**4. Communication with patients and outcomes: assessment of IT utilization by patient populations**

Effective treatment and good outcome rely upon effective communication with patients. Better communication with patients produces better health outcomes and increased ratings of satisfaction by patients and providers of care [70, 71]. Paradoxically, over the past decade health care organizations have defaulted to the use of IT for patient communication, in the absence of any data supporting patient utilization of IT for the purpose of communication with health care providers. With one exception [18, 60, 69, 72], health care protocols, especially for working with older adults, have not included frequency of internet or IT utilization as a specific area of assessment or treatment [18, 55, 60, 61, 69, 72–74]. In fact, the American Psychological Association's (APA's) 21 Guidelines for psychologists working with older adults [75] do not specifically include familiarity with the assessment and treatment of technology challenges or barriers for older adults as a guideline [18, 55, 60, 61, 69].

In general, IT has not been included as area of assessment or treatment in healthcare protocols [18, 55, 60, 61, 69, 72, 74]. Most of the research exploring IT utilization has come from the IT sector [76–88]. Most IT assessment instruments assess the person's perception of their own proficiency with various technologies [89–95]. These instruments and studies assess factors determining a person's decision to use specific technologies, or self-perceived proficiency in using specific technologies, but none of them assesses the person's frequency of actual IT use or perhaps more importantly, the person's frequency of different kinds of IT use, information necessary for individualized treatment planning using media that allows effective communication with the specific patient to facilitate better treatment outcomes [18, 55, 60, 61, 69]. The Functional Assessment of Currently Employed Technology Scale (FACETS, Appendix 1) [18, 69] was designed specifically to meet those previously unaddressed needs.

## **4.1 The Functional Assessment of Currently Employed Technology Scale (FACETS): description, reliability and validity**

The Functional Assessment of Currently Employed Technology Scale (FACETS) is a 10-item questionnaire that can be completed in one to three minutes. It asks two questions in each of 5 functional IT domains: Home, Social, E-commerce, Health Care, and Technical [18, 60, 69]. For each question there are 6 optional answers, characterizing the respondent's frequency of use for the specific type of IT referenced in the question. Higher scores are associated with more frequent

utilization of IT. A subtotal score for each functional domain is derived from summating the scores for the two questions in that domain. The combined total of the subtotal scores from each of the functional domains yields an overall FACETS score. Higher utilization of IT across domains produces a higher overall FACETS score. High reliability and validity have been found for FACETS, including multiple group factor analysis, McDonald's omega, Cronbach's alpha coefficient, and confidence intervals for alpha and omega [69].
