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Factors Affecting Information and Communication Technology Use and eHealth Literacy among Older Adults in the US and South Korea

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Title: Factors Affecting Information and Communication Technology Use and eHealth Literacy among Older Adults in the US and South Korea
Language: English
Authors: Lee, Othelia Eun-Kyoung, Kim, Do-Hong, Beum, Kyung Ah
Source: Educational Gerontology. 2020 46(9):575-586.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 12
Publication Date: 2020
Document Type: Journal Articles
Reports - Research
Descriptors: Older Adults, Cultural Context, Educational Attainment, Knowledge Level, Self Efficacy, Low Income, Computer Use, Internet, Information Literacy, Health Materials, Barriers, Urban Areas, Foreign Countries, Computer Attitudes, Attitude Measures, Social Isolation, Access to Computers, Social Capital
Geographic Terms: South Korea, United States
Assessment and Survey Identifiers: Computer Anxiety Scale
DOI: 10.1080/03601277.2020.1790162
ISSN: 0360-1277
Abstract: This study examined ways in which Information and Communication Technology (ICT) plays a role in contexts between two countries: the US and South Korea, comparing individual situations and structural factors that support the use of ICT among older adults. Surveys were administered to 113 US and 104 Korean community-dwelling respondents, inquiring about their ICT use, eHealth Literacy, and Social Capital. Significant differences between the two countries were found in respondents' educational levels, marital status, and types of social activities. A vast majority of Korean elders (77.9%) reported being current users of the Internet, compared to 63.7% of their US peers. A greater level of eHealth literacy was found among Koreans. In both groups, factors affecting eHealth literacy included educational levels and confidence in using ICT. In both countries, ICT can provide a diverse array of online resources for low-income elders to manage their health problems and maintain social connections. Hence, further services are needed to help older adults become more involved in technology in order to maximize the utilization of ICT.
Abstractor: As Provided
Entry Date: 2020
Accession Number: EJ1263674
Database: ERIC
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  Value: <anid>AN0144871626;egr01sep.20;2020Aug03.03:07;v2.2.500</anid> <title id="AN0144871626-1">Factors affecting information and communication technology use and eHealth literacy among older adults in the US and South Korea </title> <p>This study examined ways in which Information and Communication Technology (ICT) plays a role in contexts between two countries: the US and South Korea, comparing individual situations and structural factors that support the use of ICT among older adults. Surveys were administered to 113 US and 104 Korean community-dwelling respondents, inquiring about their ICT use, eHealth Literacy, and Social Capital. Significant differences between the two countries were found in respondents' educational levels, marital status, and types of social activities. A vast majority of Korean elders (77.9%) reported being current users of the Internet, compared to 63.7% of their US peers. A greater level of eHealth literacy was found among Koreans. In both groups, factors affecting eHealth literacy included educational levels and confidence in using ICT. In both countries, ICT can provide a diverse array of online resources for low-income elders to manage their health problems and maintain social connections. Hence, further services are needed to help older adults become more involved in technology in order to maximize the utilization of ICT.</p> <p>Whereas aging can be characterized as a slowing down, new technologies are speeding up. The internet has become a good health resource, helping us to build a connection via information and communication technology (ICT). Although Internet technology may promote older adults' physical and mental health, a variety of cognitive, emotional, and social barriers impact an older adult's ability to effectively use ICT (Cotten, [<reflink idref="bib8" id="ref1">8</reflink>]; Hill et al., [<reflink idref="bib14" id="ref2">14</reflink>]).</p> <p>Both individual and structural factors can influence technology use among older adults. Individual factors include functional status, education, socioeconomic status, attitudes toward technology, and the perceived usefulness of the technology (Pew Research Center, [<reflink idref="bib25" id="ref3">25</reflink>]). Functional changes older adults commonly experience that may affect their ability to use technology include decreased attention span, decreased memory capabilities, and changes in vision (Mitzner et al., [<reflink idref="bib19" id="ref4">19</reflink>]). The natural decline in physical and cognitive abilities as individuals' age is a common barrier to successful technology use (Czaja et al., [<reflink idref="bib11" id="ref5">11</reflink>]). Individual attitudes of mistrust toward computers and internet use, as well as a perceived lack of benefit, were found to be the leading barriers older adults face (Hill et al., [<reflink idref="bib14" id="ref6">14</reflink>]; Szabo et al., [<reflink idref="bib28" id="ref7">28</reflink>]).</p> <p>Structural factors include the dynamism in technology design, cohort-based differences, and availability of and access to technology (Kim et al., [<reflink idref="bib15" id="ref8">15</reflink>]). Price, internet availability, and lack of training opportunities to promote self-efficacy and gain confidence have also been proposed as significant barriers to successful engagement in technology use by older adults (Cotten et al., [<reflink idref="bib9" id="ref9">9</reflink>]). As a result, individuals may be unable or uninformed on how to operate their technology, leading to avoidance of its use altogether.</p> <hd id="AN0144871626-2">Internet use and digital divide in the US</hd> <p>In the US, research has identified a digital divide in older adults' use of ICT that is primarily caused by lower socioeconomic status and poor health status (Choi & DiNitto, [<reflink idref="bib5" id="ref10">5</reflink>]). Older adults who were younger, non-Hispanic whites, and of higher socioeconomic status (based on education, health literacy, and income) were more likely to use the Internet (Lelkes, [<reflink idref="bib18" id="ref11">18</reflink>]). Lee & Kim ([<reflink idref="bib16" id="ref12">16</reflink>], [<reflink idref="bib17" id="ref13">17</reflink>]) reveals that one of the hardest challenges older adults face today is lack of accessibility to information technology and the consequent social isolation. Because the Internet is increasingly used for information dissemination, nonusers find themselves at a growing disadvantage.</p> <p>Research also implies that interventions can reduce the anxiety and lack of confidence older adults feel toward technology. Chu et al. ([<reflink idref="bib6" id="ref14">6</reflink>]) found that experience with computers/Internet reduced anxiety and increased self-confidence and positive attitudes about computers/Internet use in older adults, regardless of age, income, or educational level. Werner et al. ([<reflink idref="bib29" id="ref15">29</reflink>]) found that older adults with a proactive approach to the challenges of learning to use technology were more likely to use a computer.</p> <p>eHealth literacy, a set of skills required to effectively seek, find, understand, and appraise information technology for health, and apply the knowledge gained to addressing or solving a health problem, requires literacy in a variety of areas, including health, science, and media (Norman & Skinner, [<reflink idref="bib21" id="ref16">21</reflink>]). Research has shown that eHealth literacy is lower among older adults, especially those with lower socioeconomic status, and those with less computer experience (Choi & DiNitto, [<reflink idref="bib5" id="ref17">5</reflink>]). Higher eHealth literacy is associated with more positive outcomes from Internet searches in three domains: cognitive (e.g., health knowledge/information gathering), instrumental (e.g., self-management of health needs and health behaviors), and interpersonal (e.g., communication with health-care providers) (Czaja et al., [<reflink idref="bib11" id="ref18">11</reflink>]; Neter & Brainin, [<reflink idref="bib20" id="ref19">20</reflink>]).</p> <p>Social capital refers to individual resources that emerge from one's social networks, which can be explained as one's social integration/ties and social support (Choi & DiNitto, [<reflink idref="bib4" id="ref20">4</reflink>]). An individual's social networks are the conceptual and structural core of his or her social capital. Those with strong and dense social networks have an easier time with accessing information because network members provide bridging and bonding support and contribute to boosting confidence and trust (Czaja et al., [<reflink idref="bib10" id="ref21">10</reflink>]; Williams, [<reflink idref="bib31" id="ref22">31</reflink>]).</p> <p>When applied to older adults' Internet use, those with a larger social network (e.g., children, friends) are more likely to receive encouragement to learn to use the Internet, as well as emotional and instrumental assistance from their social network connections (Choi & DiNitto, [<reflink idref="bib4" id="ref23">4</reflink>]). Participation in activities with family, friends, and other network members is also likely to increase the need for and perceived benefits of Internet connectivity as a means to maintain communication. The most frequent pathways to computer/Internet use were having observed and talked with children and grandchildren about their use and having informal help from family and friends on how to use a computer/the Internet (Lee & Kim, [<reflink idref="bib16" id="ref24">16</reflink>]; Czaja et al., [<reflink idref="bib10" id="ref25">10</reflink>]).</p> <hd id="AN0144871626-3">Educational disparities in South Korea</hd> <p>South Korea is in a phase of rapid transition demographically, culturally, and technologically, experiencing remarkable economic growth and unprecedented population aging simultaneously. Among the 36 Organization for Economic Co-operation and Development (OECD) countries, South Korea has been transformed from one of the poorest countries to the world's eighth largest exporter ([<reflink idref="bib23" id="ref26">23</reflink>].). According to Statistics Korea ([<reflink idref="bib27" id="ref27">27</reflink>]), 5% of the Korean population are aged 65 and over, and the figure is projected to be 37% in 2045, surpassing Japan. In the past decade, South Korea has become the world leader in ICT, with the highest broadband penetration in the world at 97% (Wikipedia, [<reflink idref="bib30" id="ref28">30</reflink>]). This makes it a country ideally situated for an international comparison study to investigate the effects of ICT and structural factors.</p> <p>In spite of the deep-rooted value of filial piety and respect for elders in Korean culture, the current generation aged 65 and older is one of the most socially and economically disadvantaged age cohorts in South Korea. The OECD data present three alarming characteristics of this generation. First, unlike most OECD countries, which have seen considerable reductions in old-age poverty, older South Koreans are at a high risk of being poor. In 2017, more than 43.8% of South Koreans over 65 were in relative poverty, with incomes below half of the median household income – the highest proportion among OECD countries (Statistics Korea, [<reflink idref="bib27" id="ref29">27</reflink>]).</p> <p>Second, South Korea ranks highest in educational disparities by age cohorts among the OECD countries. Ninety-seven percent of South Koreans aged 25 to 34 received a high school diploma, compared to 37% of those aged 55 to 64 (OECD, [<reflink idref="bib22" id="ref30">22</reflink>]). This makes it harder for older adults to retain their career and social integration in the highly competitive South Korean market economy and keep up with ICT.</p> <p>Third, South Korea revealed a strong rise in death by suicides among adults aged 55 and older (OECD, [<reflink idref="bib24" id="ref31">24</reflink>]). Since suicide is often used as a proxy indicator of the mental health status of a population, further research is needed to better understand emerging social problems in a culture undergoing socioeconomic transformation and population aging at the same time.</p> <p>The following research questions were posed in this study.</p> <p></p> <ulist> <item> What are the rates of current Internet use, previous use, and/or never use among older adults in the US vs. South Korea? Does country/culture play a role?</item> <p></p> <item> Among current users, what is the frequency of their Internet use, what types of Internet activities do they engage in, and what physical/functional difficulties do they face when using the Internet? Are there differences in attitudes toward the Internet, eHealth literacy, and social integration across the two countries?</item> <p></p> <item> What factors are associated with eHealth Literacy across the two countries?</item> </ulist> <hd id="AN0144871626-4">Methods</hd> <p></p> <hd id="AN0144871626-5">Participants and settings</hd> <p>The data for this study were drawn from cross-sectional, semi-structured, face-to-face interviews with a convenience sample of 217 older adults, aged between 65 and 97. In the US, respondents were recruited at senior centers and senior housing facilities in a Southeastern city. On the list of 50 cities evaluated in terms of social mobility, or the ability of a person to move up the economic ladder (Chetty et al., [<reflink idref="bib3" id="ref32">3</reflink>]), this city ranked at the bottom, representing extremely low social mobility. In an effort to recruit low-income older adults, this city was chosen as the study site. Using convenient sampling strategies, 113 older adults were recruited at three local senior centers and one senior housing facilities. The interviews with US respondents, each lasting between 20 and 30 minutes, were conducted in private rooms of the senior centers by the first author and three master's-level social workers.</p> <p>Similar sampling strategies were used in South Korea. Comparable older adults (n = 104) residing in two low-income urban areas were recruited from three senior centers in South Korea. The Korean survey was translated and back-translated to ensure accuracy. Three social workers and the third author conducted the interviews with Korean respondents. In both US and Korean samples, the primary reasons that attendees of the senior centers gave for nonparticipation in the study were dislike of 'too many personal questions' and a lack of interest.</p> <hd id="AN0144871626-6">Measurements</hd> <p></p> <hd id="AN0144871626-7">Internet use, patterns, and activities</hd> <p>Internet use was measured with the question, "Have you ever used the Internet?" The answer categories were (<reflink idref="bib1" id="ref33">1</reflink>) No, I have never used it (nonuser), (<reflink idref="bib2" id="ref34">2</reflink>) I have used it before but not currently (previous user), and (<reflink idref="bib3" id="ref35">3</reflink>) Yes, I am a current user.</p> <p>Among nonusers, two additional questions were inquired. Willingness to use online health information was measured with one item, "If someone can teach me how to use the Internet to look for health information, I am willing to try." Comfort with joining online discussions and exchanging e-mails with other participants was measured with one item, "I would be comfortable joining an online health discussion group and exchanging emails with other participants." The items were scored on a 5-point Likert scale, with higher scores indicating greater levels of willingness and comfort.</p> <p>Patterns and activities of Internet use among current users (<emph>n</emph> = 72 US and 81 Korea respondents) were ascertained with the following items: (<reflink idref="bib1" id="ref36">1</reflink>) frequency of Internet use (at least once a day, every few days, once a week, a few times a month, once a month or less often), (<reflink idref="bib2" id="ref37">2</reflink>) type of activities conducted on the Internet (research health-related information, research information about other topics or issues of interest, send/receive e-mail, buy products online, do banking online and/or pay bills, read news, papers, magazines, and books online, play games online, watch videos such as YouTube), use social networking sites such as Facebook, and other – specify), (<reflink idref="bib3" id="ref38">3</reflink>) ease/difficulty of locating useful websites and finding desired information within the site (on a 5-point Likert scale: 1 = "always easy" to 5 = "very difficult"), and (<reflink idref="bib4" id="ref39">4</reflink>) any physical/functional problems making it harder for the respondent to use the Internet (pain in the limbs, unsteady hands, difficulty concentrating for long periods of time, difficulty sitting for long periods, eyes that tire easily, and other). Respondents' preferred types of ICT devices were inquired. These included computers, smartphones, and tablets (e.g., iPad).</p> <hd id="AN0144871626-8">eHealth literacy</hd> <p>The 8-item eHealth Literacy Scale (eHEALS) was used to measure participants' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems (Norman & Skinner, [<reflink idref="bib21" id="ref40">21</reflink>]). The items included knowing what information is available, where/how to find it, how to use the Internet to answer health-related questions, and the use of information to make health decisions. The final eHEALS score was the average of all eight items, with higher scores indicating higher eHealth literacy. In the present study, the internal consistency reliability coefficient for the 8-item eHEALS was Cronbach's alpha =.98 for US sample and.85 for Korean sample.</p> <p>In addition, two eHEALS supplemental items were used to measure perceived usefulness of the Internet in helping the older adults to make health decisions and the perceived importance of being able to access health resources on the Internet. All items were scored on a 5-point Likert scale, with higher scores indicating higher levels of perception.</p> <hd id="AN0144871626-9">Attitudes toward computers/the Internet</hd> <p>Attitudes were measured with the 5-item Computer Efficacy subscale and the 5-item Computer Interest subscale of the Attitudes Toward Computers/Internet Questionnaire (ATCIQ), with each item scored on a 5-point Likert scale (Bear et al., [<reflink idref="bib1" id="ref41">1</reflink>]). Examples of efficacy items are: "I know that if I worked hard to learn about computers/Internet, I could do well," and "Given a little time or training, I know I could learn to use a computer/Internet." Examples of interest items are "Learning about computers/Internet is a worthwhile and necessary subject," and "Reading or hearing about computers/Internet would be boring." For both the efficacy and interest subscales, the final score is the average of all five items, and higher scores suggest higher computer/Internet efficacy or interest. The internal consistency reliability coefficients for the efficacy and interest subscale in this sample were Cronbach's alpha =.96 and.81 for US respondents and.90 and.64 for Korean respondents, respectively.</p> <p>The Computer Anxiety Scale (CAS) is a measure of individual perceptions of anxiety and confidence in different situations related to computers (Gressard & Loyd, [<reflink idref="bib13" id="ref42">13</reflink>]). The Anxiety subscale is a ten-item Likert-type instrument measuring computer anxiety with responses ranging from "strongly agree" to "strongly disagree." The Confidence subscale is also a ten-item scale with the same response category. Higher scores on the scale reflect a lower degree of anxiety and more confidence with computer use. Alpha coefficient reliabilities for anxiety and confidence subscale were 0.76 and 0.71 for individuals from the US and.69 and.66 for Koreans.</p> <hd id="AN0144871626-10">Social integration</hd> <p>Social integration was measured by whether or not the respondents reported having any living child/stepchild and/or sibling; worked for pay or volunteered; provided caregiving; visited in person with friends or family; attended religious services; participated in clubs/classes; and went out for enjoyment/dinner. Response categories for all these variables were yes, no, refused, and do not know. Additionally, the following two scales were used to assess social integration.</p> <hd id="AN0144871626-11">Social capital</hd> <p>The Internet Social Capital Scales (ISCS) are intended to measure two different types of social capital – "bridging" and "bonding" (Williams, [<reflink idref="bib31" id="ref43">31</reflink>]). For each set of measures, a starting set of criteria led to the formation of questions that relate to a series of theorized dimensions. The internal consistency reliability coefficients for the scale were Cronbach's alpha =.89 for the US and.82 for the Korean sample, respectively.</p> <hd id="AN0144871626-12">Social isolation</hd> <p>A perceived social isolation measure, developed by Cornwell and Waite ([<reflink idref="bib7" id="ref44">7</reflink>]), was used with a scale that combined nine items that assess loneliness and perceived (lack of) social support. Regarding social support from one's family, respondents were asked, "How often can you open up to members of your family if you need to talk about your worries?" and "How often can you rely on them for help if you have a problem?" The same two questions were asked about the respondent's friends and spouse or current partner. The 3-item loneliness scale included the following questions: "How often do you feel that you lack companionship?," "How often do you feel left out?," and "How often do you feel isolated from others?" Higher scores indicate greater perceived isolation. This scale has acceptable internal consistency (<emph>α </emph>=.75 for US and.71 for Korean respondents).</p> <p>Demographic variables included age, gender, marital status, and educational attainment. A race/ethnicity category was used only for the US respondents.</p> <p>Health status variables included the number of impairments in activities of daily living (ADL) and instrumental activities of daily living (IADL). The ADL categories included using the bath or shower, using the toilet, getting dressed or putting on outdoor clothing, combing or brushing hair, getting into and out of bed, and feeding. The IADL categories included using the telephone, preparing and cooking meals, grocery shopping, doing housework, taking medications, and managing money. The combined ADL and IADL scores ranged from 0 to 12.</p> <p>Serious daily life problems were measured using a checklist (adopted from the current serious problems list used in the Health and Retirement Study: https://ssl.isr.umich.edu/hrs/): (<reflink idref="bib1" id="ref45">1</reflink>) not having enough money to live on, (<reflink idref="bib2" id="ref46">2</reflink>) loneliness or not having enough friends, (<reflink idref="bib3" id="ref47">3</reflink>) having to depend too much on other people for daily living due to health problems and disability, (<reflink idref="bib4" id="ref48">4</reflink>) having too many problems or conflicts in the family, and (<reflink idref="bib5" id="ref49">5</reflink>) having to take care of a sick spouse or other relatives.</p> <hd id="AN0144871626-13">Data analysis</hd> <p>Descriptive statistics (frequencies, proportion distributions, and mean and standard deviation) were used to summarize the data. Chi-squared test and <emph>t</emph>-test analyses were conducted to examine whether there were differences between the two countries on the demographic characteristics and health information technology use. Independent <emph>t</emph>-tests were conducted to compare cultural/country differences associated with eHealth literacy, attitudes toward computer/Internet, social isolation, and social capital.</p> <p>A two-step hierarchical linear regression model was employed to examine factors affecting eHealth literacy. In step 1, demographic variables of age, gender, and education were entered. In step 2, attitudes toward computer/Internet, confidence, and technophobia were entered. Though not shown in the table, correlational analysis was performed to examine possible multicollinearity among the predictor variables. A separate regression model was analyzed for each country.</p> <hd id="AN0144871626-14">Results</hd> <p>Table 1 presents demographic profiles of 113 US and 104 Korean respondents. There was a significant difference between the two countries in educational levels (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 42.93, <emph>p</emph> <.001). While 21.3% of US respondents reported less than high school education, 30.7% of Korean respondents did. Completion of college was similar in both samples, 32.7% and 36.5%, respectively.</p> <p>Table 1. Demographic profile.s</p> <p> <ephtml> <table><thead><tr><td /><td>US</td><td>S. Koreans</td><td /></tr><tr><td /><td><italic>n</italic></td><td>%</td><td><italic>n</italic></td><td>%</td><td><p id="ilm0002"><graphic href="uedg_a_1790162_ilm0002.gif" content-type="Graph" /><math xmlns="http://www.w3.org/1998/Math/MathML"><mrow xmlns=""><msup><mi>χ</mi><mn>2</mn></msup></mrow></math></p></td></tr></thead><tbody><tr><td>Gender Male</td><td>37</td><td>32.7</td><td>45</td><td>43.3</td><td>2.55</td></tr><tr><td> Female</td><td>76</td><td>67.3</td><td>59</td><td>56.7</td><td /></tr><tr><td>Race/ethnicity Non-Hispanic White</td><td>60</td><td>53.1</td><td>0</td><td>0</td><td /></tr><tr><td> Non-Hispanic Black</td><td>45</td><td>39.8</td><td>0</td><td>0</td><td /></tr><tr><td> Other</td><td>8</td><td>7.1</td><td>104</td><td>100%</td><td /></tr><tr><td>Education Less than a high school education</td><td>8</td><td>7.1</td><td>30</td><td>28.8</td><td>42.93***</td></tr><tr><td> Complete some high school</td><td>16</td><td>14.2</td><td>2</td><td>1.9</td><td /></tr><tr><td> High school grad</td><td>26</td><td>23.0</td><td>29</td><td>27.9</td><td /></tr><tr><td> Some college</td><td>26</td><td>23.0</td><td>4</td><td>3.8</td><td /></tr><tr><td> College grad and above</td><td>37</td><td>32.7</td><td>38</td><td>36.5</td><td /></tr><tr><td>Marital status Married</td><td>18</td><td>15.9</td><td>71</td><td>68.3</td><td>73.28***</td></tr><tr><td> Widowed</td><td>44</td><td>38.9</td><td>24</td><td>23.1</td><td /></tr><tr><td> Divorced/separated</td><td>37</td><td>32.7</td><td>4</td><td>3.8</td><td /></tr><tr><td> Never married</td><td>14</td><td>12.4</td><td>3</td><td>2.9</td><td /></tr><tr><td>Social integration Living child</td><td>99</td><td>87.6</td><td>99</td><td>95.2</td><td>3.89+</td></tr><tr><td> Living sibling</td><td>80</td><td>70.8</td><td>92</td><td>88.5</td><td>10.28*</td></tr><tr><td> Working</td><td>22</td><td>19.5</td><td>24</td><td>23.1</td><td>1.56</td></tr><tr><td> Volunteer</td><td>53</td><td>46.9</td><td>41</td><td>39.4</td><td>1.23</td></tr><tr><td> Caregiving</td><td>36</td><td>31.9</td><td>31</td><td>29.8</td><td>.10</td></tr><tr><td> Visiting friends</td><td>93</td><td>82.3</td><td>89</td><td>85.6</td><td>.43</td></tr><tr><td> Religious attendance</td><td>89</td><td>78.8</td><td>62</td><td>59.6</td><td>9.38**</td></tr><tr><td> Social club</td><td>80</td><td>70.8</td><td>99</td><td>95.2</td><td>22.31***</td></tr><tr><td> Dinner</td><td>92</td><td>81.4</td><td>93</td><td>89.4</td><td>2.76</td></tr><tr><td /><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>t</italic></td></tr><tr><td>Age</td><td>73.0</td><td>11.9</td><td>71.34</td><td>6.69</td><td>1.28</td></tr><tr><td>Family size</td><td>1.8</td><td>11.3</td><td>1.33</td><td>1.08</td><td>.39</td></tr><tr><td>Years live alone</td><td>9.9</td><td>12.4</td><td>2.68</td><td>6.14</td><td>5.19***</td></tr><tr><td>ADLs</td><td>0.35</td><td>0.98</td><td>0.29</td><td>1.25</td><td>.39</td></tr><tr><td>IADLs</td><td>0.84</td><td>1.42</td><td>0.37</td><td>1.34</td><td>2.50*</td></tr><tr><td>Number of health conditions</td><td>2.58</td><td>1.61</td><td>1.32</td><td>1.22</td><td>6.45***</td></tr><tr><td>Number of life problems</td><td>0.81</td><td>1.14</td><td>0.58</td><td>1.20</td><td>1.48</td></tr><tr><td>Geriatric depression</td><td>8.95</td><td>1.54</td><td>9.18</td><td>1.76</td><td>−.92</td></tr></tbody></table> </ephtml> </p> <p>1 + <emph>p</emph> < 0.06; *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; ***<emph>p</emph> < 0.001.</p> <hd id="AN0144871626-15">Internet use patterns and activities</hd> <p>As shown in Table 2, significant differences were observed in respondents' Internet use patterns between the two countries (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 148.69, <emph>p</emph> <.001). A vast majority of Korean elders (77.9%) reported being current users of the Internet, compared to 63.7% of US peers. Only 10.6% of Koreans had never used the Internet, while 21.2% of US respondents were never users. Consequently, more Koreans (73.1%) than their US peers (61.1%) had an e-mail address, and yet, these differences were not significant. Significant differences in the frequency of Internet use were found (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> =31.47, <emph>p</emph> <.001). More US Internet users reported daily online activity (44.2%), compared to 16.3% of Korean users.</p> <p>Table 2. Health information technology use.</p> <p> <ephtml> <table><thead><tr><td /><td>US</td><td>S. Koreans</td><td /></tr><tr><td /><td><italic>n</italic></td><td>%</td><td><italic>n</italic></td><td>%</td><td><p id="ilm0005"><graphic href="uedg_a_1790162_ilm0005.gif" content-type="Graph" /><math xmlns="http://www.w3.org/1998/Math/MathML"><mrow xmlns=""><msup><mi>χ</mi><mn>2</mn></msup></mrow></math></p></td></tr></thead><tbody><tr><td>Internet Never used Internet</td><td>24</td><td>21.2</td><td>11</td><td>10.6</td><td>148.69***</td></tr><tr><td> Previous user Internet</td><td>16</td><td>14.2</td><td>12</td><td>11.5</td><td /></tr><tr><td> Current user Internet</td><td>72</td><td>63.7</td><td>81</td><td>77.9</td><td /></tr><tr><td>Have e-mail address</td><td>69</td><td>61.1</td><td>76</td><td>73.1</td><td>.71</td></tr><tr><td>Frequency of use Once a day</td><td>50</td><td>44.2</td><td>17</td><td>16.3</td><td>31.47***</td></tr><tr><td> Every few days/once a week</td><td>18</td><td>15.9</td><td>34</td><td>32.7</td><td /></tr><tr><td> Few time/once a month</td><td>8</td><td>7.1</td><td>27</td><td>25.9</td><td /></tr><tr><td>Types of use Research health info or other info</td><td>54</td><td>47.8</td><td>74</td><td>71.2</td><td>12.22***</td></tr><tr><td> Send e-mails</td><td>61</td><td>54.0</td><td>38</td><td>36.5</td><td>6.64**</td></tr><tr><td> Buy products/online banking</td><td>49</td><td>43.4</td><td>38</td><td>36.5</td><td>1.05</td></tr><tr><td> Read papers</td><td>28</td><td>24.8</td><td>15</td><td>14.4</td><td>3.65+</td></tr><tr><td> Play games</td><td>25</td><td>22.1</td><td>26</td><td>25.0</td><td>.24</td></tr><tr><td> Watch video</td><td>27</td><td>23.9</td><td>39</td><td>37.5</td><td>4.73*</td></tr><tr><td> Social media</td><td>39</td><td>34.5</td><td>5</td><td>4.8</td><td>29.56***</td></tr><tr><td>Accessibility Always easy</td><td>26</td><td>23.0</td><td>29</td><td>27.9</td><td>14.72**</td></tr><tr><td> Somewhat easy</td><td>35</td><td>31.0</td><td>28</td><td>26.9</td><td /></tr><tr><td> Not so easy</td><td>12</td><td>10.6</td><td>18</td><td>17.3</td><td /></tr><tr><td> Difficult</td><td>4</td><td>3.5</td><td>15</td><td>14.4</td><td /></tr><tr><td> Very difficult</td><td>13</td><td>11.5</td><td>3</td><td>2.9</td><td /></tr><tr><td>Challenges Pain in the limb</td><td>12</td><td>10.6</td><td>4</td><td>3.8</td><td>3.64+</td></tr><tr><td> Unsteady hands</td><td>10</td><td>8.8</td><td>1</td><td>1.0</td><td>7.00*</td></tr><tr><td> Concentration</td><td>7</td><td>6.2</td><td>13</td><td>12.5</td><td>2.57</td></tr><tr><td> Difficulty sitting</td><td>18</td><td>15.9</td><td>11</td><td>10.6</td><td>1.34</td></tr><tr><td> Tired eyes</td><td>24</td><td>21.2</td><td>62</td><td>59.6</td><td>33.34***</td></tr><tr><td>Devices Smartphone</td><td>43</td><td>38.1</td><td>73</td><td>70.2</td><td>22.48***</td></tr><tr><td> Computer</td><td>80</td><td>70.8</td><td>69</td><td>66.3</td><td>.49</td></tr><tr><td> Tablet</td><td>29</td><td>25.7</td><td>12</td><td>11.5</td><td>7.05**</td></tr><tr><td>Among nonusers</td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>t</italic></td></tr><tr><td> Interest</td><td>3.17</td><td>1.91</td><td>3.25</td><td>1.42</td><td>−.14</td></tr><tr><td> Willing</td><td>3.16</td><td>1.87</td><td>3.00</td><td>1.41</td><td>.28</td></tr></tbody></table> </ephtml> </p> <p>2 + <emph>p</emph> < 0.06; *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; ***<emph>p</emph> < 0.001.</p> <p>Among never users of the Internet, the level of willingness and comfort of respondents to engage in conducting health-information searches, join online health discussion groups, and exchange e-mails was assessed. There was no significant difference in responses between these two samples, US and South Korean respondents, in terms of their level of comfort and willingness to use the Internet.</p> <p>Whereas the primary functions of Internet use patterns among US respondents were communication, Koreans were more likely to search for information. More US respondents used the Internet to send/receive e-mails (54.0%,</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 6.64, <emph>p</emph> <.01) and to participate in social media (34.5%,</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 29.56, <emph>p</emph> <.001). The usage of the Internet for e-mail and social media for the purpose of communication among Koreans were relatively low. The most popular use for Koreans were information search (71.2%,</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 12.22, <emph>p</emph> <.001) and video watching (37.5%,</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 4.73, <emph>p</emph> <.05).</p> <p>Slightly over half of the respondents (54% US and 54.8% Koreans) found the Internet to be easy to use. More Koreans reported difficulties in using the Internet (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 14.7, <emph>p</emph> <.01). The most common challenge across countries was tired eyes (21.2% US and 59.6% Koreans). Significantly, more Korean reported this challenge of tired eyes (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 33.34, <emph>p</emph> <.001). More US respondents reported challenges of unsteady hands (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 7.0, <emph>p</emph> <.05) and pain in a limb (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 3.64, <emph>p</emph> <.06).</p> <p>Significant differences were observed in the types of popular devices used by respondents in the two countries. The vast majority of Koreans (70.2%) possessed a smartphone, compared to 38.1% of US respondents. Usage of a tablet was more popular among US respondents (</p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math> </ephtml> = 7.05, <emph>p</emph> <.001).</p> <hd id="AN0144871626-16">eHealth literacy, attitudes, and social connections</hd> <p>Table 3 presents country comparisons of respondents' attitudes toward the Internet, eHealth literacy, and social integration. Korean elders perceived greater usefulness (<emph>t</emph> (<reflink idref="bib185" id="ref50">185</reflink>) = −3.73, <emph>p</emph> <.001) and importance (<emph>t</emph> (<reflink idref="bib186" id="ref51">186</reflink>) = −4.33, <emph>p</emph> <.001) of using the Internet in their daily life, compared to their US peers. Hence, a greater level of eHealth literacy was found among Koreans (<emph>M</emph> = 3.56, <emph>SD </emph>=.60, <emph>t</emph> (<reflink idref="bib204" id="ref52">204</reflink>) = −4.94, <emph>p</emph> <.001).</p> <p>Table 3. eHealth literacy, attitudes, and social connections.</p> <p> <ephtml> <table><thead><tr><td /><td>US</td><td>S. Koreans</td><td /></tr><tr><td /><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>t</italic></td></tr></thead><tbody><tr><td>eHealth literacy</td><td>2.70</td><td>1.58</td><td>3.56</td><td>0.60</td><td>−4.94***</td></tr><tr><td>Usefulness of Internet</td><td>3.02</td><td>1.77</td><td>3.76</td><td>.75</td><td>−3.73***</td></tr><tr><td>Importance of Internet</td><td>3.17</td><td>1.76</td><td>4.01</td><td>.65</td><td>−4.33***</td></tr><tr><td><italic>Attitudes toward Internet</italic> Self-efficacy</td><td>2.99</td><td>1.73</td><td>2.90</td><td>1.08</td><td>.18</td></tr><tr><td> Interest</td><td>2.85</td><td>1.66</td><td>3.00</td><td>1.11</td><td>−.31</td></tr><tr><td>Confidence</td><td>2.02</td><td>0.90</td><td>2.54</td><td>0.50</td><td>−5.21***</td></tr><tr><td>Anxiety</td><td>2.08</td><td>0.87</td><td>2.84</td><td>0.68</td><td>−7.22***</td></tr><tr><td>Social capital</td><td /><td /><td /><td /><td /></tr><tr><td> Bonding</td><td>30.49</td><td>5.39</td><td>27.9</td><td>3.49</td><td>7.10***</td></tr><tr><td> Bridging</td><td>31.71</td><td>5.90</td><td>27.6</td><td>3.36</td><td>6.17***</td></tr><tr><td> Bonding + Bridging</td><td>62.22</td><td>9.74</td><td>53.69</td><td>5.90</td><td>7.69***</td></tr><tr><td>Social isolation</td><td /><td /><td /><td /><td /></tr><tr><td> Loneliness</td><td>6.36</td><td>1.48</td><td>3.91</td><td>1.29</td><td>9.16***</td></tr><tr><td> Social support</td><td>13.36</td><td>3.24</td><td>12.27</td><td>2.98</td><td>1.79</td></tr><tr><td> Loneliness + social support</td><td>19.73</td><td>4.38</td><td>16.19</td><td>3.31</td><td>4.90***</td></tr></tbody></table> </ephtml> </p> <p>3 + <emph>p</emph> < 0.06; *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; ***<emph>p</emph> < 0.001.</p> <p>Attitudes toward computer/Internet use was measured in terms of self-efficacy and interest. US respondents presented slightly higher scores in self-efficacy and Koreans in interest. However, this difference was not significant. Koreans also presented a greater level of confidence (<emph>t</emph> (<reflink idref="bib215" id="ref53">215</reflink>) = −5.21, <emph>p</emph> <.001) as well as lesser anxiety (<emph>t</emph> (<reflink idref="bib215" id="ref54">215</reflink>) = −7.22, <emph>p</emph> <.001) about using Internet/computers.</p> <p>US respondents reported a great level of both bonding (<emph>t</emph> (<reflink idref="bib214" id="ref55">214</reflink>) = 7.10, <emph>p</emph> <.0010 and bridging (<emph>t</emph> (<reflink idref="bib213" id="ref56">213</reflink>) = 6.17, <emph>p</emph> <.001) social capital, compared to their Korean counterparts. Thus, the total score of social capital also revealed significant differences among US and Korean samples (<emph>t</emph> (<reflink idref="bib213" id="ref57">213</reflink>) = 7.69, <emph>p</emph> <.001).</p> <p>Simultaneously, the US respondents perceived greater levels of loneliness (<emph>t</emph> (<reflink idref="bib135" id="ref58">135</reflink>) = 9.16, <emph>p</emph> <.001). The total score of the social isolation scale shows that US respondents perceive a greater level of isolation from their family and friends (<emph>t</emph> (<reflink idref="bib135" id="ref59">135</reflink>) = 4.90, <emph>p</emph> <.001).</p> <p>The effects of attitudes, confidence, and anxiety on eHealth literacy are also explored in Table 4. Among US respondents, educational attainment (β =.36, <emph>B</emph> =.40, <emph>p</emph> <.001) was found to be a significant predictor of eHealth literacy. In the second step, education remained significant. Confidence (β =.61, <emph>B</emph> =1.08 <emph>p</emph> <.001) was a significant factor associated with eHealth literacy after controlling for differences in age, gender, and education. The second model explained an additional 31% of variance in eHealth literacy among US respondents.</p> <p>Table 4. Regression analysis of factors impacting eHealth literacy.</p> <p> <ephtml> <table><thead><tr><td /><td>US</td><td>S. Koreans</td></tr><tr><td /><td><italic>Model 1</italic></td><td><italic>Model 2</italic></td><td><italic>Model 1</italic></td><td><italic>Model 2</italic></td></tr><tr><td /><td><italic>B</italic></td><td><italic>β</italic></td><td><italic>B</italic></td><td><italic>β</italic></td><td><italic>B</italic></td><td><italic>β</italic></td><td><italic>B</italic></td><td><italic>β</italic></td></tr></thead><tbody><tr><td>Step 1</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Age</td><td>.01</td><td>.07</td><td>.02</td><td>.14</td><td>−.00</td><td>−.03</td><td>.01</td><td>.07</td></tr><tr><td> Female gender</td><td>−.53</td><td>−.16</td><td>.02</td><td>.01</td><td>−.13</td><td>−.11</td><td>−.06</td><td>−.05</td></tr><tr><td> Education</td><td>.40</td><td>.36***</td><td>.22</td><td>.20*</td><td>.11</td><td>.32**</td><td>.09</td><td>.25*</td></tr><tr><td>Step 2 Self-efficacy</td><td /><td /><td>−.08</td><td>−.08</td><td /><td /><td>−.14</td><td>−.09</td></tr><tr><td> Interest</td><td /><td /><td>.09</td><td>.07</td><td /><td /><td>.10</td><td>.07</td></tr><tr><td> Confidence</td><td /><td /><td>1.08</td><td>.61***</td><td /><td /><td>.25</td><td>.22*</td></tr><tr><td> Anxiety</td><td /><td /><td>.14</td><td>.08</td><td /><td /><td>.06</td><td>.07</td></tr><tr><td>F</td><td>5.87***</td><td>12.17***</td><td>4.62**</td><td>2.86**</td></tr><tr><td>R<sup>2</sup></td><td>.14</td><td>.45</td><td>.12</td><td>.17</td></tr><tr><td>R<sup>2</sup> change</td><td /><td>.31</td><td /><td>.05</td></tr></tbody></table> </ephtml> </p> <p>4 + <emph>p</emph> < 0.06; *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; ***<emph>p</emph> < 0.001.</p> <p>Likewise, educational attainment was statistically significant in the Korean respondents (β =.32, <emph>B</emph> =.11, <emph>p</emph> <.01). In the second step, education remained significant (β =.25, <emph>B</emph> =.09, <emph>p</emph> <.05). Confidence was found to be a significant predictor of eHealth literacy after controlling for differences in age, gender, and education level and explained an additional 5% of the variance (β =.22, <emph>B</emph> =.25, <emph>p</emph> <.05).</p> <hd id="AN0144871626-17">Discussion</hd> <p>Population aging affects formal and informal social support systems and the ability of communities to provide resources for their older citizens across cultures and countries. In recent years, Internet technology has offered useful information and facilitated communication that transcends geographic distance at a relatively low cost. Whereas most adults cannot bear living a day without the Internet, older adults have often indicated in surveys that the pace of technology has left them behind, putting them at risk for cultural and social isolation (Chen & Schulz, [<reflink idref="bib2" id="ref60">2</reflink>]; Seifert & Schelling, [<reflink idref="bib26" id="ref61">26</reflink>]).</p> <p>This study's findings implied that the main ways in which older adults use the Internet, regardless of countries of residence, are for e-mail, searches (for news, health information, and product information), and communication with family and friends. In both countries, ICT may likewise present challenges and opportunities to promote older adults' physical and mental health and reduce their social isolation and dependence on informal and formal support systems. Interestingly, in this study, significant differences were found between US and South Korean residents in older adults' Internet use patterns, types of online activities, perceived challenge of using the Internet, attitudes toward the Internet, eHealth literacy, and social integration.</p> <p>Despite having, on average, a lower level of education, Korean elders in the study perceived greater usefulness and importance of using the Internet in their daily life and reported higher levels of eHealth literacy. Particularly in Korean culture, the Internet has become a prerequisite for all types of daily activities, and it therefore became imperative for low-income older adults to access necessary information via the Internet (Yoon et al., [<reflink idref="bib32" id="ref62">32</reflink>]). Even though it was difficult to directly measure structural factors in this study, in South Korea, low costs, easy accessibility, widespread Wi-Fi connections, ubiquitous apps (e.g., Kakao Talk), and more opportunities to learn ICT could have facilitated Internet use among older adults with a low level of ITC knowledge. Therefore, Korean respondents' higher eHealth literacy may be related to their beliefs about the usefulness and importance of using the Internet in their daily lives.</p> <p>In both groups, universal factors found to affect eHealth literacy were preexisting educational attainment and current level of confidence in using ICT. This finding also implied that appropriate training opportunities to educate older adults about new technology have the potential to boost confidence and overcome technophobia (Chu et al., [<reflink idref="bib6" id="ref63">6</reflink>]; Werner et al., [<reflink idref="bib29" id="ref64">29</reflink>]). By increasing their confidence, older Internet users can perceive multiple benefits of using ICT, including convenience of accessing health-related information; increased communication with family and friends; keeping abreast of news and events in their communities; participating in a variety of online educational and recreational activities; and convenience of online shopping, banking, and travel arrangements (Lee & Kim, [<reflink idref="bib17" id="ref65">17</reflink>]).</p> <p>This descriptive study is limited in generalizability due to the small sample size, convenience sampling, and descriptive research design. However, to the best of our knowledge, this is the first international comparison study of its kind to examine individual and structural factors in internet use patterns in these two countries.</p> <p>Initially, this study attempted to examine relationships between social isolation and eHealth literacy. While not shown in the table, results indicated no significant association between the two variables. One evident limitation of these analyses was the small sample size. Further research should be conducted to identify both individual and structural factors that reduce the digital divide among older adults in various countries using representative samples.</p> <hd id="AN0144871626-18">Implications</hd> <p>The COVID-19 pandemic has illuminated tremendous digital divides in the US. Older adults, who are already excluded from much of social life, are being asked to distance themselves even further, deepening their social isolation. Internet access can allow them to benefit from the growing number of tele-health interventions in the post-COVID-19 era. During this time of social distancing, older adults should be able to stay connected to their close social support networks and the larger community via video calls and by visiting social networking sites, chat/discussion groups, interest/hobby groups, and news sites (Forsman et al., [<reflink idref="bib12" id="ref66">12</reflink>]).</p> <p>Despite lower levels of education, Korean respondents appeared to be technologically savvy. Along with previous research, findings from this study implied that Internet technology and web-based resources may have the potential to promote independence and eHealth literacy to manage informal and formal support systems among low-income older adults. In our previous study, a subsample of US respondents (<emph>n</emph> =55; mean age of 73) participated in a six-session technology tutorial. These older participants presented significant improvement between pretest and posttest in various outcomes such as eHealth literacy, technophobia, self-efficacy, interest in technology, and social isolation (Lee & Kim, [<reflink idref="bib17" id="ref67">17</reflink>]).</p> <p>Therefore, further training and educational opportunities are needed to help older adults become more involved in technology in order to maximize the utilization of ICT. Effective access to ICT is more than just having the technology; it involves effectively and efficiently using technological skills to utilize ICT. To illustrate, older adults can be taught to use the Internet to search for health information; participate in freely available online programs (e.g., chronic disease self-management, mental health support groups, and exercise); order medications; and communicate with their health-care providers (Lee & Kim, [<reflink idref="bib16" id="ref68">16</reflink>], [<reflink idref="bib17" id="ref69">17</reflink>]).</p> <p>Health service professionals who work with older adults should consider providing their clients with training and the opportunity to use ICT and to overcome technophobia. Community-based senior centers can be vital links for older adults to gain low-cost access to computers and the Internet. Training and guidance should be offered to low-income older adults to assist them in gaining computer proficiency and confidence. Recommendations can be made for appropriate adaptation and modification strategies for older adults to assure accessibility to gaining technology skills and eHealth literacy.</p> <hd id="AN0144871626-19">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <ref id="AN0144871626-20"> <title> References </title> <blist> <bibl id="bib1" idref="ref33" type="bt">1</bibl> <bibtext> Bear, G. G., Richards, H. C., & Lancaster, P. (1995). Attitudes toward computers: Validation of a computer attitudes scale. Journal of Educational Computing Research, 3 (2), 207 – 218. https://doi.org/10.2190/1DYT-1JEJ-T8J5-1YC7</bibtext> </blist> <blist> <bibl id="bib2" idref="ref34" type="bt">2</bibl> <bibtext> Chen, Y. R., & Schulz, P. J. (2016). The effect of information communication technology interventions on reducing social isolation in the elderly: A systematic review. 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Korean Content Academy, 34 (4), 1 – 12.</bibtext> </blist> </ref> <aug> <p>By Othelia Eun-Kyoung Lee; Do-Hong Kim and Kyung Ah Beum</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib14" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib25" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib19" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib11" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib28" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib15" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib18" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib16" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib17" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib29" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib21" firstref="ref16"></nolink> <nolink nlid="nl12" bibid="bib20" firstref="ref19"></nolink> <nolink nlid="nl13" bibid="bib10" firstref="ref21"></nolink> <nolink nlid="nl14" bibid="bib31" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib23" firstref="ref26"></nolink> <nolink nlid="nl16" bibid="bib27" firstref="ref27"></nolink> <nolink nlid="nl17" bibid="bib30" firstref="ref28"></nolink> <nolink nlid="nl18" bibid="bib22" firstref="ref30"></nolink> <nolink nlid="nl19" bibid="bib24" firstref="ref31"></nolink> <nolink nlid="nl20" bibid="bib13" firstref="ref42"></nolink> <nolink nlid="nl21" bibid="bib185" firstref="ref50"></nolink> <nolink nlid="nl22" bibid="bib186" firstref="ref51"></nolink> <nolink nlid="nl23" bibid="bib204" firstref="ref52"></nolink> <nolink nlid="nl24" bibid="bib215" firstref="ref53"></nolink> <nolink nlid="nl25" bibid="bib214" firstref="ref55"></nolink> <nolink nlid="nl26" bibid="bib213" firstref="ref56"></nolink> <nolink nlid="nl27" bibid="bib135" firstref="ref58"></nolink> <nolink nlid="nl28" bibid="bib26" firstref="ref61"></nolink> <nolink nlid="nl29" bibid="bib32" firstref="ref62"></nolink> <nolink nlid="nl30" bibid="bib12" firstref="ref66"></nolink>
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  Label: Title
  Group: Ti
  Data: Factors Affecting Information and Communication Technology Use and eHealth Literacy among Older Adults in the US and South Korea
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Lee%2C+Othelia+Eun-Kyoung%22">Lee, Othelia Eun-Kyoung</searchLink><br /><searchLink fieldCode="AR" term="%22Kim%2C+Do-Hong%22">Kim, Do-Hong</searchLink><br /><searchLink fieldCode="AR" term="%22Beum%2C+Kyung+Ah%22">Beum, Kyung Ah</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Educational+Gerontology%22"><i>Educational Gerontology</i></searchLink>. 2020 46(9):575-586.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
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  Data: 12
– Name: DatePubCY
  Label: Publication Date
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  Data: 2020
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  Label: Document Type
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  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Older+Adults%22">Older Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Context%22">Cultural Context</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Attainment%22">Educational Attainment</searchLink><br /><searchLink fieldCode="DE" term="%22Knowledge+Level%22">Knowledge Level</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Low+Income%22">Low Income</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Use%22">Computer Use</searchLink><br /><searchLink fieldCode="DE" term="%22Internet%22">Internet</searchLink><br /><searchLink fieldCode="DE" term="%22Information+Literacy%22">Information Literacy</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Materials%22">Health Materials</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Urban+Areas%22">Urban Areas</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Attitudes%22">Computer Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+Measures%22">Attitude Measures</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Isolation%22">Social Isolation</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Computers%22">Access to Computers</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Capital%22">Social Capital</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22South+Korea%22">South Korea</searchLink><br /><searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Computer+Anxiety+Scale%22">Computer Anxiety Scale</searchLink>
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  Label: DOI
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  Data: 10.1080/03601277.2020.1790162
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  Label: ISSN
  Group: ISSN
  Data: 0360-1277
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study examined ways in which Information and Communication Technology (ICT) plays a role in contexts between two countries: the US and South Korea, comparing individual situations and structural factors that support the use of ICT among older adults. Surveys were administered to 113 US and 104 Korean community-dwelling respondents, inquiring about their ICT use, eHealth Literacy, and Social Capital. Significant differences between the two countries were found in respondents' educational levels, marital status, and types of social activities. A vast majority of Korean elders (77.9%) reported being current users of the Internet, compared to 63.7% of their US peers. A greater level of eHealth literacy was found among Koreans. In both groups, factors affecting eHealth literacy included educational levels and confidence in using ICT. In both countries, ICT can provide a diverse array of online resources for low-income elders to manage their health problems and maintain social connections. Hence, further services are needed to help older adults become more involved in technology in order to maximize the utilization of ICT.
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  Data: 2020
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  Data: EJ1263674
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/03601277.2020.1790162
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 575
    Subjects:
      – SubjectFull: Older Adults
        Type: general
      – SubjectFull: Cultural Context
        Type: general
      – SubjectFull: Educational Attainment
        Type: general
      – SubjectFull: Knowledge Level
        Type: general
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Low Income
        Type: general
      – SubjectFull: Computer Use
        Type: general
      – SubjectFull: Internet
        Type: general
      – SubjectFull: Information Literacy
        Type: general
      – SubjectFull: Health Materials
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Urban Areas
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Computer Attitudes
        Type: general
      – SubjectFull: Attitude Measures
        Type: general
      – SubjectFull: Social Isolation
        Type: general
      – SubjectFull: Access to Computers
        Type: general
      – SubjectFull: Social Capital
        Type: general
      – SubjectFull: South Korea
        Type: general
      – SubjectFull: United States
        Type: general
      – SubjectFull: Computer Anxiety Scale
        Type: general
    Titles:
      – TitleFull: Factors Affecting Information and Communication Technology Use and eHealth Literacy among Older Adults in the US and South Korea
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Lee, Othelia Eun-Kyoung
      – PersonEntity:
          Name:
            NameFull: Kim, Do-Hong
      – PersonEntity:
          Name:
            NameFull: Beum, Kyung Ah
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2020
          Identifiers:
            – Type: issn-print
              Value: 0360-1277
          Numbering:
            – Type: volume
              Value: 46
            – Type: issue
              Value: 9
          Titles:
            – TitleFull: Educational Gerontology
              Type: main
ResultId 1