The Tablet Transition

I purchased my first tablet a few weeks ago, and have since been thinking more about tablets for seniors and caregivers. Like many, I’ve assumed that tablet-based tools will eventually make certain aspects of healthcare easier for clinicians, for older adults, and for their caregivers. But so far I’ve found the tablet harder to use than I’d expected.

Actually, technically this is my third tablet purchase. The first was an iPad last summer, which I promptly sent back after realizing that my laptop was much better suited to supporting me in my clinical work (read my full minority report here).

The second was a Nexus 7 which I purchased as a holiday gift for my 62 year old step-father, a structural engineer. (As he’s mildly uncomfortable figuring out new-fangled technology, I set up his device and helped get him started using it.)

Now, I finally have a tablet that I’ll be keeping for myself: a Samsung Galaxy Note 10.1.

The device is slowly growing on me, but it hasn’t been quite the intuitive seamless experience that I’d anticipated. Hence I have a new perspective via which to consider tablets for people who are even less digitally savvy than myself.

Now, I should disclose that my phone is a Blackberry – the only smartphone last summer at Verizon that could be answered by pushing a button rather than swiping – but I had an iPhone from 2008-2009 and an Android phone for a month in 2011. Also, as my husband remains an iPhone devotee, I’ve found myself regularly using his phone regularly to access some app not available on my phone.

So this year I came to try these Android tablets having a little prior Android experience to draw on, as well as some iOS familiarity. Here are some of the hitches I experienced:

  • Disorientation when first getting started. This happened with both the Nexus and the Samsung. Obviously both devices walk the user through some basic setup initially, but I still found myself often perplexed and in “figure-it-out” mode. I struggled with things like figuring out how to switch between apps, decluttering the main screen, copying text, and searching the device. I found myself often turning to Google on my laptop to solve the latest small quandry of the moment.
  • Annoyance with the mobile versions of websites. Tablets are supposed to make it easy to access the web, but I found it annoying to find my usual websites presented in mobile format, especially when using the larger Galaxy Note 10.1, whose screen is not that much smaller than that of my compact Thinkpad. Not only do the mobile versions of websites look different, which takes a little getting used to, but they are often less functional.
  • Too many preloaded apps. The Samsung tablet came with 51 app icons in the app section. I feel a little overwhelmed everytime I look at the app list. I’d like to have less to look at, but I’m not sure what is deletable, or how to hide things. Many apps also seem redundant, such as having both an email app and a Gmail app.
  • But I still needed to install additional apps for functions I considered basic. For my step-father to be able to read library e-books, we had to install an Overdrive app and also a Kindle app, since the library books come in both formats. In order to be able to print to my wireless Brother printer, I had to futz around with my Samsung for well over an hour. I ended up installing a cloud print app and a Brother iPrint app, both of which continue to perplex me and neither of which creates satisfactory print jobs.
  • Difficulty finding the right app for a given need. How to read an e-book in PDF format on my Samsung tablet? The Play Books app preinstalled on the device didn’t seem to do PDFs. (Actually, it seemed to only do books purchased through the Google Play store, and annoyed me by cluttering the screen with recommendations which I couldn’t seem to get rid of.) Realizing that I’d need to add yet another e-reading app to the device, I started looking online to find a good choice. Sigh. Too many choices, hard to know which to get, once an app downloaded have to figure out how it works. Argh…
  • Hard to find a decent manual. The included quick start guides are ok for a quick start, but do not provide a lot of help for those who are lacking a certain amount of tacit knowledge, or past familiarity with the OS. It took me a while digging around on Samsung’s site to find the tablet’s complete user’s manual. Which is basically like a small encyclopedia: ok to search in, but not something that is pleasant to read from start to finish.
  • So these are my current conclusions about transitioning to Android tablets:

    • A fair amount of tacit knowledge is presumed. Although the included quick start guides do help one get started, they still assume one understands certain basics, like what a widget is. (I’ll admit that I didn’t know what a widget was, and am still unsure of how to use them.)
    • Becoming comfortable with a helpful group of apps takes time. One has to spend time figuring out what are the darn apps already included on the device, one has to spend time identifying additional needed apps, and then one has to learn how to use the apps themselves. This is not a trivial process, especially given the choice fatigue involved in selecting apps to use.
    • It’s an effort to avoid cognitive clutter. From the multitude of preloaded apps to the unavoidable recommended books in the Play Books reader, these tablets seem to bombard the user’s brain with all kinds of tiresome extras. I suppose the manufacturer would tell me these are meant to be helpful, but I’m sure that if one did psychological research, one would find that people have better cognitive performance and feel calmer when there is less to look at.
    • A tablet is not a substitute for a laptop or desktop. In particular, I’ve found the tablets very limiting in two specific aspects. One is web browsing capability: the mobile versions of many websites drive me slightly batty. The other is text entry: even with voice input or Samsung’s Swype-like keyboard feature, entering text still feels painfully clumsy compared to typing on a keyboard. (Yes, I could get a Bluetooth keyboard, but then I might as well use my laptop, right?)

    How we might make the tablet transition easier

    Here’s what I think someone like me – or even my step-father – needed in order to transition more easily to the tablet:

    • Coaching on the basics of using the operating system and the device. Ideally this tutorial is adapted to the type of new user: my step-father and I will have different needs from this kind of tutorial, because even though we are both new, we have different learning styles and comfort levels with new technology. Alternatively, if there had been a Samsung Galaxy Note 10.1 for Dummies book, I would’ve bought it as the Dummies series is usually much more readable and practical than the user’s manual. (I imagine the poor Dummies authors are having trouble keeping up with Android updates and the general pace of tech evolution however.)
    • Needs assessment and recommendations on which apps to use. The dream scenario would be to talk to a capable person about what you’d like to use the device for, and then have good apps recommended (without undue influence from the app makers). Bonus if the apps can be installed and configured for you. This is, of course, the role that many younger adults play for older adults wanting to use a tablet or new digital device. And many of us rely on a tech-savvy friend to recommend apps to us; otherwise the choices easily become overwhelming.
    • Help optimizing frequently-used apps. Even if one is using a well-designed app or program, one often doesn’t get the best use out of it without either making an effort to the learn the ins-and-outs, or getting some guidance from an expert. The ideal scenario is for someone to watch one using the app, and then make a few suggestions as to how to use it more effectively.
  • Help decluttering the tablet. It’s nice to not have too much to look at, and it makes it easier to find the apps that one actually uses. A decluttered tablet would likely be especially helpful to those who are very busy (i.e. caregivers, doctors), very stressed (caregivers, doctors), or cognitively impaired.
  • Access to someone who can answer questions as they come up. So nice to be able to talk to someone when one runs into yet another little hitch. Many of us again will rely on a more tech-savvy friend or family member. Otherwise, online forums can provide some of this functionality, but of course one needs to search them.
  • Remote control and viewing of one’s tablet. I gave my step-father his tablet when he was here in San Francisco visiting us for the holidays, but a week later my parents returned to their home in Arizona. This made it much harder for me to help him with his tablet. I found myself wishing there was a way for me to view and configure his tablet remotely, just as the Lenovo support team remotely controls my laptop when I call them for support.
  • Summing it up

    Tablets and their associated apps can in theory be useful tools, especially for digital health purposes. However, my own recent experience transitioning to an Android tablet was harder than I expected, leaving me to wonder how we might make the process easier for boomer caregivers and for older adults. (And for other practicing clinicians, for that matter).

    In particular, I found that using the tablet presumed a fair amount of tacit knowledge, and required me to do a lot of on-the-fly figuring things out. Finding the right apps for my needs and learning to use them was a bit time-consuming. Tablets are very customizable and offer a lot of choices, but all these choices can easily be overwhelming. It also takes a while to learn to use an app efficiently.

    In an ideal world, I would’ve like to have access to some tailored coaching on how to use the device efficiently. I would’ve also liked to have a needs assessment and then have apps be recommended, rather than having to spend time and mental energy hashing it all out on my own. In many cases, tech-savvy people provide this kind of orientation, navigation, and troubleshooting to less tech-adept friends and family. Is there a way to provide this kind of assistance more broadly to people transitioning to tablets?

    Leslie Kernisan, MD, MPH, has been practicing geriatrics since 2006, and is board-certified in Internal Medicine and in Geriatric Medicine. She blogs at GeriTech.

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    8 replies »

    1. yes, I’ve looked at user reviews on iTunes but it’s a tiring process…much easier to ask a savvy techie friend.

      Happtique organizes medical apps for professionals; there may be some other sites doing this too.

    2. I wonder if you didn’t have an older version of the Galaxy tablet? I thought the Note 10.1 was released August 2012. Also, they updated the OS this past Jan and that apparently improved things too.

      I haven’t had trouble selecting links or using the touchscreen, and I like the stylus .

      Apple is really not for me. I even switched my computer to a mac — for 3 years — and it was a big relief to return to PC. But obviously I’m in a minority there…

    3. I tried two of the Kindle devices and returned them for various reasons. I have not used any of the Android tablets, so I cannot comment on them.

      Although I dislike Apple’s proprietary model, the iPad seems to be the tablet to use because of
      1. the large number of apps written for it. This alone makes it difficult for other tablet makers to compete.
      2. the reasonably well thought out interface and hardware.
      3. the Apple support desk, which is generally very helpful. This does not help with app-specific questions, but certainly can reduce the learning curve for the device itself.
      4. the extensive reviews of many apps on the iTunes App Store.

      Decluttering the iPad is easy. I suspect that is true for the Samsung as well, although I have no experience with it. On the iPad you can set up folders.

      Regarding dissatisfaction with mobile versions of websites: I concur. the website developers have their own learning curve. In any case, different hardware requires different solutions. A tablet is not a replacement for a computer. For these and other reasons, I rarely use my tablet for the web.

      As to finding the right app for your needs: I look at the user reviews on the iTunes App Store. For specific application areas such as medical apps, this might not be so useful. A separate web site devoted to a specific application area, e.g., medical practitioners, would be helpful — just as thehealthcareblog.com is useful. This might even be a useful addition to this site.

    4. Just had to comment due to my amazement that you returned an iPad and kept the Galaxy. I had a Galaxy of the same model as you for an infuriating year. I found the sensitivity of touch for selecting links to be extremely erratic even if I zoomed the page to an enormous size. During my frequent outbursts of frustration my dear son, a junior at in computer engineering explained that for android devices the majority of apps are written for phones and not for tablets so an app that works beautifully on my droid is a nightmare on the Galaxy. Four months ago I got an iPad – my first Apple device other than an iPod and I’ve rarely put it down since. Due to its popularity most apps are written for both the iPhone and a version for the iPad.

      You are correct that the iPad is not a replacement for a laptop but in my experience the Galaxy is best used as a large coaster.


      “Annoyance with the mobile versions of websites. Tablets are supposed to make it easy to access the web, but I found it annoying to find my usual websites presented in mobile format”

      I can’t tell you how many times I’ve had this happen. Nothing more annoying than a well-designed web site which goes away and is replaced by a poorly conceived mobile upgrade …

    6. you’ll have to let me know which tablet you get for them!

      i think most of us need a techie in our lives…i serve as techie for my parents (and for many of my colleagues) but i think i need one for myself too…

    7. Leslie-I serve as the techie for my very sweet grandparents. Every two weeks, my grandmother picks my brain about items such as skype (and as of late, because she’s a savvy woman, kayak and LivingSocial).

      I’m always happy to make time for this, but worry that I’m not always in sync with what might be most confusing for them.

      Next on the list this spring: getting them a tablet that they can enjoy and use in their recently retired life.

      You can be sure I’ll revisit this article in the coming weeks, and pass along links and information I find as I prepare for our next tutorial (they will be visiting very soon, and are interested in making the purchase).