# A Systematic Review of the Usability of Telemedicine Interface Design for Older Adults
## 3 Results
### Factors Affecting the Usability of Interface Design
#### 3.2.4 User Experience  
Older adults face barriers to telehealth due to limited computer experience, unfamiliarity with e-health applications, and mismatched needs [74]. They often struggle with comprehension, data entry, and terminology, while the screen design significantly impacts their satisfaction [12; 74]. Security and privacy concerns can also hinder their willingness to use these services [56]. Addressing these issues, along with cultural adaptation, a simple design, and clear content, can enhance user satisfaction [12]. The system should ensure accessibility and provide a sense of control by centralizing information for monitoring health, checking medications, and accessing data [56]. [PERSON] [70] proposed eight usability structures, including a readable design, text style, layout, navigation, learning, memory load, user guidance, and error handling. Additionally, in gait test applications, incorporating background music can improve the user experience, and including reference ranges for gait parameters with clear explanations is essential [78]. To address these challenges and improve the overall user experience for older adults in telehealth applications, six key strategies can be implemented:  
_(1) Gamification_. Gamification has become an increasingly popular approach in various fields, particularly in healthcare technology. Gamification enhances user interest and engagement by making experiences enjoyable and is commonly used as a motivation strategy [72]. It should consider users' disease characteristics and preferences while balancing the need to improve both the gaming experience and interface usability. Elements such as rewards and competition can motivate older adults [66], while features like a flashing \"done\" button or task countdown can further boost engagement [58]. _(2) Sociability_. Elderly individuals often experience loneliness and social isolation due to mobility or health issues [42]. Barriers to using health websites include navigation difficulties [68; 80], hard-to-understand accents, poor accessibility, and low digital literacy [80]. Key intrinsic motivations for using health service apps include maintaining health, independence, social connection, and caring for others. Extrinsic motivations include saving time, accessing health information, and receiving rewards [81]. _(3) Personalization_. Addressing the personalized technology needs of the elderly can help bridge the digital divide and enhance satisfaction with telemedicine services [57]. Technology enables engaging and tailored interventions that can boost physical activity among older adults [71]. When designing telemedicine applications, it is essential to consider factors such as gender, health information needs, and the usage frequency to create personalized strategies for those who may be less attentive to health information [50]. Providing credible, high-quality, tailored information effectively promotes healthy lifestyles in older adults [63]. _(4) Ease of use_. Elderly users often struggle with complex functions, thus, apps should be simple, engaging, and user-friendly [58]. They should utilize large, clearly visible buttons and intuitive interfaces [64]. The system must facilitate smooth navigation with easy-to-understand content [69], allowing users to quickly learn its operations [13; 70]. To minimize the memory load and mental effort, the app should be task-focused, providing ample time for users to read and respond while keeping instructions visible at the top of the screen to guide them through tasks [70]. Given their tendency toward forgetfulness and risk aversion, elderly users often rely on clear operational instructions or assistance from others [68]. _(5) Fault tolerance._ The application should include error correction capabilities, quick input responses, and user guidance for handling mistakes while avoiding complex error messages [13]. It must highlight common options, allow users to skip irrelevant queries, and support information clearing or restoration [70].