“You just have to be careful how you do it”: A qualitative study of the Healthwise decision aid for older drivers
DOI: 10.1080/15389588.2024.2351203
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Summary
This qualitative study investigates the implementation strategies and stakeholder perspectives regarding the Healthwise online decision aid for older drivers. While a prior randomized controlled trial demonstrated that this tool reduces decision conflict and increases knowledge among older adults, this research seeks to understand how, when, and where the tool is most effective for healthcare providers, subject matter experts, and families. The study addresses the critical need for structured support in driving retirement decisions, which are complex due to the lack of a definitive age cutoff and the significant impact driving cessation has on older adults’ independence and mental health. The researchers conducted semi-structured, one-on-one interviews between June and December 2023 with 31 participants: 16 healthcare providers (including physicians, nurse practitioners, and social workers) and 15 subject matter experts in aging, health, or traffic safety. Participants reviewed the Healthwise decision aid prior to the interview. Data were analyzed using a team-based approach with MAXQDA software, employing an iterative coding process to identify emerging themes related to barriers, benefits, settings for use, and specific feedback on the tool’s content and structure. Key findings revealed three primary themes: individual/interpersonal considerations, institutional/cultural factors, and decision aid content/structure. Participants highlighted interpersonal barriers, such as patient denial and the risk of damaging provider-patient rapport, noting that clinicians must be cautious in how they introduce the topic. However, the tool was viewed as beneficial for prompting internal reflection and engaging family members, who are often trusted intermediaries. Institutional barriers included clinician time constraints and concerns about ageism if the tool were broadly distributed. Conversely, participants suggested integrating the tool into electronic health records (EHRs) or Medicare wellness exams to normalize the conversation. Regarding content, experts recommended including information on driver rehabilitation and medical interventions, adopting a more graduated approach to driving cessation, and improving visual accessibility for older adults with vision impairments. Many participants also preferred printed versions over digital formats for patient use. The study concludes that successful dissemination of driving decision aids requires attention to individual, interpersonal, institutional, and cultural factors. Integrating these tools into existing clinical workflows, such as EHRs, and ensuring they are accessible to families and community organizations can enhance their utility. The findings suggest that while the decision aid is a valuable resource, its effectiveness depends on careful implementation strategies that respect patient autonomy and leverage trusted relationships. Future research should explore the perspectives of additional stakeholders, including older drivers themselves, and test the implementation of these aids in real-world clinical settings.
Key finding
Healthcare providers and experts identified that successful implementation of an online driving decision aid requires addressing interpersonal relationship dynamics, institutional constraints, and cultural factors like ageism, alongside improving the tool's content and accessibility.
Methodology
survey
Sample size: 31
Provenance
The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via author_sweep_intake on 2026-05-28.
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | author_sweep | — | — | 2 | 2026-05-28 |
| archive | success | unpaywall | — | — | 2 | 2026-06-04 |
| extract | success | cached | — | — | 3 | 2026-06-10 |
| clean | success | clean | — | — | 1 | 2026-06-04 |
| chunk | success | chunk | — | — | 1 | 2026-06-04 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-04 |
| enrich | success | — | — | — | 1 | 2026-05-28 |
| promote | success | — | — | — | 1 | 2026-06-04 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 2 | 2026-06-10 |
| tag | success | vector_similarity | — | — | 15 | 2026-06-11 |
| verify | success | — | — | — | 2 | 2026-06-10 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.
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- Methodological Resource: tool software