Zhang Shangyang, Wu Min, Sun Ruini, Cui Changjie, Zhang Ziqing, Liao Jing, Gong Ni
School of Nursing, Jinan University, Guangzhou, China.
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
J Med Internet Res. 2025 Mar 25;27:e66393. doi: 10.2196/66393.
Digital cognitive training (DCT) has been found to be more effective than traditional paper-and-pencil training in enhancing overall cognitive function. However, a significant barrier to its long-term implementation is that older adults with mild cognitive impairment (MCI) do not continue to use it or even show a dropoff in usage after the initial engagement. Such short-term engagement may limit the potential benefits of DCT, as sustained use is required to achieve more pronounced cognitive improvements. Exploring the reasons for the shift in discontinuous usage behavior is crucial for promoting successful DCT implementation and maximizing its positive effects.
This study aimed to explore the intrinsic reasons for the transition from initial acceptance to discontinuous usage behavior among older adults with MCI throughout the DCT process, by employing the extended model of IT continuance (ECM-ITC).
We employed a qualitative research methodology and conducted 38 semistructured interviews before and after the use of DCT (3 times per week over 1 month, with each session lasting 30 minutes) with 19 older adults with MCI (aged 60 years or older) and 4 family members between January and March 2024. Thematic analysis and deductive framework analysis were used to identify the reasons for the discontinuous usage of DCT, with mapping to the ECM-ITC.
Most participants failed to complete the standard dosage of DCT. Data analysis revealed the reasons for the shift to discontinuous usage. Despite their need to improve cognitive function, participants found the cognitive training confusing and discovered that DCT did not align with their preferred method of training upon actual use. The disparity between their vague expectations and reality, combined with the contradiction between the "delayed gratification" of DCT and their desire for "immediate gratification," made it difficult for them to discern the usefulness of DCT. Participants also viewed DCT as an additional financial burden and tended to avoid training under family pressure. They relied on motivational measures, which further weakened their intention to continue DCT, ultimately leading to the inability to develop continuous usage behavior.
Continuous usage behavior differs from initial acceptance as it evolves dynamically with user experience over time. To encourage older adults with MCI to persistently engage with DCT, it is essential to not only thoroughly consider their genuine preferences and the potential disruptions DCT may bring to their lives but also bridge the gap between expectations and actual experiences. While ensuring that older adults receive appropriate external incentives and encouragement, it is equally important to foster their intrinsic motivation, thereby gradually cultivating the habit of sustained DCT usage.
数字认知训练（DCT）在增强整体认知功能方面已被证明比传统的纸笔训练更有效。然而，其长期实施的一个重大障碍是，轻度认知障碍（MCI）的老年人不会持续使用它，甚至在初次参与后使用量会下降。这种短期参与可能会限制DCT的潜在益处，因为需要持续使用才能实现更显著的认知改善。探索不连续使用行为转变的原因对于促进DCT的成功实施并使其积极效果最大化至关重要。
本研究旨在通过采用信息技术持续使用扩展模型（ECM-ITC），探讨MCI老年人在整个DCT过程中从最初接受转变为不连续使用行为的内在原因。
我们采用定性研究方法，在2024年1月至3月期间，对19名60岁及以上的MCI老年人和4名家庭成员在使用DCT之前和之后（每周3次，共1个月，每次持续30分钟）进行了38次半结构化访谈。采用主题分析和演绎框架分析来确定DCT不连续使用的原因，并与ECM-ITC进行映射。
大多数参与者未能完成DCT的标准剂量。数据分析揭示了转向不连续使用的原因。尽管参与者需要改善认知功能，但他们发现认知训练令人困惑，并且在实际使用中发现DCT与他们喜欢的训练方法不一致。他们模糊的期望与现实之间的差距，加上DCT的“延迟满足”与他们对“即时满足”的渴望之间的矛盾，使得他们难以辨别DCT的有用性。参与者还将DCT视为额外的经济负担，并倾向于在家庭压力下避免训练。他们依赖激励措施，这进一步削弱了他们继续进行DCT的意愿，最终导致无法形成持续使用行为。
持续使用行为与最初接受不同，因为它会随着时间的推移根据用户体验动态演变。为了鼓励MCI老年人持续参与DCT，不仅要充分考虑他们的真实偏好以及DCT可能给他们生活带来的潜在干扰，还要弥合期望与实际体验之间的差距。在确保老年人获得适当外部激励和鼓励的同时，培养他们的内在动机同样重要，从而逐步培养持续使用DCT的习惯。
