別 紙 様 式1(修 士 申請 者 用)
修 士 学 位 論 文
Thebeneficialroleofsmartphone onoccupationsamongThaielderlypeople
タ イ の 高 齢 者 の 作 業 活 動 た お け る ス マー トフ オ ン 使 用 の 有 効性
(西 暦) 2019年 7月 5日 提 出
首 都 大 学 東 京 大 学 院
人 間 健 康 科 学 研 究 科 博 士 前 期 課 程 人 間健 康 科 学 専 攻 作 業 療 法 科 学 域
学 修 番 号:17896611 氏 名:SupatidaSorasak
ス パ テ ィ ダ ー ソー ラ サ ッ ク
(指 導 教員 名:井 上 薫)
【要 旨 】 近 年 、高 齢 化 社 会 へ 突 入 した タ イ 国 で は 、 作 業 療 法 士 は 医療 専 門職 と して 高 齢 者 の 健 康 的 な 生 活 を 支 援 す る 必 要 が高 ま っ て い る。 こ こ で 、 作 業 療 法 支援 の 一 手 段 と して 支 援 機 器 の活 用 が あ る。 本 研 究 は身 近 な先 端 技 術 で あ る ス マ ー トフ 才 こイに着 目 し、バ ン コ ク地 域 在 住 の60歳 以 上 の 高 齢 ユ ー ザ ー が スマ ー トフ ォ ン を ど の よ うに生 活 に役 立 て て い る か を作 業 療 法 士 の視 点 か ら明 らか とす るた め に 計 画 され た面 接 調 査 で あ る。
20名 の対 象 者 に対 し使 用 ア プ リケー シ ョ ン 、使 用 目的 や そ の理 由 につ い て 半 構 造 化 面 接 に よ り聴 取 し、 主題 分 析 を 用 い て 分 析 した 。 そ の 結 果 、対 象 者 に とっ て の利 点 は① 個 人 に とっ て 大 切 な 活 動 を よ り豊 か にす る、
② 活 動 へ の 参 加 を促 す 、 ③ リ ソー ス を有 効 活 用 す る、 か ら構 成 され て い る こ とが 示 され た。 作 業 療 法 士 は 、 高齢 者 の 生 活 の個 別 ニ ー ズ を満 た し、彼 らの健 康 な 生活 を 維 持 す る た め に 、 ス マ ー トフ ォ ン を 支援 手 段 の 一 つ と して 活 用 す る こ と が で き る と考 え る。 ・
キ ー ワー ド:作 業 、 高 齢 者 、 スマ ー トフ ォ ン、 支 援 機 器 、 作 業 療 法
I. INTRODUCTION
The United Nations') reported that the number of people aged 60 and above would triple to 2.1 billion by the year 2050. Thailand is one of the countries that has been turning into an aged society since 2005 and will become a completely aged society by 2021. In year of 2018, the elderly population aged 60 and above of Thailand was the_second highest among South East Asian countries with 16.06% of its total population). On the other hand, in modern Thai culture, the young generation do not have enough time to take care of their parents in the daytime because of their work. However, elderly people still need to engage in various occupations by managing financial transactions, gardening, doing housework, preparing meals, shopping for food & goods, taking medicine, and maintaining socialization. As aging, these elderly people are typically declined in physical and cognitive functions. Hence, these influence cause limitation in doing their daily occupations.
To support elderly people, it is useful to apply not only human resources but also adjustment of physical environment.
As previous studies supported, technology could help elderly people to engage in occupations with ease. For example, robots assisted the elderly for cleaning, calling for help, suggesting medical advice and supporting with personal care.
Moreover, assistive technology provided mobility support for transferring in the bathroom4), face-to-face telerehabilitation for checking health status at home. However, these devices are relatively expensive and not easy to introduce for majority of population. On the other hand, smartphone is one of the advanced technology devices which is portable, easy to access and not expensive than others. The modern smartphone devices have impacted human interaction in both private and public spaces and changed the pattern of everyday activity and social life. A Smartphone is a type of mobile phone possesses advanced features such as internet connection to surf the web and applications with accessibility features. This device has been an influence on the elderly as well. It was reported to assist elderly people to complete daily activities independently through compensating daily tasks to avoid regressed bodily functions6). Even though activities on smartphone does not always cover or replace the human activities such as communication with others and managing information, the appropriate introduction of smartphone could be one of supporting ways for elderly's life.
In Thailand, the survey regarding the use of smartphones among the elderly shows an upward trend from 6.44% last 2015 to 22.13% last 20177). This data indicated that smartphone had been one of famous devices for elderly people in Thailand. Recently, social network services have been • popular for Thai population8). The Elders in Thailand have particular communication by sending a morning greeting photo via smartphone. It is the culture to keep in touch with
people by sending photo. In addition, other study found that, initially, Thai elderly perceived that smartphones were difficult to use however, after gaining experience, they realized its advantages and were more likely to use smartphone in support of their life activities9). Moreover, this new technological advancement could facilitate human to promote
health and enhance the quality of life"). The trend of elderly smartphone users could show possibility of not only communication but also other beneficial roles to support them.
To address the problem of an ageing society, Thailand launched the 2nd National Plan on the Elderly 2002-202111) to develop and promote health in the elderly's lives. After that, numerous studies on elderly has been published however, .a few studies mentioned the use of smartphone in support of an elderly's life12),13),14),15),16). Furthermore, the focus of such studies limited on the communication view point only and did not cover other everyday occupations.
On the other hand, occupational therapy (OT) is one of the health professions to play an important role in health promotion and life-skills maintenance for elderly people in every activities and occupations. Thus, from this point, OT practitioners may regard smartphone .as one of assistive devices for supporting Thai elderly's daily activities, and so it is important to understand the way of life in the use of smartphone patterns and their routine utilization rather than a role as communication tool. Therefore, this research aim is, to reveal the advantage roles of using smartphone to promote occupations in Thai elderly people, with the research question; what is/are the purposes of using smartphone on occupation?
II. METHODS
This research utilized a hermeneutic phenomenological approach") to understand and explain an individual's experience, thought, meaning, and behavior in using a smartphone among the elderly population. Semi-structured interview was used in this study for both having guideline questions not to stray off the aim while interviewing, and having opportunity for interviewees to explain their experience that involve the main subject. Interview guideline was useful to follow the topic during conversation. The questions were adapted from the guidelines in "A Handbook of Research Methods for Clinical and Health Psychology"18) to specifically explore use of smartphone, and were created based on the research questions for guiding the same sort of questions to every participant. Thematic analysis was performed to highlight on searching for meaning in depth interpretation on participants' view point.
A. Participants
A non-probability purposive sampling') was used in order to acquire, a rich information in this study. The following inclusion criteria were set: a user of a smartphone which had accessed to the Internet, sufficient hand and eye function for the use of a smartphone, no communication problem using Thai language, and a current resident of Bangkok region.
Exclusion criteria included: severe cognitive deficits as indicated by the Mini-Mental State Examination : MMSE — Thai version 2002; score <22 points'), presence of orthopedic, neurological, and visual deficits which could impact the use of smartphone, smartphone users for less than 1 month and educational attainment of less than grade 7 in accord to the requirement of MMSE-Thai version.
Twenty Thai elderly participants were recruited through poster announcement posted in public areas such as city halls, community places, village areas and public transportation stations of 6 provinces namely (called Bangkok region):
Bangkok, Nakhon Pathom, Pathum Thani, Nontaburi, Samut Prakan, and Samut Sakhon. People living in Bangkok region are more likely to use technological devices such as smartphones more than other provinces due to different life patternI4).
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Investigation in Bangkok might lead to know the future possibility as increasing the number of smartphone users in the coming years. Hence, the researchers sought to examine smartphone use in the region of Bangkok.
All participants were informed of the goal and detail of research through written and verbal media. Informed consent was explained and signed by all participants before data collection. In order to allow them to exercise autonomy,
participants were informed that they could quit the project at anytime without any obligations if they wish to withdraw
from the study.
B. Data collection
Duration of data collection was from November 3rd to November 14th 2018. All participants were interviewed
individually with each interview lasting for 30-45 minutes. Thai language was the media of communication with voice recording done throughout interview. A 5-minute break was then provided, after break, the MMSE cognitive screening
test was administered for 10 minutes. When participants did not achieve the cut-off score of MMSE, they would be excluded. Total administration time is 45-60 minutes.
Interview contained 2 parts: personal information form and semi-structured interview form. In personal information
form comprised of general questions about gender, marital status, person who live with, educational level, former/current
job. The interview form was composed of 15 questions which lead to the answer of smartphone using's experiences,
opinions and comments. -Example of questions are; Why do you use smartphone?, What is/are the advantage(s) of smartphone in your opinion?, How smartphone helps you to complete your routine tasks?, Do you like to use it?, What
kind of support would you like to have? and so on.
C. Data Analysis
All interviews were transcribed verbatim. Thematic analysis in accord with Braun and Clarke), an analysis method for describing patterns within the data, was used. Six phases are described as following: to begin with, familiarizing with
the interview data (phase 1); carefully listening the recorder and re-reading the raw data transcriptions many times.
Secondly, generating initial codes (phase 2); creating the codes of significant ideas that involve with purposes of using
smartphone in term of supporting occupations among Thai elderly people. The data allocation into meaningful clusters
was included in this step. Thirdly, searching for the themei (phase 3); searching wider level of themes rather than codes,
trying to put difference codes into possible themes, and organizing them. This re-focusing analysis was regulated by raw
data table and mind-mapping program. Next, reviewing themes (phase 4); considering internal homogeneity and external
heterogeneity of each extract themes and sub-themes. Clusters of codes in similar meaning were examined to generate
appropriate each theme. Then, defining and naming themes (phase 5); specifying and refining the essence of all themes
and building the themes' name. It was necessary to check that the name fits broadly story inside the themes. Final step
was producing the report (phase 6); after setting of worked-out themes, presenting a concise, coherent and logical account
which providing enough proof of being in the themes. Generated themes were convinced the validity of analysis with
considering the research question.
The implementation of this research has been approved by the Tokyo Metropolitan University Arakawa campus Research Safety Ethics Committee (RSERC), Japan (Approval No.18056).
D. Trustworthy
In this research, trustworthiness was verified follows; 1) Credibility: after data gathering step, raw data was analyzed,
compared and discussed with three researchers together in team. 2) Transferability: research result carefully presented
the experience of smartphone using by elderly users in various aspects, hence, those who wants to use results might apply to the similar condition. 3) Dependability: data was harmonized together from interviewing and writing short note following interview guideline. 4) Confirmability, data was systematically collected and examined (audit 'trail) from raw data and analysis process.
III. RESULTS
The findings of the hermeneutic qualitative research were given based on research purpose to reveal the advantage roles of using smartphone for supporting occupations in Thai elderly people. The results were divided into participants' characteristic and thematic analysis result from the twenty participants as shown in text and graphic data.
Participants' demographic characteristics are presented in Table 1. Real names of participants were concealed by using pseudonyms. The participants were 12 males and 8 females at ages 60-73 years old. All participants had religious and live with family together. Participants had marital status as married except only one widowed status. Sixteen participants held bachelor or master education level and eleven of them were still working. All recruits passed the required MMSE level.
• Table 1: Participants' characteristic
Participants Sex Age. Religion Marital status
Educational level
Previous iob
Current Job
MMSE score Kraton
Kluay Noina Turian Maprao Angun Farang Lamyai Mamuang Som.
Linji
Makham Mangkhut
Supparod Malakor Tubtim
Chompoo Tangmo Ngoa
Ragam
M M M
F M M M F F F M
M F M F M F M M
F 68 73 62 68 72 62 63 60 61 62 62 69 68 68 66 72 68 68 68 62
Buddhist Buddhist Buddhist Buddhist Buddhist Buddhist Buddhist Buddhist Buddhist Islam
Islam Buddhist Buddhist Buddhist Buddhist Buddhist Buddhist Buddhist
Buddhist Christian
Widowed Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married Married
Master Bachelor Bachelor Bachelor Bachelor Master Diploma Certificate
Bachelor Bachelor Certificate
Master Diploma Bachelor Bachelor Bachelor Bachelor Bachelor Bachelor I Bachelor
Army Teacher' Engineer
Teacher Army
State enterprise
Officer Cashier Officer Manager Officer Teacher
Officer Army Banker
Army Teacher
Banker Pilot Teacher
President of NGO Retired Personal Business, Construction & Estate
Retired Retired Retired Retired Officer Officer Personal Business,
Restaurant Personal Business,
Restaurant Retired
(Retired G
ardener Baker Retired Retired Personal Business,
Travel and Tours
Retired Retired
30 27 28
30 30 29 25 29 22 30 28 27 27 28 26 30 28 29 24
30
**Full marks of MMSE score is 30 points
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In thematic analysis as Figure 1 shows, 134 initial codes were produced from transcriptions in the second phrase of analysis. After strived to categorize all codes, seven themes were created in the third phrase as analysis method. Then in the fourth phrase, all seven themes were reinterpreted in similarities and differences of content, then some codes were moved or changed into other themes. Theme E (Reminding navigation & time) in previous phase were divided into 2 themes: Reminding time & memory (E-1) and Finding route & navigation (E-2): Then eight themes were generated, and were conjoined to be three new themes after reviewing the depth meaning. Theme A, B and C were combined to be
`Theme 1' because these related to individual needs with mental
, social, and spiritual support. Theme 5, E-1 and E-2 were put together in 'Theme 2' due to involving with guiding to engage in various life activities. Theme F and G were in
`Theme 3' because they made tasks easier and fewer steps . Eight themes became eight sub-themes under theme 1, 2, 3.
Next, in the fifth phase of analysis, 'Theme 1', which is, composed of three sub-themes: Keep contact & communication, Promoting mental health and Following religious principle & beliefs, was named as 'Enriching individual worthy activities' because three sub-themes were acting toward what the elderly- did for fulfilling individual mental, social and spiritual needs. Secondly, 'Theme 2', which contained three sub-themes: Updating news & information, Reminding time
& memory and Finding route & navigation, was named as 'Orienting participation in activities', regarded as indicating preparation to engage in daily activities by managing the information on smartphone. 'Theme 3', including with two sub- themes: Managing & engaging in financial activities and Work support, was named as 'Conserving resources' because of shortening activities processes that lead to economize their activities load on smartphone. After naming three main themes, all eight sub-themes' names were revised to make sure that all titles were matched the content inside and appropriable. All analysis processes were done with coresearcher who were OT -and had efficiency to understand academic Thai and English language. The analysis described objectives of smartphone using among the participants in 3 themes: '1. Enriching individual worthy activities', 'Orienting participation in activities' and 'Conserving resources. The beneficial roles on daily occupation were presented with some quotations to support the results.
1. Enriching individual worthy activities •
Majority of participants explained how smartphone experiences could enhance their individual worth related to having particular desire with mental, social, and spiritual support. This theme consists of three sub-themes: 'Keeping connection', 'Promoting recreation and relaxation', and 'Performing religious rituals'.
1.1. Keeping connection
This sub-theme mentions about communication usability via smartphone as maintaining relationship with family members, friends and acquaintances. Contacting others reduced the miss according to Kluay's account. He addressed the feeling 'miss' because of not seeing his brother in person for long time, and smartphone helped him to see his brother via online application as below:
I use video calling with my brother who lives in another province. We haven't met, haven't seen each other faces for many years, missed him. I want to see his face because I'm afraid that he feels lonely. Sometimes he afraid that I feel
lonely too. (Kluay) -
6
In addition, they used some special online culture using LINE application (SNS) only for Thai elderly. The seniors sent photos to their LINE friends' account every morning. The greeting photos contained greeting message, for example, Hello Monday, Happy Friday (sometimes with blessing sentence), and daily color background; Thai daily color belief is derived from Hindu myth which followed the birthdays of angels who protect the planets. Morning greeting photo expression was easy communication way to express happiness and care to beloved persons as this participant commented below:
Well I sent the greeting photo just to let them know that...I'm doing great, being healthy. I sent to them then they sent me back, that's quite obvious they are doing fine too. Were connected! I can contact with my friend who I have known for 30-40 years. This person studied with me at grade 7 err...he (or she) is still ok. (Lamyai)
1.1. Promoting recreation and relaxation
Many participants talked about entertainment aspect, which they received from internet browsing via smartphone, aiming to pleasure themselves with personal needs, e.g. listening to music, singing in karaoke, watching drama and TV programs and so on. One of participants who previously loved to go to countryside to see local show, however she watched movies via smartphone instead as described:
I usually watch YouTube (application) for a whole day. It my best entertainment stuff. I'm a Lige lover (Thai musical folk drama). I could spend a whole night watching it. It's fun for me. No need to go to the cinema, I love it. (Mamuang)
Likewise appear in Ragam's story that explained her experience, using YouTube application could calm herself after taking care her husband.
...listen to music, and sing karaoke sometimes for enjoyment, something like this. It kind of relaxing and no stress.
(Ragam)
1.2. Performing religious rituals
Purpose of using smartphone to carry on religious or creed ceremony following individual demand, are presented in this sub-theme. Several seniors indicated the way to engage in rituals related beliefs with confident, correction and convenience, as highlighted in the following:
Muslim Pro (application), the mostly used app for Muslim. It tells prayer time and has Al-Quran (Islam holy scripture) ...has prayer direction guide which helps us a lot. I normally set up the app, it will tell us the accurate direction we have to turn to, so convenience! (Som)
Buddhawajana (application), this app broadcast Dhamma (Buddha's words) which are not distorted. I listen to the sermon for more understanding the core of Buddhism. (Makham)
Regarding to three sub-themes, participants reflected smartphone could help them to fulfill their worthiness that made happiness and pleasure well in everyday activities.
2. Orienting participation in activities
This theme aimed to focus on finding and planning the way to participate in daily occupations. The theme included diverse experiences from participants, which supported the idea of how to behave and manage their life situation.
'Three sub-themes are presented in the theme: 'Receiving and Searching information'
, 'Reminding time and memory'
and 'Finding route and navigation'. -
2.1. Receiving and Searching information
Getting and finding news and information on smartphone helped them to organize activities in daily life as an example from Farang's account below:
I check weather app because I want to know about raining. It's like I plan to wash the clothes tomorrow but weather forecast tells it going to rain. Then I change plan to wash the clothes another day. (Farang)
Similarly, Maprao, who mainly receive the news by watching TV every day, described benefit of having smartphone in hand:
When I travel, I can't watch TV at home so I watch the lives news on smartphone. ...Vely important because I can update all news and information here, especially LINE app. (Maprao)
Participants referred to taking an updated information from social as the crucial point to make them know the outside environment, thus, they kept up with up-to-date information to cope with the current and future situation promptly.
2.2. Reminding time and memory
Many of participants explained that they used functions and applications as a memory not to forget information, and things to do by making note or/and setting alarm to recall them. Two illustration accounts are showed as:
I set time to get up by using Clock (smartphone function). Now I need alarm clock to get up for running errands.
Whether I use it, I can't do whatever in time. (Maprao)
To notes myself." use the note (smartphone function) to remind myself such as, shopping list. I turn on the notification to remind myself to prioritize the tasks. Most of all I use is the schedule calendar because I have lots of stuff to do, the mostly used might be this one. (Noina)
2.3. Finding route and navigation
There were several descriptions that senior users presented that the aim of using smartphone was to see location of the places, navigate the routes and to support them for not getting lost during driving as following descriptions:
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Google Maps (application) leads the way. It is very useful for finding GPS when Igo to the place where I do not know the route. If I open the app I know how many kilometers to go, where I should turn the corner. I'm not lost anymore. It helps elderly a lot. (Tangmo)
Furthermore, even if some participants knew the route, they still use the application to check the traffic situation as following interview extracts:
Google Maps is the best. I use every time Igo outside, use a lot. 2-3 minutes before going, I check the route then, make the decision which route I will go and follow it. Once I didn't believe the route that recommended by Google Maps and I found very bad traffic. It's accurate prediction: (Noina)
3. Conserving resources
A lot of them highlighted the feeling of minimizing the tasks, economy, and saving the time when using smartphone.
These could help them to handle their life easily. Two sub-themes were interpreted in this theme: 'Managing and engaging in financial activities' and 'Work support'.
3.1. Managing and engaging in financial activities
Although elderly people were in retirement period, it was necessary for them to maintain some occupations similar as in the previous time when they had been working. Almost all participants got pension by transferring to bank account in every month. Without a doubt, they had to pay all utilities bills, for instance, accommodation, electricity, water, telephone, insurance and so on. Therefore, to complete financial transactions with ease, they proceeded all steps through smartphone instead of going to the bank and other organizations, following Angun's explanation:
Previously, I didn't know my expenses if the invoice was lately sent. Since I downloaded applications (credit cards and Electricity Generating Authority of Thailand), I know how I can manage money, without waiting invoice letter. .I use e- banking to complete money transactions. After I retired, no need to go to the bank, everything finishes on smartphone.
(Angun)
Moreover, some seniors prefer to stay at home, nevertheless, they sometimes wanted to buy something. From the interview, some seniors were expert at online shopping. The answer of Tubtim showed that he bought item with only few processes to finish on his smartphone:
I do shopping by swiping Facebook (application). When I find. out the products I want, I just press button and it will be automatically opened to the main app that I can buy. Press the confirmation and then boom! finish. Super easy!
(Tubtim)
3.2. Work support
Half of the study's participants were still working after the age of retirement. Consequently, alternative tools in smartphone seemed to be important for them because smartphone applications which reduce the steps of working could
kindly support the elderly to work more convenient, more comfortable and save time. Two subjects expressed their thought about assisting programs which shorten the path of doing their job responsibilities in the following quotes:
I use LINE (application) for contact about the work.. in my organization that has 23 provinces branches, I must use it to gather all members into the same group so I can assign their duties only in one time. (Keaton)
I keep so many document flies about international business that I work for. So I choose File Manager (application) to arrange all my files. (Linji)
Other perspective
Meanwhile, participants complained about the difficulties and problems while using smartphone. Three mainly obstacles for senior participants were found. First, complexity of applications/functions made elderly get confusion, for instance, symbols, technology language, too many steps and so on. Second was fearing of trouble using new application because of additional fee and damage of device that participants thought that it might happen. The other was physical effects such as eye fatigue, eye irritation, dizziness and so forth.
IV. DISCUSSIONS
In this study, it was investigated what beneficial roles were played in using smartphone among Thai elderly people in Bangkok region when they engaged daily occupations from their experiences, opinions, and feeling through interview session. As the result in Figure 1, it was shown that smartphone was one of useful assistive devices to support the elderly's daily needs in Thailand.
Firstly, the results revealed that participants used smartphone to fulfill their personal daily needs such as social, spiritual, and mental activities. That means that smartphone could have beneficial role to encourage elderly people to maintain active life. As Kim's study') addressed that smartphone played advantage role on improving psychological, mental and social aspects, this study supported the previous study. In this study, even though some participants had their works, the others who did not work mainly stay at home. This situation might make them cram into smaller society because of environment change after retirement'). The narrowed environment could cause loneliness that lead to bad consequences, for example, feeling worthless, depression, not perceiving self-worth and finally influence on their daily occupations.
Nonetheless, this result indicated that elderly participants tended to use smartphone to eliminate the loneliness by communication with family members and friends and to find new community especially, with people who had the same preference on social network. The other way to decease lonely feeling was promoting recreation and relaxation by using functions of entertainment that could pleasure themselves, make happiness and decrease stress. Similarly, Meneses Ferndndez et aff, Teng&Joo25), Berenguer et al26) found that the elders were interested in using smartphone for their own personal needs and leisure. In addition, persisting in religious and beliefs was the other role to dispel uncertain feeling. Particularly Thai people are generally implanted mindset of the religious attitude since childhood. The culture beliefs mention that religious is a spiritual anchor to protect one's feeling and mind. Therefore, the results reported that participants used smartphone in term of performing religious custom to keep peaceful mind. Accordingly, smartphone
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may help elderly participants to maintain their community or compensate narrowed community with individual worthy fulfillment. Satisfaction with individual could lead to further motivation and confidence to do activities.
Secondly, the advantage role of smartphone presented that the elders use it to help them orient how to engage in the activities. Updating news from smartphone supported persons to decide what they should prepare themselves and be
ready for current and following situation as a guide tool. As the same as survey's outcome from Malaysia's) mentioned,
elderly people perceived that the news from social media was beneficial to support their life. Interestingly, participants
in Thailand could manage and deal with information through smartphone to some extent, so provision of health promotion
or daily useful information through smartphone might be provided to the elderly. Moreover, reminder tools on smartphone were utilized by participants to manage and remember their activities. Consistent with survey research of Bhutta27) displayed that calendar and alarm were famous functions for elderly's smartphone user. As the other role, navigation on smartphone might be the effective support device by precisely calculating direction and time. To be similar
to Berenguer's researchm), elderly people in developed countries used smartphone for location navigation on public transportation. Despite of inconvenient Thai transportation systems and traffic situation, the elders still wanted to go
outside, for example, working, meeting with friends and traveling with using smartphone. Thus, the beneficial role of
smartphone could support to manage their own life, to review their. daily schedule and to find chance of improving their daily habit. These indicate possibilities to introduce to Thai elderly applications/functions that might support their life
such as managing their daily habit, health prevention and promotion.
Thirdly, smartphone played roles as results illustrated that participants used it to manage occupations easily, comfortably and effectively. Both of elders who get and not get pension/salary need to manage their financial activities:
doing money transactions, paying utilities bills and buying what they want. Instead of traveling to the bank, office, market and mall in the past, today financial engagement could be done everywhere by smartphone in hand. In addition, the
finding in Hong's research') indicated that the advanced technology such as electronic money supported the elderly to
maintain an independent life. Therefore, financial activities on smartphone could save the time and money, and reduce
physical load. In work support aspect, for elderly participants who were continually working after retirement period,
smartphone helped them to achieve the job tasks faster and more productive even as aging. Thai participants in this study
managed financial activities and their works by smartphone.
Finally, smartphone was addressed to be very useful for elderlies' life, meanwhile, difficulties were discovered, for example, complicacy of functions, fault fearfulness. Participants were not grown up among technology platform, so it
might be hard for them to make full, use of functions. In addition, physical effects based on participants' comments may
happen from long duration of using and not proper light volume and text size for elderly9). These inconvenient conditions
should be considered to introduce devices such as smartphone. On the other hand, in developed countries, smartphone
was popularly used as health related role, for example, falling prevention28), vital sign measurement26' and so forth.
Therefore, smartphone may have potential role to support elderly's life for security and safety aspect, for example,
Smarthome camera which broadcasts video in real time or disasters warning application. Even if participants'
performance of smartphone using in this study was good, there could be many functions on smartphone that not popular for currently Thai participants due to lacking of knowledge of function existence and use instruction. Diversified functions/applications which may provide benefit for elderly particularly to enhance engagement in daily occupations
would be expansion use in Thai situation. From the results that showed several roles of usefulness of smartphone, it might be thought that elderly users in this study living in urban area were familiar with technology device. However, upcountry
area may have less feasibility to use function compared with users in the city. This study had limitation because only Bangkok elderly were recruited, thus the results could not apply to all Thai elderly people.
Implication to OT practice
Occupational Therapist could apply the results to help Thai elderly people for reducing the limitation and promoting engagement in occupations in order to increase the quality of life after retirement period. Regarding influences of smartphone to self-worth, as a health profession, OT could carefully recommend functions/applications that fits with the elder's ability individually, and this support might lead to their confidence and motivation of participating in occupations.
Furthermore, advising family member for supporting the elders in dealing with smartphone could be one way for OT to improve elderly performance. OT could give effective information, for example, producing guideline for elderly people to help them for having alternative and easier choices on daily life activities participation. In the guideline it could be contained the instruction and benefits of using smartphone, suggest applications for elderly and so forth. In addition, OT could provide essential information to other related professions for example, engineer and system designer for developing applications which have trustworthy data and easy-to-use function for elderly in Thailand. As aged society, OT could apply beneficial roles of smartphone as assistive device to support elderly people. In addition, it would be needed that OT support them as considering feature of assistive devices to fulfill individual needs and promote successful' aging.
ACKNOWLEDGEMENT
This research was supported by Asian Human Resource Development Project for Medical Professionals funded by Tokyo Metropolitan Government
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Abstract: Thailand become the second largest number of seniors in ASEAN. As aged society, occupational therapist (OT) as health professionals are required more to support elderly's life in healthy. Previous studies indicated that technology could help elderly people to engage in occupations with ease, and OT can arrange these devices for their everyday activities. Smartphone is one of popular technology devices that make support elderly's everyday activities with more convenience and effective. In Thailand, there is no study on daily activities promotion with smartphone usage except as communication tool. Thus, this study aimed reveal the advantage roles of using smartphone to promote occupations in Thai elderly people from the OT viewpoint. This study was conducted by semi-structured interview asking for the purpose of using base on hermeneutic phenomenological approach. Participants were twenty Thai elderly people (8 females and 12 males aged 60-73) who were using smartphone in Bangkok regions through purposive sampling.
Collected data sets were analyzed by thematic analysis to find significant concepts related to research aim. Three themes that were beneficial roles of smartphone using for elderly participants were generated. 1) Enriching individual worthy activities, 2) Orienting participation in activities, 3) Conserving resources. The results showed that participants used smartphone to fulfill their personal needs by encouraging them to maintain the smooth of life. Also, smartphone helped participants to deal with information for making decision and preparing themselves to participate in daily activities.
Furthermore, it supported them to manage tasks easily, comfortably and effectively by shortening steps. Therefore, smartphone could maintain or increase the elders' function abilities to complete the tasks although they face environment changes and difficulties of aging. OT as health profession could use smartphone as an alternative assistive device for elderly to keep their participation in occupations for promoting successful aging after retirement period.
Keywords: Occupation, Elderly, Smartphone, Assistive technology, Occupational Therapy
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