Technology Affordance in an Information and Communication Technology Delivered Group Psychotherapy and Exercise Program for Older People With Depressive Symptoms: A Multiple Triangulation Qualitative Study

Abstract

Background and Objectives Health and mental health interventions, such as psychotherapy and exercise programs, delivered via information and communication technology (ICT) may improve service access. However, adjustment among older people and in synchronous group interventions is more challenging. Technology affordance concerns the possibilities engendered by technology for various users and purposes and can help understand challenges in ICT-delivered groups and identify possible solutions. Research Design and Methods Adopting a multiple triangulation approach, we observed ICT-delivered groups of acceptance and commitment therapy and exercise for older people with depressive symptoms, conducted focus groups with older people who had received group psychotherapy with or without an exercise component, and obtained clinical notes from interventionists. We conducted a thematic analysis on the observation notes, focus group transcriptions, and clinical notes. Results Four focus groups were conducted with 22 participants (mean age = 72.6 years, SD = 7.2, 86% female). We identified three challenges: (1) seeing-be seen dilemma, (2) speaking-hearing dilemma, and (3) blurred therapy-home boundary, and two solutions: (1) maneuvering layouts and collaborative tools, and (2) cross-platform mediated strategies. Participants struggled to observe the interventionist while simultaneously demonstrating their posture in front of a camera. Remaining silent and moderated turn-taking allowed for clearer hearing but limited interactions. Interruptions from the background environment and intersections of family living spaces disrupted audio-visual communication and jeopardized the sense of security. As a solution, interventionists maneuvered layouts and collaborative tools on teleconferencing applications to achieve intervention goals and provided support through different media. Discussion and Implications The identified challenges and potential solutions can be understood from interactivity, portability, temporality, persistence, and multimediality. Technology affordance can guide ICT-delivered group design by matching the affordance of various technologies and communication media with the characteristics of the intervention and users to enhance efficacy and avoid an unnecessary digital divide.

Hybrid-delivered community psychoeducation for people aged 50 and older: A mixed-method evaluation and lesson learned

“…The need for on-site support has been documented in a previous study with older people with dementia and their carers, with carers serving as stand-by support at home ( Hui et al, 2022 ). Previous studies conducted by the research team found that in-person technical training did not only help participants navigate the devices and software but was also helpful in building rapport with participants individually ( Leung et al, 2023b ). Printed operational guideline also has the advantage of allowing older people to learn navigating a new media platform through a form of materials that is more familiar to them ( Leung et al, 2023b ).…”

“…Previous studies conducted by the research team found that in-person technical training did not only help participants navigate the devices and software but was also helpful in building rapport with participants individually ( Leung et al, 2023b ). Printed operational guideline also has the advantage of allowing older people to learn navigating a new media platform through a form of materials that is more familiar to them ( Leung et al, 2023b ). Trainers could assess participants' digital resources and literacy to offer corresponding level of technological support.…”

“…Although teleconferencing allows interactions, they are often moderated. Previous study has shown that while instructors could gain control over interactions with individual participants using the “mute all” function, it limited the interactions between participants, impeding the sense of engagement in the group ( Leung et al, 2023b ). These factors may affect participants' learning experience and their willingness to continue engaging in it.…”