1. ©2014 Elena Bellio, Luca Buccoliero 1 Department of Marketing Citizens Lab The Adoption of “Silver” E-health Technologies First Hints on Technology Acceptance Factors for elderly in Italy Elena Bellio: Bocconi University – Milan - Italy Luca Buccoliero: Bocconi University – Milan - Italy

2. ©2014 Elena Bellio, Luca Buccoliero 2 Department of Marketing Citizens Lab Università Bocconi, Marketing Department and CERMES l Università Bocconi, founded in 1902, was the first Italian university to grant a degree in management. l For over a century, Bocconi has played a leading role in Italy's social and economic modernization. It has remained true to its founding values of being a major research university, with democratic values and open to the world, as well as financially and politically independent.

3. ©2014 Elena Bellio, Luca Buccoliero 3 Department of Marketing Citizens Lab Marketing Department and CERMES Research Center at Bocconi l The Department of Marketing and the Center for Research on Marketing and Services (CERMES) aim at developing research projects on the crucial themes of customer orientation and competitiveness in the service sectors. l Bearing in mind 1 main element: The empowerment of customers – citizens - patients.

4. ©2014 Elena Bellio, Luca Buccoliero 4 Department of Marketing Citizens Lab l Public, healthcare and social marketing are the research priorities of «Citizens Lab»; l «Citizens Lab» fosters innovation through marketing strategies and tools in the area of public services provided to citizens (in markets or quasi-market contexts or where public administration is the main player). l The main research fields of Citizens Lab include:  Healthcare services (hospitals and local healthcare units)  Sm@rtcities and Public utilities (transportation, urban network, energy, telecoms, etc.)  Not for profit sector and Corporate Philantropy  Value creation for patients and citizens through empowerment  Territorial branding and value  Social marketing: the systematic application of marketing, along with other concepts and techniques, to achieve specific behavioural goals for a social good

5. ©2014 Elena Bellio, Luca Buccoliero 5 Department of Marketing Citizens Lab «Citizens» Lab researches Patient Behaviour Healthcare services use Patient Empowerment Patient Trust Innovation acceptance Citizen-Customer Behaviour Public Services use Lifestyle Empowerment and participation Citizen Trust Senior Citizen Behaviour Attitude towards innovation Attitude towards healthcare Consumption behaviour Senior Citizen Trust Donor Behaviour Understanding donor’s motivations Innovation in fundraising Social Marketing and «consumer» behaviour

6. ©2014 Elena Bellio, Luca Buccoliero 6 Department of Marketing Citizens Lab Agenda l A «marketing approach» to ageing society; l Literature review; l Our «Silver» Technology Acceptance Model; l Methodology; l Discussion and conclusions.

7. ©2014 Elena Bellio, Luca Buccoliero 7 Department of Marketing Citizens Lab A «marketing approach» to ageing society

8. ©2014 Elena Bellio, Luca Buccoliero 8 Department of Marketing Citizens Lab Marketing???? Please, consider the following definition…. « Marketing is the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large ». (American Marketing Association)

9. ©2014 Elena Bellio, Luca Buccoliero 9 Department of Marketing Citizens Lab A new perspective FROM the 4 “P”…TO the 4 “C”... Product Price Place Promotion Citizens’ needs and wants Cost to the citizen Convenience Communication

10. ©2014 Elena Bellio, Luca Buccoliero 10 Department of Marketing Citizens Lab Elderly population: a marketing approach l Success factors:  interconnecting new technologies and market needs;  understanding senior citizens’: behaviours; consuming time; ways of living.  Developing new market opportunities.

11. ©2014 Elena Bellio, Luca Buccoliero 11 Department of Marketing Citizens Lab Silver citizens meet Technologies l Interconnection of both technologies and market need is necessary; l Understanding consumers’:  Behaviours;  Perceptions;  Life styles. l Giving voice to the silver population is the key to really understand opinions and perspectives.

12. ©2014 Elena Bellio, Luca Buccoliero 12 Department of Marketing Citizens Lab Silver citizens meet Technologies

13. ©2014 Elena Bellio, Luca Buccoliero 13 Department of Marketing Citizens Lab Silver citizens meet Technologies l Silver citizens are no longer seen merely as consumers with lots of time and money; l Silver citizens often feel uneasy in their everyday life, and demand home services (IT systems allow a wide range of service provision); l Silver citizens are more authonomous than in the recent past; l Life styles are changing; l They must be considered as a mixture of needs and interests which must be understood.

14. ©2014 Elena Bellio, Luca Buccoliero 14 Department of Marketing Citizens Lab Targeted market research: the elderly are not a homogenous segment  Financial situation  Health conditions  Preferences, needs, values  Consumption behaviour  Responses to advertising campaigns  Skills l the current use of different ICTs by seniors- computers, Internet, mobile phones and consumer electronics l access, frequency, purposes of usage by each age group within a senior aged; l uptake of ICT according to occupation based social status, income, gender and educational attainment, health condition; l ICT access and usage by people with and without an impairments and disabilities; l ICT related attitudes towards the design of ICT products; l affordability of ICT/ICT services for seniors, availability of public funds

15. ©2014 Elena Bellio, Luca Buccoliero 15 Department of Marketing Citizens Lab «Silver» Technology Acceptance Model

16. ©2014 Elena Bellio, Luca Buccoliero 16 Department of Marketing Citizens Lab Objectives l To explore the factors that influence technology adoption, particularly where they differ from the factors that have proved to be important in predicting the acceptance of technologies by younger generations; l To reveal cultural differences and similarities in older people’s ICT adoption and use.

17. ©2014 Elena Bellio, Luca Buccoliero 17 Department of Marketing Citizens Lab «Silver» Technology Acceptance Model

18. ©2014 Elena Bellio, Luca Buccoliero 18 Department of Marketing Citizens Lab Research hypotheses H1: The influence of external variables (age, education, family status, occupation, income, health status, concerns) on perceived usefulness and perceived ease of use ; H2: The influence of social norms on perceived usefulness and perceived ease of use ; H3: The influence of perceived usefulness and perceived ease of use on behavioural intentions ; H4: The influence of perceived usefulness and perceived ease of use on actual use.

19. ©2014 Elena Bellio, Luca Buccoliero 19 Department of Marketing Citizens Lab Investigated Technological Areas Internet, personal computer and peripherals, phones, smartphones and other communication devices; Electronic devices used in daily life for housekeeping (microwaves, dish washer, etc.) or for entertainment (blue ray player, digital camera, etc.); Electronic devices for managing personal health (aerosol device, glucometer, etc.); Automated devices for smart houses (electric shutters, automatic aids for mobility, etc.).

20. ©2014 Elena Bellio, Luca Buccoliero 20 Department of Marketing Citizens Lab Methodology

21. ©2014 Elena Bellio, Luca Buccoliero 21 Department of Marketing Citizens Lab Methodology l A questionnaire was drawn up. It was made of 42 questions divided into 7 sections: - Personal data; - Use of Internet; - WEB, PC, communication; - Consumer Technology Goods; - Technology for Healthcare; - Domotic consumer applications; - Final opinion. It addressed people over 65 years old. l Most of the answers were based on a scale from 1 to 7, where 1 corresponds to strong disagreement and 7 strong agreement. There were also some dichotomist questions (yes or no). l 109 questionnaires were filled out in Italy between June and September 2013. Once the data was collected the analysis phase started.

22. ©2014 Elena Bellio, Luca Buccoliero 22 Department of Marketing Citizens Lab Discussion

23. ©2014 Elena Bellio, Luca Buccoliero 23 Department of Marketing Citizens Lab The sample (1) l 67% of female and 33% of male; l The average age is 72.20 years while the oldest person is 90 years old; l The 98.2% of the sample is Italian; l About the 58% of the sample stays in cities instead about the 39% in small towns; l The majority of the respondents (84.3%) is not working, in fact 82.4% declares to be retired; l As for the family status, our sample is composed as follows: Married or in a couple account for 58.3%; Widowed seniors represent the 24.1% of the total; 11.1% are single; separated or divorced seniors account for 6.5%. l 32.4% of the sample lives alone.

24. ©2014 Elena Bellio, Luca Buccoliero 24 Department of Marketing Citizens Lab The sample (2) l Family bonds: only 5.6% of the sample declares it “doesn’t have any relatives or son”; in 9.3% of the cases relatives are living with the respondent; in 14.8% they live in the same building. the highest percentage is when relatives are “living in the same city“ (48.1%); in 8.3% of cases relatives are “living in a city not far away”; instead in 13.9% of the cases relatives are “living in a city far away”. l Health status: the majority of the enrolled seniors has few symptoms (61.5%); some of them face difficulties in regular activities (15.6%) ; 13.8% feels perfectly well and has no symptoms; Only one respondent has important symptoms and requires help and frequent medical care. l To better understand life styles and routine, a “personal frailty index” was calculated by assessing the level of difficulty in carrying out possible daily activities. The more a person finds it hard to conduct the listed activities, the more he is considered frail.

25. ©2014 Elena Bellio, Luca Buccoliero 25 Department of Marketing Citizens Lab Internet l About half of the respondents does not use the internet (47.1%); l People are mostly either using internet less than once a day (19%) or are always connected (20%); l Internet usage didn’t differ according to people living areas.; l The most common place to access the Web is home (50.5%). Only 2.9% of the people surf Internet through the wireless network and in mobility. l Most of the people who connect to the internet use a desktop computer (33.3%) or a laptop (28.6%) while only 3.8% uses smartphones or tablets. l 38.2% of the sample doesn’t know what social networks are, in the rest of the sample 22.2% of the people use Facebook and 3.7% use Twitter.

26. ©2014 Elena Bellio, Luca Buccoliero 26 Department of Marketing Citizens Lab Activities performed by internet users

27. ©2014 Elena Bellio, Luca Buccoliero 27 Department of Marketing Citizens Lab Pc and communication devices

28. ©2014 Elena Bellio, Luca Buccoliero 28 Department of Marketing Citizens Lab Health devices

29. ©2014 Elena Bellio, Luca Buccoliero 29 Department of Marketing Citizens Lab Domotics

30. ©2014 Elena Bellio, Luca Buccoliero 30 Department of Marketing Citizens Lab SEM 1: Internet

31. ©2014 Elena Bellio, Luca Buccoliero 31 Department of Marketing Citizens Lab SEM 2: Health technologies

32. ©2014 Elena Bellio, Luca Buccoliero 32 Department of Marketing Citizens Lab SEM 3: PC & communication

33. ©2014 Elena Bellio, Luca Buccoliero 33 Department of Marketing Citizens Lab SEM 4: Domotic technologies

34. ©2014 Elena Bellio, Luca Buccoliero 34 Department of Marketing Citizens Lab Conclusions

35. ©2014 Elena Bellio, Luca Buccoliero 35 Department of Marketing Citizens Lab Hypothesis 1: external variables l The first hypothesis enables to understand how external variables influence perceived usefulness and perceived ease of use in the case of the technological areas considered. l The presence of relatives living close or far from the enrolled person has a positive significant impact on the perceived usefulness when considering Internet, pc and communication technologies and domotics, while the frailty index negatively impacts on the ease of use perceived in case of pc and communication technologies, health technologies and domotics. In case of Internet the ease of use is positively linked to educational levels.

36. ©2014 Elena Bellio, Luca Buccoliero 36 Department of Marketing Citizens Lab Hypothesis 2: social norms l The second hypothesis enables to understand how social norms influence perceived usefulness and perceived ease of use in the case of the four technological areas considered. l In the four technological areas considered social norms are highly significant and positively linked to perceived usefulness. The positive influence is also registered in case of ease of use for internet, health technologies and domotics while the significant relationship becomes negative when considering pc and communication technologies.

37. ©2014 Elena Bellio, Luca Buccoliero 37 Department of Marketing Citizens Lab Hypothesis 3: perceived usefulness and ease of use on behavioural intentions l The third hypothesis enables to understand the influence of perceived usefulness and perceived ease of use on behavioural intentions. l The most significant influence is registered for health technologies with an extremely high positive relationship in case of perceived usefulness and an high significant positive relationship as for perceived ease of use.

38. ©2014 Elena Bellio, Luca Buccoliero 38 Department of Marketing Citizens Lab Hypothesis 4: perceived usefulness and ease of use on actual use l The fourth hypotesis enables to understand the influence of perceived usefulness and perceived ease of use on actual use. l The most significant influence is registered for internet with a high positive relationship in case of perceived usefulness and an extremely high significant positive relationship as for perceived ease of use.

39. ©2014 Elena Bellio, Luca Buccoliero 39 Department of Marketing Citizens Lab Managerial implications l ICT success in supporting ageing society dynamics requires that new strategic approaches are adopted, both by industries and by public bodies. l First, technologies must be strictly linked with a clear analysis of silver citizens’ needs and demand. Traditionally, innovation has been characterized by a “technology” driven approach rather than by a “market” driven approach and too often the customer perspective has been missing. l Moreover, the elderly have been often considered as a homogenous segment of customers, and therefore no or limited efforts have been put on targeting different segments.

40. ©2014 Elena Bellio, Luca Buccoliero 40 Department of Marketing Citizens Lab Managerial implications (2) l On the opposite, different segments with heterogeneous consumption behaviours are identifiable according with the following variables:  health conditions;  personal frailty;  family status;  social relationship. l Each segment should be understood as a mixture of needs, perceptions and interests that must be investigated in order to provide the right “value proposition” for ICT solutions.

41. ©2014 Elena Bellio, Luca Buccoliero 41 Department of Marketing Citizens Lab Further research l Further analysis is in progress in order to improve the magnitude and the significance of the sample. Moreover, a comparative analysis with different Countries could be useful in order to present an international benchmark and to highlight the role of different national cultures.

42. ©2014 Elena Bellio, Luca Buccoliero 42 Department of Marketing Citizens Lab Thank you luca.buccoliero@unibocconi.it elena.bellio@unibocconi.it