Dissertation Defence: Integrating User Centred Design with Andersen’s Model

Lindsay Elizabeth Burton, supervised by Dr. Kathy L. Rush, will defend their dissertation titled “Integrating User Centred Design with Andersen’s Model: Multi Method Insights into Older Adult Preventive Service Use” in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing.

An abstract for Lindsay Elizabeth Burton’s dissertation is included below.

Examinations are open to all members of the campus community as well as the general public. Please email kathy.rush@ubc.ca to receive the Zoom link for this exam.

Abstract

Preventive services uptake among community-dwelling adults aged 60 years and older remains low despite numerous public health initiatives. Although older adults are increasingly willing to engage with technology, they face substantial barriers, including limited digital health literacy, inadequate technical support, and poorly designed interfaces that can exacerbate health inequities. These barriers are not uniformly distributed across the population, necessitating a clearer understanding of the determinants of digital-enabled preventive services use for designing interventions that are both effective and equitable. Therefore, the purpose of this 3-study dissertation was to identify and understand older adults in relation to their use of preventive services. This was achieved through three objectives: (1) to appraise and synthesize existing evidence on the effectiveness of digital interventions promoting the use of clinical preventive services for older adults; (2) to apply Andersen’s Model to determine the influence of predisposing, enabling, and needs-related factors on composite preventive services uptake among older adults; and (3) to identify unique older adult personas using theory-guided preventive service utilization factors. For objective one, a systematic review of 23 peer-reviewed studies extracted data on a range of interventions – telephone calls, text messages, patient-portal reminders, and video education – using a standardized extraction form and narrative synthesis. For objective two, a cross-sectional survey of 172 adults aged 65 years and older applied Andersen’s Behavioural Model, with hierarchical regression examining associations between predisposing, enabling, and need variables and composite preventive services uptake. For objective three, a three-step sequential design combined K-means clustering of 167 survey respondents, co-design workshops with 13 older adults, and member-checking to generate empirically derived personas. The systematic review found modest but statistically significant improvements for personalized or human-augmented digital approaches, portal-based FIT self-ordering (83% vs. 37%, OR 3.8) and tailored telephone counselling for mammography (51% vs. 25%), whereas generic automated messages produced mixed or null effects. Regression analysis explained 13.2% of variance in composite preventive services use; employment status (retired vs. working) was the sole significant predictor, while digital health literacy and ageism were not significant. Persona analysis revealed three profiles: high utilizers with strong social support and near-optimal service uptake (Molly); moderate utilizers facing access barriers and lower digital literacy (Grace); and low utilizers who deny health needs despite moderate literacy (Roy). Integrating behaviour change theory with service utilization theory is essential for effective preventive-care interventions in older adults. Digital interventions achieve the greatest impact when personalized, attentive to structural barriers such as scheduling constraints, and co-designed with older adults. Future research should prioritize inclusive digital design, provider-initiated outreach, and tailored strategies for immunizations versus chronic disease screening to advance equitable preventive services uptake.