Older Adults and OATS Computer Training Programs. A Social Impact Analysis. Findings Report

Transcription

1 Older Adults and OATS Computer Training Programs A Social Impact Analysis Findings Report Prepared by: Paula J Gardner, PhD The New York Academy of Medicine Division of Health Policy Funding Provided by: The Fan Fox and Leslie R. Samuels Foundation April 2010

2 Table of Contents EXECUTIVE SUMMARY... 4 INTRODUCTION... 7 A REVIEW OF THE LITERATURE AGING AND COMPUTER TECHNOLOGY... 8 USERS AND USE... 9 IMPACT OF USE TRAINING A NOTE ON OUTCOMES FROM THE LITERATURE METHODS AND METHODOLOGY DATA COLLECTION SITE SELECTION PARTICIPANT RECRUITMENT, ELIGIBILITY AND SCREENING STUDY PARTICIPANTS FINDINGS OBJECTIVE 1. TO ASSESS THE IMPACT OF THE OATS PROGRAM ON THE COMPUTER SKILLS AND UTILIZATION OF PARTICIPANTS Increased confidence: Improved ability: Increased use: Impact on older adult members as reported by service providers: Changes in overall feeling using the computer: Other findings: OBJECTIVE 2. TO ASSESS THE IMPACT OF THE OATS PROGRAM ON THE HEALTH AND WELL-BEING OF PARTICIPANTS AS MEASURED BY CHANGES IN: I) SOCIAL CONNECTEDNESS, II) ACCESS TO INFORMATION, AND III) SOCIAL AND CIVIC PARTICIPATION Social connectedness: Access to information Social and civic participation OBJECTIVE 3. TO EXPLORE THE EFFECTS OF HOSTING OATS TRAINING COURSES ON COMMUNITY PARTNER ORGANIZATIONS Impact on the organization itself: Impact on staff, other members, organization:

3 OBJECTIVE 4. TO IDENTIFY THE KEY STRENGTHS AND WEAKNESSES OF THE CURRENT OATS COMPUTER TRAINING PROGRAM Overall evaluation of OATS by study participants: A few participants reported negative experiences and/or feelings: OATS versus other computer training programs: Overall evaluation of the OATS program by the service providers: Standing the test of success: Key strengths and weaknesses of the OATS program: Recommendations and suggestions from participants: Recommendations and suggestions from service providers: OATS getting students turned on for success: OVERALL SUMMARY REFERENCES

4 Executive Summary There is growing consensus that access to essential services, information, social support networks, and meaningful social and civic engagement are increasingly compromised by a lack of digital access and literacy. This is a particularly salient issue among older adults as they lag behind other age groups in adoption and use of computers and the Internet. Computer training programs have been highlighted as a way to increase computer use among older populations. Older Adults Technology Services (OATS) is a 501(c)(3) nonprofit organization whose mission is to, engage, train and support older adults in using technology to improve their quality of life and enhance their social and civic engagement. Collaborating with over 30 partner sites across New York City, OATS has been providing a variety of computer courses to older adults since The goal of this study was to explore how participation in the OATS computer-training program impacts the lives of older adults. The four objectives of the study were: 1. To assess the impact of the OATS program on the computer skills and utilization of participants 2. To assess the impact the OATS program had on the health and well-being of participants as measured by changes in: i) social connectedness, ii) access to information, and iii) social and civic participation 3. To explore the effects of hosting OATS training courses with community partner organizations 4. To identify the key strengths and weaknesses of the current OATS computer training program A mixed-method research design was adopted and the study took place across four study sites in New York City over an eight-month period. Data were collected using three strategies telephone surveys, ethnographic fieldwork and in-depth interviews with service providers. A total of 66 community-dwelling older adults (46 women and 20 men) between the ages of 55 and 85 years of age participated in the study. The relationship status among the study group was varied, approximately half lived alone, most were white or African American, and English was their primary language. Findings demonstrate the efficacy of the OATS computer training program across various measures including: increased and sustained computer use; improved ability and 4

5 confidence with computer and Internet technology; a substantial and positive impact on social connectedness, access to information, and social and civic participation; and a favorable effect on community partners. Key findings include: 1. Confidence, ability, and computer use increased significantly for students completing the OATS computer training courses, and these outcomes were sustained over time. 94% of study participants reported an increase (64% significantly; 30% somewhat) in their confidence using computers as a result of the OATS training 98% reported an increase (47% significantly; 27% somewhat) in their ability to use computers after completing the OATS course Prior to the OATS course 51% of participants used a computer regularly (daily or several times per week). Immediately after the training 95% reported regular use. Six months later 93% continued to use their computers regularly 2. Analysis revealed that the OATS training course had a positive impact on the social connectedness, access to information, and social and civic participation of study participants. 64% of participants reported that the amount of time they spent communicating with friends and family increased as a result of the OATS training Prior to OATS training 1.8% of participants used as their primary and 24.6% as their secondary form of communication with family; after the training, 8.8% reported as their primary and 49.1% as their secondary form of communication with family In the post-course survey, 89% reported that their ability to access information increased as a result of the training (56% significantly increased; 33% somewhat increased). Health and medical information was the most common type of information pursued on the Internet (71% of participants reported searching for health information online) OATS training and the concomitant increase in computer literacy had a positive impact on participants social and civic engagement: 44% felt their awareness of social activities had increased as a result of the OATS training and 24% reported that the number of social activities they participated in had increased. 3. According to the community partners, working with OATS and offering OATS classes is beneficial to an organization in several ways. OATS can enhance the capacity of the organization OATS courses can increase the visibility of the organization within the local community 5

6 Service providers felt that by hosting OATS courses there was potential to positively shift people s attitudes and beliefs about older adults 4. Analysis revealed that OATS computer training programs are effective and appreciated. The data are very compelling and illustrate a package of well-designed and thoughtfully administered components (curriculum, trainers, manuals, class atmosphere, and style) that together create a package for success. During the evaluation of key components, students indicated they were very pleased with OATS classes: 94% rated the OATS program overall as either excellent (64%) or very good (30%). Trainers were rated particularly high; 94% rated them either excellent (74%) or very good (20%). Close to 90% of study participants said they were planning on taking another OATS course, and 100% said they would recommend OATS to other older adults Six months after the OATS training 63 of the 66 study participants were still using their computers and 89% of participants reported they were still able to do what they learned in the course In summary, study findings provide a comprehensive picture of the ways in which OATS programs can impact the lives of older adults. OATS training programs were found to positively affect the lives of community-dwelling older adults who were interested in learning how to use computers and Internet technologies. OATS trainings promoted the successful adoption and sustained use of these technologies and served to enhance social connectedness, increase access to information, and facilitate opportunities for social and civic participation among OATS students. Each core element of the OATS program is effective, and together provides a technology training program that serves older adults extremely well. Findings also suggest a positive impact on the community partners; hosting OATS programs seems to increase organizational capacity as well as promoting a more positive image of older adults among staff. The study findings make an important contribution to the field of aging and technology and are helpful to policy-makers and programmers charged with supporting the health and well-being of the growing older population. The findings also provide direction and guidance to OATS as it moves forward with programming and curriculum development, continues to grow as an organization, and seeks additional and sustainable funding. 6

7 Introduction Older Adults Technology Services (OATS) is a 501(c)(3) nonprofit organization whose mission is to, engage, train and support older adults in using technology to improve their quality of life and enhance their social and civic engagement. Collaborating with over 30 partner sites across New York City, OATS has been providing a variety of computer courses to older adults since OATS offers lab-based courses for beginners and advanced students as well as training geared towards workforce development. In addition, OATS offers training for seniors with mobility limitations and some programs include an intergenerational component where youth are trained as trainers and help to teach the older adult students. In the past OATS received financial support from New York City Council however, in June 2008 a significant portion of their funding was cut. Meetings and communications with City Council members, DFTA leadership, senior advocates, and leaders in the senior services sector identified a key challenge facing OATS - decision-makers continue to view courses through the lens of the traditional senior center programming, perceiving it as a recreational program to be offered alongside bingo or arts and crafts. From this perspective, the value of computer training as an important and increasingly necessary tool for health, well-being, and independent living among older adults is not recognized and OATS programs are, therefore, seen as expendable in times of financial restraint. Seeking to shift the perception of policy makers by providing evidence of the value of computer training and in particular OATS training programs to the health and wellbeing of older adults in New York City, OATS approached staff at the New York Academy of Medicine (NYAM) to evaluate the effectiveness and impact of their programs. With an interest and expertise in aging research and policy in New York City, the Division of Health Policy (DHP) at NYAM was an appropriate research partner for this work. In January 2009, OATS was awarded a grant from the Samuels Foundation and the Older Adults and OATS Computer Training: A Social Impact Analysis project began. The overall purpose of this study was to examine the impact of the OATS computer training courses on older adult participants. The study objectives were: 7

8 1. To assess the impact of the OATS program on the computer skills and utilization of participants 2. To assess the impact of the OATS program on the health and well-being of participants as measured by changes in: i) social connectedness, ii) access to information, and iii) social and civic participation 3. To explore the effects of hosting OATS training courses on community partner organizations 4. To identify the key strengths and weaknesses of the current OATS computer training program A Review of the Literature Aging and Computer Technology The recent and growing interest in aging and technology is the result of two major trends population aging and the digital revolution each of which is uniquely changing the ways in which we, both individually and collectively, think about and plan our current and future lives. It is estimated that by the 2030, there will be 72.1 million (20% of the population) older Americans, almost twice their number in The group aged 75+ are the fastest growing segment of older adults and by 2050, it is estimated that there will be close to 50 million people over the age of 75 living in the United States. i The aging society is also an information society, and while the aging population steadily grows, so does the use, development, design, research and sales of information technology (IT). Internet use for example, has risen in the United States from approximately 10% in 1995 to over 75% today so that there are now 225 million Americans over the age of 18 who have a computer in their homes and connect to the Internet. ii These two trends however population aging and the digital revolution have yet to coincide, meaning the fastest growing segment of the population is the least likely to use the fastest growing technologies. Recent reports illustrate the age-based digital divide still exists, and, although older adults are increasingly using computers and the Internet, today fewer than half (45%) of seniors over 65 and 27% of seniors over 75 are using computers compared to 78% of people 50-54, 87% of those 30-34, and 93% of year olds. iii In addition to lagging behind in adopting these technologies, older adults 8

9 report having fewer skills and are less confident in their abilities to use computers than younger cohorts. iv The ability to use information technology is now assumed by most to be a prerequisite to living in the information age, transforming all aspects of society from communication, information, social and civic participation, employment, entertainment, education and healthcare. As technology becomes an increasingly integral part of daily life, there is concern that those who use it less (i.e., oldest old, immigrants and minority populations, poor and those with limited education) 1 may become increasingly disenfranchised and disadvantaged. v Using information technology has been described as nothing less than the indispensible grammar of modern life. vi Today it is an important vehicle for information dissemination and access in most areas of daily life including news, educational and cultural activities, and government services. It is also increasingly used within the healthcare arena for information, service delivery, in-home monitoring, interactive communication and support. As we advance our understandings of the ways in which technology can promote the health and quality of life of older people and play a key role in supporting them to age in place, researchers and policy makers have increasingly turned their attention to the topic of aging and technology. Consequently, there is substantial literature within the area of aging and technology from a variety of disciplines including computer and information science, psychology, neuroscience, geriatrics, gerontology, business, public policy and public health. The majority of this literature can be organized into three categories: users and use, impact of use, and technology training. Users and use A key source of information regarding Internet and computer use among older adults is the PEW Internet and American Life Project. vii Using telephone interviews to survey large, random samples of Americans (e.g., 18+=2,204; 65+=436), PEW data viii provide a snapshot of wired seniors in America, and how their patterns of use compare to other age groups: Users ix 1 The digital divide exists within the older adult population generally, however it is most pronounced among certain subgroups that are already considered some of the most vulnerable in our society - the oldest old, immigrants and minority populations, the poor and those with limited education. 9

10 22% of Americans (8 million) 65 and older use the Internet Of those over 65+ who use the internet, men and women are equally represented Online seniors are more likely (than the general population of older adults) to be white (22%) than Hispanic (17%) or African American (7%), with higher levels of education (e.g., in % of users had attended college) and income (e.g., in 2004, 17% of users lived in high income households compared to 8% of all seniors) Once online, wired seniors are just as enthusiastic as younger users: they are just as likely as younger groups on a typical day to: go online, use , and are nearly as likely to look for information using a search engine Although older Internet users do these activities at lower rates than younger users, they report having done the following: looked for health information (66%), conducted product research (66%), bought something online (47%), made travel reservations (41%), and visited government websites (60%). The most popular online activity for wired seniors is ; 94% of wired seniors report having sent or received . The more years of computer and Internet experience a wired senior accumulates, the more likely they are to fit the pattern of other online veterans (>3 years experience) of any group by going online first thing in the morning, spending more time online, and trying more activities. PEW reports also suggest that a large number (78%) of older adults remain offline, although this is changing. Offline seniors are described as being very disconnected from computer and Internet technology: Most seniors live lives far removed from the Internet, know few people who use or surf the Web, and cannot imagine why they would spend money and time learning how to use a computer. In 2004, eight out of ten offline seniors reported they would never go online. Computer and Internet use (including adoption) among older adults is not, however, a simple matter of users and nonusers ; the adoption and use of IT among this population is a complex process that depends on a variety of factors and occurs across a continuum from silver surfers (confident and competent older computer users) x to offline seniors (individuals with no interest or desire in using the technology). A summary of the literature indicates the key factors influencing the use of IT among older adults are access, age, gender, marital status, socioeconomic status, personal attitudes, and perceived benefits of going xixii xiii online. For example, in a study examining data from a large-scale household survey of information and communication technologies (ICT) in the UK, researchers found that wired 10

11 seniors are more likely to be married, more highly educated and wealthy. xiv They report computer use is not only determined by access (although this is important), but is also highly stratified by gender, age, marital status and educational background. Attitude toward technology was also seen to play an important role in technology use; non-use among study participants was primarily attributed to its (perceived) low relevance and relative advantage" to their lives. The literature also includes barriers to computer use and adoption among older adults, with functional status and financial barriers most commonly reported. Research indicates physical health problems (limitations to vision, hearing, and mobility) as well as cognitive limitations related to memory use that are common among older people can create barriers for computer use among this population. xvxvi In other research, design (hardware, software and web design) was identified as an important factor impacting computer use among older adults. xvii Examining the impact of web design on Internet use among a group of 43 older adults for example, Hendrix found that poor website design, and in particular those sites that are difficult to navigate, created a barrier to use among study participants. xviii Finally, there has also been some research to suggest that older adults may be late adopters of technology (including computers) due to a lack of self-efficacy. A 2002 survey conducted by AARP reports adults over the age of 65 have less confidence in their ability to use computers than younger people. xix Similarly, findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults report computer anxiety as an important predictor of the use of computers and the World Wide Web among older adults. xx Impact of use Studies examining the impact of computer and Internet use on older adults have received the most attention in the aging and technology literature. The majority of this research is designed as intervention studies where individual measures (e.g., levels of depression, social connectedness and cognitive function) are collected pre- and post-intervention (computer training program), to assess change. A synthesis of this body of literature indicates a strong positive trend on all measures: computer and Internet use is shown to be associated with lower 11

12 levels of loneliness and higher levels of social connectivity, decreased depression, and improved xxi xxii xxiii xxiv self-esteem and cognitive functioning. For example, researchers examining the psychological impact of learning how to use a computer and the Internet in old age found use contributes to older adults well-being and sense of empowerment by affecting their interpersonal interactions, promoting their cognitive functioning and contributing to their experience of control and independence. xxv In other research, computer training was combined with health literacy training in a group of low-income seniors and findings demonstrated that intervention reduced computer anxiety and increased confidence and computer self-efficacy in retrieving and evaluating online health information among the group. xxvi In a review of the impact of computer use among older adults, Hendrix (2000) highlighted several key outcomes: enhanced self-efficacy; fulfillment of need for meeting people; fun and mental stimulation; enhanced personal control and self-determination; improved education and skills development (e.g., monitor their health status); and increased social interaction. xxvii The most recent studies on the impact of computer use on older adults come from neuroscience where researchers are exploring the direct relationship between using digital technology and cognitive function. At the present time however, these results are mixed. Small et al., report that for older adults with prior computer knowledge, Internet searching may stimulate the brains circuitry in the area of decision-making and complex reasoning. xxviii However, other researchers found no relationship between computer training or Internet use and cognitive ability in older adults. xxix In other studies, current older adult users were identified or existing data sets analyzed to explore the impact of use. For example, examining the relationship between self-efficacy, computer anxiety, computer knowledge and overall life satisfaction, researchers surveyed 222 retired older adult computer users from computer clubs in Florida and report computer savvy older adults are more satisfied with their life. According to the researchers, having computer knowledge makes older people feel more independent, allows them to maintain social networks and stay informed about their health. xxx Computer use is said to promote independence by helping to mitigate social isolation, facilitating important activities of daily life such as banking and shopping, as well as enhancing employment and educational opportunities 12

13 (locating courses to attend as well as opportunities for online education/distance learning). xxxi xxxii Using a subsample (n=7000) of data from the Health and Retirement Study (a longitudinal household survey of more than 22,000 persons over 50 years of age), researchers from the University of Michigan used a variety of empirical tests (econometric and statistical analyses) to examine the relationship between Internet use and depression. Their findings indicate a positive contribution of Internet use to mental well being among older Americans and report Internet use leads to a 20% reduction in depression classification. xxxiii Despite these generally positive findings, Dickinson and Gregor (2006) report some problems with the literature on impact of computer use among older adults and highlight issues with sample size, inclusion criteria, and measures. xxxiv They caution researchers to be careful when reporting on their findings arguing the causal pathways of the impact of computer use has not been fully demonstrated; although positive trends are evident, it is very difficult to tease out the impact of computer use specifically (versus training, personality, etc). It has been argued elsewhere that those working in the area of aging and technology must be aware of, and report on, the negative, as well as positive outcomes of technology use (e.g., the ways in which technology can undermine autonomy, dignity, self-efficacy, or social interaction). xxxv Training Older adults are more accepting of new technologies if they are provided with adequate training. xxxvi The importance of training to the attitudes, knowledge, and confidence, as well as the sustainability of these outcomes among older adults, has been examined. Overall findings from this literature indicate teaching methods and style play an important role in facilitating older individuals interaction with, and ongoing use of, technologies. In particular, a friendly approach, xxxvii supportive environment, xxxviii and a relevant curriculum xxxix are important. For example, assessing the impact of computer training programs on the changes in attitudes towards computers, Segrist (2004) found that a direct, customized computer training program (SeniorNet) significantly increased older adults feelings of comfort. xl In a critique of the aging and technology literature, Dickenson argues that, although current research is unable to fully 13

14 demonstrate computer use (specifically) has an independent effect on the well being of older people, there is some evidence that appropriate training does have an effect. Overall, the aging and technology literature highlights the increasing use of digital technologies, the potential benefits to be gained from this use, the complex nature of the process of use, and the role that training can play in facilitating the uptake and sustained usage of these technologies among older people. The literature makes several calls for future work in this area: the need for more training opportunities for older people, xli a more comprehensive understanding of the ways in which older adults utilize computers in their everyday lives and the impact this use has on their health and well-being, and the need for more research to determine how best to train older adults to use new technologies. xlii A Note on Outcomes from the Literature Preserving and improving the health and well-being of older people is a significant public health issue of the 21st century. As life expectancy continues to increase and in the face of accelerated population aging, healthy aging (i.e., maintaining older adults in good health and keeping them autonomous and independent over a longer period of their remaining years) will likely be of singular importance for local, state and federal governments as they anticipate the costs of health and long term care. xliii Promoting healthy aging therefore as an approach that seeks to create the environments, policies and programs that allow people to live longer and healthier lives in which they are fully engaged in and contributing members of society is a key priority among governments, academics, and community organizations. Social connectedness, social participation and access to information are key predictors of healthy aging. Belonging to a supportive social network makes people feel cared for, loved, esteemed, and valued all of which have a powerful protective effect on health. xliv Research on social networks and aging demonstrate social isolation is a serious health concern among older adults. In previous research, social isolation has been linked to cancer and cardiovascular disease, xlv re-hospitalization, xlvi depression, xlvii delayed care-seeking, poor nutrition, and premature mortality. xlviii According to the City s Department of Health and Mental Hygiene, social isolation is a significant health concern among older New Yorkers; in approximately 132,800 New Yorkers age 65 and older were at risk for social isolation. xlix 14

15 A lack of good information impedes access to opportunities and services. l The availability of, and access to, information and effective forms of communication are predictors of overall health and well-being for older people: Seniors who cannot gain access to information and services because of illiteracy, language barriers, lack of technological knowledge, or a general lack of awareness about the help that is available are at a severe disadvantage when trying to connect with others. li A lack of awareness of services among older adults has been reported as a problem in New York City by Walker and Herbitter (2005) in their report Aging in the Shadows, as well as in the Council of Senior Centers & Services of New York City (2006) document Growing Old in New York City: The Age Revolution. lii Health literacy the ability to access and understand health information in particular plays an important role in individual health; limited health literacy has been linked to problems with the use of preventive services, understanding of one s medical condition, and adherence to medical instructions. liii Social and civic participation have been linked with improved physical and mental health, cognition and emotional well-being among older adults. Older adults who are actively engaged in forms of social participation are less likely to report poor general health or depression liv and social engagement has been found to alleviate cognitive decline among the elderly population. lv Civic participation has been positively associated with better physical and mental health in older adults. lvi Research on volunteering, for example, suggests it contributes to reduced mortality lvii and higher levels of well-being (measured by self-rated health, functional dependency and depressive symptomology) among older volunteers. lviii Civic participation also helps to build and maintain strong and supportive communities. lix The importance of civic participation has been recognized in the city of New York; in April 2009, Mayor Bloomberg launched NYC Service an initiative aimed at promoting service and volunteerism in New York City by creating opportunities that address the City's most pressing local needs for those who want to serve. There is a wealth of information demonstrating the positive impact of social connectedness, social and civic participation and access to information on health and wellbeing among older populations. Based on this information, health promoters, programmers, 15

16 policy makers and community groups are seeking ways to encourage and support opportunities for these positive outcomes among older adults. Technological literacy and use has the potential to address these issues among older adults and, as such, represents a key strategy for promoting healthy aging. In this study, the impact of the OATS program on the well-being of study participants will be assessed through increases in these proxy measures: technological literacy and use, social connectedness, information and communication, and social and civic participation. Enhancing opportunities for older adults to participate in effective technology training programs is understood as a way to both directly and indirectly affect the health and well-being of elderly, enhance healthy aging and impact health and long-term care costs. Methods and Methodology A mixed-method research design was adopted for the study. Study procedures, including data collection strategies, site selection, and participant recruitment, were as follows: Data Collection Data were collected using three strategies: a) Telephone Surveys: Three waves of telephone surveys were conducted with study participants pre, post and 6-month follow-up after completion of the OATS computer training. The surveys included both open and close-ended questions and took minutes to complete. Questions were designed to collect data on the impact of the OATS courses (as per study objectives), the sustainability of this impact over time, as well as to assess the strengths and weaknesses of various aspects of the OATS program. Basic demographic information was also collected for each participant. b) Ethnographic Field-work: While the computer training courses were taking place, the researcher conducted seven site visits at two of the community sites, as well as visiting one of the at-home sites to observe participants as they engaged in the OATS course. During these visits, individual case study observations and informal interviews were also conducted with several participants. The fieldwork provided important insight into study data collected during the telephone surveys by allowing NYAM researchers to observe the trainers in action and the interactions between the seniors as well as providing an opportunity to situate these experiences within the personal trajectories of the individual participants. c) In-depth Interviews with Service Providers: At the completion of the OATS training course, in-depth, semi-structured interviews were conducted with core staff from each study site 16

17 who had administrative duties or responsibilities directly related to the delivery of OATS programs (e.g., program directors or technology lab coordinators). Interviews followed a semi-structured interview guide, and questions were designed to solicit information related to organizational capacity to provide technology programs, social dynamics among participants at the location, and changes in attitudes among staff about older people and/or technology. As well as providing important insights into the impact of OATS on the organization and its staff, data from these interviews provided an additional and unique perspective for evaluating the various components of the OATS program and examining the ways in which OATS impacted the older adults themselves. Site Selection The study was conducted across four sites within New York City. The criteria used to select study sites were: Demonstrated interest in supporting an OATS program Serve diverse constituencies in different parts of the city Capacity to support home-based programs and/or intergenerational components as well as the basic lab-based classes At least one new site (community partner that OATS has not worked with before) Participant Recruitment, Eligibility and Screening All four community partners actively participated in the study by providing site-based computer labs for training, collaborating with OATS staff on program implementation, and conducting senior outreach and recruitment. To be eligible for the study, participants met the following criteria: Registered in an OATS training course (beginners, advanced or workforce) at one of the study sites during the spring 2009 session Over the age of 50 Spoke English fluently Able to provide their consent In order to examine the various types and formats of courses offered through OATS, participants were recruited from the three most common OATS courses and formats available. 2 2 Due to the relatively small sample size study participants were, in most cases, amalgamated into one group during the analysis. This makes findings more robust, however it also limits individual program results. 17

18 Course Type and Format Course Details n % Course Type (level) basic advanced workforce Course Format classroom classroom (with intergenerational component) Data Analysis Telephone survey data were coded and analyzed using SPSS software. Qualitative data (field notes, case study narratives and in-depth interviews with service providers) were analyzed using the principles of grounded theory, assessed using established standards of rigor for qualitative research, and analyzed using NVivo (an analytic software package that allows users to code common themes and to analyze data across participants). Final analysis integrated qualitative and quantitative data to identify key findings within each of the four study objectives. Study Participants A total of 66 older adults (46 women and 20 men) participated in the study, ranging in age from 55 to 85 years of age, and with a mean age of Relationship status was fairly evenly split: 42% were married, 35% widowed and 23% were single or divorced. Almost half (48%) of all participants lived alone, most were either white (52%) or African American (35%) 3 81 participants were originally recruited into the study and completed Survey #1 (pre-). Of this group 69 completed Survey #2 (post-) and 66 completed Survey #3 (6-month follow up). Despite the loss, the study sample size remains strong and when compared with other research, the rate of attrition is not uncommon for this population. Reasons for the loss are as follows: seven participants dropped out of the OATS course due to illness (2), not enough time (3), and new responsibilities caring for an ill spouse (2); two (2) participants did not register for Internet service at home and therefore no longer met study criteria; three (3) participants reported they were too busy when contacted to complete the post-course survey; and two (2) participants could not be reached (telephone # no longer in service) to complete the 6-month follow-up survey. One (1) participant no longer wanted to participate in the study. 18

19 and English was the primary language for the majority of participants (89%). Overall, the group was quite well educated; almost all had received at least a high school education and 44% were college graduates. Three quarters (76%) were retired, 10% (mainly those in the workforce course) were unemployed and seeking work, and the rest were still working either full (5) or part-time (4). Level of income was concentrated in the low (45% lived on $ /month) and moderate (39% lived on $ /month) range. 4 Almost all participants (89%) reported living independently and overall they were a happy and healthy group. Characteristics of Study Participants Age Characteristics of Participants (n=66) N % (mean=70 years) Sex Male Female Course Location Castle Hill Lincoln Square Samuel Field SAGE 7 11 Relationship status married/common law partner separated/divorced/single widowed Living arrangement alone spouse/partner other family 4 6 roommate 2 3 Race/Ethnicity White Black/African American Latino/Hispanic 6 9 Asian Living on this amount is particularly challenging for older adults living in New York City where rents and the cost of living is much higher than in other places in the country. For a more appropriate measure of poverty for this population see the report produced by the CEO (Center for Economic Opportunity) at 19

20 Primary language English Spanish 3 5 Other 4 6 Education some high school 4 6 high school graduate business, vocational, or technical school 4 6 some college college graduate Employment status full-time 5 8 part-time 4 6 retired (not seeking employment) unemployed/looking for work 7 11 Monthly income < > Self-rated health excellent very good good not so good 5 8 poor 1 2 Self-rated happiness happy all the time 9 14 happy most of the time content unhappy most of the time 1 2 Level of independence completely independent sometimes get help 4 6 most of the time get help 1 2 use paid service

21 Findings The overall purpose of this study was to examine the impact of the OATS computer training courses on older adult participants. Findings were generated from an integrated analysis of all study data that served to complement one another. In particular, field notes and individual narratives collected during the site visits complemented the quantitative data from the telephone surveys by providing context and highlighting the lived experience of the older adults. Data from the service provider interviews provided an additional lens through which to examine both the experience of the older adults as well as the OATS training itself. Together these data provide a comprehensive picture of the OATS training and the impact of the training on participants computer skills and usage, social connectedness, social participation and access to information. Analysis also provides insight into some of the ways in which hosting OATS courses has an effect on the service providers (organization and staff). Key findings from this study are identified, discussed, and organized according to the four study objectives. Objective 1. To assess the impact of the OATS program on the computer skills and utilization of participants Confidence, ability, and computer use increased significantly for students completing the OATS computer training courses, and these outcomes were sustained over time. Increased Confidence: In the open-ended post- survey question, What is the most important thing you learned in the OATS course? 83% of participants described feeling much more confidant using the computer, and negotiating the Internet. I have been an incredible technophobe and been so afraid from the very first class. I lost all fear, it s amazing. (66-year-old woman) Indeed, 94% of study participants reported an increase in their confidence using computers as a result of the OATS training (64% significantly; 30% somewhat). 21

22 Changes in confidence using computers (Post-course Survey) Frequency Percent significantly increased somewhat increased significantly decreased 0 0 somewhat decreased 0 0 did not affect Total Participants equated the importance of their increased confidence with their emerging recognition that computers and the Internet are: a) here to stay, b) an increasingly important tool in today s society, and c) that there was, therefore, a need to get beyond their inhibitions and learn and embrace these technologies: Before it was a luxury, now it s a necessity. (69-year-old woman) Like it or not, being on the computer is no longer optional. (67-year-old man) I don t know if I m gonna love it but I ll be darned if I m going to learn it. (60-year-old woman) Improved Ability: Participants ability to use the computer and negotiate the Internet improved significantly from pre- to post-oats course. Improved ability was demonstrated through selfreported changes, changes in computer and Internet use over time and computer-related vocabulary among participants, and also through differences observed during field research. The data reflect a very strong sense of improved computer ability among study participants as a result of the OATS training course; 98% reported an increase (47% significantly; 27% somewhat) in their ability to use computers after completing the OATS course: 22

23 Changes in ability to use computers post OATS training (self-reported) Frequency Percent Valid significantly increased somewhat increased significantly decreased 0 0 somewhat decreased 0 0 did not affect Total Data from post-survey Participants also reported feeling confident they would be able to sustain this improved ability over time: Ability to maintain computer skills now the course is over (selfreported during post-course survey) Frequency Percent very well quite well not very well unsure Total This was shown to be the case, as 89% of participants reported they were still able to do what they learned in the course six months later: Ability to still do what was learned (follow-up) Frequency Percent very well quite well not very well Total Improved skill was also reflected in the way in which participants used the technology. Over the course of the study, participants expanded the types of activities they did on their computers and also broadened their explorations on the Internet. For example, prior to taking the OATS course, six participants (of the 66) used the Internet to search for information, whereas in the six-month follow-up, 63 (of 66) were doing so. Almost all participants had a first-time story they shared (either in post- or follow-up surveys) which illustrated new skills, knowledge, and their improved prowess with the technology: 23

24 I m the recording secretary at our Temple. In the past I wrote it out and gave it to everyone. Now I type it into my computer, save it to a file with a date It s a very big thing for me. (74-year-old woman) I don t get help, now I m the computer person. (58-year old-woman) I use Pandora now to listen to music. And I installed some new games to play. (72-year-old man) I went online and got a parking sticker for a State Park, then I used mapquest to get directions to the Park. (75-year-old man) Improved ability and skill level was also demonstrated by changes in computer-related vocabulary among participants; there were a lot fewer whatchamacallits and hoosits in the post-course surveys and instead made reference to the usb cable, address bar, and search engine. For those who have grown up in the digital age, it is easy to forget how much of our language is technological and how we assume fluency in the language. As one participant reminds us, this assumption makes life challenging and frustrating for those who are unable to, speak the language : The first line on anything is take the usb cable and plug it into the What hole? What s a usb? (76-year-old woman) Finally, there were tangible differences in the physical comfort and ease shown by participants as they progressed through the training programs. A certain level of ability and understanding are required in order for us to relax and begin to enjoy something, and in-class observations provided an opportunity to witness this evolve among participants. For example, what were tentative and nervous touches on the keys became confident and rapid punching; what was sometimes confused and awkward handling of the mouse evolved into smooth, capable steering; and by the final classes, bodies appeared much more relaxed and at ease with shoulders down and bodies leaning in to engage eagerly with the machines. 24

25 Increased Use: The frequency of computer use increased significantly for participants post OATS training, and this result was sustained over time. 5 Prior to the OATS course 51% of participants used a computer regularly (daily or several times per week); immediately after the training 95% reported regular use and six months later 93% reported regular use. There may be an inclination to attribute the increase in frequency of use to the fact that the participants received computers as a requirement to being a part of this study. However, it should be noted that 79% of participants reported having a computer in their homes (71% own; 8% other family member) prior to taking the course. As well as increasing the regularity of computer use, the amount of time participants spent on their computers also grew. In the six-month follow-up surveys, 100% of participants reported that when they use their computers, they stay on them for longer than they did previously and/or they use them more than once a day. I had a computer for a long time but never really used it. Now I do. (80- year-old female) 5 p=.000 (baseline to 6-month follow-up) 25

26 It s the first thing I do every morning now. (80-year-old female) My computer is my second wife I m hooked. (61-year-old male) I m addicted to it in a good way. (78-year-old female) Increases in use and confidence were the norm among participants, however the data also reveal several individuals who had either stopped using their computers altogether or were not utilizing the technology to the same degree as others: although 100% of participants were using computers immediately after the training, three (of the 66) were no longer doing so six months later. The reason for discontinuing computer use was the same for all three they had experienced technological problems since the course ended that they were unable to remedy either themselves or with help from others. Those in this situation reported feeling frustrated, unconfident and saddened: I had a problem and it destroyed my confidence completely. I feel very uncomfortable on it. Now I lack the motivation. It s just sitting there glaring at me. My kids are disappointed with me. (77-year-old female) I m not using my computer now because it stopped working. I called Verizon but they told me nothing was wrong. Well something s wrong! It s too bad. When it was working I was communicating with my family in Puerto Rico a lot more using the computer, but not now. (67-year-old female) Impact on older adult members as reported by service providers: Reports from the in-depth interviews with the service providers lent support to participant data: all of the staff at the host organizations felt that the OATS training had a positive impact on the students in the course. Overall they felt the students were excited about what they were learning and that the training was improving the older adults computer skills and confidence as well as increasing their computer use. Staff based their impressions on their observations of the OATS students as they used the computer labs during open times, as well as on what the students said to them about how they were using and applying their new knowledge. For example, they reported students would frequently say things such as: My husband had to yell at me last night to get off the computer. (74-yearold female) 26

27 You know what I did last night? I ed my children AND I attached to it too. (85-year-old female) Service providers also noticed the language used by OATS students as they were nearing completion of the various courses reflected a more advanced understanding of the technology. For example, student would say things to them such as: I ll just look on the website ; Oh I can install this or Did you use a usb cable? Changes in overall feeling using the computer: When participants were asked what their overall feeling was when using their computer, there was a trend among the group toward more positive feelings about the technology after the OATS training: prior to taking the course 39% reported positive feelings, 42% negative and 18% mixed, whereas in the six-month follow-up, 50% reported positive feelings, 12% negative and 27% mixed. Pre Follow-Up Overall feeling using computer Positive Excited/happy Confident Negative Frustrated/ Nervous/apprehensive Mixed (good/bad) Positive Excited/happy Confident Negative Frustrated Nervous/apprehensive Mixed (good/bad) Frequency Percent Note: Changes were statistically significant in both the positive (p=.001) and negative categories (p=.000) The case study data and open-ended survey questions provide insight into the high number of participants in the follow-up survey reporting mixed (good/bad) feelings. When prompted about their responses, participants explained that with increasing confidence and skills they were beginning to explore further and to try new things on their computer and that although this new learning came with growing pains (uncertainty, anxiety, frustration), most believed these would dissipate as they gained more experience. 27

28 Other findings: Beyond highlighting increases in participant ability, confidence, and usage, several other important findings were identified during analysis. Use caution when making assumptions about previous experience and training: Analysis revealed previous computer training and experience does not necessarily translate into a confident and efficient home-user. Although most participants reported either previous computer use (88%) and/or previous computer training (57%) prior to taking the OATS course, half of these individuals (51%) also described being frustrated, nervous, and unconfident using computer technology. Frustrating? I ll say! I wanna throw the thing out the window all the time. But I can t so I just yell at my husband instead. (73-year-old female) This study provides important insight into this phenomenon that suggests the use of caution when making assumptions about the confidence and ability of older adults who report previous training and experience. The data in this study suggest much of this experience fails to lay the foundation for independent, at-home computer and Internet use. Workplace training and/or experience in particular failed to translate to home-use where Brad (the workplace technology expert) was not available to help when things went awry. Workplace training courses were also said to be too specific, in terms of task and software, to be helpful when doing more generic computer activities (such as searching the Internet for information) at home. Other, non-work related computer courses were also identified as providing insufficient expertise to allow students to take home what they learned and apply it. When prompted to explain why not, participants said the classes were either not long enough, had poor instruction, or were too specific. Changes in attitude: Participants attitudes toward computers and the Internet changed over the course of the study. When asked during the post-course survey to indicate if and how their feelings about computers changed as a result of taking the OATS course, 94% said they felt more positive about the technology: 28

29 I had a mental block when it came to computers. I resisted them. Now it s opened. (60-year-old female) My computer was NOT my friend before, now it is. (66-year-old female) Four participants reported feeling more negative towards the technology, which they explained as either feelings of annoyance or frustration. OATS - changed feelings about computers Frequency Percent more positive more negative no change 0 0 Total Post-course survey data Increased broadband use: All study participants were required to have an Internet connection at home during the study. After the course was over, none of the 66 study participants reported they had, or were planning, to disconnect from the Internet. Six months later, 63 of the 66 participants were still using their computer and no one (including those who were no longer using their computers) had disconnected their Internet service. In addition, 11 of the 12 who began the OATS training using dial-up Internet service had switched to high-speed. Internet Connection at 6-month follow up Frequency Percent Dial-up High-Speed High-Speed (change from dial-up) Total Embracing a future that includes technology: Most participants described a future for themselves that included technology. Study data supports the idea that improvements in confidence and ability can serve as a gateway to new technologies. For example, prior to the OATS training 5 participants owned and regularly used a digital camera; six months later 20 29

30 reported regularly using a digital camera. Cell phone use also increased; interestingly however, there was no increase in mp3 use: Changes in regular and confident use of other digital technologies Frequency Percent Cell Phone Pre Post Digital Camera Pre Follow Up Ipod/mp3 player Pre Follow Up Note: In the pre-survey, 40 reported owning a cell phone; however only 15 of these individuals said they felt confident using their cell phones. This was similar with digital cameras: 10 owned but only 5 felt confident using them. There were also many reports from participants that they were asking family and friends for computer equipment or gadgets as gifts (birthdays or Christmas). Wish lists included printers, digital cameras, jump drives, webcams, and even newer, faster computers. While these changes in attitudes and usage of other digital technologies cannot be directly attributed to the OATS course, exposure to and the increased confidence from the course likely played an important role. Overall, most participants view themselves as lifelong computer users after taking the OATS training and report that they are looking forward to a future for themselves that includes these technologies. I m on the service road now, which is a big improvement from the sidewalk where I used to be and I can t wait to get on the highway! (66-year-old female) I m so excited, I m in the 21st century now. I can t wait to see what s next. (85-year-old female) Enhanced overall self-efficacy: Data suggest that improved confidence and ability with computers translated into a sense of enhanced overall self-efficacy for some participants. In the six-month follow-up surveys, several participants discussed feeling more confident generally in their lives, more ready to tackle the world, which they attributed to their new 30

31 knowledge and skills. The word empowered was used several times to describe how some students were feeling since the training ended. As one participant summarized, using the computer makes me feel courageous. And powerful. (83-year-old female) Increased overall self-efficacy was also reflected in the in-depth interviews with the service providers. These staff members have extensive hands-on experience working with older adults and are insightful and seasoned observers of the ways in which their members respond to different types of programs. Several of them noticed an overall improved sense of confidence among OATS students: They feel good about themselves, you can see it on their faces; they are accomplishing something; they like to be students and learn. Prior to taking the OATS course, several participants described how not having skill and knowledge of computers was disconcerting and made them sometimes feel incompetent or stupid : I feel so ashamed and embarrassed and so I just pretend and tell people ok when they say go look at that website or look here I feel so left out sometimes. (61-year-old female) I m old but I m not stupid and computers make me feel like I am. (73-yearold female) I feel stupid with my kids and that is annoying. (66-year-old male) These negative feelings were seen to contribute to an overall lack of self-efficacy, which is detrimental to the well-being of older adults. Feelings of empowerment, self-efficacy and a sense of control, on the other hand, are all related to improved health and well-being among older populations. Objective 2. To assess the impact of the OATS program on the health and well-being of participants as measured by changes in: i) social connectedness, ii) access to information, and iii) social and civic participation. The analysis reveals the OATS training course had a positive impact on the social connectedness, access to information, and social and civic participation of study participants. 31

32 Social Connectedness: Most participants (64%) reported that the amount of time they spent communicating with friends and family increased as a result of the OATS training: Changes in the amount of time spent communicating with family & friends as a result of OATS course Frequency Percent increased decreased 0 0 did not affect Total Increases were attributed to greater use of as a form of communication. Indeed, prior to OATS training 1.8% of participants used as their primary and 24.6% as their secondary form of communication with family. After the OATS training, 8.8% reported as their primary and 49.1% as their secondary form of communication with family. The qualitative data provides additional insight into changes in use by participants and suggests caution in relying on simple yes/no frequency scales to ascertain use. In the openended survey questions and through the anecdotal stories shared during on-site case study interviews, many participants elaborated on the specific way in which they were using prior to taking the OATS course: all of the beginner students as well as many of those in the advanced course explained that their use was, in fact, reliant on someone else (e.g., grandson, daughter or husband/wife) or, was not very proficient: Well actually, my wife gets my s and reads them to me. (61-year-old male) I read them all when they come in, but I don t write back. I don t how to do that part. (76-year-old female) Oh I get them alright, they just keep coming and coming! I don t know what to do with them all! (78-year-old female) usage changed considerably however for these participants after completing the OATS course. In post-course surveys, all of the participants reported using entirely on their own, and most were using the application effectively (e.g., responding to s, and to a 32

33 greater capacity than previously (e.g., organizing s into folders, forwarding attachments, adding contacts to their address books and sending and receiving group s). Although use and ability increased over the course of the study, the telephone remains the primary form of communication for most participants (in follow-up survey 78.9% reported the telephone was the primary means of communication with family and 60.7% with friends). There were slight increases in the use of as the primary means of communication among the group, however, as a secondary or other form of communication for both friends and family the increases were much more significant (see chart below). Cell phone use as a communication tool also increased somewhat over the course of the study and at the six-month follow-up some participants were using new digital communication tools IM, videoconferencing, and texting- with positive results: I just had my 80th birthday and we celebrated it all together on Skype! (80-year-old male) Primary Secondary Tertiary Primary, secondary and tertiary means of communication with family (%) Telephone Cell Phone In-person IM, text, or video Pre Follow-up Pre Follow-up Pre Follow-up N/A Note: 1) Not all participants communicate with family, and therefore totals for each form of communication do not add up 100%; 2) Some participants communicated with family in one way or two ways only (i.e., did not have a secondary and/or alternate form of communication), and those who were in these categories were allocated N/A. Primary Secondary Tertiary Primary, secondary and tertiary means of communication with friends (%) Telephone Cell Phone In-person IM, text, or video Pre Follow-up Pre Follow-up Pre Follow-up N/A Note: 1) Not all participants communicate with friends and therefore totals for each form of communication do not add up 100%; 2) Some participants communicated with family in one way or two ways only (i.e., did not have a secondary and/or alternate form of communication) and those who were in these categories were allocated N/A 33

34 was not seen as a replacement for the telephone by study participants, but as another tool for staying connected and one that, in certain situations, was seen to be more effective than the telephone: I use now for my kids and grandkids cause they ll catch it cause that s what they re into. They get back to me faster than if I leave a message on their telephone. (65-year-old female) is good for me I have trouble hearing on the phone. (66-year-old male) Some participants integrated telephone and communication: I use all the time now. I my kids, a lot! I them and tell them to call me. (74-year-old female), or I still use the telephone mostly to call my kids I call them to see if they got my . (64-year-old female) One of the most interesting insights into use among the group helps to explain why, particularly with friends but also with older family members (e.g., siblings), is not used more extensively. Participants reported wanting to use with friends and siblings more often but were prevented from doing so because many of these individuals did not have, or know how to use, computers: I would my sister, but she doesn t have the computer. These findings reflect the large number of offline seniors, and suggest there is a huge potential for increased use of communication among this population if/when more members of their social networks do get online. It was common for study participants to describe feeling more connected to their families in ways they were unable to before their OATS training: I m part of the family again, I get family s, I m part of the gang. (73- year-old female) communication was used by participants to stay in touch with friends and relatives both near (in New York City) and far. It was seen as particularly important, however, as a way for immigrants and those whose families lived in other countries to stay better connected to family and friends: 34

35 I have family in the Philippines now I feel very connected to them. (74- year-old female) In these cases, was seen as an effective form of communication for many reasons including that it was easier to deal with the time differences between countries, and it was also a lot cheaper than using the telephone and having to pay for long distance charges. grandchildren: was also seen by many to be very important for staying connected to My main support person in my life is leaving my grandson is going to college. This is my main reason for taking OATS. I need to be able to stay in touch with him. (78-year-old female) The importance of computer use as a way to foster and maintain intergenerational connectedness was highlighted in other ways: They look to grandma for all answers and now I have some. (55-year-old female) He helps me so much, he s 22 and he has so much patience for me. And it s fun with him! (73-year-old female) (Participant told the story of how she meets with her grandson once a week since the course ended to work together on her computer skills.) Participants also increased their social connectedness directly through the OATS training by meeting others in the class (both the instructor and other students). Taking the course increased the social networks of all participants during the course, and many reported maintaining contact with other students or the OATS trainer (either online, in-person or via telephone) after the class was over. I made so many new friends, the girls we call ourselves. (66-year-old female) These new friendships were described as being very important to the participants as they explained that many of their old friends had passed and it was increasingly difficult to make new friends as they got older. Improved social connectedness among OATS participants was also observed by the community partners. All of them reported noticing the camaraderie among the students in the 35

36 class, they often saw them coming and leaving together and witnessed as some of these friendships were sustained even after the course was over. As one staff member exclaimed: If the purpose is to get them connected then it worked! They are more connected with each other, with us, and with their families. (Service Provider) The OATS course enhanced the social connectedness of participants, which, as previous research demonstrates, is linked to improved health and well-being among older adults. Many of the comments and stories shared over the course of the study highlight this. Several people described the ways in which the computer has eased their loneliness: by providing opportunities to participate in family events they would not have been able to without the technology or, for some, by providing company for them, filling their lives with something to do music, videos, games which made them happy, entertained them, alleviated their stresses, and eased their loneliness: I live alone. I go on the computer all the time, as soon as I get home, I talk to my grandchildren on Facebook. It s company. (64-year-old female) You just forget about all your problems when you are on there. (75-year-old female) I was in the dark since my husband died and this is my bright spot. (66- year-old female) Now I come home to something. (79-year-old female) I have my sick wife in the house so it s difficult for me to get out this computer opened it up for me. (83-year-old male) OATS enhances seniors lives; even if we are stuck at home we can get on and reach the world. (64-year-old female) During a site visit, a participant told a powerful story about how, as she put it, OATS had changed her life. Recently, her children and grandchildren went on a trip to Israel and despite really wanting to go, she felt she couldn t travel the distance any longer. She knew the day that her children and grandchildren were going to spend time seeing her family and old friends and she was feeling very sad that she couldn t be there. Then she described what happened on that 36

37 day: I opened my computer and I started to cry just one hour after their meeting I was getting pictures and notices from everyone. How wonderful. (78-year-old female) Access to Information Researching the Internet for information was the second most popular computer activity among study participants ( being the first). Before it was like I was in the best library in the world but all the books were laying all over the floor and not organized now they are on the shelves and I can find what I need. (60-year-old male) The OATS training had an impact on information access among study participants most directly by increasing their use and ability to utilize the Internet as tool for information. Study data also provide insight into the kinds of information participants were using their computers to search for, as well as the specific ways in which this information was accessed. Increased use and ability to access information using computer technology: There was a strong sense among participants that the OATS training enhanced their individual competence and ability to access information online. In the post-course survey, 89% reported that their ability to access information increased as a result of the training (56% significantly increased; 33% somewhat increased): Ability to access information Frequency Percent Significantly increased Somewhat increased Did not affect Total Further analysis illustrates a significant increase in the frequency with which the group used the Internet as a tool for information. Prior to taking the OATS course 22% of participants said they used the Internet regularly (often 12.5%, very often, 9.4%) to get information compared with 78% who reported regular use (often 51.6%, very often 26.6%) in the six-month follow up survey. Indeed, prior to the OATS course, 44% of participants (28) said they never 37

38 used a computer to access information whereas six months later 100% of participants who were still using their computers (63/66) reported they did so. As a result of their improved online abilities and increased use of the Internet as a source of information, participants described feeling better informed. When asked if they ever felt like they were missing information, 47% answered yes in pre-oats surveys compared with 14% in the 6-month follow-up surveys. As evidence of this positive development (perceived or actual), many participants added comments such as not anymore when answering no to this question. Missing Information Yes No Don t Know % # % # % # Pre month follow-up One of the things that participants liked the most about online access to information is that they felt in greater control. As one participant explained: Now I m in charge, not my television set. Some reported liking that they could get the kind of information they wanted, 38

39 others appreciated that they could get it when they wanted it, and for others the choice of format was important (large font, from newspaper or attached from friends or family). Several felt information from traditional sources in the US was limited or biased and they were very pleased that they could read what people from other countries were thinking about the US, and learn about different perspectives and opinions on international events. Despite a significant increase in the number of participants using the computer to access information (see graph below), more traditional sources of information, in particular, television and newspapers, remain popular among this group of older adults. Participants were well aware however, of the shift to electronic media, and described various ways in which their usual sources for information were starting to limit information available to those without access or ability to computers and the Internet: Now it s getting really bad the T.V. is always the same want more go to www dot that s what got me on the computer, that s the reason. (74-yearold female) Newspaper closures and the emergence of online newspapers was a particular concern among many participants: 39

40 I ve been getting the New York Times delivered to me for 45 years, I don t know what I ll do if that stops. (64-year-old male) Most commonly researched information is health, politics and current events: Health and medical information ranked number one in terms of the type of information pursued on the Internet, closely followed by news and politics. When asked during the post-course surveys to list and rank their top three types of information looked for on the Internet, 71% of participants reported Health and Medical Information, and 65% reported Politics and Current Events among their top three: First, second and third most common types of information looked for on the Internet Types of Information Most common Second Third Total Health and Medical Frequency Percent Politics and Current Events Frequency Percent Total Frequency Percent Note: Totals do not equal 100 because a) only those individuals who reported using the computer to access information are reflected and, b) participants could select multiple answers. The value of the Internet as a useful tool for finding health-related information was frequently reported by participants: Much easier to find medical information now. (74-year-old female) More and more medical things now [as an older person], so you need it to look up things. (83-year-old male) The follow-up survey data illustrate many participants are using their computer skills to access health information and connect with health and medical services in a variety of ways including researching a personal health condition or medication, learning more about a health issue online, and locating a healthcare provider: 40

41 Searching for political and current event information beyond New York and the United States was common. For example, exploring news items (e.g., weather reports) from places where family members lived or reading electronic newspapers from back home (where participants were born or lived previously) was common. This new source of information was described as a very helpful way to stay connected to places and people far away (which was important and comforting to participants). I m from Nigeria, I like to know what s going on there and now I can read about it every day I stay more connected. (61-year-old male) I can read all the Spanish newspapers on my computer, this is very, very good. (67-year-old female) Accessing online information: The principal way in which participants use their computers to access information is through the search engine Google (56%). Many (21%) also read the newspaper online as a way to get information: 41

42 Primary way computer is used to get information (6-month follow up) Frequency Percent Use Google Read newspaper online Search homepage (e.g., Yahoo, Verizon, AOL) Other (Including listservs, government websites, known sites) Does not use the computer to get information Total Although relying primarily on Google and electronic newspapers to access information, participants also reported using a variety of other online search strategies, including Senior Planet (online digital community sponsored by OATS) and government websites: Have used the following to access information online (6 month follow-up) Frequency Percent Valid Google Newspaper or news-related website Senior Planet Government websites Subscribe to listservs Read blogs Listservs and blogs as sources of information were rarely used by this group of older adults, although there is some evidence to suggest this may change in the future as several participants reported an interest in these types of information sources and a few had experimented with them. One of the reasons why these may not be popular information sources for participants is that they are not taught as part of the OATS curriculum. Indeed, there is a strong correlation between the kinds of search strategies taught in the OATS courses (e.g., Google) and the frequency of use by participants. Increased access to information is a link to social connectedness and social and civic participation. Information keeps these older adults connected to family and friends as well as to 42

43 the city and all it has to offer. It also connects them to vital services which support them as they live independently and save them money, energy, and anxiety: I plan to look for information on social security online now. (66-year-old female) I use the computer to book appointments with my doctor I used to get put on hold all the time. (66-year-old female) I used it because I needed new glasses and also to search for medications. (80-year-old female) I ve saved hundreds of dollars being able to search products and price compare and shop online. (72-year-old male) Now I use Fresh Direct. (55-year-old female) I m saving money, I cancelled HBO and use my computer now. (59-year-old male) Students felt the OATS training and increased technological skills contributed to them feeling more informed overall. During the post-course survey, 85% reported they felt more informed as a result of the OATS training (50% much more informed, 35% somewhat more informed): Has OATS training made you a more informed person? Valid Cumulative Frequency Percent Percent Percent Valid much more informed somewhat more informed no change Total The capacity, speed, and relative ease with which information was available served as a constant source of amazement to most participants, many of whom grew up in a time before television was popularized. This sense of wonder and amazement was demonstrated in their voices during the telephone surveys as well as in the energy and enthusiasm witnessed in their classrooms: I sat in on the beginner class today and [the instructor] introduced the students to Google Earth for the first time. It was incredible it was as if he had shot them to Mars! The small windowless computer lab became a portal to the world, and the bright-eyed 43

44 students sat in the pilot seats in absolute amazement at the adventure before them. Their excitement and awe is so contagious When was the last time I was that excited about something? (Excerpt from researcher field notes March 2009) Social and Civic Participation 6 My social life is a lot better since learning the computer. I can find cheap hotels, book trips, find dance classes! (69-year-old female) Analysis of study data also provides evidence to suggest the OATS training and the concomitant increase in computer literacy had a positive impact on participants social and civic engagement. This impact was highlighted and demonstrated in various ways: through improved access to, and awareness of, social events and opportunities available in the city; increased interest and, in some cases, participation in online social networking; increased engagement in politics via online news sources; and enhanced social engagement as a direct result of attending the OATS training courses. Access and awareness of social events and opportunities: Forty-four percent of study participants felt their awareness of social activities had increased as a result of the OATS training and 24% reported that the number of social activities they participated in had increased. Self-reported changes as a result of OATS training Awareness of social activities Number of social activities participated in Frequency Percent Frequency Percent Significantly increased Somewhat increased Did not affect Total As their skills and confidence improved, participants increasingly used their computers to learn about cultural events and activities available in the City (49% reported doing so in 6 Social and civic participation refers to engagement in social and/or civic (political and non-political activities that make a difference in the civic life of our communities) activities. 44

45 follow-up surveys). Follow-up survey data illustrate the popularity of other ways participants used their computers to increase their awareness and participation in online and offline social and civic activities. Most participants used their online skills to access information (e.g., locations and directions, dates, times, ticket fees, reviews, venue telephone numbers, discounts for seniors) about particular events they were interested in (e.g., sports, movies and theatre were the most popular) and used this information to make decisions about attending social events. They rarely, however, went the step further to actually purchase tickets online to these events. The two reasons cited for this were fear of not doing it properly and becoming victim to some kind of identity theft. Participants were generally very pleased with the results they were able to get as they pursued their social interests online. Although they admitted they were able to access much of this information previously without using the computer, the speed and up-to-date nature of the online information sometimes made it easier to make decisions to go out to social and cultural events in the city. Several participants who did order tickets online, as well as many who did not, noticed that there were sometimes discounts available for electronic ticketing which made it a compelling option for many. 45

46 Online social networking: Most of the individuals (7/10) who engaged with online social networking sites were doing so on Senior Planet (OATS online community). Although there was some interest among participants to explore other social networking sites like spacebook (as one particpant called the popular social network site Facebook ), only three had done so at the time of the follow-up surveys. The reasons for not engaging with these sites were common and were most often described as either a fear or a distaste for exposing the personal and intimate details of their lives. No, I m not interested in that, I don t want people all up in my business, no way. (67-year-old female) Despite these concerns however, many participants did indicate a willingness to explore social networking sites in the future, I want to get the computer to chat you know because I want to use the computer to meet some friends, meet a partner, maybe get married again (74-year-old female) Those who were engaging with social networking sites expressed an excitement, enthusiasm and pride about their involvement in these digital communities: I have a blog now on Senior Planet, my own blog. (69-year-old female) I think I m the oldest person on Facebook! (84-year-old male) The most common way participants engaged socially online was through forwarding, receiving, and sending group s; 29% of participants reported engaging in this kind of activity. If understood as an online discussion, group s can be seen to directly enhance social participation. For example, many participants described being a part of family discussions around social events such as weddings or holidays. Group s also affected social activity by prompting interest or facilitating opportunities to attend social events or activities. For example, participants explained how they often sent or received group s with information (ticket sales, discounts, upcoming events), attachments, or links to interesting websites that peaked their interest and prompted them to attend an event. 46

47 I love going to concerts. Now my friends send me announcements about concerts. (83-year-old male) It was noted that online social activity among this group of older adults was most often with previously established groups, either informal (family or friends) or formal (e.g., hobby groups); just 3% of participants had used the Internet to identify and join new online social groups. Individuals new to Facebook joined through support and encouragement from family and friends and only allowed these individuals to be their friends. Counting my two grandkids? Just two. (77-year-old female) (Response to the question, How many friends do you have on Facebook? ) Civic Engagement and Employment: Although some participants expressed an interest in pursuing volunteer and/or employment opportunities via the Internet, very few (6%) indicated they had done so in the follow-up surveys. Those most interested were from the workforce course, though students from other courses also expressed an interest in using their technological skills for employment purposes. Some workforce students were taking the course more to learn about the specific software taught in the course rather than to use it to gain employment. Those who did express an interest in pursuing employment in the future acknowledged that without computer and Internet skills they would be unqualified for most jobs. I was thinking of working but everything needs computers maybe when I get my course I can do it. (59-year-old female) (Pre-course survey comment) One of the most interesting ways increased civic engagement was demonstrated by study participants related to the election campaign and new presidency of US President Obama. Obama and his team used digital media strategies such as Facebook, Twitter and online organizing techniques extensively in his campaign. At the same time, there has been an incredible growth in digital media sources that are not just supplementary to traditional media, but replace it. For those (like many of the study participants) who are interested in following Obama s political (and personal) life, there is, therefore a need to have access and ability with these technologies. Many participants reported that keeping track of Obama and following his presidency was a key motivator for their computer use and a focus of their online searching. 47

48 These participants were very pleased with the kinds of information they could access from the Internet in this regard, as well as the speed and interactive nature of the information: You can watch him give a speech, see his schedule and then see a slide show of photos of him and his family living in the White House! (73-year-old female) Now I can research my travel to see Obama in the White House, I m going to arrange a tour. (72-year-old female) I like to follow the president now, how could I do that without it [the computer]? (61-year-old male) Don t use computer for news unless of course Obama is on, then yes. (64- year-old male) Enhanced social participation through attendance of OATS class: The social lives of study participants were enhanced directly through their attendance in the ten-week OATS training courses. Students spent a considerable amount of time in the classes (twice a week/75 minutes each class) and described making new friends as well as feeling the time spent in the classes was interesting, productive and fun. In post-course and follow-up surveys many participants said they missed the social interaction with students and the instructor and some experienced a loss of activity in their lives since the class ended: I m so sorry it ended, it filled up two days and now I don t have it anymore I really miss it. (71-year-old female) The significance of the OATS courses as an important activity in the lives of participants was illustrated further in the interviews with the service providers. Several of them saw the intensity of the OATS programs as a big commitment for their members and reported the high rates of attendance were a testimony to the course content (computer and Internet training) as well as the context (fun, social atmosphere). There is an indication that the full impact of the OATS training on the social and civic participation among students may be better understood in the future that the training laid the foundation for the skills and attitudes necessary to foster more adventurous exploration in these areas at a later time and as confidence and skills further develop. For example, for some 48

49 participants the OATS training reminded them they could still be learners, that they were capable of acquiring new skills and, additionally, that learning was an activity that could be both inspiring and important to them as they grow older. It was nice to be a student again! (59-year-old female) I m looking at taking a university course now. (64-year-old male) The more I learn, the happier I feel. (67-year-old female) I m more interested in things than I have been in years! (67-year-old male) It is so great to see older people engaged and healthy and learning it s inspiring we ARE still alive! (73-year-old female) Concerns: Prior to taking the OATS training some participants were concerned that their increasing use of digital technology may begin to erode more personal forms of communication. In particular there was a strong sense among the group that compared to the telephone and face-to-face interaction is very impersonal. These concerns were sustained among several participants who were worried that now they were able to use , their friends and family would begin replacing the telephone with digital communication: Not going to tell my cousin I m on the computer. He loves the computer and I know he ll never call me once I m on it. (59-year-old female) Others worried (in the post and 6 month follow-up surveys) that their increasing computer use was/would keep them from going outside, prevent them from getting exercise, or cause them to miss social activities they had previously attended (which had happened to at least one participant): I got so caught up I missed my exercise class. That s twice this week, which isn t good. (66-year-old female) I don t want to stay inside with the computer. (78-year-old female) I m a bit worried because if you sit there you're going get fat. So then you have to read on computer what classes to take for exercise its crazy. (75- year-old female) 49

50 Overall, the OATS training was seen to enhance participant social connectedness, access to information and social and civic engagement. Participation in the OATS course, in combination with new technological abilities, helped participants to maintain, enhance as well as grow existing social networks, fostered a stronger connection to the city and its people, and, perhaps most importantly, made people feel they were more a part of today s world: The world was passing me by. (71-year-old female) OATS brings seniors into the world of today. (83-year-old male) I always felt totally out of it now I feel I m a part of the world again. (78- year-old female) Objective 3. To explore the effects of hosting OATS training courses on community partner organizations The service providers (i.e., the staff at the community hosting organizations) have a unique vantage point through which to observe the OATS training courses, and their observations, comments and perceptions provide an additional lens through which to view the impact of OATS. Although the sample size for these interviews was relatively small (n=6), all of the participants had direct contact with the OATS programs (as administrators or IT staff) and collectively reflect more than 80 years of hands-on experience in the field of aging services. Observations shared during the in-depth interviews with these individuals contribute substantially to overall study findings and offer important insight into the effects of hosting OATS courses on the membership, programming and staff at these partner organizations. Impact on the organization itself: As well as providing a unique perspective through which to view the efficacy of the OATS training and the effect of this training on older adult members, community partners were asked to reflect on the impact of OATS courses on their organization and staff. The relationship between OATS and their community partners and the impact of their training programs on these host organizations is a critical component of the OATS model and one that has received very little attention in the literature. Interview questions focused on identifying the 50

51 administrative challenges of offering OATS courses, the impact on organizational and program capacity, changes in staff attitudes, beliefs or awareness about older adults and technology, and feedback and suggestions for improving the programming and delivery of OATS courses in community organizations. The overall impression from the interviews with the community partners is that working with OATS and offering OATS classes is beneficial to an organization in two important ways. First, OATS was seen to enhance the capacity of the organization. Offering OATS courses generated a great deal of interest among existing members, which was reflected in the speed at which classes filled as well as the waiting list generated. At two of the sites where OATS courses have been offered previously, staff reported a continuous and growing waiting list of people wanting to register. In addition, when OATS classes were advertised through their organization, staff at three of the four study sites reported a very good response: The response [was] overwhelmingly positive We had 64 calls in 2 weeks! Offering OATS courses also had the effect of attracting new members to the facility: We see all kinds of new people who come here for OATS. OATS increases the attendance at my center for sure and this is important, this helps. Also many of them stay at the Center after OATS and take other classes. Some staff, however, were unsure whether these new members would remain active after completing the OATS courses or that offering these courses in sites where there were existing programs would generate much new interest from members: Not a lot of existing members joining because they take our on-site courses. New members interested in OATS, don t think they will stay members here, only interested in OATS. Secondly, OATS courses were also seen to increase the visibility of the organization within the local community: Good PR for us and brought awareness of our facility to people who didn t know about us. Much more interest in our facility because of OATS classes and we are seeing new people. 51

52 Although seen to be a primarily positive experience that benefited the host organization three key challenges to offering OATS programs were raised by the service providers. First, staff acknowledged that hosting OATS programs creates some additional administrative duties and challenges for host organizations. For example, several service providers flagged intake as a particularly difficult issue to manage: You need to do interviews to make sure about proper match and this was a lot of work. Difficult to say to some they were not qualified. Secondly, scheduling OATS courses was also mentioned as a challenge: Sometimes the class changes last minute or is added last minute and this creates problems. The logistics are difficult sometimes. A third difficulty was raised by staff at one of the organizations that had a previously established computer training program. At this facility, staff described some confusion and miscommunication between OATS and on-site IT staff: We offer training already at our facility. Our on-site instructors were unsure of their role and felt a lack of communication and understanding of their position created misunderstandings. Surprisingly, there were very few technological problems reported, and the few that were mentioned in the interviews reflected limitations with on-site labs rather than with OATS services: We just wish our lab was better. Impact on staff, other members, organization: There was a shared feeling among interviewees that there was potential to positively shift people s attitudes and beliefs about older adults as a consequence of housing OATS training courses. Although changes in attitude are often subtle and can even go unnoticed, the service providers spoke many times about witnessing changes within themselves, other staff, and also among other members of their facilities: 52

53 Our staff looked at the computer lab as a place for teens and children, not seniors. This has changed now. Respect for the tenacity of seniors who came, their dedication to learning. We are really trying to change the culture here It s not cute for older adults to use computers and this supports that change. It changed the image of seniors among the Y staff and changed the image of the Y among the seniors. One of the final questions posed to the service providers was whether or not they felt it was important for older adults to receive computer training and their response was a collective yes. All of the interviewees felt very strongly that computer training for older adults enhanced their engagement in life, improved their ability to communicate and stay connected with friends and family and, increasingly, was an essential tool for negotiating the digital world in which we are now living: Yes very important helps them stay connected with family and broader world and important for their health too. Crucial the world is increasingly wired and if you don t know how to use it, you are left out. Objective 4. To identify the key strengths and weaknesses of the current OATS computer training program This course is one of the best things I ve ever seen done. It gave us an incredible opportunity to be a part of it all and be able to function in today s society. And I m just very very grateful. (83-year-old male) The evaluation of the OATS program is based on an integration of the study data: participant telephone survey data (particularly the post-course survey which was completed within two weeks of the course completion and contained a number of direct evaluation questions about the program), on-site case study participant data, responses from the in-depth interviews with the service providers, and researcher field notes and observations collected over the eight months of the study. Findings are organized according to the strategies used to evaluate the OATS program: outcome evaluation of key components, testing the OATS 53

54 program against criteria for success as identified in the literature, and a synthesis of study data to highlight key strengths and weaknesses of OATS. The section concludes with recommendations and suggestions. Overall evaluation of OATS by study participants: Using a five-point scale (excellent, very good, good, not very good, poor), participants were asked to rate the key components of the OATS training program: trainer, teaching manual, teaching style (curriculum design and delivery), class setting 7 and webinars as well as to provide an overall rating of the OATS program. Results indicate students were very pleased with OATS classes 94% rated the OATS program overall as either excellent (64%) or very good (30%). Trainers were rated particularly high; 94% rated them either excellent (74%) or very good (20%). Evaluation of OATS program components by participants (%) 7 For in-class participants class setting referred to: with other older adults, lab set up and class size. For at-home participants class setting referred to: instructor comes to your house and one-on-one instruction. 54

55 Forty-four percent of participants did not attend the optional webinars; reasons given were mainly due to prior commitments, although a few mentioned they were not interested. The 7.6% of participants that were unsure about how they would rate class setting all said they felt the class size and in-lab setting was very good, but they felt either ambivalent or unsure about the age-specific design of the OATS courses (i.e., they didn t know if they needed or benefited from having a class just for older adults). In addition to direct questions asking them to evaluate the classes, participants were given an opportunity to make additional comments regarding their experiences as students in an OATS course. It is important to note that at this point in the telephone surveys participants were reminded that the researcher was not an OATS employee, that their comments were completely confidential, and that they were encouraged to provide the good, the bad and the ugly about any aspect of their OATS experience. Their responses to this request were overwhelmingly positive, as participants raved enthusiastically about the various components of the OATS program, from the patient, compassionate, wonderful instructors, to the incredible, easy to follow and useful manual, to the well-paced, organized and effective curriculum and the open, safe and fun classroom atmosphere. OATS is amazing- instructors are full of humanity. (64-year-old female) The book is wonderful, it s an essential guide and great reference tool. (74- year-old female) The camaraderie was wonderful they set it up that way. (75-year-old male) I loved being with students my own age. (83-year-old female) A few participants reported negative experiences and/or feelings: I ended up in the wrong course it was very frustrating trying to keep up. (66-year-old female) I would have liked to learn more about how to meet people on the Internet and get into more activities. (66-year-old female) We should have been taught right away how to make the font bigger on the computer. (79-year-old female) 55

56 The manual for our course [workforce] is out of date and this made it hard to use at home. (55-year-old female) Even with the book practicing at home didn t always go very well. (78-yearold female) I love the computer but even now I still feel so stupid sometimes when things go awry. (80-year-old female) OATS versus other computer training programs: The study also provides some evidence to support the efficacy of the OATS training program as compared to other computer training programs. When asked whether or not they had taken a computer training course elsewhere and, if so, to compare it to their OATS training, 29 (44%) of the participants reported they had taken other computer courses, and 55% of these individuals said the OATS training was the superior of the two. Taken other computer class and compare to OATS Frequency Percent Yes and it was better Yes and it was different (can t compare) Yes and it was not as good No Total Students also made the following comments to support their convictions: OATS took me places other courses wouldn t go near! (59-year-old male) Tried to take at library big difference. (55-year-old female) John [the instructor] is such a nice man. I feel so comfortable with him. He gives you hope that you can learn and that s what keeps me going! I ve been to a lot of computer classes and never felt this way. (72-year-old female) Overall evaluation of the OATS program by the service providers: During the in-depth interviews staff were asked to reflect on their overall feelings both positive and negative about the OATS training program. Responses were primarily very positive. When reporting on the trainers, the service providers felt they were very professional 56

57 both with them, their staff, as well as with the older adults. The trainers were described as good, enthusiastic, and able to build positive rapport with their older students. OATS trainers are very well selected and trained they are very patient and compassionate this is the key to the success. The staff members explained that good rapport was particularly important in this situation, as many of their members were apprehensive about the computers themselves, as well as their ability to learn and understand the new technology. Staff shared several anecdotal stories and comments from participants that illustrated to them the positive experiences of their members. In addition, they reported that most OATS participants had approached them either during or after the course, wanting to register in future OATS courses, which for them was a strong indication of the success of the program. Another measure of success from a provider point of view was the strong commitment demonstrated by students. All of the partners reported being surprised by the dedication of the students as reflected in the high rates of attendance as well as the homework they completed each week outside of class. I was unsure about it really, people are going to come twice a week for 10 weeks but they did! There were very few negative feelings about the OATS training sessions: one staff member at a facility with substantial numbers of Spanish speaking students expressed disappointment that courses were only available in English. At least half of my seniors speak Spanish and it s harder for them, they feel bad sometimes because they don t understand. Additionally, the response to the OATS webinars 8 was mixed. Although students seemed generally interested in the webinars, and there were some positive reports, staff at two of the sites said attendance was low, the technology didn t seem to operate properly, and a few students left frustrated with the experience. 8 OATS organized several webinars across the four study sites that occurred during the 10-week course. These were free and optional to the students. 57

58 No one really showed up. I don t think they could see or hear it very well. Standing the test of success: Within the aging and technology literature, three key components for successful technology training with older adults have been identified: usability, transfer, and retention. lx To ascertain whether the OATS training program can stand the test, data was analyzed according to these three criteria. Usability: Usability refers to performance and satisfaction measures that reflect the effectiveness of the training experience. Analysis indicates both performance and satisfaction were improved as a result of the OATS training. When asked whether their OATS training increased their ability to use computers, 65 of the 66 participants said yes; 47 (71%) said the increase was significant: Ability to use computers (post-survey) Frequency Percent significantly increased somewhat increased did not affect Total Another way in which performance can be assessed is by examining changes in the tasks participants were able to complete using their computers. Improvements in performance were noted during on-site visits when comparing what students were doing (and not doing) in early classes with what they were doing in later classes. There was a notable difference in the complexity of tasks students were able to confidently complete in classes near the end of the course. Performance changes were also highlighted in the analysis of qualitative data from the telephone surveys. By juxtaposing pre-course responses to the post- and follow-up responses, clear improvements are demonstrated. This was most obvious for beginner students who revealed (with humor, as they were often well aware they weren t getting it quite right ) their inabilities as well as inexperience with computer and Internet during pre-course surveys: 58

59 I need to learn more yes, but for now I use GOGGLE and can find most things. (76-year-old female) I think my mouse is broken, it moves backwards and upside down all the time and it never goes the way I want it to. (74-year-old female) My kids gave me a computer it s quite nice... I ve been dusting it for 6 months now. (65-year-old female) I ll tell you the real reason I want to take this course, if I can get onto that SPACEBOOK I can see what my grandkids are doing. (72-year-old female) I had a WORM living on my computer for awhile but I just turned it off and didn t turn it back on again for three weeks, ha ha, I think I killed it! (83- year-old female) These comments were collectively much different than the majority from this same group of students after the OATS training when participants revealed a good grasp and understanding of the technology and reported both new and improved performance in their computer and Internet skills and knowledge: Now I have a digital camera, I fill out our medical forms online now, its like wow. (64-year-old male) Now when I see something I need to know about in the newspaper or tv I can search it myself. (65-year-old female) Now I can my family in California. They are so proud of me. I m so proud of me. (72-year-old female) I use Pandora now to listen to music. And I installed some new games to play. (72-year-old male) Two measures that can be used to illustrate satisfaction are whether or not participants intend to take another OATS course, and if they would recommend the course to others. Survey results from both of these were very positive: close to 90% said they were planning on taking another OATS course, and 100% of participants said they would recommend OATS to other older adults. 59

60 Planning on taking additional OATS (post survey) Frequency Percent yes no don't know Total In both questions participants responded very confidently and in almost every case they emphasized their convictions with comments such as: I can t wait for the next course! (66-year-old male) or, I tell everyone I know about OATS, I print and distribute the flyers myself! (69-year-old female) Transfer: Transfer refers to the ability of older adults to take the skills they learn in their training into other environments, such as home or the library. All of the participants reported successfully using their computers and applying their new skills on their home computers. During the course they translated what they were learning while they practiced and did homework on their home computers. After the course and six months later, participants continued to use the skills they learned in the course on their home computers. All participants reported their homes as their primary location for computer use, which they explained was not because they didn t feel able to do so elsewhere, just that it was less convenient. Several mentioned being forced off the computers at libraries when school children arrived after school, and that the minute time limits at libraries were too short for them to do much. Some participants translated their skills and used computers when visiting family. They mainly did this either to check their s, although some reported doing it to show off a bit to family members. The OATS manual was shown to be very important to the transferability of skills among many students: I use my OATS book all the time, I keep it on my desk next to me at all times. (64-year-old male) Teaching manual is great. I refer to it often. I keep it in my bathroom. (61-year-old male) 60

61 There were a few problems reported with skill transfer, all of which related to software incompatibility. This was particularly true for those in the workforce course, where participants home versions of Word or Excel were either older, or in some cases newer (e.g., VISTA), than those they were using in class. The OATS manual was not as helpful to these students because it was written for even older versions of the software. These problems definitely caused some confusion as well as frustration as students attempted to transfer their classroom skills to their home environments. One of the most significant ways transferability of skills and knowledge was demonstrated was in the way in which participants were able to successfully troubleshoot problems on their home computers. Their reports, when asked how they dealt with the inevitable problems that occur during computer use (e.g., screen freezing, pop-ups, unable to print a document), illustrated a good foundation of skills and knowledge as well as a confidence that prepared them well to deal with these issues. Synthesizing their strategies, OATS students adopt a stop, drop and roll approach to troubleshooting: Stop everything turn it off, restart it, pull the plug, shut the lid, walk away, or just ignore it for a little while, it needs a rest. Drop in for help wait until family member comes for a visit and, ask them, corner them or, don t give them anything to eat until they fix it. Roll you just gotta be patient, try some things, relax and remember what you learned or breathe deeply and try not to cry. Using this approach, which is both directly (via curriculum) as well as indirectly (increased confidence, students sharing these strategies with each other in class) taught to OATS students, was one of the most compelling examples of the ways in which OATS helps students prepare for sustained computer and Internet use. This approach reflects confidence, ability, and ingenuity, and means students are less likely to by stymied by computer or Internet glitches and more likely to continue using their computers at home long after completing OATS training. 61

62 Retention: Retention refers to how well benefits and ability are retained after completion of the course. The study design, with a six-month follow-up survey, allowed for an assessment of retention and results are very positive: 6 months after the OATS training 89% of participants reported they were still able to do what they learned in the course (41% very well, 49% quite well). Ability to still do what was learned (follow-up) Valid Cumulative Frequency Percent Percent Percent Valid very well quite well not very well Total Retention can also be assessed by examining how many OATS graduates continue to use their computers after the training is complete and again results were extremely positive: six months after the course, 63 of the 66 study participants were still using their computers (67% daily, 26% several times a week and 3% occasionally). In summary, findings illustrate that OATS is a successful technology training program for older adults, effectively standing the test across all three criteria. Key Strengths and Weaknesses of the OATS program: program: Study data was synthesized to identify the key strengths and weaknesses of the Key Strengths: The people: OATS trainers (at least the three that were observed and evaluated in this study) are exceptional instructors who are very good at what they do. They are patient, compassionate, and make the content accessible and the environment conducive to learning. The curriculum: OATS courses are organized into a series of well-defined units that incrementally increase in complexity. They are paced in such a way as to not overwhelm the students by providing too much too fast, but also are not boring to those who are progressing more quickly than others. 62

63 The teaching manual: Students found the OATS manual to be a highly effective guide throughout the course, and most continued to use and rely on it as an important resource after completing their training. The class style: The small number of students, the fact that OATS classes are lab-based, and the open, relaxed, fun environment encouraged social interaction and a safe place for students to ask questions. In addition, the school feel - with assigned homework and a dedication to the process of advancing students through the curriculum - means students felt like real students and took the classes seriously. The overall experience: The emphasis in the course toward a positive experience and increased confidence means students leave OATS feeling good about the technology, their ability to use it, and themselves. Key Weaknesses/Areas for Improvement: The workforce course: There were very few negative comments about any of the components of the OATS program, however much of what was considered problematic or annoying was concentrated among students in the workforce courses. Their complaints were mainly focused on: a) the incompatibility between the version of software referred to in the teaching manual and the software used in the computer labs, b) the curriculum, and in particular what several students felt was an overemphasis on Powerpoint versus Excel and Word and, c) a lack of training on other computer related skills that students felt are very important in an employment setting (e.g., the ways in which the Internet is used to attach documents, creating and using distribution lists, and how to make labels used often in offices). Intake: Comments that the process of intake was confusing and stressful came from both the service providers as well as the participants. Both felt ill-equipped to make these decisions and held OATS at least partially responsible for the occasions when students ended up in the wrong course. When it happened that a student ended up in the wrong course it was a bad situation for everyone: the participant who may have a negative experience as a result; other students in the class who may become annoyed or impatient with the wrongly-placed student; the trainer who is trying to teach to a variety of levels; and the service provider who may receive complaints from this or other students. Intergenerational component: Participants who participated in OATS classes with an intergenerational component felt that although this was a very compelling component of the OATS training and one that held incredible potential, as it was currently structured it did not live up to its potential. Participants reported that although it was wonderful to spend time with the youth, and it gave them some insight into their world, they were not sure how helpful or useful the interaction was to their computer training specifically. 63

64 Recommendations and suggestions from Participants: When asked if they could change anything about the OATS course, 30% reported they wouldn t change anything, and 35% said the only suggestions they had was to have more OATS by extending the amount of class time in some way. The other suggestions were mainly focused on offering the course in other languages, offering courses more often at each site, teaching new courses on a specific topic (e.g., How to increase social participation using the computer and How to use a digital camera ), and improving screening procedures. Change anything about OATS Frequency Percent Nothing Extend the course (more weeks) or Have longer classes (more time each class) Other suggestions Total Recommendations and Suggestions from Service Providers Providers were thoughtful and forthcoming with their feedback and made several suggestions about how to improve the OATS programs: Bilingual Training: Hire more bilingual instructors Offer courses in Spanish Translate OATS manuals into Spanish Intake: Provide a short intake questionnaire that would help determine the most appropriate class for students Use OATS graduates as volunteers to help the older adults figure out which class they should register for On-site training and support for staff: Train volunteers at the host sites so they were able to offer or increase open hours in their computer labs Offer additional training to on-site IT staff so they can provide better support to OATS students once the course is over Scheduling: 64

65 Provide more consistency scheduling OATS trainings Offer workforce courses nights and weekend to accommodate those in the workforce Funding: Assist organizations to procure sustainable and sufficient funding so they can make OATS courses a regular and consistent course offering at their facility 65

66 On-site IT staff Include IT managers and instructors in planning and regular communications so they can assist in planning and implementation and do not feel alienated from the process Better coordinate with existing IT staff and current computer training programming to avoid replication OATS getting students turned on for success: It is not enough to simply offer technology training to older adults. Supporting this population to engage with what is often considered foreign and confusing and, as one participant reported, completely out of my element, requires much more. It requires good training. Good training will build confidence, alleviate confusion and anxiety, pique interest, and promote understanding and improved skills that are sustained over time. OATS programs do this. The data are very compelling and illustrate a package of well-designed and thoughtfully administered components (curriculum, trainers, manuals, class atmosphere, style) that together create a package for success. What OATS does best is lay the foundation for confident, enthusiastic, excited computer users who are turned on by the technology and not looking back. Overall Summary Study findings provide a comprehensive picture of the ways in which OATS programs can impact the lives of older adults. OATS training programs were found to positively affect the lives of community-dwelling older adults who were interested in learning how to use computer and Internet technologies. OATS trainings promoted the successful adoption and sustained use of these technologies and served to enhance social connectedness, increase access to information, and facilitate opportunities for social and civic participation among OATS students. Each core element of the OATS program is effective, and together provides a technology training program that serves older adults extremely well. Findings also suggest a positive impact on the community partners; hosting OATS programs seems to increase organizational capacity as well as promoting a more positive image of older adults among staff. Study findings make an important contribution to the field of aging and technology, are helpful to policymakers and programmers charged with supporting the health and well-being of the growing 66

67 older population, and provide direction and guidance to OATS as it moves forward with programming and curriculum development, continues to grow as an organization, and seeks additional and sustainable funding. 67

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