settings. development and rollout of a technology literacy program (TLP) Although it is important to limit the spread of COVID-19, these as being fundamentally person focused, leading to the selection measures have disrupted the normal social routines of older of the framework for person-centered care. Through consultation adults, which may increase the risk of anxiety, depression, with the enTECH team, the TLP framework maps the knowledge cognitive dysfunction, heart disease, and overall mortality [5,6]. translation toolkit onto the framework for person-centered care, Throughout the pandemic, the World Health Organization and in which it provides foundational principles and potential actions public health agencies have encouraged individuals to maintain to guide the framework’s implementation. The implementation social connections through digital alternatives, using phones, of technology literacy programming through this framework computers, tablets, and other electronic devices, but little support aims to encourage older adults to use technology and to create is available to assist those who need help using technology for opportunities for fostering social connections and maintaining these purposes. healthy aging. Previous research has identified that older adults are often Methods interested in using technology for recreation, but feelings of apprehension and difficulty in accessing and using technology Framework Model Exploration limit its uptake by older adults [7-9]. Existing literature suggests A search using Google Scholar was conducted during June 2020 that active steps should be taken to educate and support older to search for existing frameworks involving or implementing adults in their engagement with technology to help them build change in health care contexts, particularly with the use of and maintain social connections with their family, friends, and technology. The framework for person-centered care by Santana the wider community [9-12]. Implementing teaching and et al [16] (Figure 1) was identified as having general education opportunities by volunteer organizations, for instance, person-centered domains that could be consistent with a TLP that involve peer-to-peer learning and intergenerational program for older adults, the residential care facility, and its relationships to help older adults adopt technology are staff. The framework for person-centered care is itself based on recommended [5,9,13]. the Donabedian Model [17] for the assessment of quality of Although technology adoption in LTC settings increased during care, which divides assessment into “structure,” “process,” and the pandemic, ensuring continued access to technology and “outcome” components. The framework for person-centered technology education can maintain and increase its uptake by care was selected over other frameworks, such as those older adults [8]. In many regions, community organizations applicable to adult education (eg, Kirkpatrick model [18]) or provide technology education and assistance to older adults at implementation (eg, RE-AIM [19,20]), due to a focus on a low cost or for free, such as the enTECH Computer Club, implementation, person-centeredness, and provider-patient based out of the University of Waterloo in Waterloo, Ontario, partnership [16]. The framework for person-centered care Canada. Before the pandemic, enTECH volunteers worked with contains 13 domains split between 3 themes that serve as residents of local LTC homes and supported older adults foundational pillars to implement person-centered care in a reaching their technology goals [13,14]. To facilitate the health care environment [16]. expansion of club activities to other locations, enTECH club https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 2 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Figure 1. Framework for person-centered care (PCC) by Santana et al [16]. PRO: patient-reported outcomes. ideal steps to be taken to implement a successful TLP. Potential Domain Mapping actions are defined as action items to help with a particular The lead author of the knowledge translation toolkit (NN) domain, but they are not completely mandatory for a TLP to be modified the 13 domains from the framework for implemented. Author KL identified and extracted every major person-centered care to reflect the requirements of starting a concept from enTECH’s knowledge translation toolkit, focusing TLP in a LTC setting. The language in framework for on TLP; these concepts were organized under the 13 TLP person-centered care by Santana et al [16] was adapted to focus domains. Authors NN, CW, and KL performed a final check of on technology literacy programming, incorporating program the domains and associated concepts on the Miro whiteboard. implementation, technology education, quality assurance, and The resulting Miro whiteboard is shown in Multimedia stakeholder relations [16]. To identify relevant foundational Appendix 1. Authors KL, NN, EM, and CW finalized the principles and potential actions for TLPs, the 13 domains for categorization of the concepts into either foundational principles the TLP implementation framework were inserted into a Miro or potential actions for each domain. This process is detailed whiteboard (RealtimeBoard, Inc), a cloud-based collaborative in Figure 2. whiteboard software. Foundational principles are defined as https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 3 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Figure 2. Process of developing the technology literacy program implementation framework. were placed under “structure,” 4 domains were placed under Results “process,” and 2 domains were placed under “outcome.” To build this framework, domains were used to guide discussion Framework Overview about foundational principles and potential actions. The 3 main Similar to the framework for person-centered care [16], the TLP categories and their domains are organized in the order that they implementation framework uses the 3 main categories of should be executed during the implementation process. The “structure,” “process,” and “outcome” to sort the 13 domains final TLP framework model is shown in Figure 3. needed to implement a TLP. Under these 3 categories, 7 domains https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 4 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Figure 3. Technology literacy program (TLP) framework. financials, human resources, and organizational structure of the Domains Overview place where care occurs. The framework for person-centered The TLP framework consists of 3 main categories that are care also uses this definition to build their domains for this essential to designate the domains and components of the category [16]. As shown in Table 1, the “structure” category framework; these 3 categories are “structure,” “process,” and for TLP implementation focuses on developing organizational “outcome.” The domains and components under each category infrastructure to deliver a successful TLP. This category also are detailed in Tables 1-3. includes strategies on how various resources may be used to serve as the foundation of TLP implementation. Structure (S1-S7) According to Donabedian [17], “structure” defines the attributes of the setting in which care takes place. It describes the facilities, https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 5 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Table 1. Structure domains and components of the technology literacy program (TLP) framework. Structure domains Foundational principles Potential actions S1: Create a Remove barriers to accessing technology for older adults Ensure that there is easy access to the internet, preferably • • • tech-friendly Ensure staff buy-in wireless internet (ie, Wi-Fi) culture Create support structures if older adults have questions Encourage family member buy-in and technology provision S2: Create Define a clear goal for the program Focus on technology that allows for connection between • • • clear-cut goals older adults and family for the TLP Break technology instructions into smaller steps building to larger goals Consult existing resources to help start the program S3: Outline the Demonstrate the ability for tech to reduce isolation and Show how technology can be used to achieve older adults’ • • • benefits of im- loneliness goals and interests plementing Emphasize that learning can happen at any age Encourage word-of-mouth advertisement of the program • • technology for between older adults older adults Expand to include other easy-to-access services (eg, Wikipedia and YouTube) S4: Provide re- Ensure robust onboarding and training Encourage open communication between instructors and • • • sources for ac- administrators tive TLP volun- Ensure that the program’s schedule meets the needs of teers and long- older adults and instructors term care Recruit community volunteers to reduce staff workload homes staff burden members Create clear policies around how technology issues are resolved Designate a single point of contact to manage educational tools and documents S5: Curate an Reduce paperwork burden on instructors, understanding Have resources that can be easily accessed by instructors, • • • effective and that some documentation might be needed including printouts impactful tech- Ensure that technology is user-friendly and accounts for Advertise the benefits of technology to older adults via • • friendly envi- differences in strengths between individuals posters and town halls ronment Consider a buddy or group system where older adults can be taught the same content together Listen to and act on what older adults themselves indicate they want to learn or achieve S6: Offer sup- Stress that the requirements to become an instructor are Ensure instructors have basic tech literacy skills to help • • • port to instruc- low: only basic technology literacy with common soft- older adults tors before ware (ie, email and YouTube) is needed Create a straightforward onboarding process working with Host practice sessions with instructors (eg, on ethical sce- older adults narios and common technology problems) Use a web-based platform (eg, Slack and Microsoft Teams) where instructors can easily communicate, while maintain- ing confidentiality S7: Explore the Schedule sessions at practical times and create opportu- Create a knowledge base that older adults can access if • • • availability of nities for learning and follow-up if questions arise when there are no instructors available or for self-study (eg, an instructors and there is no instructor available easy-to-access website or binder) provide “after- Reevaluate instructor availability frequently hours” program- Ensure older adults can anonymously leave feedback about ming programming (eg, an anonymous comment box) resemble the action items to begin and maintain a TLP in LTC Process (P1-P4) homes in the “process” category of TLP implementation. As The “process” category used in the framework for depicted in Table 2, the domains in the “process” category person-centered care includes the processes to deliver outline procedures undertaken by stakeholders involved (eg, person-centered care [16]. Specifically, it describes strategies volunteers, club executives, resident facility staff, and older that can be used by health care practitioners to ensure adults) to ensure a smooth transition from conceptualization person-centered care is being provided [16]. These steps closely into action. https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 6 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Table 2. Process domains and components of the technology literacy program (TLP) framework. Process domains Foundational principles Potential actions P1: Establish intergenerational There is no set number of instructors needed to help Encourage older adults to write any ques- • • • partnerships to help technology lit- set up a successful TLP tions they have in between teaching ses- eracy in older adults sions Instruction can be in person, digital, or over video chat or phone Network with other community groups to identify potential volunteers P2: Practice patience and compas- Encourage older adults to protect their personal in- Repetition and practice are key to support • • • sion throughout the TLP formation, including financial information learning and are sometimes overlooked Encourage instructors to use their judgement and limit their support to their comfort level Ensure that instruction allows older adults to learn at their own pace Instructors can develop or improve their teaching, leadership, and communication skills P3: Use interactive teaching and Programs can be one-on-one, in small groups, or Limit session to 1.5- to 2-hour blocks to • • • learning techniques lecture based, depending on older adults and instruc- minimize participant and instructor fatigue tor’s comfort and knowledge as well as room capac- Have diverse learning resources available ity limitations for older adults and instructors Facilitation must be sensitive to the needs of older adults, including vision, hearing, and mobility chal- lenges Encourage instructors to adapt to different learning styles to assist older adults as best as possible Remember that layperson terms for instructors may not be layperson terms for older adults P4: Create partnerships with stake- Identify what existing TLPs do in other settings to Advertise this opportunity broadly; pre- • • • holders to provide effective TLPs develop curriculum and foster participant engage- health professional students may be partic- for older adults ment ularly interested in participating in it Identify existing local supports for commu- Be open to the potential for collaborating with exist- nity programs, including organizations that ing organizations that provide digital services may provide technology at a discounted price Reach out to long-term care or retirement home stakeholders and the community at large to see if any organizations are looking to liquidate older technology Designate one representative from your organization to liaise with other stakehold- ers for the purposes of acquiring technology donations and recruiting instructors improvement to better serve patients [16]. Table 3 reflects how Outcome (O1-O2) TLP implementation shares similar attributes with the “outcome” In the framework for person-centered care, the “outcome” category, as it focuses on how TLPs can benefit older adults category describes the effects of person-centered care on patients even with diminished volunteer capacity, and how quality [16]. It also describes performance indicators of person-centered improvement can be used to adjust programming to better serve care in hopes of measuring such indicators to identify areas for the needs of the community. https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 7 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Table 3. Outcome domains and components of the technology literacy program framework. Outcome domains Foundational principles Potential actions O1: Perform check-ins with older adults Older adults’ progress on accomplishing goals Check in with older adults to see how they • • • to gain insight on progress and aid with can be tracked using a web-based spreadsheet feel about their progress quality improvement like Google Sheets A brief informal postsession feedback Focus on the person not the technology; tech- question is recommended, even a simple nology should always come second “did you like this session today?” Validated tools like the Single Ease Question [21] can be used to evaluate the difficulty of a task Questions or questionnaires to be filled out by older adults can be hosted via the internet, us- ing Google Forms, to encourage older adults to practice their tech skills O2: Create documentation to track educa- Consider curriculum and training documents Lesson plans can be used to teach content • • • tion progress as “living documents,” and iterate on them and can optionally be used by residents in based on feedback the absence of instructors Provide training documents to instructors A “best practices” guide can be used to struc- Platforms like Google Docs and Notion ture lessons more generally (Notion Labs Inc) can be used to organize documents and can be updated immediately Tracking students’ progress and interests can facilitate transition between different instructors potential actions of domain S7 were consistent with existing Discussion findings, including those suggesting a strong training preference for self-teaching through methods such as reading a printed Overview manual and learning through “trial and error” or “playing This paper outlines an implementation framework for TLPs in around” approach [22,26]. Although self-practicing after a lesson LTC and residential homes and with older adults. Building on can be beneficial, the TLP framework focuses on the value of a person-centered care framework, the TLP framework starts instructors to teach older adults and facilitate their learning in by outlining how the program should be structured to create a TLPs (domains S7 and O1). There is a focus on providing safe learning environment for older adults to learn to use resources for program leaders so that they can effectively technology. The framework also outlines processes that can be support older adults, as emphasized in domains S4 through S7. used to build confidence and competence among both older Process adult learners and instructors, including multigenerational pairings, focusing on web-based safety, and ample hands-on Domains P1 to P4 outline the means by which TLP should be learning opportunities. The framework concludes with 2 operated. This includes engaging older adult learners with staff domains under “outcome” that are focused on identifying the of TLP within retirement homes and residential care facilities benefits to older adults and opportunities for quality to lead to a person-centered programming. A study conducted improvement. during the COVID-19 pandemic suggested that LTC facilities should have dedicated staff to assist residents in using Structure information communication technologies that are already Domains S1 to S7 are aimed to create a safe learning provided by the facilities, such as tablet devices [27]. Therefore, environment for older adults to learn how to use technology. domain P1 has considered this by creating a group of instructors Having a positive initial experience supported by a to teach older adult learners and facilitate the TLP operations. well-established, friendly, and supportive learning environment Existing cognitive aging research has outlined recommendations can promote continual participation of the TLP and continual on techniques that instructors may find useful when teaching use of technology among older adults, and so domain S1 older adults to use computer software applications [28]. Many reinforces this [22]. Domain S3 concentrates on informing older of the “process” domains align with recommendations based adults of the benefits of implementing technology in their lives. on that research [28]. Additional research identified reasons for Beyond increasing technology literacy, existing research has older adults’ negative attitudes about technology use, which suggested that learning new skills and keeping an active mind were frequently associated with inconvenience with the may maintain cognition and mental health throughout life [23]. technology device, disliking the features of technology, and In addition, the “structure” category of the framework aims to security and reliability concerns [29]. Given these concerns, reduce the social isolation and loneliness that older adults may foundational principles from domain P2 emphasize the experience during the pandemic through delivering interactive importance of protecting personal and financial information. learning [24,25]. Many of the foundational principles and Social contact or other social interactions have been shown to https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 8 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al be the second most important motivator for older adult learners to support older adults through periods of intense isolation. to participate in learning activities [30]. Therefore, domains P2 Periods of visitor and volunteer service restrictions, such as and P3 aim to have older adults develop healthy interpersonal local or global disease outbreaks, can present challenges to the relationships with instructors to foster participant engagement. implementation of TLPs. For instance, older adults may have Another study that examined teaching modality themes used to ask LTC staff outside of TLP for help, and this may interfere by student mentors to help older adults learn technology with the techniques they learned with their usual TLP reinforces the foundational principles and the overall theme of instructors. Organizations implementing TLPs could consider domains P2 and P3 [22]. Finally, other research has suggested incorporating a group of on-site staff who can assist older adults social engagements may also maintain cognitive aging and during periods of visitor and volunteer service restrictions if lower mortality outcomes as much as physical activity, they see fit. Although these events cannot easily be anticipated depending on the level of social activity [31]. aside from typical seasonal patterns (ie, increased probability of influenza outbreaks in fall and winter months), ensuring TLP Outcome participants are sufficiently trained such that they can Domains O1 and O2 aim to evaluate the progress of the TLP accomplish basic communication tasks independently can foster and determine if it is meeting older adults’ goals to learn independence and reduce feelings of isolation. technology. Existing research has recognized the need for Furthermore, the authors’ experience of TLPs are based on technological training programs focused on older adults to implementing TLPs directly and assisting with situating them evaluate and analyze the effectiveness of teaching technology in existing retirement and LTC settings as an external to them [32]. To enhance the experience of TLP for staff and organization. The authors do not have experience implementing older adults, TLPs must determine the positive feedback and a TLP as an employee of a retirement home or LTC home. improvements that can be made. The insights received from EnTECH’s experience in TLP implementation is also limited following the foundational principles and potential actions of to Ontario, Canada. Thus, the generalizability of this TLP domain O2 allow for more research to be conducted to determine framework may be limited, as the structure of residential care the strengths and improvements needed for TLP. facilities and retirement homes outside of Ontario may differ Strengths and Applicability of the Framework from those in Ontario. Finally, despite the value of technology, the financial cost of the devices and additional equipment to Governments and health care systems have been encouraging run a TLP is a concern in both private and publicly funded people to remain engaged with their communities via the internet residential care facilities, and that is addressed in domain P4. during the COVID-19 pandemic [1-3]. The implementation of TLPs for older adults may help them overcome some of the Future Research known barriers to engage with technology. Increased technology Further research should be conducted to validate the utility of literacy, fostered through TLP, may also support older adults this framework in retirement homes and residential care in accessing health care digitally, an adoption of which has been facilities. This could include evaluating the success in accelerating in response to the pandemic [33,34]. implementing a TLP in retirement homes and residential care It has been suggested by findings of a recent study that using a facilities according to the insights on the progress and quality person-centered care approach to engage older adults with of the program gained from the check-ins with older adults technology is crucial in creating meaningful (domain O2). Additionally, there is an interest in exploring technology-mediated enrichment experiences for them [35]. whether older adults are able to independently apply the The TLP framework supports this approach as it aims to technology literacy skills they have developed or improved implement fundamentally person-focused TLPs, hence the from their TLP to achieve and expand on their technology use. framework for person-centered care was chosen as the template After the implementation of a TLP in retirement homes and [16]. By organizing the domains’ content into foundational residential care facilities, the publication of case studies aimed principles and potential actions, we hope that organizations can at both industry and academics is suggested to raise awareness identify parts of the framework that are readily applicable and of this framework for residential care employees and can be implemented with little difficulty, which can be beneficial stakeholders. during times of high visitor restrictions. For instance, during Conclusions visitor restrictions in LTC, organizations may begin with creating a knowledge base that older adults can access with Recognition in staying socially connected through technology minimal assistance if there are no instructors available, which has undoubtedly increased throughout the course of the is a potential action from domain S7. In addition, organizations COVID-19 pandemic. A framework for implementing TLPs can plan opportunities to expand their existing TLPs. Lastly, was developed to support retirement homes and residential care there is a focus on creating and externalizing partnerships to facilities that are interested in starting their own TLP to support run the program to reduce costs and foster new relationships older adults’ technology competence. The foundation of the with others in the community. framework was constructed from enTECH’s knowledge translation toolkit for implementing TLPs for older adults, and Limitations it was structurally organized by following the framework for Despite the benefits of implementing TLPs using this person-centered care by Santana et al [16]. Although framework, there are some drawbacks to consider. The modifications to the framework may be required depending on COVID-19 pandemic has highlighted how complex it can be https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 9 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al an organization’s needs, starting TLPs for older adults can have potential positive impacts on them in the long term. Acknowledgments Sincere thanks are extended to the enTECH Computer Club Spring 2020 executive team for assisting with the organization of extracted activities from enTECH’s knowledge translation toolkit under appropriate domains on the Miro whiteboard. This paper was funded by a Network for Aging Research Catalyst grant awarded to KB and KG. Conflicts of Interest None declared. Multimedia Appendix 1 Domains and their foundational principles of the technology literacy program framework on Miro whiteboard. [PDF File (Adobe PDF File), 724 KB-Multimedia Appendix 1] References 1. 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JMIR Aging 2022 Apr 12;5(2):e31162 [FREE Full text] [doi: 10.2196/31162] [Medline: 34975014] Abbreviations LTC: long-term care TLP: technology literacy program Edited by T Leung; submitted 19.11.21; peer-reviewed by S Bhattacharjya, K Colorafi; comments to author 14.03.22; revised version received 31.05.22; accepted 20.06.22; published 19.08.22 Please cite as: Li KS, Nagallo N, McDonald E, Whaley C, Grindrod K, Boluk K JMIR Aging 2022;5(3):e34997 URL: https://aging.jmir.org/2022/3/e34997 doi: 10.2196/34997 PMID: ©Karen S Li, Nathan Nagallo, Erica McDonald, Colin Whaley, Kelly Grindrod, Karla Boluk. Originally published in JMIR Aging (https://aging.jmir.org), 19.08.2022. 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Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities: Conceptual Framework

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Abstract

Background: The COVID-19 pandemic caused widespread societal disruption, with governmental stay-at-home orders resulting in people connecting more via technology rather than in person. This shift had major impacts on older adult residents staying in retirement homes and residential care facilities, where they may lack the technology literacy needed to stay connected. The enTECH Computer Club from the University of Waterloo in Ontario, Canada created a knowledge translation toolkit to support organizations interested in starting technology literacy programs (TLPs) by providing guidance and practical tips. Objective: This paper aimed to present a framework for implementing TLPs in retirement homes and residential care facilities through expanding on the knowledge translation toolkit and the framework for person-centered care. Methods: Major concepts relating to the creation of a TLP in retirement homes and residential care facilities were extracted from the enTECH knowledge translation toolkit. The domains from the framework for person-centered care were modified to fit a TLP context. The concepts identified from the toolkit were sorted into the three framework categories: “structure,” “process,” and “outcome.” Information from the knowledge translation toolkit were extracted into the three categories and synthesized to form foundational principles and potential actions. Results: All 13 domains from the framework for person-centered care were redefined to shift the focus on TLP implementation, with 7 domains under “structure,” 4 domains under “process,” and 2 domains under “outcome.” Domains in the “structure” category focus on developing an organizational infrastructure to deliver a successful TLP; 10 foundational principles and 25 potential actions were identified for this category. Domains in the “process” category focus on outlining procedures taken by stakeholders involved to ensure a smooth transition from conceptualization into action; 12 foundational principles and 9 potential actions were identified for this category. Domains in the “outcome” category focus on evaluating the TLP to consider making any improvements to better serve the needs of older adults and staff; 6 foundational principles and 6 potential actions were identified for this category. Conclusions: Several domains and their foundational principles and potential actions from the TLP framework were found to be consistent with existing literatures that encourage taking active steps to increase technology literacy in older adults. Although there may be some limitations to the components of the framework with the current state of the pandemic, starting TLPs in the https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 1 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al community can yield positive outcomes that will be beneficial to both older adult participants and the organization in the long term. (JMIR Aging 2022;5(3):e34997) doi: 10.2196/34997 KEYWORDS older adult; technology; retirement home; long-term care; social connections; technology literacy program; retirement; elderly; literacy; implementation; concept; framework; knowledge translation members have also developed a knowledge translation toolkit Introduction in consultation with the University of Waterloo faculty [15]. The toolkit serves as a starting point for LTC homes to Older adults’ ability to stay socially connected has become more implement technology programming, consolidating much of challenging as a result of the COVID-19 global pandemic. The the club’s work. World Health Organization and public health agencies in North America have advised all individuals to follow physical The purpose of this paper is to describe a framework to guide distancing measures and limit gatherings to minimize the implementation of technology programming in residential transmission of COVID-19 [1-3]. Older adults (individuals who care facilities and retirement home settings, using the framework are 65 years of age or older) are identified as a group at greater for person-centered care by Santana et al [16] as a template. To risk for severe illness from COVID-19, compared to the general complement the toolkit by Nagallo et al [15], we aimed to public [4]. Throughout the course of the pandemic, long-term develop a comprehensive framework with which a technology care (LTC) visitor restrictions have been implemented to protect program can be started. Additionally, we wish to frame the the health of residents and staff members in these settings. development and rollout of a technology literacy program (TLP) Although it is important to limit the spread of COVID-19, these as being fundamentally person focused, leading to the selection measures have disrupted the normal social routines of older of the framework for person-centered care. Through consultation adults, which may increase the risk of anxiety, depression, with the enTECH team, the TLP framework maps the knowledge cognitive dysfunction, heart disease, and overall mortality [5,6]. translation toolkit onto the framework for person-centered care, Throughout the pandemic, the World Health Organization and in which it provides foundational principles and potential actions public health agencies have encouraged individuals to maintain to guide the framework’s implementation. The implementation social connections through digital alternatives, using phones, of technology literacy programming through this framework computers, tablets, and other electronic devices, but little support aims to encourage older adults to use technology and to create is available to assist those who need help using technology for opportunities for fostering social connections and maintaining these purposes. healthy aging. Previous research has identified that older adults are often Methods interested in using technology for recreation, but feelings of apprehension and difficulty in accessing and using technology Framework Model Exploration limit its uptake by older adults [7-9]. Existing literature suggests A search using Google Scholar was conducted during June 2020 that active steps should be taken to educate and support older to search for existing frameworks involving or implementing adults in their engagement with technology to help them build change in health care contexts, particularly with the use of and maintain social connections with their family, friends, and technology. The framework for person-centered care by Santana the wider community [9-12]. Implementing teaching and et al [16] (Figure 1) was identified as having general education opportunities by volunteer organizations, for instance, person-centered domains that could be consistent with a TLP that involve peer-to-peer learning and intergenerational program for older adults, the residential care facility, and its relationships to help older adults adopt technology are staff. The framework for person-centered care is itself based on recommended [5,9,13]. the Donabedian Model [17] for the assessment of quality of Although technology adoption in LTC settings increased during care, which divides assessment into “structure,” “process,” and the pandemic, ensuring continued access to technology and “outcome” components. The framework for person-centered technology education can maintain and increase its uptake by care was selected over other frameworks, such as those older adults [8]. In many regions, community organizations applicable to adult education (eg, Kirkpatrick model [18]) or provide technology education and assistance to older adults at implementation (eg, RE-AIM [19,20]), due to a focus on a low cost or for free, such as the enTECH Computer Club, implementation, person-centeredness, and provider-patient based out of the University of Waterloo in Waterloo, Ontario, partnership [16]. The framework for person-centered care Canada. Before the pandemic, enTECH volunteers worked with contains 13 domains split between 3 themes that serve as residents of local LTC homes and supported older adults foundational pillars to implement person-centered care in a reaching their technology goals [13,14]. To facilitate the health care environment [16]. expansion of club activities to other locations, enTECH club https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 2 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Figure 1. Framework for person-centered care (PCC) by Santana et al [16]. PRO: patient-reported outcomes. ideal steps to be taken to implement a successful TLP. Potential Domain Mapping actions are defined as action items to help with a particular The lead author of the knowledge translation toolkit (NN) domain, but they are not completely mandatory for a TLP to be modified the 13 domains from the framework for implemented. Author KL identified and extracted every major person-centered care to reflect the requirements of starting a concept from enTECH’s knowledge translation toolkit, focusing TLP in a LTC setting. The language in framework for on TLP; these concepts were organized under the 13 TLP person-centered care by Santana et al [16] was adapted to focus domains. Authors NN, CW, and KL performed a final check of on technology literacy programming, incorporating program the domains and associated concepts on the Miro whiteboard. implementation, technology education, quality assurance, and The resulting Miro whiteboard is shown in Multimedia stakeholder relations [16]. To identify relevant foundational Appendix 1. Authors KL, NN, EM, and CW finalized the principles and potential actions for TLPs, the 13 domains for categorization of the concepts into either foundational principles the TLP implementation framework were inserted into a Miro or potential actions for each domain. This process is detailed whiteboard (RealtimeBoard, Inc), a cloud-based collaborative in Figure 2. whiteboard software. Foundational principles are defined as https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 3 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Figure 2. Process of developing the technology literacy program implementation framework. were placed under “structure,” 4 domains were placed under Results “process,” and 2 domains were placed under “outcome.” To build this framework, domains were used to guide discussion Framework Overview about foundational principles and potential actions. The 3 main Similar to the framework for person-centered care [16], the TLP categories and their domains are organized in the order that they implementation framework uses the 3 main categories of should be executed during the implementation process. The “structure,” “process,” and “outcome” to sort the 13 domains final TLP framework model is shown in Figure 3. needed to implement a TLP. Under these 3 categories, 7 domains https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 4 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Figure 3. Technology literacy program (TLP) framework. financials, human resources, and organizational structure of the Domains Overview place where care occurs. The framework for person-centered The TLP framework consists of 3 main categories that are care also uses this definition to build their domains for this essential to designate the domains and components of the category [16]. As shown in Table 1, the “structure” category framework; these 3 categories are “structure,” “process,” and for TLP implementation focuses on developing organizational “outcome.” The domains and components under each category infrastructure to deliver a successful TLP. This category also are detailed in Tables 1-3. includes strategies on how various resources may be used to serve as the foundation of TLP implementation. Structure (S1-S7) According to Donabedian [17], “structure” defines the attributes of the setting in which care takes place. It describes the facilities, https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 5 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Table 1. Structure domains and components of the technology literacy program (TLP) framework. Structure domains Foundational principles Potential actions S1: Create a Remove barriers to accessing technology for older adults Ensure that there is easy access to the internet, preferably • • • tech-friendly Ensure staff buy-in wireless internet (ie, Wi-Fi) culture Create support structures if older adults have questions Encourage family member buy-in and technology provision S2: Create Define a clear goal for the program Focus on technology that allows for connection between • • • clear-cut goals older adults and family for the TLP Break technology instructions into smaller steps building to larger goals Consult existing resources to help start the program S3: Outline the Demonstrate the ability for tech to reduce isolation and Show how technology can be used to achieve older adults’ • • • benefits of im- loneliness goals and interests plementing Emphasize that learning can happen at any age Encourage word-of-mouth advertisement of the program • • technology for between older adults older adults Expand to include other easy-to-access services (eg, Wikipedia and YouTube) S4: Provide re- Ensure robust onboarding and training Encourage open communication between instructors and • • • sources for ac- administrators tive TLP volun- Ensure that the program’s schedule meets the needs of teers and long- older adults and instructors term care Recruit community volunteers to reduce staff workload homes staff burden members Create clear policies around how technology issues are resolved Designate a single point of contact to manage educational tools and documents S5: Curate an Reduce paperwork burden on instructors, understanding Have resources that can be easily accessed by instructors, • • • effective and that some documentation might be needed including printouts impactful tech- Ensure that technology is user-friendly and accounts for Advertise the benefits of technology to older adults via • • friendly envi- differences in strengths between individuals posters and town halls ronment Consider a buddy or group system where older adults can be taught the same content together Listen to and act on what older adults themselves indicate they want to learn or achieve S6: Offer sup- Stress that the requirements to become an instructor are Ensure instructors have basic tech literacy skills to help • • • port to instruc- low: only basic technology literacy with common soft- older adults tors before ware (ie, email and YouTube) is needed Create a straightforward onboarding process working with Host practice sessions with instructors (eg, on ethical sce- older adults narios and common technology problems) Use a web-based platform (eg, Slack and Microsoft Teams) where instructors can easily communicate, while maintain- ing confidentiality S7: Explore the Schedule sessions at practical times and create opportu- Create a knowledge base that older adults can access if • • • availability of nities for learning and follow-up if questions arise when there are no instructors available or for self-study (eg, an instructors and there is no instructor available easy-to-access website or binder) provide “after- Reevaluate instructor availability frequently hours” program- Ensure older adults can anonymously leave feedback about ming programming (eg, an anonymous comment box) resemble the action items to begin and maintain a TLP in LTC Process (P1-P4) homes in the “process” category of TLP implementation. As The “process” category used in the framework for depicted in Table 2, the domains in the “process” category person-centered care includes the processes to deliver outline procedures undertaken by stakeholders involved (eg, person-centered care [16]. Specifically, it describes strategies volunteers, club executives, resident facility staff, and older that can be used by health care practitioners to ensure adults) to ensure a smooth transition from conceptualization person-centered care is being provided [16]. These steps closely into action. https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 6 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Table 2. Process domains and components of the technology literacy program (TLP) framework. Process domains Foundational principles Potential actions P1: Establish intergenerational There is no set number of instructors needed to help Encourage older adults to write any ques- • • • partnerships to help technology lit- set up a successful TLP tions they have in between teaching ses- eracy in older adults sions Instruction can be in person, digital, or over video chat or phone Network with other community groups to identify potential volunteers P2: Practice patience and compas- Encourage older adults to protect their personal in- Repetition and practice are key to support • • • sion throughout the TLP formation, including financial information learning and are sometimes overlooked Encourage instructors to use their judgement and limit their support to their comfort level Ensure that instruction allows older adults to learn at their own pace Instructors can develop or improve their teaching, leadership, and communication skills P3: Use interactive teaching and Programs can be one-on-one, in small groups, or Limit session to 1.5- to 2-hour blocks to • • • learning techniques lecture based, depending on older adults and instruc- minimize participant and instructor fatigue tor’s comfort and knowledge as well as room capac- Have diverse learning resources available ity limitations for older adults and instructors Facilitation must be sensitive to the needs of older adults, including vision, hearing, and mobility chal- lenges Encourage instructors to adapt to different learning styles to assist older adults as best as possible Remember that layperson terms for instructors may not be layperson terms for older adults P4: Create partnerships with stake- Identify what existing TLPs do in other settings to Advertise this opportunity broadly; pre- • • • holders to provide effective TLPs develop curriculum and foster participant engage- health professional students may be partic- for older adults ment ularly interested in participating in it Identify existing local supports for commu- Be open to the potential for collaborating with exist- nity programs, including organizations that ing organizations that provide digital services may provide technology at a discounted price Reach out to long-term care or retirement home stakeholders and the community at large to see if any organizations are looking to liquidate older technology Designate one representative from your organization to liaise with other stakehold- ers for the purposes of acquiring technology donations and recruiting instructors improvement to better serve patients [16]. Table 3 reflects how Outcome (O1-O2) TLP implementation shares similar attributes with the “outcome” In the framework for person-centered care, the “outcome” category, as it focuses on how TLPs can benefit older adults category describes the effects of person-centered care on patients even with diminished volunteer capacity, and how quality [16]. It also describes performance indicators of person-centered improvement can be used to adjust programming to better serve care in hopes of measuring such indicators to identify areas for the needs of the community. https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 7 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al Table 3. Outcome domains and components of the technology literacy program framework. Outcome domains Foundational principles Potential actions O1: Perform check-ins with older adults Older adults’ progress on accomplishing goals Check in with older adults to see how they • • • to gain insight on progress and aid with can be tracked using a web-based spreadsheet feel about their progress quality improvement like Google Sheets A brief informal postsession feedback Focus on the person not the technology; tech- question is recommended, even a simple nology should always come second “did you like this session today?” Validated tools like the Single Ease Question [21] can be used to evaluate the difficulty of a task Questions or questionnaires to be filled out by older adults can be hosted via the internet, us- ing Google Forms, to encourage older adults to practice their tech skills O2: Create documentation to track educa- Consider curriculum and training documents Lesson plans can be used to teach content • • • tion progress as “living documents,” and iterate on them and can optionally be used by residents in based on feedback the absence of instructors Provide training documents to instructors A “best practices” guide can be used to struc- Platforms like Google Docs and Notion ture lessons more generally (Notion Labs Inc) can be used to organize documents and can be updated immediately Tracking students’ progress and interests can facilitate transition between different instructors potential actions of domain S7 were consistent with existing Discussion findings, including those suggesting a strong training preference for self-teaching through methods such as reading a printed Overview manual and learning through “trial and error” or “playing This paper outlines an implementation framework for TLPs in around” approach [22,26]. Although self-practicing after a lesson LTC and residential homes and with older adults. Building on can be beneficial, the TLP framework focuses on the value of a person-centered care framework, the TLP framework starts instructors to teach older adults and facilitate their learning in by outlining how the program should be structured to create a TLPs (domains S7 and O1). There is a focus on providing safe learning environment for older adults to learn to use resources for program leaders so that they can effectively technology. The framework also outlines processes that can be support older adults, as emphasized in domains S4 through S7. used to build confidence and competence among both older Process adult learners and instructors, including multigenerational pairings, focusing on web-based safety, and ample hands-on Domains P1 to P4 outline the means by which TLP should be learning opportunities. The framework concludes with 2 operated. This includes engaging older adult learners with staff domains under “outcome” that are focused on identifying the of TLP within retirement homes and residential care facilities benefits to older adults and opportunities for quality to lead to a person-centered programming. A study conducted improvement. during the COVID-19 pandemic suggested that LTC facilities should have dedicated staff to assist residents in using Structure information communication technologies that are already Domains S1 to S7 are aimed to create a safe learning provided by the facilities, such as tablet devices [27]. Therefore, environment for older adults to learn how to use technology. domain P1 has considered this by creating a group of instructors Having a positive initial experience supported by a to teach older adult learners and facilitate the TLP operations. well-established, friendly, and supportive learning environment Existing cognitive aging research has outlined recommendations can promote continual participation of the TLP and continual on techniques that instructors may find useful when teaching use of technology among older adults, and so domain S1 older adults to use computer software applications [28]. Many reinforces this [22]. Domain S3 concentrates on informing older of the “process” domains align with recommendations based adults of the benefits of implementing technology in their lives. on that research [28]. Additional research identified reasons for Beyond increasing technology literacy, existing research has older adults’ negative attitudes about technology use, which suggested that learning new skills and keeping an active mind were frequently associated with inconvenience with the may maintain cognition and mental health throughout life [23]. technology device, disliking the features of technology, and In addition, the “structure” category of the framework aims to security and reliability concerns [29]. Given these concerns, reduce the social isolation and loneliness that older adults may foundational principles from domain P2 emphasize the experience during the pandemic through delivering interactive importance of protecting personal and financial information. learning [24,25]. Many of the foundational principles and Social contact or other social interactions have been shown to https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 8 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al be the second most important motivator for older adult learners to support older adults through periods of intense isolation. to participate in learning activities [30]. Therefore, domains P2 Periods of visitor and volunteer service restrictions, such as and P3 aim to have older adults develop healthy interpersonal local or global disease outbreaks, can present challenges to the relationships with instructors to foster participant engagement. implementation of TLPs. For instance, older adults may have Another study that examined teaching modality themes used to ask LTC staff outside of TLP for help, and this may interfere by student mentors to help older adults learn technology with the techniques they learned with their usual TLP reinforces the foundational principles and the overall theme of instructors. Organizations implementing TLPs could consider domains P2 and P3 [22]. Finally, other research has suggested incorporating a group of on-site staff who can assist older adults social engagements may also maintain cognitive aging and during periods of visitor and volunteer service restrictions if lower mortality outcomes as much as physical activity, they see fit. Although these events cannot easily be anticipated depending on the level of social activity [31]. aside from typical seasonal patterns (ie, increased probability of influenza outbreaks in fall and winter months), ensuring TLP Outcome participants are sufficiently trained such that they can Domains O1 and O2 aim to evaluate the progress of the TLP accomplish basic communication tasks independently can foster and determine if it is meeting older adults’ goals to learn independence and reduce feelings of isolation. technology. Existing research has recognized the need for Furthermore, the authors’ experience of TLPs are based on technological training programs focused on older adults to implementing TLPs directly and assisting with situating them evaluate and analyze the effectiveness of teaching technology in existing retirement and LTC settings as an external to them [32]. To enhance the experience of TLP for staff and organization. The authors do not have experience implementing older adults, TLPs must determine the positive feedback and a TLP as an employee of a retirement home or LTC home. improvements that can be made. The insights received from EnTECH’s experience in TLP implementation is also limited following the foundational principles and potential actions of to Ontario, Canada. Thus, the generalizability of this TLP domain O2 allow for more research to be conducted to determine framework may be limited, as the structure of residential care the strengths and improvements needed for TLP. facilities and retirement homes outside of Ontario may differ Strengths and Applicability of the Framework from those in Ontario. Finally, despite the value of technology, the financial cost of the devices and additional equipment to Governments and health care systems have been encouraging run a TLP is a concern in both private and publicly funded people to remain engaged with their communities via the internet residential care facilities, and that is addressed in domain P4. during the COVID-19 pandemic [1-3]. The implementation of TLPs for older adults may help them overcome some of the Future Research known barriers to engage with technology. Increased technology Further research should be conducted to validate the utility of literacy, fostered through TLP, may also support older adults this framework in retirement homes and residential care in accessing health care digitally, an adoption of which has been facilities. This could include evaluating the success in accelerating in response to the pandemic [33,34]. implementing a TLP in retirement homes and residential care It has been suggested by findings of a recent study that using a facilities according to the insights on the progress and quality person-centered care approach to engage older adults with of the program gained from the check-ins with older adults technology is crucial in creating meaningful (domain O2). Additionally, there is an interest in exploring technology-mediated enrichment experiences for them [35]. whether older adults are able to independently apply the The TLP framework supports this approach as it aims to technology literacy skills they have developed or improved implement fundamentally person-focused TLPs, hence the from their TLP to achieve and expand on their technology use. framework for person-centered care was chosen as the template After the implementation of a TLP in retirement homes and [16]. By organizing the domains’ content into foundational residential care facilities, the publication of case studies aimed principles and potential actions, we hope that organizations can at both industry and academics is suggested to raise awareness identify parts of the framework that are readily applicable and of this framework for residential care employees and can be implemented with little difficulty, which can be beneficial stakeholders. during times of high visitor restrictions. For instance, during Conclusions visitor restrictions in LTC, organizations may begin with creating a knowledge base that older adults can access with Recognition in staying socially connected through technology minimal assistance if there are no instructors available, which has undoubtedly increased throughout the course of the is a potential action from domain S7. In addition, organizations COVID-19 pandemic. A framework for implementing TLPs can plan opportunities to expand their existing TLPs. Lastly, was developed to support retirement homes and residential care there is a focus on creating and externalizing partnerships to facilities that are interested in starting their own TLP to support run the program to reduce costs and foster new relationships older adults’ technology competence. The foundation of the with others in the community. framework was constructed from enTECH’s knowledge translation toolkit for implementing TLPs for older adults, and Limitations it was structurally organized by following the framework for Despite the benefits of implementing TLPs using this person-centered care by Santana et al [16]. Although framework, there are some drawbacks to consider. The modifications to the framework may be required depending on COVID-19 pandemic has highlighted how complex it can be https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 9 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al an organization’s needs, starting TLPs for older adults can have potential positive impacts on them in the long term. Acknowledgments Sincere thanks are extended to the enTECH Computer Club Spring 2020 executive team for assisting with the organization of extracted activities from enTECH’s knowledge translation toolkit under appropriate domains on the Miro whiteboard. This paper was funded by a Network for Aging Research Catalyst grant awarded to KB and KG. Conflicts of Interest None declared. Multimedia Appendix 1 Domains and their foundational principles of the technology literacy program framework on Miro whiteboard. [PDF File (Adobe PDF File), 724 KB-Multimedia Appendix 1] References 1. 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JMIR Aging 2022 Apr 12;5(2):e31162 [FREE Full text] [doi: 10.2196/31162] [Medline: 34975014] Abbreviations LTC: long-term care TLP: technology literacy program Edited by T Leung; submitted 19.11.21; peer-reviewed by S Bhattacharjya, K Colorafi; comments to author 14.03.22; revised version received 31.05.22; accepted 20.06.22; published 19.08.22 Please cite as: Li KS, Nagallo N, McDonald E, Whaley C, Grindrod K, Boluk K JMIR Aging 2022;5(3):e34997 URL: https://aging.jmir.org/2022/3/e34997 doi: 10.2196/34997 PMID: ©Karen S Li, Nathan Nagallo, Erica McDonald, Colin Whaley, Kelly Grindrod, Karla Boluk. Originally published in JMIR Aging (https://aging.jmir.org), 19.08.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 11 (page number not for citation purposes) XSL FO RenderX JMIR AGING Li et al in any medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org, as well as this copyright and license information must be included. https://aging.jmir.org/2022/3/e34997 JMIR Aging 2022 | vol. 5 | iss. 3 | e34997 | p. 12 (page number not for citation purposes) XSL FO RenderX

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JMIR Aging – JMIR Publications

Published: Aug 19, 2022

Keywords: older adult; technology; retirement home; long-term care; social connections; technology literacy program; retirement; elderly; literacy; implementation; concept; framework; knowledge translation

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