Decoding the Influence of eHealth on Autonomy, Competence ,and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model

Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied Elder Tree, an online system for older adults that provides on-demand videos of healthy livingcontent, self-monitoring, and weekly researcher-hosted video meetings. Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determinationtheory using features of ElderTree to understand the usability of the technology and how it may support older adults'autonomy,competence, and relatedness. Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronicconditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results: Older adults did find that features within Elder Tree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants'experiences with the smart displays. Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization