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J Korean Gerontol Nurs > Volume 25(4):2023 > Article
Park, Kim, Jung, Kim, Lee, and Lee: Factors relating to intention of use non-face-to-face services among family caregivers of persons with dementia: A cross-sectional study

Abstract

Purpose

This study investigated the decision factors influencing the intention to use non-face-to-face services such as online support, social networking, educational programs, and video conferencing among family caregivers of persons with dementia (PwD).

Methods

This correlational study uses the Technology Acceptance Model as a decision process model. The study targeted family caregivers registered at local dementia care centers, and data from 284 participants were analyzed. An online questionnaire survey was conducted to obtain general characteristics, perceived usefulness, perceived ease of use, and intention to use non-face-to-face services.

Results

The results indicated that perceived ease of use differed according to family caregivers’ age, education level, and relationship with the PwD. Intention to use significantly differed by education level, relationship with the PwD, and caregiving duration. Perceived usefulness and perceived ease of use were the main influential factors in the intention to use non-face-to-face services. The regression model accounted for 63.9% of the variance in the intention to use.

Conclusion

This study contributed to understanding the intention to use non-face-to-face services for family caregivers and identified the influencing factors. The results indicate the need to communicate better the usefulness of non-face-to-face service and early information and education about available technologies in helping caregivers prepare to adopt new services.

INTRODUCTION

1. Background

According to the World Health Organization (WHO), dementia is the seventh primary cause of mortality globally, affecting over 55 million individuals [1]. In 2019, dementia cost the world 1.3 trillion US dollars, with around half of this expense attributed to informal caregivers, such as family members and close friends, who provided an average of 5 hours of daily care and supervision [1]. As of 2022, the estimated number of people aged 65 and above with dementia in South Korea was 935,086, accounting for 10.3% of the total older population [2]. By 2060, the number of persons with dementia (PwD) is projected to increase to 3.32 million, representing 17.7% among those 65 and older [2].
Many PwD receive home care from informal caregivers, often family members [3,4]. Dementia is a progressive disease, and the role of family caregivers in caring for individuals with dementia is highly crucial [5,6]. There is an urgent need to provide sufficient support and resources to enhance family caregivers’ well-being and alleviate the challenges associated with dementia care [6-8]. Taking care of a family member with dementia can pose significant challenges for caregivers, resulting in a decline in their mental well-being and diminished quality of life [5-9]. Considering this, South Korea launched the “National Dementia Responsibility System” in 2017 to alleviate the burden on PwD and their families. As part of this initiative, dementia care centers were established nationwide to provide services such as assessing caregiver burden, counseling, and conducting family workshops [10].
With the advent of the Fourth Industrial Revolution, devices such as smartphones, tablets, and computers have become useful tools to reduce family caregivers’ psychological burdens, promote social engagement, and ease the pressure of daily activities [11-13]. Providing dementia-related services through remote means is a cost-effective way to support families and allows for the easy transmission of various information over distances [14-18]. Internet-based dementia technology, including smartphone apps, computer programs, wearables, e-learning, and online platforms, provides care support and facilitates communication with healthcare professionals, enabling the monitoring of disease progression, identification of emerging issues, and delivery of professional interventions [19,20].
The COVID-19 pandemic has been identified as a barrier to service access among family caregivers of PwD [21-23]. Social distancing facilitated non-face-to-face services, including video platforms, social network services, and video conferencing programs [24,25]. The pandemic has led to the dissemination of a culture of non-face-to-face services to limit contact and transmission [25,26]. Following the pandemic, the demand for non-face-to-face services has continued. In caring for PwD, it is essential to establish the use of both face-to-face and non-face-to-face services, and it is important to ascertain factors that affect the use of non-face-to-face services due to technological advancements and educate family caregivers accordingly.
The Technology Acceptance Model (TAM) [27] is a decision model that explains how users accept and use technology (Figure 1). In TAM, actual system usage is the ultimate goal of how users interact with technology. Additionally, behavioral intention is a factor that drives users to decide to use the technology and is influenced by the general perception of attitude toward the technology. This model suggests that external variables such as perceived usefulness and perceived ease of use, as well as social influence, impact users when they encounter new technology. Perceived usefulness refers to the degree to which users believe that a particular system will enhance their performance and is helpful for the tasks they intend to accomplish by using the technology. Perceived ease of use refers to the degree to which users believe that using a specific system will be effortless and without much effort, making the technology useful for the tasks they intend to accomplish.
According to TAM, the two factors, ‘perceived usefulness’ and ‘perceived ease of use’, are directly linked to an individual's attitude (positive or negative) toward using technology. This attitude influences an individual's ‘intention to use’ the technology and ultimately leads to actual usage [27]. In other words, when PwD and their family caregivers consider adopting a new non-face-to-face service related to dementia, the perceived usefulness in terms of how beneficial it will be for them and the perceived ease of use in terms of how easy it is to use play a significant role. If the perceived usefulness and ease of use are high, there is a high likelihood that they will accept and actively use the technology. Researchers need to identify the factors that influence family caregivers' acceptance, decision process, and use of the technology, ensuring that they can benefit from the advantages offered by new technologies.
Therefore, this study investigated the intention of family caregivers of PwD to use non-face-to-face services, such as social networking, online support, educational programs, and video conferencing, by applying the TAM.

2. Purpose

This study aimed to analyze the perceived usefulness and ease of use of non-face-to-face services among family caregivers of PwD to understand their decision process and identify factors that influence the intention to use non-face-to-face services.

METHODS

Ethic statement: This study was approved by the Institutional Review Board (IRB) of Chungnam National University (IRB No. 202107-SB-128-01). Informed consent was obtained from the participants.

1. Study Design

This study, following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines (http://www.strobe-statement.org), investigated the perception and demand for non-face-to-face services among family caregivers of PwD to identify the factors influencing their intention to use such services.

2. Study Participants

This study included family caregivers aged 18 years and above of individuals with dementia. The inclusion criteria were having no difficulty reading, writing, understanding the study content, possessing a smart device, and expressing willingness to participate.
The sample size was calculated using G-Power 3.1.9.7. The calculations were based on a significance level of .05, a medium effect size of .15, and a power of .95. These parameters resulted in an estimated sample size of 242 participants based on a previous study [28]. This study recruited 300 participants to account for potential missing data, and 284 participants completed the survey.

3. Ethical Considerations

Approval was obtained from the IRB of Chungnam National University (IRB No: 202107-SB-128-01). All participants were granted informed consent online before participating in the study.

4. Measures

The questionnaire used in this study was adapted and modified by the researchers based on the previous study [27]. The questionnaire consisted of perceived usefulness (four items: quick and easy obtain the necessary information by using various functions; saving time and money; information obtained through non-face-to-face services helps me efficiently handle what I do; non-face-to-face services are generally useful), perceived ease of use (four items: easy to use; easy to learn how to use; easy to obtain the necessary information; easy problem solving), and intention to use (three items: try to use the services; recommend others to use; willing to use the service in the future). Responses were rated on a 5-point Likert scale. Higher scores are related to higher perceived usefulness, perceived ease of use, and intention to use non-face-to-face services. In this study, Cronbach α values for perceived usefulness, perceived ease of use, and intention to use were .92, .90, and .95, respectively.
Sociodemographic characteristics, including age (year), gender (man/woman), education level (middle school or less/high school/college or higher), relationship with the PwD (spouse/children), health status of the PwD (poor/average/good), caregiving duration (year), employment (yes/no), and secondary caregiver (yes/no), were measured as social influence factors.

5. Data Collection

Data for this study were collected using an online survey administered to family caregivers of PwD in 2022 through the Seoul Metropolitan Center for Dementia, which has its affiliated 25 local dementia centers. The family caregivers facing difficulty participating in online surveys received assistance from the coordinators. A recruitment notice on the center’s bulletin board included information about the study’s purpose, methodology, subject rights, and data protection. The participants were assured of anonymity, voluntary participation, confidentiality of their information, and freedom to withdraw from the study at any time.

6. Data Analysis

In this study, the collected data were analyzed using the SPSS version 26.0 program (IBM Corp.). sociodemographic characteristics were examined in frequency, percentage, mean, and standard deviation. The reliability of the measurement tools was assessed by calculating Cronbach's α coefficients. Perceived usefulness, perceived ease of use, and intention to use based on sociodemographic characteristics were analyzed using an Independent sample t-test and ANOVA. Post-hoc tests were conducted using the Duncan test. The analysis utilized Point-biserial correlation coefficients to examine the correlation between gender, relationship with the PwD, employment, secondary caregiver, perceived usefulness, perceived ease of use, and intention to use. Additionally, Pearson correlation coefficients were employed to analyze the correlation between age, education level, health status of the PwD, caregiving duration, perceived usefulness, perceived ease of use, and intention to use among the sociodemographic characteristics. The factors influencing the intention to use non-face-to-face services was identified using linear regression analysis.

RESULTS

1. Sociodemographic Characteristics

Two-hundred eighty four family caregivers participated in this study, with an overall response rate of 97.9%. The ages of the family caregivers ranged from 30 to 91 years (mean=65.19, standard deviation [SD]=11.82). Most caregivers (88.0%) were women. More than 60% had not graduated from college, and approximately half (52.5%) were spouses of PwD. Regarding the recent health status of PwD, 50.4% reported poor health. The caregiving duration averaged 4.48±3.58 years. Moreover, 68% did not have secondary caregivers (Table 1).

2. Perceived Usefulness, Perceived Ease of Use, and Intention to Use

The levels of perceived usefulness, perceived ease of use, and intention to use are presented in Table 2. The overall mean scores for perceived usefulness, perceived ease of use, and intention to use were 3.47±0.84, 3.17±0.88, and 3.55±0.87, respectively.

3. Differences in Variables Based on Participant Characteristics

The differences in perceived usefulness, perceived ease of use, and intention to use based on participant characteristics are presented in Table 3. Perceived ease of use showed significant differences based on age (F=6.34, p=.002), education level (F=7.24, p=.001), and relationship with the PwD (t=-4.17, p<.001). Intention to use differed according to education level (F=3.72, p=.025), relationship with the PwD (t=-2.24, p=.026), and caregiving duration (F=3.36, p=.036). Perceived usefulness was not statistically significant in all participant characteristics.

4. Correlations Between Study Variables

The results indicated a significant positive correlation between education level and intention to use (r=.13, p=.022) and between the relationship with the PwD and intention to use (r=.13, p=.026). Additionally, a significant negative correlation between caregiving duration and intention to use (r=-.12, p=.040). The findings demonstrated a significant positive correlation between intention to use, perceived usefulness (r=.76, p<.001), and ease of use (r=.72, p<.001) (Table 4).

5. Multiple Regression for Intention to Use

A multiple linear regression analysis investigated the factors influencing the intention to use non-face-to-face services. The findings are presented in Table 5. First, residuals and multicollinearity were assessed. A Durbin-Watson value of 1.97 indicated proximity to 2, suggesting the independence of residuals. Tolerance values ranged from 0.50 to 0.92, exceeding the threshold of 0.1, and the variance inflation factor (VIF) values ranged from 1.08 to 1.97, remaining below 10. These results confirmed the absence of multicollinearity issues based on the criteria of tolerance> 0.1 and VIF<10. The regression model yielded statistically significant results (F=96.47, p<.001), with an explanatory power of 63.9%. The factors found to influence the intention to use non-face-to-face services were perceived usefulness (β=0.48, p<.001) and perceived ease of use (β=0.38, p<.001).

DISCUSSION

The research highlighted that family caregivers, especially those engaging in long-term caregiving, often face challenges such as a lack of caregiving efficacy and social isolation. This situation underscores the necessity for personalized and prompt support [29]. By providing online support options, the study aimed to make it easier for family caregivers, who may not be able to access in-person services, to acquire essential caregiving skills relevant to each stage of dementia care. This approach seeks to address the unique needs and circumstances of caregivers, thereby enhancing their ability to provide effective care.
In the TAM model, perceived usefulness involves the scope individuals believe that a specific technology or innovation will elevate their performance. Perceived ease of use involves the scope to which individuals believe a specific technology or innovation is easy to use [27]. According to the TAM [27], perceived usefulness and ease of use are associated with use and can predict adopting a specific technology or innovation. The results of this study showed that perceived usefulness and perceived ease of use were crucial factors in the intention of family caregivers to use non-face-to-face services. There is a need to enhance the utility and convenience not only in the content and programs of the non-face-to-face services provided to family caregivers, but also in the service delivery system. Enhancing the effectiveness and accessibility of non-face-to-face services for family caregivers involves improvements not only in the content and programs offered but also in the delivery system itself. To increase the perceived usefulness for family caregivers, it is vital to provide practical, actionable information crucial for the care of PwD and resources that assist in daily problem-solving. Additionally, to improve the perceived ease of use, it is important to provide comprehensive education on how to utilize these services effectively and offer ongoing feedback. This approach ensures that family caregivers are not only well-informed but also feel comfortable and competent in using these services, thereby enhancing the overall caregiving experience.
In this study, the perceived usefulness of family caregivers was higher than perceived ease of use. This mean that the expectation of the non-face-to-face service being useful is high but the perception of it being easy to use may be relatively low. Therefore, it is essential to sufficiently convey to family caregivers not only the benefits of non-face-to-face service but also the ease with which they can access it. In the aspect of perceived usefulness of non-face-to-face services, a systematic review of internet-based support interventions for family caregivers found that online services had beneficial effects on reducing symptoms of depression, perceived stress, and anxiety [30]. This highlights the importance of providing necessary emotional support for family caregivers with social isolation. Services with various technologies can enhance access to vulnerable family caregivers who are not actively participating in outside services. Non-face-to-face services can provide essential knowledge and skills to many family caregivers with limited health and social resources [30]. Perceived easiness was different depending on the age, education level, and relationship with PwD of family caregivers. This result indicates older family caregivers have more difficulty using non-face-to-face services, and young or tech-savvy family caregivers can easily access non-face-to-face services [8]. Nurses need to evaluate the proficiency of family caregivers in utilizing internet or mobile technology and provide tailored education based on their proficiency level.
This study had several limitations. First, this study was based on data collected from a convenience sample of dementia caregivers in a metropolitan city; therefore, there are limitations to generalizing the findings in rural areas. In addition, this study did not include other variables, such as the information technology environment such as information literacy and availability of internet devices. As this study did not investigate the actual use of technology, we cannot guarantee whether the intention to use will manifest in actual use. The study faced challenges with the online survey format, particularly for some family caregivers who experienced difficulties in participating. Although technical support was provided, these challenges underline the importance of considering multiple modalities to enhance participation among family caregivers. To mitigate the issue of high correlation between variables in TAM, future research could benefit from broadening the multivariate analysis. This expansion could include variables like information literacy or social influence, providing a more comprehensive understanding of technology acceptance among diverse user groups. Despite the study’s limitations, the results emphasize awareness's importance in accepting and adopting new technology. Additionally, examining the decision process to adopt emerging technologies produced results that align with the TAM model, underscoring the significance of users' perceptions of usefulness and ease of use. The research indicates that caregivers have a keen interest in emerging technologies. Nonetheless, evident obstacles exist concerning the awareness of any novel ATM, necessitating effective dissemination of information to caregivers and their advisors regarding the potential benefits of these diverse technologies in caregiving. As family caregivers age, developing and producing new technologies to meet emerging needs and communicating information about these and their possible advantages to those who need them is critical.
The findings of this study underscore the necessity for nurses to recognize the significance of in adopting new technology to support family caregivers and to be proficient in facilitating technology use of family caregivers. Research is needed to investigate the effective implementation mode of non-face-to-face services applicable regardless of the family caregivers’ age, educational background, and information literacy.
In gerontological nursing research, there is a growing emphasis on user-centered studies that aim to improve both 'perceived usefulness' and 'perceived ease of use' of technologies and services. Developing user-friendly technologies and services that take into account the interactions between PwD and their family caregivers is crucial. Additionally, there is a pressing need for research focused on creating individualized support plans and devising effective education strategies specifically designed for family caregivers. These tailored approaches can enhance the caregiving experience by addressing the unique needs and challenges faced by caregivers in their roles.
In the field of gerontological nursing education, empowering family caregivers to effectively use new technologies is vital. Such programs are essential for enhancing the skills and knowledge that nurses need to have to adequately support both PwD and their family caregivers. By focusing on ease of use and practical application, these training programs can help ensure that caregivers are well-equipped to navigate and benefit from technological advancements in caregiving.
In the practice of gerontological nursing, providing effective support to PwD and their family caregivers through online platforms and technology is critical. It's paramount to ensure that family caregivers have access to the necessary skills for the timely care of PwD and can receive the support they need via convenient online approach. This approach not only facilitates easier access to essential resources but also allows for more flexible and responsive care that can adapt to the evolving needs of PwD and their caregivers.

CONCLUSION

This study investigated factors influencing family caregivers’ perceptions of non-face-to-face services based on the TAM. The findings revealed that the intention to use non-face-to-face services was influenced by perceived usefulness and ease of use. In other words, the more family caregivers perceived non-face-to-face services as useful and easy to use, the higher their intention to use them was. It is imperative to formulate comprehensive strategies and approaches that facilitate proficiently implementing non-face-to-face methods for delivering these services.

NOTES

Authors' contribution
Conceptualization - MP; Data curation - JL; Formal analysis: JK and JJ; Investigation - SK and JL; Methodology MP and DL; Project administration - SK and JL; Visualization - JK; Writing – original draft - MP and JK; Writing – review & editing - SK and JL
Conflict of interest
No existing or potential conflict of interest relevant to this article was reported.
Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2022R1A2C10039041131482092640101).
Data availability
Please contact the corresponding author for data availability.

ACKNOWLEDGEMENTS

None.

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Figure 1.
Technology acceptance model.
jkgn-2023-00164f1.jpg
Table 1.
Participant Characteristics (n=284)
Variable Category n (%) Mean±SD Range
Age (year), (n=276) <60 81 (29.3) 65.19±11.82 30~91
60~69 75 (27.2)
≥70 120 (43.5)
Gender Man 34 (12.0)
Woman 250 (88.0)
Education level Middle school or less 90 (31.7)
High school 82 (28.9)
College or higher, (n=271) 112 (39.4)
Relationship with the person with dementia Spouse 149 (52.5)
Children 135 (47.5)
Health status of the person with dementia Poor 143 (50.4)
Average 111 (39.1)
Good 30 (10.6)
Caregiving duration (year) <3 107 (39.5) 4.48±3.58 0~20
3~4 63 (23.2)
≥5 101 (37.3)
Employment Yes 92 (32.4)
No 192 (67.6)
Secondary caregiver Yes 91 (32.0)
No 193 (68.0)

The sum of the percentages does not equal 100% because of rounding. SD=Standard deviation.

Table 2.
Degree of Perceived Usefulness, Perceived Ease of Use, Intention to Use (n=284)
Variable Mean±SD Range
Perceived usefulness 3.47±0.84 1~5
 It is possible to quickly and easily obtain the necessary information by using various functions of non-face-to-face services 3.47±0.87 1~5
 Non-face-to-face services save time and money 3.49±0.95 1~5
 Information obtained through non-face-to-face services helps me efficiently handle what I do 3.36±0.96 1~5
 Non-face-to-face services are generally useful 3.56±0.94 1~5
Perceived ease of use 3.17±0.88 1~5
 Non-face-to-face services are easy to use 3.18±0.99 1~5
 It is easy to learn how to use non-face-to-face services 3.20±1.03 1~5
 I can easily obtain the information I want by using a non-face-to-face service 3.34±0.96 1~5
 Problems arising from the use of non-face-to-face services can be easily resolved 2.98±1.03 1~5
Intention to use 3.55±0.87 1~5
 I will try to use the non-face-to-face services 3.55±0.86 1~5
 I will recommend that people around me use non-face-to-face services 3.51±0.90 1~5
 I am willing to use the non-face-to-face service in the future 3.58±0.98 1~5

SD=Standard deviation.

Table 3.
Perceptions of Non-Face-to-Face Services Based on Participant Characteristics (n=284)
Variable Category Perceived usefulness
Perceived ease of use
Intention to use
Mean±SD t or F (p) Duncan Mean±SD t or F (p) Duncan Mean±SD t or F (p) Duncan
Age (year) <60a 3.45±0.91 0.84 3.34±0.94 6.34 3.63±0.94 1.22
60~69b 3.57±0.80 (.430) 3.31±0.84 (.002) 3.58±0.79 (.295)
≥70c 3.41±0.83 2.95±0.82 a>c 3.45±0.84
Gender Man 3.28±0.87 -1.35 3.21±0.73 0.28 3.55±0.93 0.05
Woman 3.49±0.83 (.177) 3.16±0.90 (.779) 3.54±0.86 (.953)
Education level Middle school or lessa 3.40±0.83 0.74 2.92±0.92 7.24 3.45±0.89 3.72
High schoolb 3.43±0.86 (.475) 3.14±0.79 (.001) 3.42±0.87 (.025)
College or higherc 3.54±0.83 3.39±0.86 c>a 3.72±0.82 c>b
Relationship with PwD Spouse 3.40±0.81 -1.41 2.97±0.80 -4.17 3.44±0.84 -2.24
Children 3.54±0.87 (.157) 3.39±0.91 (<.001) 3.67±0.88 (.026)
Health status of PwD Poor 3.43±0.94 0.32 3.15±0.90 0.34 3.54±0.89 0.02
Average 3.50±0.68 (.720) 3.22±0.80 (.708) 3.56±0.78 (.976)
Good 3.52±0.86 3.09±1.06 3.54±1.07
Caregiving duration (year) <3a 3.52±0.86 1.49 3.30±0.86 2.62 3.65±0.86 3.36
3~4b 3.59±0.81 (.226) 3.21±0.86 (.074) 3.71±0.76 (.036)
≥5c 3.37±0.83 3.02±0.90 3.40±0.89 b>c
Employment Yes 3.35±0.81 1.54 3.08±0.85 1.14 3.43±0.95 1.55
No 3.52±0.85 (.123) 3.21±0.89 (.253) 3.60±0.82 (.122)
Secondary caregiver Yes 3.52±0.85 -0.75 3.23±0.86 -0.82 3.67±0.87 -1.69
No 3.44±0.83 (.454) 3.14±0.89 (.410) 3.49±0.86 (.091)

PwD=Persons with dementia; SD=Standard deviation.

Table 4.
Correlations Among Participant Characteristics and the Study Variables (n=284)
Variable 1 2* 3 4* 5 6 7* 8* 9 10 11
r (p)
1. Age 1
2. Gender* .02 1
(.715)
3. Education level -.53 -.08 1
(<.001) (.167)
4. Relationship with PwD* -.72 -.06 .59 1
(<.001) (.301) (<.001)
5. Health status of PwD .07 -.17 .09 .01 1
(.202) (.004) (.098) (.763)
6. Caregiving duration .24 .13 -.24 -.22 -.19 1
(<.001) (.027) (<.001) (<.001) (.001)
7. Employment* -.36 -.13 .29 .36 .06 -.03 1
(<.001) (.019) (<.001) (<.001) (.291) (.543)
8. Secondary caregiver* -.30 -.07 .20 .28 .09 -.07 .28 1
(<.001) (.225) (<.001) (<.001) (.121) (.232) (<.001)
9. Perceived usefulness -.02 .08 .06 .08 .04 -.07 -.09 .04 1
(.667) (.177) (.244) (.157) (.441) (.223) (.123) (.454)
10. Perceived ease of use -.19 -.01 .22 .24 .01 -.13 -.06 .04 .68 1
(.001) (.779) (<.001) (<.001) (.952) (.024) (.253) (.410) (<.001)
11. Intention to use -.09 -.01 .13 .13 .01 -.12 -.09 .10 .76 .72 1
(.125) (.953) (.022) (.026) (.903) (.040) (.122) (.091) (<.001) (<.001)

All correlation cofficients are Pearson except* are point biserial; PwD=Persons with dementia.

Table 5.
Factors Influencing Intention to Use (n=284)
Variable Intention to use
B SE β t p-value Tolerance VIF
(Constants) 0.71 0.19 3.71 <.001
Education level 0.01 0.04 .01 0.26 .790 0.62 1.59
Relationship with PwD -0.03 0.08 -.01 -0.37 .707 0.61 1.61
Caregiving duration -0.03 0.03 -.03 -0.96 .335 0.92 1.08
Perceived usefulness 0.50 0.05 .48 9.79 <.001 0.54 1.85
Perceived ease of use 0.37 0.05 .38 7.50 <.001 0.50 1.97
F (p)=96.47 (<.001), R2=.64, adjusted R2=.63, Durbin-Watson=1.97

PwD=Persons with dementia; SE=Standard error; VIF=Variance inflation factor.

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