Introduction

Improvements in medical technologies and public health have prolonged the human life span globally. Thus, the growing population of aging civilians has become an important societal issue. The World Health Organization (WHO) defines an elderly person as one who has reached the age of 65 and an aging society as one where 7% of the population is elderly. Furthermore, the WHO also proposes the concept of active ageing, which allows people to realize their potential for physical, social, and mental well-being throughout the course of their lives, and includes provisions for adequate protection, security, and care when it is needed. By 2015, the number of elderly users in Taiwan had increased to 2.81 million (Ministry of the Interior 2015) which was 12% of the total population and indicated that Taiwan has gradually become an aging society. Hence, helping the elderly enjoy a healthy life has become an important issue in Taiwan.

Most studies on this topic have focused on improving the learning attitude of young learners by analyzing factors including perceived ease of use, enjoyment, and usefulness. Other studies have been aimed at developing public safety for old adults, such as pill monitoring systems that remind them to take their medications on time. In addition, QuietCare smart sensor technology monitors abnormal movements and sends warning messages. Recently, the government has implemented a national health insurance policy to ensure good physical health care for old adults, but their psychological health is another relatively important issue that must be addressed.

With respect to the current situation of the domestic elderly in Taiwan, we find that most elderly people suffer from a series of physical problems related to loss of memory, depression, and a lack of self-confidence. Allaire et al. (2013) found digital games a viable activity by which to maintain cognitive functioning and happiness. Furthermore, Ijsselsteijn et al. (2007) suggested that the designs of digital games should take both easy and pleasurable elements into consideration to develop a friendly interface for older individuals. Moreover, Nintendo found that complexity is the major barrier to older people’s enjoyment when playing digital games. Boot and Charness (2013) indicated that attitudes and ability are the two major factors related to elderly adoption of a new technology and that adoption of new technologies improves the quality of their lives.

The literature on this topic indicates that understanding the target users’ needs and preferences, such as friendly interfaces, an enjoyable game environment, and useful information, are important factors for digital game designers (Institute for Information Industry 2011). Additionally, games equipped with feedback, clear goals, and challenges may improve the attitude of players toward knowledge acquisition and may increase self-efficacy and also improve interpersonal skills (Kiili 2005).

To better the learning attitude of the subjects in this study, we developed an interactive digital orchid game, which combines Adult Learning Theory and TAM, intended to help them learn how to grow orchids. Furthermore, with grandchildren’ supports, old adult users are familiar with panel manipulation and acquire knowledge of growing orchids. Moreover, we also add self-efficacy and social interaction to examine the relationship toward attitude. It is expected that old adult users will enjoy learning in the digital game world and that they will experience improvement in both self-efficacy and social interaction as well via playing the digital orchid game. Finally, we elaborate a research framework and intend to investigate the relationship of perceived ease of use, enjoyment, self-efficacy, social interaction, and attitude for elderly users.

Literature Review

Adult Learning Theory

Thorndike et al. (1928) defined adult learning as a professional domain of practice from the perspective of behavioral psychology. Andragogy (Knowles 1980), which is a new label for adult learning (Knowles 1968), is distinguished from pedagogy. Davenport (1985) categorized andragogy into a theory of adult education, adult learning, adult learning technology, and methods and techniques for adult education. Meanwhile, the theories of adult development in adult education include theories of cognitive development, humanistic psychology, and theories of lifespan development (Sandlin et al. 2011). Furthermore, adult learning is internally motivated and self-directed learning (Knowles 1984). Adult learners learn best because they adopt self-directed learning that incorporates personal experience and readiness to learn into the acquisition of desirable knowledge and improvement in literacy skills (Schecter and Lynch 2011) and applies them in real world practice (Merriam 2001). Thus, adult learning and problem-based approaches work well with adult learners. They help learners develop new knowledge to build on what they already know and practice (McKenna and Walpole 2008).

Digital Learning

Shulman (1986) argued that teachers should perceive the level of students’ cognition, motives, and interest in incorporating content knowledge (CK) to develop proper pedagogical content knowledge (PCK) for learners. Mishra and Koehler (2006) integrated technology into pedagogical content knowledge (PCK) and proposed technological pedagogical content knowledge (TPACK), which contains seven categories, including content knowledge (CK), pedagogical knowledge (PK), technological knowledge (TK), pedagogical content knowledge (PCK), technological content knowledge (TCK), technological pedagogical knowledge (TPK), technological pedagogical content knowledge (TPACK). Even though providing students with integrated knowledge and a pedagogical approach is important, so is arousing pupils’ interest in learning. Davis (1989) proposed through the Technology Acceptance Model, in which perceived ease of use, enjoyment, and usefulness are viewed as influencing attitudes toward learning. Previous studies have also proposed that how well students are doing under seven flow conditions with feedback might impact their attitude toward learning (Csíkszentmihályi 1975; Schaffer 2013). Angeli and Valanides (2009) explored performance assessments as feedback to embed into courses, and Mishra and Koehler (2006) introduced TPCK into the educational research field. Hence, we developed an digital orchid game with features including perceived ease of learning, enjoyment, and instant feedback on performance to enhance and improve the self-efficacy, social interaction, and learning attitude of old adults’ subjects under consideration in this study.

Technology Acceptance Model

This study mainly relies on the Technology Acceptance Model (Davis et al. 1992) as the theoretical foundation by which to explore the acceptance of digital games in an elderly population. The Technology Acceptance Model originated from the Theory of Reasoned Action. Furthermore, perceived usefulness and ease of use in the model have been proven to have a positive influence on both attitude and intention (Venkatesh and Morris 2000). Furthermore, motivation is separated into two categories, intrinsic, and extrinsic. Perceived usefulness is defined as an extrinsic motivation; however, intrinsic motivation includes fun, play, and enjoyment (Davis et al. 1992). Additionally, enjoyment also plays an important role in attitude and intention in the Technology Acceptance Model (Grant 1991). However, we add two elements, self-efficacy and social interaction, in this study. Greater self-efficacy has been proven to have a positive relationship with experience (Bandura 1982). In addition, social interaction not only improves interpersonal relationships, but also improves players’ attitude toward entertainment (Sellers 2006). According to the above review, prior studies have focused on technology acceptance in the younger generation in areas such as computer technology, information technology, and on-line games. To our knowledge, only a few studies have discussed the use of digital games for old adults; therefore, we develop a digital game about growing orchids for elderly subjects within a framework intended to examine the effects of perceived ease of use, enjoyment, self-efficacy, and social interaction on attitude.

Perceived ease of use

Davis (1989) indicated that perceived ease of use has a positive influence on attitude. Al-Gahtani and King (1999) suggested that perceived usefulness, ease of use, and comparative advantage have a positive influence on attitude and intention. Lu et al. (2005) indicated that perceived usefulness and ease of use have a positive influence on attitude toward mobile technology. Other studies have verified the relationship between perceived ease of use and attitude in mobile medical systems (Wu and Wang 2005). Tung and Chang (2008) explained that perceived usefulness and ease of use have a positive influence on attitude and intention in online learning. However, Chang and Tung (2008) suggested that perceived ease of use and self-efficacy are key elements related to students’ behavioral intentions toward an online learning course. Meanwhile, Venkatesh and Davis (1996) suggested a relationship between perceived ease of use and self-efficacy. Hence, we adopted the concept of perceived ease of use to develop a friendly, interactive interface, easy-to-access platform, and ease of learning for digital games intended for elderly users.

Enjoyment

Enjoyment refers to hedonic experiences (Csikszentmihalyi 1975). Play, fun, and enjoyment are regarded as intrinsic factors that have a positive influence on attitude (Davis et al. 1992; Nysveen et al. 2005). Prior studies have verified that vivid on-line interactive content and interfaces cause buyers to enjoy the online purchase process (Wan 2000). In addition, self-efficacy and social interaction arouse users’ motivation to play digital games because the environment is enjoyable (Tseng 2001). In conclusion, if designers want to develop interesting games for old adults, large fonts, interesting contents, and interactive interfaces must be taken into consideration when designing digital games for grey users.

Self-Efficacy and Attitude

Previous studies indicate that efficacy beliefs, which influence how we think, feel, and implement projects, are the driving force that instigates motivation (Bandura 1982). Self-efficacy is also defined as when individuals have the ability to overcome difficulties and complete assigned tasks (Bandura and Ozer 1990). Additionally, it has been verified that students with greater levels of self-efficacy involve themselves more frequently in social interactions with peers in order to complete assigned homework (Compeau and Higgins 1995). Another study suggested that social interaction and self-recognition are motivations to play games (Tseng 2001). Another study on this topic revealed a positive relationship between self-efficacy and attitude among university students (Wu and Tsai 2006).

When individuals gain knowledge through playing digital games, it directly transfers personal experiences into a databank. The more knowledge that people have in their individual databank, the greater their self-efficacy they will have. Owing to the reviews above, we make the first and second hypothesis as follows:

H1

The more perceived ease of use that elderly users feel toward digital orchid game, the greater the self-efficacy they will have.

H2

The more enjoyable feelings that elderly users have when playing the digital orchid game, the greater self-efficacy they will have.

Social Interaction and Attitude

Social interaction, which relies on continuous communication (Mead 1934), is an information and resource channel among human beings (Chen et al. 2008). Participants’ attitudes and behaviors are explicit messages to affect others unintentionally (Chartrand and Bargh 1999) and the manner of attitude formation may result from direct experiences of social interactions (Fazio and Zanna 1981). In social influence paradigms, attitudes and interaction are broadly discussed in social settings (Prislin and Wood 2005) and the support from families, relatives, friends, and neighbors has been labeled as social support of social interaction (Brown 1974). Thus, intensive or long-term social interactions may gradually influence people’s existing thoughts. Hoogen, Ijsselsteijn, and Kort (2009) indicated that the functions of digital games, multi-player facilitation of social connections, motivation toward participation in rehabilitation, and social support develop both real and virtual social interactions and improve attitudes toward technology acceptance. Other studies have suggested that mobile devices not only provide users with more opportunities to participate in learning activities (Roger et al. 2005), but also increase social interaction (Markett et al. 2005) and collaboration (Lai and Wu 2006; Schwabe and Goth 2005).

Overall, physical degeneration and changes in social roles cause pessimism in aging people. However, intensive social interactions with families and friends may make elderly users feel relaxed, stable, and happy. In this study, we aim at the valuation of the benefit of social interaction by users. Thus, it acts as crucial roles to encourage those elders to engage in social interactions through inviting friends to be players and sharing the experiences on growing virtual orchids on the platform of multiplayer game. Therefore, we make the following hypotheses:

H3

More knowledge obtained from the digital game will lead to greater self-efficacy and more intensive social interactions among elderly users.

H4

Greater self-efficacy in elderly users resulting from knowledge obtained from the digital orchid game will lead to an improved attitude toward learning when playing digital games.

H5

Greater social interaction resulting from playing the digital orchid game will improve the interpersonal skills and attitude of old adults toward playing digital games.

Methodology

This section introduces the case study, research design, interviews with nine experts, and the development of the framework for this study. The operational definitions used for the questionnaire, target sampling, and return rate are provided. SPSS and AMOS are used as statistical tools to verify the hypotheses. Finally, we implement another interview with 13 elderly users to gain a further understanding of their attitude toward the digital orchid game.

Case Introduction

The combination of the explosion of technology and digital games has cultivated a popular digital game industry in the younger generation. However, there have thus far been few suitable games designed for old adults. According to observations, an increasing number of older people are using computers and smart phones in their daily lives. Therefore, we suggest interactive and educational digital games for elderly users as a brand-new educational market. Additionally, functions involving training in physical exercise, learning mechanisms, and social interaction can help old adults become physical healthy and improve their interpersonal skills. Furthermore, we discovered that most retired people like to grow plants. Therefore, in order to help them learn about the care of orchids, including such things as watering, and proper temperature, humidity, and heat, we developed a digital orchid game shown on Fig. 1.

Fig. 1
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Content of orchid game

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Research Design

We designed two-stage experiments for this study. In the first stage, we did a literature review and interviewed nine experts (one doctor, three professors, one deputy manager, two game designers, and two elderly users) in order to develop the research framework. In the second stage, after subjects had 2 months of experience with the digital orchid game, we also conducted another interview with 13 elderly users.

Interview with Experts and Elderly Users and Results

The purpose of the interview was to explore key factors related to the adoption of digital games from the perspective of old adults. The interview included one doctor specializing in geriatrics and gerontology, three experts in the orchid field, two individuals majoring in computer science, one individual majoring in marketing, and two elderly users, as shown in Table 1.

Table 1 Background of nine experts (n = 9)
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After interviewing the nine experts, we determined five scopes of study, including perceived ease of use, enjoyment, self-efficacy, social interaction, and attitude. The results indicate that eight of the experts (88%) agreed that the digital orchid game is easy to use. Seven experts (77%) enjoyed playing the digital game. Five experts (55%) believe that memory improvement increases self-efficacy and that social interaction leads to improved interpersonal skills and social support. Seven of the experts (77%) indicated that they felt that digital orchid game improved their interpersonal skills, and five (55%) felt that digital orchid game would lead to social support from family and friends. Finally, six of the experts (66%) demonstrated higher interest in orchids and interest in continuing to play digital games. The detailed information is shown in Table 2. Based on this information, we developed the research framework for the empirical study.

Table 2 The results of the expert interviews (n = 9)
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Research Framework

The five major constructs of model in this study were developed by interviewing nine experts (see Fig. 1). We kept ease of use, enjoyment, and attitude from the TAM and added two constructs, self-efficacy, and social interaction, to develop old adult users Technology Acceptance Model framework.

Definitions and Measurement of Constructs

Six items for perceived ease of use (Davis 1989), social interaction (Hoogen et al. 2009), enjoyment (Nysveen et al. 2005), and attitude (Davis et al. 1992) were developed, separately. Finally, there were seven items for self-efficacy (Bandura 1982). The operational definitions are shown in Table 3.

Table 3 Operational definitions of constructs
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Sample and Procedure

Our sample comprised elderly users over 65 years old. Two measurements were adopted during different periods to avoid common method variance. First, two stages for filling out the questionnaires were in different period, respectively. Second, discriminant validity was verified for each construct. We only had 40 responses for the pilot study for examining consistency and developing corrected semantic and syntax. The survey took place in Tainan City, Taiwan from September 1 to October 11, 2014. Two hundred and fifty questionnaires were filled out in Tainan City, and 160 valid responses were obtained, thus providing a response rate of 64%.

Analysis and Results

Initially, a framework including ease of use, enjoyment, self-efficacy, social interaction, and attitude were developed. Then, SPSS and AMOS were adopted as the statistical tools to examine the validity and reliability of each construct.

Validity and Reliability

The criteria for validity and reliability are as follows: KMO > 0.5, communality > 0.5, eigenvalue > 1, factor loading > 0.6, Cronbach’s alpha > 0.7, and item-total correlation > 0.6. Dependent variable: The four items on attitude have factor loadings of 0.91, 0.91, 0.73, and 0.79 (α = 0.90). Independent variables were determined based on the literature review. The five items in perceived ease of use have factor loadings of 0.74, 0.81, 0.82, 0.85, and 0.83 (α = 0.90). The four items for enjoyment have factor loadings of 0.78, 0.80, 0.85, and 0.87 (α = 0.89). The three items were preserved in social interaction have factor loadings of 0.85, 0.93, and 0.93 (α = 0.93). The three items SE1, SE2, and SE7 in self-efficacy have factor loadings of 0.87, 0.88, and 0.78 (α = 0.88), respectively, as shown in Table 4. The confirmatory factor analysis indicated a good model fit for which the values were CMIN/DF = 1.67, NFI = 0.91, RFI = 0.90, IFI = 0.96, TLI = 0.95, CFI = 0.96, and RMSEA = 0.06.

Table 4 Validity and reliability
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The convergent validity of a construct can be evaluated by two criteria: composite reliability and average variance extracted, which are required to be higher than 0.6 and 0.5, respectively (Fornell and Larcker 1981). The values for composite reliability were 0.90, 0.89, 0.93, 0.88, and 0.90. In addition, the values of the AVE were 0.65, 0.68, 0.81, 0.71, and 0.70. Both the CR and AVE were higher than 0.6 and 0.5, respectively, as shown in Table 4. Hair argued that the square root of the AVE should be at least 75% higher than the correlation coefficients among the constructs (Hair et al. 1998). The diagonal values were 0.82, 0.83, 0.90, 0.84, and 0.83, which were all higher than the correlation coefficients, as shown in Table 5. Thus, the constructs showed good discriminant validity.

Table 5 Discriminant validity
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Results of the Research Model

The VIF values were below 10 (Neter et al. 1996), which verified that there was no issue of multi-collinearity in the research model. In addition, the values for the Structural Equation Models showed good model fit, which were as follows: CMIN/DF = 3.15, NFI = 0.83, RFI = 0.81, IFI = 0.88, TLI = 0.86, CFI = 0.88. The results of the regressions indicated that perceived ease of use had a significant influence on self-efficacy (β = 0.48, p < 0.001), so Hypothesis 1 was supported. Secondly, enjoyment had a positive influence on self-efficacy (β = 0.78, p < 0.001); therefore, Hypothesis 2 was supported. Thirdly, self-efficacy had a positive influence on social interaction (β = 0.80, p < 0.001); hence, Hypothesis 3 was supported. Finally, we also found that self-efficacy and social interaction had positive influence on Attitude (β = 0.62, p < 0.001) (β = 0.33, p < 0.01), respectively. The results of the research model are shown in Fig. 2. Finally, H1, H2, H3, H4, and H5 were all supported, as shown in Table 6.

Fig. 2
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The results of the framework

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Table 6 Results of the hypotheses
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Interviews with 13 Elderly Users

Background of 13 Elderly Users

Interviews were held 2 months after old adult subjects experienced the digital game. Thirteen elderly users were interviewed. There were 5 males and 8 females ranging in age from 65 to 73. The timeframe of the interview was controlled to approximately 20 min for each user. Only five of the subjects had prior computer experience, and four users had experiences with using Wi-Fi; however, only one female had experience with playing Game Boy. The result is shown on Table 7.

Table 7 Background of interviewing individual elderly users (n = 13)
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The Results of Interviews with 13 Elderly Users

This study was aimed at five scopes of study including perceived ease of use, enjoyment, self-efficacy, social interaction, and attitude. Thirteen elderly users participated in the interview process. Seven users (53%) indicated that they experienced perceived ease of use of the digital orchid game. Ten users (76%) experienced feelings of enjoyment while playing the digital game. Self-efficacy is composed of memory improvement and knowledge acquisition. We found that eight users (61%) experienced memory improvement, and twelve (92%) acquired knowledge. Social interaction comprises both interpersonal skills and social support. Ten users (76%) expressed that they had polished their interpersonal skills, and seven (53%) experienced social support from their family and friends. Finally, there were seven users (53%), who demonstrated higher interest in the digital orchid game and indicated that they plan to continue playing digital games. The detailed information is shown in Tables 8 and 9.

Table 8 The results of user interviews (n = 13)
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Table 9 The results of interviewing with users
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Conclusions

The interactive orchid game has changed old adults’ attitude toward digital games in this research model through perceived ease of use, enjoyment, self-efficacy, and social interaction. We will discuss the relations among the following four aspects: (A) perceived ease of use and self-efficacy, (B) perceived enjoyment and self-efficacy, (C) self-efficacy toward social interaction and attitude, and (D) social interaction and attitude.

In the aspect A, the simple interfaces, clear interactive model, and user-friendly learning platform did lower the entry barriers for old adults and make them acquire orchid knowledge easily. In the aspect B, playing the orchid game made the subjects feel senses of comfort and pleasure when they saw the orchid blossom in the digital orchid game. Thus, the seniors acquired knowledge and skills via playing a relaxing, enjoyable, and interactive orchid game. The results are in line with those of previous studies (Davis 1989). In the aspect C, the elder users continuously observe the changes in the orchids and acquire proper approaches such as watering, humidity, and temperature to take good care of orchids, so they grow beautiful orchids. The successful experience in growing virtual orchids not only provide old adults with knowledge and skills of growing orchids, but also make them gain confidence and dedicate to social interaction through sharing the knowledge of growing orchids with other senior. In addition, the increasing of self-efficacy also has changed old adults’ image on playing digital games. The results were in line with those of prior studies (Ijsselsteijn et al. 2007; Knowles 1980). In the aspect D, when old adults’ subjects are familiar with the orchid game, they expect to have great improvements so they turn to ask experts for advice on growing orchids. The intensive social interaction that occurred in the study context helped the subject interpersonal skills. Meanwhile, the confident elderly subjects invite friends to be new players of the game and share their previous experiences of playing the orchid game to new ones. The social interactions that took place while transferring orchid knowledge make the older adults feel proud of their achievements, improve their interpersonal skills, and change their attitude toward digital games. The results appeared to be consistent with those of prior studies (Chen et al. 2008).

In conclusion, the enjoyable and user-friendly orchid game platform attracted old adults’ attention. With help from friends and family members, old adults’ subjects became familiar with interfaces, acquired orchid knowledge, and increased their self-efficacy as well. Therefore, old adults’ subjects gained self-efficacy and confidence and they volunteered to share their experiences of growing orchids with others. These knowledge-sharing interactions encouraged the pursuit of new knowledge and led to improvements in learning attitude. In addition, the orchid game is a communicative platform for social interaction. Through this platform, old adult players engaged in sharing orchid knowledge and in discussions of the correct procedures for growing orchids. Therefore, the more they participated in the interactive social activities, the greater improvement they experienced in terms of their interpersonal skills as well as knowledge acquisition. The results are in accordance with those of prior studies (Chen et al. 2008). Therefore, the evidence conveys an important message suggesting that custom-made and educational digital games do make old adult users happier and more confident and help them acquire knowledge, develop interpersonal skills, and change their attitudes toward digital games. Consequently, we consider that the digital orchid game is an effective design for old adults. The results of this study also suggest that old adult users is a new market for digital game industry and they also argue that different digital games could be promoted and implemented in the community colleges in Taiwan as interactive teaching aids for old adults. Moreover, we can also introduce the concept of interactive digital games to agricultural training schools for tutoring farmers.