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<article xmlns:xlink="http://www.w3.org/1999/xlink" article-type="letter" dtd-version="2.0">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JMIR Human Factors</journal-id>
      <journal-id journal-id-type="nlm-ta">JMIR Hum Factors</journal-id>
      <journal-title>JMIR Human Factors</journal-title>
      <issn pub-type="epub">2292-9495</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v12i1e65684</article-id>
      <article-id pub-id-type="pmid">39773887</article-id>
      <article-id pub-id-type="doi">10.2196/65684</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Research Letter</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Research Letter</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Older Adults’ Experiences With an Online Survey</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Kushniruk</surname>
            <given-names>Andre</given-names>
          </name>
        </contrib>
        <contrib contrib-type="editor">
          <name>
            <surname>Borycki</surname>
            <given-names>Elizabeth</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Rodger</surname>
            <given-names>Jenny</given-names>
          </name>
        </contrib>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Serhal</surname>
            <given-names>Sarah</given-names>
          </name>
        </contrib>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Vassallo</surname>
            <given-names>Amy</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Weir</surname>
            <given-names>Kristie Rebecca</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <address>
            <institution>Sydney School of Public Health</institution>
            <institution>Faculty of Medicine and Health</institution>
            <institution>The University of Sydney</institution>
            <addr-line>City Road</addr-line>
            <addr-line>Sydney, NSW 2006</addr-line>
            <country>Australia</country>
            <phone>61 293512222</phone>
            <email>kristie.weir@sydney.edu.au</email>
          </address>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-9507-5050</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author">
          <name name-style="western">
            <surname>Maitah</surname>
            <given-names>Yehya</given-names>
          </name>
          <degrees>BS</degrees>
          <xref rid="aff3" ref-type="aff">3</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-9509-5764</ext-link>
        </contrib>
        <contrib id="contrib3" contrib-type="author">
          <name name-style="western">
            <surname>Vordenberg</surname>
            <given-names>Sarah E</given-names>
          </name>
          <degrees>PharmD, MPH</degrees>
          <xref rid="aff4" ref-type="aff">4</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-9828-9759</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Sydney School of Public Health</institution>
        <institution>Faculty of Medicine and Health</institution>
        <institution>The University of Sydney</institution>
        <addr-line>Sydney</addr-line>
        <country>Australia</country>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution>Institute of Primary Health Care (BIHAM)</institution>
        <institution>University of Bern</institution>
        <addr-line>Bern</addr-line>
        <country>Switzerland</country>
      </aff>
      <aff id="aff3">
        <label>3</label>
        <institution>Albany Medical College</institution>
        <addr-line>Albany, NY</addr-line>
        <country>United States</country>
      </aff>
      <aff id="aff4">
        <label>4</label>
        <institution>University of Michigan College of Pharmacy</institution>
        <institution>Department of Clinical Pharmacy</institution>
        <addr-line>Ann Arbor, MI</addr-line>
        <country>United States</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Kristie Rebecca Weir <email>kristie.weir@sydney.edu.au</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2025</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>8</day>
        <month>1</month>
        <year>2025</year>
      </pub-date>
      <volume>12</volume>
      <elocation-id>e65684</elocation-id>
      <history>
        <date date-type="received">
          <day>22</day>
          <month>8</month>
          <year>2024</year>
        </date>
        <date date-type="rev-request">
          <day>19</day>
          <month>12</month>
          <year>2024</year>
        </date>
        <date date-type="rev-recd">
          <day>19</day>
          <month>12</month>
          <year>2024</year>
        </date>
        <date date-type="accepted">
          <day>20</day>
          <month>12</month>
          <year>2024</year>
        </date>
      </history>
      <copyright-statement>©Kristie Rebecca Weir, Yehya Maitah, Sarah E Vordenberg. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 08.01.2025.</copyright-statement>
      <copyright-year>2025</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on https://humanfactors.jmir.org, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://humanfactors.jmir.org/2025/1/e65684" xlink:type="simple"/>
      <abstract>
        <p>The study explored older adults' perceptions after participating in an online survey about medication decisions, finding that approximately 80% of participants provided positive feedback about the research methodology and their experience.</p>
      </abstract>
      <kwd-group>
        <kwd>older adults</kwd>
        <kwd>gerontology</kwd>
        <kwd>geriatric</kwd>
        <kwd>older</kwd>
        <kwd>aging</kwd>
        <kwd>online</kwd>
        <kwd>internet</kwd>
        <kwd>survey</kwd>
        <kwd>questionnaire</kwd>
        <kwd>research engagement</kwd>
        <kwd>engagement</kwd>
        <kwd>study subject</kwd>
        <kwd>participant</kwd>
        <kwd>medication decisions</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec sec-type="introduction">
      <title>Introduction</title>
      <p>Older adults are underrepresented in research, often due to age-related biases and stringent exclusion criteria; this limits generalizability and leaves knowledge gaps [<xref ref-type="bibr" rid="ref1">1</xref>].</p>
      <p>The increasing prevalence of online research has the potential to increase older adult participation, given the rising internet use among this demographic [<xref ref-type="bibr" rid="ref2">2</xref>]. While research has primarily focused on improving recruitment of older adults, an understanding of their experiences of online research is needed to effectively engage older people [<xref ref-type="bibr" rid="ref3">3</xref>]. While most surveys include some form of piloting, they rarely capture or share participants’ perceptions of the research process. We sought to explore older adults’ perceptions after participating in an online experimental survey, given the potential high accessibility of this type of research.</p>
    </sec>
    <sec sec-type="methods">
      <title>Methods</title>
      <sec>
        <title>Overview</title>
        <p>We previously reported the main findings from a vignette-based online experiment conducted among adults aged 65 years and older from Australia, the Netherlands, the United Kingdom, and the United States [<xref ref-type="bibr" rid="ref4">4</xref>]. Participants were recruited for this 15-minute survey through a panel of internet users administered by Qualtrics Research Panels. The study focused on contextual factors influencing how older adults (mean age 71.5, SD 5.1 years) think about deciding to stop a cardiovascular disease medication. In this study, we conducted a content analysis of free-text comments (<xref ref-type="boxed-text" rid="box1">Textbox 1</xref>). The final analysis framework included 17 codes that were subsequently consolidated into 14 themes. Descriptive statistics were used to assess the frequency of each theme.</p>
        <boxed-text id="box1" position="float">
          <title>Summary of methodology for the content analysis.</title>
          <list list-type="order">
            <list-item>
              <p>A vignette-based online experiment was conducted among adults aged 65 years and older from Australia, the Netherlands, the United Kingdom, and the United States using sampling quotas to ensure balanced representation by country and gender. This study was registered at ClinicalTrials.gov (NCT04676282). At the end of the survey, participants were provided the opportunity to leave “any comments about this study.”</p>
            </list-item>
            <list-item>
              <p>A content analysis was conducted among participants who received the vignette about a hypothetical patient, Mrs EF. Participants from the Netherlands were excluded, as the study team for the content analysis was not fluent in Dutch.</p>
            </list-item>
            <list-item>
              <p>Study authors read through the comments to inductively generate codes.</p>
            </list-item>
            <list-item>
              <p>Two investigators (SEV and YM) independently coded comments, resulting in &#62;80% agreement.</p>
            </list-item>
            <list-item>
              <p>All discrepancies in codes were discussed until consensus was reached.</p>
            </list-item>
          </list>
        </boxed-text>
      </sec>
      <sec>
        <title>Ethical Considerations</title>
        <p>The online experiment was registered at ClinicalTrials.gov (NCT04676282) and was deemed exempt by the University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board (HUM00183129); by extension, a waiver of consent was granted. All data were collected anonymously. Participants were compensated based on the terms of their panel agreement.</p>
      </sec>
    </sec>
    <sec sec-type="results">
      <title>Results</title>
      <p>Participants (N=1789) most frequently did not provide any feedback in the free-text comment field (n=784, 43.8%) or wrote that they had no comments (n=487, 27.2%). Three participants (0.2%) gave unclear statements.</p>
      <p>Participants’ comments (n=515, 28.8%) were primarily positive (415/515, 80.6%), such as that the study was interesting (116/515, 22.5%). Themes and representative quotes are reported in <xref ref-type="table" rid="table1">Table 1</xref>. Participants said it made them think about their health (80/515, 15.5%) and some participants shared further health information about the study topic (48/515, 9.3%). Participants provided feedback on how to improve the study, categorized as question-specific comments (21/515, 4.1%), general suggestions (12/515, 2.3%), or country-specific comments (3/515, 0.6%). Few participants (16/515, 3.1%) provided negative feedback about the survey.</p>
      <table-wrap position="float" id="table1">
        <label>Table 1</label>
        <caption>
          <p>Older adults’ feedback about an online survey using a hypothetical vignette by theme, with representative quotes among respondents who provided feedback (n=515).</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="30"/>
          <col width="230"/>
          <col width="0"/>
          <col width="600"/>
          <col width="0"/>
          <col width="0"/>
          <col width="140"/>
          <thead>
            <tr valign="top">
              <td colspan="3">Themes</td>
              <td colspan="2">Representative quotes (participant code)</td>
              <td colspan="2">Participants, n (%)</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td colspan="7">
                <bold>Positive feedback (n=415, 80.6%)</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Interesting</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“An interesting study” (919)</p>
                  </list-item>
                  <list-item>
                    <p>“This was an interesting survey to complete” (2200)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">116 (22.5)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Thought provoking</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Interesting and insightful. Made me think a little more about how best to manage my health” (1872)</p>
                  </list-item>
                  <list-item>
                    <p>“Very good survey to ponder thoughts and beliefs” (481)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">80 (15.5)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Positive feedback</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Great stuff. Keep up the good work” (2574)</p>
                  </list-item>
                  <list-item>
                    <p>“Very good” (764)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">67 (13)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Thanks for opportunity to participate</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Thanks” (42)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">43 (8.3)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Positive feedback about survey questions or structure</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Love the format, so easy to see, follow, and understand” (1904)</p>
                  </list-item>
                  <list-item>
                    <p>“Very good questions regarding whether or not to stop a medication when you’ve been on it for an extended time” (2026)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">35 (6.8)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Enjoyed taking survey</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Enjoyed it” (328)</p>
                  </list-item>
                  <list-item>
                    <p>“Love doing your studies” (287)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">34 (6.6)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Unusual study design</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Very different enjoyed the variety” (540)</p>
                  </list-item>
                  <list-item>
                    <p>“Unusual but interesting” (1853)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">19 (3.7)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Interested in results</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Interested in purpose of results” (1863)</p>
                  </list-item>
                  <list-item>
                    <p>“Very interesting! Now I need to see the final results” (3481)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">15 (2.9)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Interested in future studies</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Great study, I’d do more” (4815)</p>
                  </list-item>
                  <list-item>
                    <p>“Need more like this” (2516)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">6 (1.2)</td>
            </tr>
            <tr valign="top">
              <td colspan="6">
                <bold>Neutral feedback (n=48, 9.3%)</bold>
              </td>
              <td>
                <break/>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Shared personal experience</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“I am afraid of going to see the dr for worries about my health” (1526)</p>
                  </list-item>
                  <list-item>
                    <p>“Thanks; my prescription drugs fall under the Federal Government program where they are funded nearly 100%” (2645)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">48 (9.3)</td>
            </tr>
            <tr valign="top">
              <td colspan="7">
                <bold>Negative feedback or suggestions for improvement (n=52, 10.1%)</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Question-specific feedback</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“The percentage charts were confusing” (2403)</p>
                  </list-item>
                  <list-item>
                    <p>“One question said check all that apply but only one was allowed” (4279)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">21 (4.1)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Negative feedback</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Boring” (1409)</p>
                  </list-item>
                  <list-item>
                    <p>“Too many generalizations” (1102)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">16 (3.1)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>General suggestions for improvement</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Consider adding a progress bar to the survey” (2027)</p>
                  </list-item>
                  <list-item>
                    <p>“Good study could be shorter” (2433</p>
                  </list-item>
                </list>
                <break/>
              </td>
              <td colspan="3"><break/><break/>12 (2.3)</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>Country-specific feedback</td>
              <td colspan="2">
                <list list-type="bullet">
                  <list-item>
                    <p>“Some questions are designed for the USA” (1471)</p>
                  </list-item>
                  <list-item>
                    <p>“Prescription insurance? In UK if you are over 65 prescriptions are free” (4075)</p>
                  </list-item>
                </list>
              </td>
              <td colspan="3">3 (0.6)</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
    </sec>
    <sec sec-type="discussion">
      <title>Discussion</title>
      <p>Among older adults who provided feedback about their experiences completing an online survey, approximately 80% (415/515) of the comments were positive. Our findings signal general acceptability of the methodology, and we have implemented the practical feedback to improve our online surveys. We have become more mindful of the survey length, selected straightforward question types, and have conducted pilot testing in all target countries to ensure that questions are appropriate for all participants.</p>
      <p>Our study had several limitations. First, less than one-third of the study participants provided any comments. Second, participants were asked if they had any comments, as opposed to more specific questions about their experience taking the survey. Finally, we acknowledge that we coded a single primary theme per comment given the short statements that were provided.</p>
      <p>With an aging population who may spend many years in retirement, participating in research can offer benefits such as reducing social isolation and loneliness, fostering a sense of purpose, and providing mental stimulation, and it may provide monetary incentives [<xref ref-type="bibr" rid="ref5">5</xref>]. While our online study lacked the social benefit of in-person interaction typical of traditional research, participants reported enjoying the survey; they found it prompted self-reflection on their health, and they expressed interest in the study’s outcomes and future research.</p>
      <p>Online research is becoming more prevalent; therefore, it is important to make sure this methodology is inclusive of older adults [<xref ref-type="bibr" rid="ref5">5</xref>]. More than half of adults older than 65 years use the internet, yet they are the least likely to have a home computer [<xref ref-type="bibr" rid="ref6">6</xref>]. While some researchers attribute this limited use to age-related functional decline, others argue that the main barriers are negative attitudes such as fear, anxiety, and low motivation—barriers that are modifiable. Anxiety about using the internet and digital technologies often leads to self-imposed limitations and low confidence, with older adults frequently underestimating their knowledge and abilities compared to younger users [<xref ref-type="bibr" rid="ref6">6</xref>]. This underscores the importance of studies like ours that highlight the positive experiences of older adults in online research.</p>
    </sec>
  </body>
  <back>
    <app-group/>
    <ack>
      <p>This study was funded by award R24AG064025 from the US Deprescribing Research Network via the Northern California Institute for Research and Education through the National Institute on Aging; a Swiss Government Excellence Scholarship (KRW), the Swiss National Science Foundation Scientific Exchanges (grant IZSEZ0_213475/1; KRW), and an Emerging Leader Research Fellowship (2017295) from the Australian National Health and Medical Research Council (KRW). The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. KRW and SEV had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.</p>
    </ack>
    <fn-group>
      <fn fn-type="con">
        <p>Concept and design: KRW, SEV</p>
        <p>Acquisition, analysis, or interpretation of data: all authors</p>
        <p>Drafting of the manuscript: all authors</p>
        <p>Critical review of the manuscript for important intellectual content: all authors</p>
        <p>Statistical analysis: SEV</p>
        <p>Obtained funding: SEV</p>
        <p>Administrative, technical, or material support: KRW</p>
        <p>Supervision: KRW, SEV</p>
      </fn>
      <fn fn-type="conflict">
        <p>KRW reports receiving grant funding from the Swiss National Science Foundation (SNSF), the National Health and Medical Research Council, and the Swiss Confederation during the conduct of the study. SEV reports receiving grant funding from the US Deprescribing Research Network during the conduct of the study.</p>
      </fn>
    </fn-group>
    <ref-list>
      <ref id="ref1">
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        <nlm-citation citation-type="journal">
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            <name name-style="western">
              <surname>Markham</surname>
              <given-names>SC</given-names>
            </name>
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            </name>
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              <surname>Clemson</surname>
              <given-names>L</given-names>
            </name>
          </person-group>
          <article-title>International responses addressing the under-representation of older people in clinical research</article-title>
          <source>Australas J Ageing</source>
          <year>2023</year>
          <month>12</month>
          <volume>42</volume>
          <issue>4</issue>
          <fpage>762</fpage>
          <lpage>768</lpage>
          <pub-id pub-id-type="doi">10.1111/ajag.13234</pub-id>
          <pub-id pub-id-type="medline">37724905</pub-id>
        </nlm-citation>
      </ref>
      <ref id="ref2">
        <label>2</label>
        <nlm-citation citation-type="web">
          <person-group person-group-type="author">
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