Next Article in Journal
Innovation Support Reduces Quiet Quitting and Improves Innovative Behavior and Innovation Outputs among Nurses in Greece
Previous Article in Journal
Functioning in an Illness and Quality of Life versus the Prevalence of Depression and Anxiety Disorders in Patients with High Cardiovascular Risk
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Nursing Reports
Volume 14
Issue 4
10.3390/nursrep14040192
nursrep-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Examining Differences in Health-Related Technology Use between Millennial and Older Generations of Caregivers

by
Virginia T. Gallagher
1,*,
Shannon E. Reilly
1,
David Martin
2,
Carol Manning
1 and
Kelly M. Shaffer
3
1
Department of Neurology, School of Medicine, University of Virginia, P.O. Box 801018, Charlottesville, VA 22908, USA
2
Claude Moore Health Sciences Library, University of Virginia Health System, Charlottesville, VA 22908, USA
3
Center for Behavioral Health and Technology, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
*
Author to whom correspondence should be addressed.
Nurs. Rep. 2024, 14(4), 2605-2617; https://doi.org/10.3390/nursrep14040192 (registering DOI)
Submission received: 8 July 2024 / Revised: 11 September 2024 / Accepted: 19 September 2024 / Published: 24 September 2024
(This article belongs to the Special Issue Advancing Nursing Care through Innovative Technologies)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background/Objective: Caregivers from the Millennial generation are an emerging and understudied group of unpaid care providers in America who may benefit from digitally delivered support. To inform the design/tailoring of interventions for this group, we aimed to understand how Millennials may differ from other generations of caregivers regarding digital health-related technology use. Methods: Using the Health Information National Trends Survey (HINTS), Version 6, we conducted a cross-sectional study comparing health technology access and use across four generations of unpaid caregivers (n = 545; Millennials, Gen X, Baby Boomers, and Silent Generation) of adults with chronic conditions using chi-square and Kruskal–Wallis non-parametric tests. Results: Compared to Baby Boomer and Silent Generation caregivers, Millennial caregivers more frequently reported having a cellular internet connection, using a wearable activity device, a health/wellness mobile application, choosing telehealth appointments for convenience, and most frequently used social media in general and to view health-related videos (ps < 0.005). Additionally, Millennials were more likely to report possessing a smartphone (compared to Gen X and Silent Generation) and more frequently used social media for peer interaction about health (compared to all older generations; ps < 0.005). Conclusion: Millennials differ from older generations of caregivers regarding health-related technology access and use, which may have implications for intervention design and tailoring.

1. Introduction

There are approximately 47.9 million unpaid caregivers in the United States supporting adult family members or friends with health or functional needs [1]. These caregivers are at risk for adverse health and quality of life outcomes due to the physical and emotional demands of caregiving [2,3,4].
Millennial caregivers are an emerging cohort of over 10 million individuals in the United States alone. This group is understudied and has unique traits compared to other generations of caregivers (Figure 1) [1].
In the general population, Millennials have higher rates of psychological distress and select chronic health problems relative to older generations [5,6]. For Millennial caregivers specifically, the time demands and burden of caregiving may be greater relative to older generations. Millennial caregivers are more likely than other age bands of caregivers to be simultaneously working and providing care [7,8,9,10,11]. Millennial caregivers may also be called upon to provide care for more family members than previous generations because decreased fertility rates over the last 50 years have yielded fewer siblings to share the care burden for supporting parents and extended relatives [8,10]. In sum, Millennial caregivers are a group at particular risk of adverse impacts from caregiving. Establishing efficacious interventions and supports for this emerging cohort of caregivers is essential.
Given the differences across generations of caregivers, it is problematic that previous caregiving interventions have largely been tested among Gen X or Baby Boomer generations [12]. Nonetheless, existing studies have demonstrated that interventions can effectively address caregivers’ burden, depression, stress, knowledge, and self-efficacy among older generations [13,14]. The widespread use of these interventions has been limited [15]. Delivering these interventions via the Internet is expected to improve reach and uptake, particularly among younger generations of caregivers [16]. Understanding how Millennial caregivers’ technology use compares with that of older generations will help inform how digital health interventions may need to be modified for the greatest acceptability and feasibility for this rising caregiver cohort.
Based on research in the general population, we expect that Millennial caregivers will be more likely than older generations to embrace digital health technology and interventions. The current literature suggests that younger generations (e.g., Millennials) are more likely than older generations (e.g., Baby Boomers) to use social media, podcasts, and blogs for healthcare purposes [17], to prioritize telehealth medical care versus in-person care [18], and to readily adopt app-based digital activity trackers [19]. While we expect generational differences in health technology use in the general population to extend to caregiver populations, prior research has demonstrated that caregivers have different health technology use compared to non-caregivers. For example, across ages, caregivers are 1.3× more likely to use the internet to search health-related topics compared to non-caregivers [20]. This underlines the importance of investigating health technology use in different age groups among caregivers specifically.
Little literature is available regarding caregivers’ use of health-related technology by age group or generation. A single study revealed that older caregivers are less likely to use health technology compared to younger caregivers [21]. However, no studies to date have specifically investigated generational differences in caregivers’ health-related technology use. Generational status offers an important, novel heuristic for tailoring interventions towards a large group of individuals with many shared characteristics, life-cycle stages, attitudes, behaviors, and technology use [22,23].
To establish necessary evidence for appropriate intervention design and tailoring for the rising generation of caregivers, the goal of this study was to evaluate the extent to which Millennial caregivers of adults with chronic conditions differ from other generations of caregivers in health-related technology access and use. Specifically, we compared Millennial caregivers to older generations of caregivers on internet access methods, digital health engagement, and telehealth use through a large national U.S. survey of diverse adults. We anticipate that the results will inform considerations of accessibility of internet-delivered caregiver support interventions.

2. Materials and Methods

2.1. Study Design and Participants

This is a cross-sectional analysis that uses data from the Health Information National Trends Survey, Version 6, Cycle 1 (HINTS 6). HINTS is a nationally representative survey administered by the National Cancer Institute to adults aged 18 or older living in the United States who speak English or Spanish. HINTS 6 was conducted from 7 March to 8 November 2022 [24]. HINTS focuses on understanding health information support needs in the population. In addition to standard HINTS content, HINTS 6 included a special interest assessment focused on the use of telehealth. HINTS 6 data are publicly available from https://hints.cancer.gov/data/download-data.aspx (accessed on 1 July 2023). The authors did not contribute to the collection of HINTS 6 data. The HINTS 6 survey was designated “exempt research” under 45-CFR-46.104 and approved by the Westat IRB on 5 October 2021 (Project: 6632.03.51). HINTS 6 also received a “Not Human Subjects Research” determination from the NIH Office of IRB Operations on 11/162021 (iRIS: 562715).
This analysis exclusively reports data from the 545 participants who self-identified as the primary, unpaid caregiver for an adult with a chronic health condition. This was operationalized as participants answering affirmatively to the item, “Are you currently caring for or making health care decisions for someone with a medical, behavioral, disability or some other condition?” Caregivers who exclusively reported providing care for a child were excluded from this analysis due to the distinct nature of providing care for a child with special care needs [25,26]. Participants were also excluded if their age (and therefore generational status) was missing.

2.2. Measures

2.2.1. Demographic, Socioeconomic, and Caregiving Characteristics

Participants self-reported demographic information including age, sex, sexual orientation, race/ethnicity, educational background, occupational status, marital status, household residents (total number of adults and presence of children), and household income attitudes. Race/ethnicity, degree of rurality, and household income attitude were selected as key socioeconomic variables that may impact digital health access and engagement based on prior studies [27,28]. Participants’ degree of rurality was measured by the USDA 2010 Primary Rural-Urban Community Area Code. Attitude regarding household income was selected over monetary household income amounts, as unadjusted monetary income may be misleading due to extreme variance in the cost of living in various parts of the United States [29]. Select categories of these key socioeconomic variables were collapsed for analysis, to aim for n > 5 per cell by generation.

2.2.2. Age Categorization into Generations

Generation was defined by post hoc categorization of participants’ self-reported age in 2022 into the following categories [22]: Silent Generation (age ≥ 77 at the time of data collection, i.e., born 1928–1945; n = 46), Baby Boomers (age 58–76, born 1946–1964; n = 277), Gen X (age 42–57, born 1965–1980; n = 149), and Millennials (age ≤ 41, born 1981–1996; n = 66). Seven participants aged 18–25, who are considered part of Generation Z, were included with Millennials (total n = 73). See Figure 1.

2.2.3. Dependent Variables

Outcomes of interest were selected from the HINTS 6 based on their relevance to informing digital health intervention development and dissemination for caregivers. Variable selection was also informed by prior work examining health technology use among caregivers [21]. Specifically, internet access mechanisms, smartphone possession, social media use, health/wellness app and devise use, and telehealth use were deemed relevant to inform intervention modality, platform, feasibility, and acceptability of future caregiver interventions. Outcomes were assessed by specified single-item questions detailed in Table 1, also available online [24]. Response options in Table 1 denote the categorization of responses used in analyses. Some response options were collapsed across categories to ensure adequate cell size (n > 5) for analysis and to aid interpretation of results.
General Internet Access. Internet use, cellular network internet access, smartphone possession, and broad social media use variables were selected to inform caregivers’ access to and use of the internet and social media more broadly. Cellular network internet access was selected based on its ability to inform the appropriateness of intervention delivery via smartphones that require internet access out of the home or workplace.
Digital Health Engagement. Digital health engagement variables were selected to evaluate the extent to which Millennials and other generations of caregivers may already be using health-related mobile applications, activity trackers, and social media.
Telehealth Use. Telehealth engagement variables were selected to understand Millennials’ and other caregiving generations’ use of more formal telehealth services, such as communicating with healthcare providers or attending virtual appointments.

2.3. Statistical Analyses

Analyses were conducted using SPSS version 28. Descriptive statistics for demographics, lifestyle factors, and caregiving characteristics included means with standard deviations, medians with interquartile range, or frequencies, as appropriate. Generational differences in key socioeconomic factors (race/ethnicity, rurality, and household income attitude) were examined via chi-square tests of independence to inform sensitivity analyses. Chi-square tests of independence tested whether caregivers’ generation was related to categorical outcomes and Kruskal–Wallis non-parametric tests were used for ordinal outcomes due to the non-normal distribution of data. Given the relationship between access/use of technology and environmental social determinants of health [27,28], post hoc sensitivity regression analyses were conducted to determine whether significant generational differences in outcomes of interest could be explained by other key socioeconomic factors (i.e., race/ethnicity, degree of rurality, and household income attitudes [see Table 2]). Specific sensitivity regression analyses were either ordinal (for ordinal outcomes), binary logistic (for dichotomous outcomes), or multinomial logistic (for categorical outcomes with 2+ categories).
An alpha threshold of p < 0.05 was used for main hypothesis testing. Where group-wise differences were detected, post hoc pairwise comparisons were made between Millennial caregivers versus the other generational groups. post hoc pairwise differences were interpreted using a Bonferroni correction of p < 0.016 for multiple (three) comparisons. Taylor’s Series variance estimation was used to estimate standard errors, which reduces bias and, therefore, type I error. These procedures are in accordance with published HINTS analysis recommendations [24].

3. Results

Sample generational demographics and lifestyle factors are presented in Table 2. Caregiving characteristics are presented in Table 3. Analysis of generational differences in key socioeconomic variables (see Table 2) revealed generational differences in race/ethnicity proportions; pairwise comparisons revealed the proportion of Non-Hispanic White caregivers was smaller in the Millennial generation relative to the Baby Boomer and Silent Generations (ps < 0.001). There was also a difference across generations in attitudes about household income; pairwise comparisons revealed Millennials were more frequently finding it difficult to get by on their income compared to Baby Boomers (p = 0.003). No generational differences in rurality were detected. Across outcome variables, responses were not ascertained (missing) for 0.00–4.40% of cases (average of 1.53% missing values per variable).

3.1. General Internet Access

See Table 4 for General Internet Access results. Overall, Millennial caregivers more frequently reported accessing the Internet compared to the Silent Generation only. Of participants who reported accessing the Internet (n = 470, 86.24% of the total sample), Millennial caregivers more frequently reported accessing the Internet through a cellular network compared to Baby Boomers and the Silent Generation. Among caregivers who access the internet, Millennials more frequently reported having a smartphone compared to Gen X and the Silent Generation. Finally, most Millennials caregivers reported visiting a social media site almost every day in the last year, which was more frequent than Baby Boomers and the Silent Generation (see Figure 2).

3.2. Digital Health Engagement

See Table 5 for Digital Health Engagement results. Overall, Millennials more frequently reported using a health/wellness app and a wearable device for health/activity tracking compared to both Baby Boomers and the Silent Generation. Relative to these two generations, Millennials also more frequently used social media for viewing health-related videos. Relative to all other generations, Millennials more frequently used social media to interact with others with similar health or medical issues.

3.3. Telehealth Engagement

See Table 6 for Telehealth Engagement results. Millennial caregivers more frequently reported using the Internet to make an appointment with a healthcare provider compared to Baby Boomer and Silent Generation caregivers. Among caregivers who chose telehealth appointments for their own healthcare needs, Millennials more frequently cited convenience as a reason they chose telehealth compared to Baby Boomer and Silent generation caregivers.

3.4. Sensitivity Analyses

Sensitivity analyses using ordinal (for ordinal outcomes), binary logistic (for dichotomous outcomes), and multinomial logistic (for categorical outcomes with 2+ categories) regression indicated that race/ethnicity, rurality, and household income attitude do not account for generational differences in general internet access, digital health engagement, or telehealth engagement variables.

4. Discussion

This analysis of a large, national U.S. survey demonstrates how Millennials differ from other generations of caregivers in their health-related technology use. Particularly when compared to Silent Generation and Baby Boomer caregivers, Millennial caregivers more frequently reported internet use, cellular internet access, smartphone possession, social media use, health/wellness app use, wearable health/activity trackers, and using telehealth healthcare options for convenience. While there were many significant differences between Millennials compared to both Baby Boomers or Silent Generation, there were fewer differences between Millennials and Gen X, in keeping with broader population trends [23]. Nonetheless, relative to Gen X, Millennials were more likely to possess a smartphone and more frequently interacted with peers on social media about health-related topics. Collectively, the findings from this study have important implications for the design, tailoring, and testing of digital interventions for younger caregivers.
Existing digital interventions for caregivers have primarily been piloted with caregivers from Gen X and Baby Boomer generations [12]. A leading suspected cause of dropout from digital caregiver intervention trials is low digital literacy, which is more common among older generations [12]. Given that in this study, Millennials were more likely than Gen X or Baby Boomers to use digital devices, apps, and social media platforms, it is possible that Millennial caregivers would remain more engaged with digital caregiver interventions than documented in prior studies with older generations.
Supportive interventions that are delivered over the Internet via smartphone may be particularly accessible and acceptable for Millennial caregivers. Specifically, over 95% of the surveyed Millennial caregivers reported accessing the Internet via a cellular network, more than any older generation (54–91%). Further, 100% of Millennial caregiver responders reported possessing a smartphone, relative to 82–93% of other caregiver generations. Findings are consistent with a 2023 Pew Research survey that revealed that American adults aged 30–49 have higher rates of smartphone ownership (97%), relative to older age bands (89% ownership for ages 50–64; 76% ownership for ages 65+) [30]. Additionally, Millennial caregivers in this study were 1.3×–1.5× more likely to have used a health/wellness mobile application in the previous year compared to Silent Generation and Baby Boomer caregivers. Further, two-thirds of Millennial caregivers in this study reported that convenience was a reason they chose telehealth over in-person medical care. These collective findings indicate that interventions delivered via smartphone can meet Millennial caregivers where they already are and capitalize on existing positive associations of telehealth use for health-related concerns in this time-scarce cohort.
While there is often concern that delivering interventions via smartphone application may perpetuate inequities in access to care among lower-resourced individuals [31], our results suggest that among Millennial caregivers, smartphone possession was high even among those experiencing subjective financial distress. Specifically, nearly 33% of Millennial caregivers in this study reported difficulty getting by on their income (Table 2), yet, as previously stated, 95% reported cellular internet access (Table 3). In contrast, 16% of Baby Boomers reported difficulty getting by on their current income, but just 77% reported cellular internet access. Findings are consistent with national longitudinal survey data revealing that younger Americans are now very likely to have a smartphone and mobile internet access regardless of income [30]. While national data indicate that smartphone possession and internet access are still less frequently reported among Black/African Americans (relative to non-Hispanic White Americans) and among rural Americans (relative to suburban/urban Americans), race/ethnicity, rurality, and income attitude did not explain generational differences in health technology use in this study. Therefore, interventions delivered by a smartphone may be well-suited to serve this younger cohort of caregivers, despite the fact that they are more financially unstable than other generations [11].
This study also demonstrates the potential of social media platforms for recruiting and engaging Millennial caregivers in research studies. Nearly 70% of Millennial caregivers in this study reported visiting a social media site such as Facebook, Twitter (now X), TikTok, YouTube, or Instagram almost daily over the last year, and an additional 13% reported at least weekly use. Instagram may be a particularly fruitful recruitment tool as approximately 50% of nearly 2.4 billion Instagram users are Millennials [32]. Social media recruitment strategies have the potential to engage clinical research participants who otherwise do not have access to research studies being conducted at academic medical centers [33].
Furthermore, given Millennial caregivers’ frequent social media use, social media may be a worthy platform to consider for intervention delivery in this cohort, particularly when considering a social support component. Indeed, emerging research has revealed that family caregivers who use social media for peer social support often gain a sense of social inclusion and belonging and that they appreciate that online platforms offer anonymity, 24 h access, and flexibility [34]. Our results suggest that Millennial caregivers already more frequently interact with people with similar health or medical issues using social media or online forums compared to all older generations, suggesting that this cohort may be more ready and willing to share private information about their caregiving experience or their health online compared to previous generations. To date, however, there is no published research on whether the use and impact of social media support groups vary based on a caregiver’s age or generation [35]. Given the gender and racial/ethnic diversity of Millennial caregivers, future research must examine how useful and effective social media support mechanisms will be for this diverse subgroup of caregivers.
Beyond social support components of caregiver interventions, social media may be a promising platform for delivering psychoeducational content for caregiving needs. In particular, we found that over half of Millennials viewed health-related videos on social media at least once per month. As such, perhaps videos and infographics delivered via social media or other online platforms may be feasible and effective ways to package psychoeducational content for Millennial caregivers in light of the decreased attention span for print content in this generation relative to previous generations [36,37].
Findings from this study must be interpreted in light of the broad definition of caregiver for inclusion (i.e., caring for or making healthcare decisions for an adult with a medical, behavioral, disability, or some other condition). Using this definition, it is possible that a caregiver may be making healthcare decisions for someone but may have low or nonexistent day-to-day engagement in assisting that individual with activities of daily living. Future studies aiming to characterize technology-related factors among caregivers should include a more specific definition of caregiver and more thorough assessments of caregiving responsibilities, including frequency, intensity, and duration of caregiving. Such factors may be important because care recipients who cannot be safely left alone may have caregivers who are more dependent on digitally delivered health services. Finally, the HINTS 6 survey did not include specific questions regarding the frequency of health/wellness app use, types of health/wellness apps used, or specific social media platforms used, and all data are self-reported.

5. Conclusions

Millennial caregivers are a growing cohort who face increased time demands relative to prior caregiver generations. Digital interventions may be particularly useful to support this emerging generation of caregivers. To that end, the results revealed that compared to select older generations, Millennials more frequently reported cellular internet access, smartphone possession, use of wearable activity devices and health/wellness mobile applications, social media use, and choosing telehealth medical care options because of convenience. These findings suggest that digital interventions or intervention components delivered via smartphone, smartphone mobile applications, and/or social media may be particularly useful among Millennial caregivers. Nursing clinicians who encounter caregivers of adults with chronic conditions may consider using Internet-based supportive tools, particularly among younger generations of caregivers.

Author Contributions

V.T.G.: Conceptualization, Methodology, Writing—Original Draft. S.E.R.: Methodology, Writing—Review and Editing, Visualization. D.M.: Methodology, Formal Analysis, Writing—Review and Editing. C.M.: Methodology, Writing—Review and Editing, Supervision. K.M.S.: Conceptualization, Methodology, Formal Analysis, Writing—Review and Editing, Supervision. All authors have read and agreed to the published version of the manuscript.

Funding

Virginia Gallagher is an iTHRIV Scholar. The iTHRIV Scholars Program is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016.

Institutional Review Board Statement

The HINTS 6 survey was designated “exempt research” under 45-CFR-46.104 and approved by the Westat IRB on 5/10/2021 (Project: 6632.03.51). HINTS 6 also received a “Not Human Subjects Research” determination from the NIH Office of IRB Operations on 11/162021 (iRIS: 562715).

Informed Consent Statement

Not applicable.

Data Availability Statement

Data are available at https://hints.cancer.gov/data/default.aspx (accessed on 1 July 2023).

Public Involvement Statement

Residents of the United States were randomly selected by address to participate. More detailed methodology is available from https://hints.cancer.gov/ (accessed on 1 July 2023).

Guidelines and Standards Statement

This manuscript was drafted against the STROBE checklist for cross-sectional studies.

Use of Artificial Intelligence

AI or AI-assisted tools were not used in drafting any aspect of this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. National Alliance for Caregiving and AARP. Caregiving in the U.S. 2020; National Alliance for Caregiving and AARP: Washington, DC, USA, 2020. [Google Scholar]
  2. Zarit, S.H.; Savla, J. Caregivers and Stress. In Stress: Concepts, Cognition, Emotion, and Behavior; Fink, G., Ed.; Academic Press: San Diego, CA, USA, 2016; pp. 339–344. ISBN 978-0-12-800951-2. [Google Scholar]
  3. Schulz, R.; Tompkins, C. Informal Caregivers in the United States: Prevalence, Caregiver Characteristics, and Ability to Provide Care. In The Role of Human Factors in Home Health Care: Workshop Summary; National Academies Press (US): Washington, DC, USA, 2010. [Google Scholar]
  4. Chiao, C.-Y.; Wu, H.-S.; Hsiao, C.-Y. Caregiver Burden for Informal Caregivers of Patients with Dementia: A Systematic Review. Int. Nurs. Rev. 2015, 62, 340–350. [Google Scholar] [CrossRef] [PubMed]
  5. Martinson, M.L.; Lapham, J.; Ercin-Swearinger, H.; Teitler, J.O.; Reichman, N.E. Generational Shifts in Young Adult Cardiovascular Health? Millennials and Generation X in the United States and England. J. Gerontol. Ser. B 2022, 77, S177–S188. [Google Scholar] [CrossRef]
  6. DePew, R.; Gonzales, G. Differences in Health Outcomes Between Millennials and Generation X in the USA: Evidence from the National Health Interview Survey. Popul. Res. Policy Rev. 2020, 39, 605–616. [Google Scholar] [CrossRef]
  7. Reed, N.; Bouldin, E.; Taylor, C.; McGuire, L. Millennials as Caregivers: Results From the BRFSS, 44 States, DC, and Puerto Rico, 2015–2018. Innov. Aging 2020, 4, 352. [Google Scholar] [CrossRef]
  8. Vega, W.A.; Professor, P.; Aranda, M.P.; Rodriguez, F.S. Millennials and Dementia Caregiving in the United States. 2017. Available online: https://www.usagainstalzheimers.org/sites/default/files/Dementia%20Caregiver%20Report_Final.pdf (accessed on 4 April 2023).
  9. Thomas Hebdon, M.C.; Jones, M.; Neller, S.; Kent-Marvick, J.; Thomas, M.; Stewart, E.; Aaron, S.; Wilson, C.; Peterson, N.; Ellington, L. Stress and Supportive Care Needs of Millennial Caregivers: A Qualitative Analysis. West. J. Nurs. Res. 2022, 44, 205–213. [Google Scholar] [CrossRef]
  10. US Census Bureau Millennials Outnumber Baby Boomers and Are Far More Diverse, Census Bureau Reports. Available online: https://www.census.gov/newsroom/archives/2015-pr/cb15-113.html (accessed on 4 April 2023).
  11. Flinn, B. Millennials: The Emerging Generation of Family Caregivers. Innov. Aging 2018, 2, 240. [Google Scholar] [CrossRef]
  12. Atefi, G.L.; Koh, W.Q.; Kohl, G.; Seydavi, M.; Swift, J.K.; Akbari, M.; de Vugt, M.E. Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review. Am. J. Geriatr. Psychiatry 2024, 32, 1271–1291. [Google Scholar] [CrossRef] [PubMed]
  13. Jadalla, A.; Page, M.; Ginex, P.; Coleman, M.; Vrabel, M.; Bevans, M. Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients with Cancer. Clin. J. Oncol. Nurs. 2020, 24, 31–50. [Google Scholar] [CrossRef] [PubMed]
  14. Walter, E.; Pinquart, M. How Effective Are Dementia Caregiver Interventions? An Updated Comprehensive Meta-Analysis. Gerontologist 2020, 60, 609–619. [Google Scholar] [CrossRef]
  15. Zhu, E.M.; Buljac-Samardžić, M.; Ahaus, K.; Sevdalis, N.; Huijsman, R. Implementation and Dissemination of Home- and Community-Based Interventions for Informal Caregivers of People Living with Dementia: A Systematic Scoping Review. Implement. Sci. 2023, 18, 60. [Google Scholar] [CrossRef]
  16. Zhai, S.; Chu, F.; Tan, M.; Chi, N.-C.; Ward, T.; Yuwen, W. Digital Health Interventions to Support Family Caregivers: An Updated Systematic Review. Digit. Health 2023, 9, 20552076231171967. [Google Scholar] [CrossRef] [PubMed]
  17. LeRouge, C.; Slyke, C.V.; Seale, D.; Wright, K. Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers. J. Med. Internet Res. 2014, 16, e3049. [Google Scholar] [CrossRef] [PubMed]
  18. State of Healthcare Report: Uncovering Healthcare Barriers and Opportunities|HIMSS. Available online: https://www.himss.org/resources/state-healthcare-report-uncovering-healthcare-barriers-and-opportunities (accessed on 30 October 2023).
  19. Kim, S.; Choudhury, A. Comparison of Older and Younger Adults’ Attitudes Toward the Adoption and Use of Activity Trackers. JMIR mHealth uHealth 2020, 8, e18312. [Google Scholar] [CrossRef] [PubMed]
  20. Purcell, S.F. Maeve Duggan and Kristen Family Caregivers Are Wired for Health; Pew Research Center: Washington, DC, USA, 2013. [Google Scholar]
  21. Shaffer, K.M.; Chow, P.I.; Cohn, W.F.; Ingersoll, K.S.; Ritterband, L.M. Informal Caregivers’ Use of Internet-Based Health Resources: An Analysis of the Health Information National Trends Survey. JMIR Aging 2018, 1, e11051. [Google Scholar] [CrossRef] [PubMed]
  22. Dimock, M. Defining Generations: Where Millennials End and Generation Z Begins; Pew Research Center: Washington, DC, USA, 2019. [Google Scholar]
  23. Vogels, E. Millennials Stand out for Their Technology Use, but Older Generations Also Embrace Digital Life; Pew Research Center: Washington, DC, USA, 2019. [Google Scholar]
  24. National Cancer Institute (NCI). Health Information National Trends Survey 6 (HINTS 6) Methodology Report. 2023. Available online: https://hints.cancer.gov/docs/methodologyreports/HINTS_6_MethodologyReport.pdf (accessed on 4 April 2023).
  25. Penning, M.J.; Wu, Z. Caregiver Stress and Mental Health: Impact of Caregiving Relationship and Gender. Gerontologist 2016, 56, 1102–1113. [Google Scholar] [CrossRef]
  26. Chen, W.-Y.; Lukens, E. Well Being, Depressive Symptoms, and Burden Among Parent and Sibling Caregivers of Persons with Severe and Persistent Mental Illness. Soc. Work. Ment. Health 2011, 9, 397–416. [Google Scholar] [CrossRef]
  27. Benda, N.C.; Veinot, T.C.; Sieck, C.J.; Ancker, J.S. Broadband Internet Access Is a Social Determinant of Health! Am. J. Public Health 2020, 110, 1123–1125. [Google Scholar] [CrossRef]
  28. Zahnd, W.E.; Bell, N.; Larson, A.E. Geographic, Racial/Ethnic, and Socioeconomic Inequities in Broadband Access. J. Rural. Health 2022, 38, 519–526. [Google Scholar] [CrossRef]
  29. Bennett, J. Improving the Way We Categorize Family Income. Decoded. 2021. Available online: https://www.pewresearch.org/decoded/2021/06/04/improving-the-way-we-categorize-family-income/ (accessed on 4 April 2023).
  30. Pew Research Center. Mobile Fact Sheet: Tech Adoption Trends; Pew Research Center: Washington, DC, USA, 2024. [Google Scholar]
  31. Bommakanti, K.K.; Smith, L.L.; Liu, L.; Do, D.; Cuevas-Mota, J.; Collins, K.; Munoz, F.; Rodwell, T.C.; Garfein, R.S. Requiring Smartphone Ownership for mHealth Interventions: Who Could Be Left Out? BMC Public Health 2020, 20, 81. [Google Scholar] [CrossRef]
  32. Dublino, J. Engaging Millennials Through Instagram. 2024. Available online: https://www.business.com/articles/engaging-millennials-instagram-marketing/ (accessed on 26 April 2024).
  33. Gelinas, L.; Pierce, R.; Winkler, S.; Cohen, I.G.; Lynch, H.F.; Bierer, B.E. Using Social Media as a Research Recruitment Tool: Ethical Issues and Recommendations. Am. J. Bioeth. 2017, 17, 3–14. [Google Scholar] [CrossRef]
  34. Newman, K.; Wang, A.H.; Wang, A.Z.Y.; Hanna, D. The Role of Internet-Based Digital Tools in Reducing Social Isolation and Addressing Support Needs among Informal Caregivers: A Scoping Review. BMC Public Health 2019, 19, 1495. [Google Scholar] [CrossRef] [PubMed]
  35. Daynes-Kearney, R.; Gallagher, S. Online Support Groups for Family Caregivers: Scoping Review. J. Med. Internet Res. 2023, 25, e46858. [Google Scholar] [CrossRef]
  36. Munsch, A. Millennial and Generation Z Digital Marketing Communication and Advertising Effectiveness: A Qualitative Exploration. J. Glob. Sch. Mark. Sci. 2021, 31, 10–29. [Google Scholar] [CrossRef]
  37. Oomen-Early, J.; Early, A.D. Teaching in a Millennial World: Using New Media Tools to Enhance Health Promotion Pedagogy. Pedagog. Health Promot. 2015, 1, 95–107. [Google Scholar] [CrossRef]
Nursrep 14 00192 g001
Figure 1. Generation definitions.
Figure 1. Generation definitions.
Nursrep 14 00192 g001
Nursrep 14 00192 g002
Figure 2. Social media: Millennial caregivers report more frequent social media use versus Baby Boomer and Silent Generation caregivers (* ps < 0.016).
Figure 2. Social media: Millennial caregivers report more frequent social media use versus Baby Boomer and Silent Generation caregivers (* ps < 0.016).
Nursrep 14 00192 g002
Table 1. Health-related technology dependent variables.
Table 1. Health-related technology dependent variables.
Variable (Original HINTS 6 Question Number)Survey Question(Re-)Coded Response Options *
General Internet AccessInternet use (B1) Do you ever go online to access the Internet or World Wide Web, or to send and receive e-mail? Yes
No
Cellular internet access (B2c)When you use the Internet, do you access it through a cellular network (i.e., phone, 3G/4G/5G)?Yes
No
Smartphone possession (B6)Please indicate if you have [the] followingSmartphone
No smartphone
Social media use (B12a)Sometimes people use the Internet to connect with other people online through social media. Examples of social media sites include Facebook, Twitter, TikTok, YouTube, and Instagram. In the past 12 months, how often did you… Visit a social media site?Never (0)
Less than once a month (1)
A few times a month (2)
At least once a week (3)
Almost everyday (4)
Digital Health EngagementHealth/wellness app use (B7)[For participants who had a smart device] In the past 12 months, have you used a health or wellness app on your table or smartphone?Yes
No (No or I do not have any health apps on my tablet or smart phone)
Wearable health device use (B8)In the past 12 months, have you used an electronic wearable device to monitor or track your health or activity? For example a Fitbit, Apple Watch, or Garmin VivofitYes
No
Social media peer health interaction (B12d)In the past 12 months how often did you… Interact with people who have
similar health or medical issues on social media or online forums		Never (0)
Less than once a month (1)
A few times a month (2)
At least once a week (3)
Almost everyday (4)
Social media health-related videos (B12e)In the past 12 months how often did you… Watch a health-related video on a social media site (for example, YouTube).Never (0)
Less than once a month (1)
A few times a month (2)
At least once a week (3)
Almost everyday (4)
Telehealth UseTelehealth use types (B3)In the past 12 months, have you used the Internet to take care of any of the following health-related needs?Look for health or medical information
Send a message to a healthcare provider
View medical test results
Make an appointment with a healthcare provider
Telehealth visits (D1)In the past 12 months, did you receive care from a doctor or health professional using telehealthYes (Video and/or phone)
No
Telehealth non-use reason (D3)[For participants who were offered telehealth but declined] Did you chose not to participate in a telehealth visit for any of the following reasons?I preferred to have the appointment(s) in person
I was concerned about the privacy of telehealth visits
I thought the telehealth technology would be difficult to use
Telehealth use reason (D4)[For participants who used telehealth] Why did you choose a telehealth visit(s) for yourself?Provider recommended or required… use [of] telehealth
I wanted advice about whether I needed in-person medical care
I wanted to avoid possible infection at the docotor’s office
It was more convenient than going to the doctor
I could include family or other caregivers in my appointment
Note. * Some response options were re-coded from original dataset to facilitate interpretability of results.
Table 2. Sample demographics.
Table 2. Sample demographics.
MillennialsGen XBaby BoomersSilent Gen
n = 73n = 149n = 277n = 46
Age, Mean (SD)32.96 (6.10)51.44 (4.22)66.53 (5.44)82.87 (4.80)
Female sex a, n (%)47 (69.12%)111 (75.51%)182 (66.91%)21 (45.65%)
Sexual orientation
Heterosexual, n (%)49 (74.24%)135 (93.75%)256 (96.24%)38 (95.00%)
Gay, Lesbian, Bisexual, or Other, n (%)17 (23.29%)9 (6.40%)10 (3.61%)2 (5.00%)
Race/ethnicity [overall X2 (9) = 45.865, p < 0.001]
Non-Hispanic White, n (%)22 (32.84%)63 (47.37%)158 (62.20%)33 (64.71%)
Non-Hispanic Black or African American, n (%)13 (20.97%)28 (21.05%)33 (12.99%)1 (1.96%)
Hispanic, n (%)10 (16.63%)23 (17.29%)33 (12.99%)5 (9.80%)
Non-Hispanic Asian, n (%) b9 (14.52%)7 (5.26%)11 (4.33%)1 (1.96%)
Non-Hispanic Other, n (%) b7 (9.59%)7 (4.70%)6 (2.16%)2 (4.35%)
Education
High school or less, n (%)12 (17.65%)25 (16.89%)48 (17.65%)12 (26.09%)
More than high school, n (%)56 (82.35%)123 (83.11%)224 (82.35%)34 (73.91%)
Occupational Status
Usually work ≥35 h/week, n (%) Yes48 (70.59%)99 (66.89%)96 (35.29%)3 (6.67%)
Marital status
Married or living as married, n (%)32 (48.48%)98 (66.67%)182 (66.91%)37 (80.43%)
Single/separated/divorced/widowed, n (%)34 (51.52%)49 (33.33%)90 (33.09%)9 (19.57%)
Household residents
Number of adults (including self), Mean (SD)2.26 (1.12)2.38 (1.09)2.21 (1.06)2.04 (0.67)
Children under 18 in the household, n (%)40 (58.82%)45 (30.82%)12 (4.44%)1 (2.33%)
Rurality [overall X2 (6) = 7.594, p = 0.055]
Metropolitan, n (%)65 (89.04%)131 (87.92%)226 (81.59%)34 (73.91%)
Micropolitan, n (%) c4 (5.48%)9 (6.04%)28 (10.11%)9 (19.57%)
Small town, n (%)c4 (5.48%)5 (3.36%)10 (3.61%)2 (4.35%)
Rural, n (%)c0 (0.00%)4 (2.68%)13 (4.69%)1 (2.17%)
Attitude about household income [overall X2 (6) = 16.133, p = 0.013]
Living comfortably, n (%)23 (34.85%)57 (39.04%)128 (47.76%)20 (46.51%)
Getting by, n (%)19 (28.79%)49 (33.56%)94 (35.07%)17 (39.53%)
Finding it difficult to get by, n (%) d15 (20.55%)29 (19.46%)35 (12.64%)6 (13.04%)
Finding it very difficulty to get by, n (%) d9 (12.33%)11 (7.38%)11 (3.97%)0 (0.00%)
Comparisons across generations are reported above for key socioeconomic variables used in sensitivity analyses. a refers to sex assigned at birth; b categories were collapsed into “Non-Hispanic Other” for analyses; c collapsed into “Micropolitan or smaller” for analyses; d collapsed into “Finding it difficult or very difficult to get by” for analyses; n may not add up to total group size due to missing data.
Table 3. Caregiving characteristics.
Table 3. Caregiving characteristics.
Caregivers’ relationship with care-recipient(s) a
Parent(s) only, n (%)25 (34.25%)70 (46.98%)107 (38.63%)1 (2.17%)
Spouse/partner only, n (%)13 (17.81%)17 (11.41%)81 (29.24%)28 (60.87%)
Another family member only, n (%)10 (13.70%)27 (18.12%)43 (15.52%)9 (19.57%)
Friend/other non-relative only, n (%)2 (2.74%)3 (2.01%)15 (5.42%)3 (6.52%)
Multiple care-recipient relationships
Yes, n (%)23 (31.51%)32 (21.48%)31 (11.19%)5 (10.87%)
Primary care-recipient condition(s) b
Cancer only, n (%)3 (4.11%)6 (4.03%)11 (3.97%)1 (2.17%)
Alzheimer’s, confusion, dementia, forgetfulness, brain injury, stroke, or other neurological issue only, n (%)5 (6.85%)20 (13.42%)38 (17.33%)8 (17.39%)
A long-term illness (i.e., high blood pressure, hypertension, diabetes, heart disease, heart attack, lung disease, or emphysema) only, n (%)9 (12.33%)23 (15.44%)26 (9.39%)7 (15.22%)
Difficulty moving around such as an orthopedic issue, a musculoskeletal issue, or an aging-related issue only, n (%)5 (6.85%)9 (6.04%)28 (10.11%)3 (6.52%)
Mental health issue, substance abuse, intellectual/developmental abnormality, n (%)7 (9.59%)15 (10.07%)12 (4.33%)2 (4.35%)
Multiple conditions, n (%)43 (58.90%)73 (48.99%)143 (51.62%)25 (54.35%)
Comparisons across generations are reported above for key socioeconomic variables used in sensitivity analyses. a Caregivers were asked if they provided care or made healthcare decisions for any of the following care recipients (check all that apply). b Caregivers were asked to specify the condition(s) of the person for whom they provide the most care; when more than one condition was marked, responses were re-coded into “Multiple conditions”; n may not add up to total group size due to missing data.
Table 4. General internet access by caregiver generation.
Table 4. General internet access by caregiver generation.
MillennialsGen XBaby BoomersSilent Gen
n = 73n = 149n = 277n = 46X2 (df) ap
Internet use, n (%) Yes65 (89.04%)136 (91.28%)238 (85.92%)31 (67.39%) *17.460 (3)<0.001
Cellular internet access, n (%) Yes62 (95.38%)122 (91.04%)182 (77.45%) * 17 (54.84%) *34.621 (3)<0.001
Cellular internet access, n (%) No3 (4.62%)12 (8.96%)53 (22.55%) *14 (45.16%) *
Smartphone possession, n (%) Yes65 (100.00)%124 (93.23)% *224 (95.73%)24 (82.76%) *12.212 (3)0.004
Social media use frequency, Median (IQR) b4 (1)4 (2)3 (3) *1 (3) *H(3) = 51.359<0.001
a Unless otherwise noted; H indicates that Kruskal–Wallis test was used; NA = not appropriate for statistical analysis due to small cell sizes; b Range: Never (0) to Almost Every Day (4); IQR = interquartile range; * significantly differs from Millennials after Bonferroni correction (p < 0.016; p = 0.050/3), also denoted by shaded cell. n may not add up to total group size due to missing data.
Table 5. Digital health engagement by caregiver generation.
Table 5. Digital health engagement by caregiver generation.
MillennialsGen XBaby BoomersSilent Gen
n = 73n = 149n = 277n = 46X2 (df) a
Health/wellness app use, n (%) Yes47 (67.14%)99 (70.21%)130 (50.78%) *15 (42.86%) *19.802 (3) **
Wearable health device use, n (%) Yes40 (54.79%)71 (47.65%)85 (30.68%) *6 (13.04%) *27.839 (3) **
Social media peer health interaction, Median (IQR) b0 (1)0 (1) *0 (0) *0 (0) *H(3) = 27.562 **
Social media health-related videos, Median (IQR) b2 (2)1 (2)1 (1) *0 (1) *H(3) = 43.808 **
Data presented as n (% of total generation group, excluding participants with missing data for the item), unless otherwise noted; a unless otherwise noted; H indicates that Kruskal–Wallis test was used; b Range: Never (0) to Almost Every Day (4); * significantly differs from Millennials after Bonferroni correction (p < 0.016; p = 0.050/3), also denoted by shaded cell; ** denotes p < 0.001 for main omnibus test across groups; n may not add up to total group size due to missing data.
Table 6. Telehealth engagement in previous year by caregiver generation.
Table 6. Telehealth engagement in previous year by caregiver generation.
MillennialsGen XBaby BoomersSilent Gen
n = 73n = 149n = 277n = 46X2 (df)
Telehealth Use Types: Used the internet to…Look for health or medical information, n (%)60 (92.31%)124 (91.18%)225 (94.54%)28 (90.32%)1.943 (3)
Send a message to a healthcare provider, n (%)48 (73.85%)103 (75.74%)181 (76.05%)18 (58.06%)4.829 (3)
View medical test results, n (%)56 (86.15%)105 (77.21%)192 (81.01%)19 (63.33%)7.345 (3)
Make an appointment with a healthcare provider, n (%)53 (81.52%) 91 (66.91%)154 (64.71%) *14 (45.16%) *13.263 (3) **
Received Telehealth CareNo, n (%)32 (44.44%)67 (45.58%)137 (50.18%)21 (46.67%)1.259 (3)
Yes, phone and/or video, n (%)40 (55.56%)80 (54.42%)136 (49.82%)24 (53.33%)
Offered Telehealth But Declined Because…In-person preference, n (%) Yes10 (76.92%)12 (92.31%)33 (97.06)%4 (100.00%)NA
Privacy concerns, n (%) Yes4 (30.77%)1 (7.69%)4 (11.76%)1 (15.63%)
Anticipated technology difficulty, n (%) Yes2 (15.38%)3 (23.08%)7 (20.59%)1 (25.00%)
Chose Telehealth Because…Provider recommended/required, n (%) Yes29 (72.50%)57 (70.37%)92 (74.19%)13 (61.90%)1.458 (3)
Wanted advice re: in-person care, n (%) Yes13 (32.50%)21 (26.25%)30 (24.19%)4 (20.00%)1.466 (3)
Avoid possible infection, n (%) Yes20 (50.00%)44 (54.32%)64 (51.61%)11 (52.38%)0.241 (3)
More convenient, n (%) Yes27 (67.50%)63 (77.78%)72 (57.60%) *9 (42.90%) *13.190 (3) **
Could include family or other caregivers, n (%) Yes18 (46.15%)19 (23.75%)31 (24.00%)7 (33.33%)7.851 (3)
NA = not applicable due to small cell sizes; * significantly differs from Millennials after Bonferroni correction (p < 0.016; p = 0.050/3), also denoted by shaded cell; ** denotes p < 0.01 for main omnibus test across groups; n may not add up to total group size due to missing data.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Gallagher, V.T.; Reilly, S.E.; Martin, D.; Manning, C.; Shaffer, K.M. Examining Differences in Health-Related Technology Use between Millennial and Older Generations of Caregivers. Nurs. Rep. 2024, 14, 2605-2617. https://doi.org/10.3390/nursrep14040192

AMA Style

Gallagher VT, Reilly SE, Martin D, Manning C, Shaffer KM. Examining Differences in Health-Related Technology Use between Millennial and Older Generations of Caregivers. Nursing Reports. 2024; 14(4):2605-2617. https://doi.org/10.3390/nursrep14040192

Chicago/Turabian Style

Gallagher, Virginia T., Shannon E. Reilly, David Martin, Carol Manning, and Kelly M. Shaffer. 2024. "Examining Differences in Health-Related Technology Use between Millennial and Older Generations of Caregivers" Nursing Reports 14, no. 4: 2605-2617. https://doi.org/10.3390/nursrep14040192

Article Metrics

Back to TopTop