Bother: a concept analysis and implications for digital health inclusion in older age

Bother: a concept analysis and implications for digital health inclusion in older age | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bother: a concept analysis and implications for digital health inclusion in older age Suzanne Cullen-Smith, Cora van Leeuwen, An Jacobs This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7087419/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Challenges persist in the implementation of digital health technologies to support health and wellbeing care and self-management in older age. Perceiving such technologies as bothersome, older persons are often reluctant to adopt these new approaches to care. Experienced bother can contribute to a sense of inefficacy, exclusion, and vulnerability in older age. However, the core characteristics of bother, and their implications for nursing, healthcare, and the digital health transition have not been examined to date. The aim of this paper is to examine the concept of bother in the context of digital health engagement in older age. Methods Using the concept analysis method of Walker and Avant, the antecedents, attributes, and consequences of bother were identified from a range of sources. The outcomes of a literature review, entries retrieved from dictionaries and thesauri, and outputs from a generative AI language exploration were thematically analyzed using an inductive approach. Results Findings indicate that bother is an emotion-based reaction to an interruption and uncertainty. Bother attributes include emotions, judgement, time, and effort. Consequences of bother can include exclusion as well as having a negative impact on relationships and quality of life. Conclusion Application and further evaluation of these characteristics of the concept, in the context of digital health adoption in older age, is necessary to inform the design of digital health interventions and care delivery. Digital Health Concept Analysis Ageing Bother Figures Figure 1 Figure 2 Figure 3 1 Introduction Increased health and care support demands are anticipated in line with ageing populations due to chronic and complex care needs in older age [1]. Adoption of digital health technologies (DHTs) is expected to transform care delivery as well as how people self-manage their health and wellbeing by offering convenient, continuous health monitoring and remote medical care [2]. However, the benefits of DHTs are not uniformly experienced by all older persons, and some encounter difficulties or frustrations when using these technologies. Intrinsic motivation, ease of use, extrinsic support, and specificity of purpose of the DHT are factors deemed necessary for sustained use or adoption of DHTs, as older persons are less likely to adopt DHTs based on novelty alone [3,4]. The nursing literature is often concerned with how symptom bother influences treatment compliance by patients. Likewise, experiences of bother can influence interactions with, openness to, and use of DHTs: ‘an awful lot of older people have shared to me that they couldn’t be bothered with technology, how their life is affected as they get older, ‘oh I couldn’t be bothering asking people again [to help with technology]’’ ([5], p. 10). Similarly, technostress, stress resulting from technology use, has potential to result in psychological, behavioral, and physical consequences including affecting the ability to use digital technology [6-8]. Understanding the nature and consequences of bother, as a concept as well as an experience, may offer insights on how to support people to use DHTs into older age and mitigate digital health exclusion. 2 Background According to Glasser [9], ‘a concept is the naming of an emergent social pattern grounded in research data’ (p. 24). Concepts are, therefore, abstract units of meaning representing some aspect of human experience. Unlike ideas, which are more general, concepts are derived from occurrences and serve as building blocks for theories [10]. Concept analysis is a process of interrogating the characteristics of a concept for effective application in nursing research and practice. The process aims to provide clarity of definition as well as a means of identifying and measuring instances of the concept, to assess its strengths and weaknesses [11]. However, a range of different factors influence the attributes of a concept in different contexts and at different times [12]. Bother is a term used across a range of disciplines relating to human behavior, emotions, and interactions. Yet, there has been no attempt to date to provide a robust operational definition for bother. Gawlicki et al. [13] identified limitations in representing symptom bother using patient recorded outcomes (PRO) instruments, highlighting a problematic lack of a clear definition and differing cultural meanings across countries and languages. Furthermore, studies using PRO instruments to measure bothersome symptoms have made limited attempts to define the concept of bother within instrument design or in their application in clinical practice or research. A concept analysis of bother is, therefore, timely. However, such analysis is only worthwhile if it can contribute to a greater understanding of connected scientific concerns [12]. As a colloquial term, the word bother is widely used, though with somewhat vague and variable representations. With a push to achieve DHT adoption to support people in older age, and common language references to bother found among quotes in qualitative studies, this analysis seeks to examine and clarify the meaning of bother. We propose that a realist ontological approach [14] may offer value in defining a concept of digital bother for practical application in nursing as well as in digital health research and innovation contexts. A clear understanding of the concept will also provide another perspective for human computer interaction researchers and DHT designers to consider when developing interventions for those in older age and those providing care. The aim of this paper is to answer the question: What is the definition of bother, in the context of digital health and older age? To address this question a landscape review and content analysis of bother definitions was completed, followed by a structured analysis of the concept of bother [10]. An operational conceptual definition of digital bother was then derived from the analysis and supported by illustrative model and contradictory cases. Finally, the implications of the newly defined concept of bother are discussed in relation to digital health in older age. 3 Method Critical to ensuring concept analyses contribute to scholarship is ensuring a rigorous and systematic methodology is implemented [12]. This study followed eight steps [10] to provide an operational frame for use in the definition of bother. After selecting the concept and clarifying the objective (above), the next step required identifying all uses of the concept. A review of two online dictionaries (oed.com, collinsdictionary.com) and thesaurus.com was conducted to identify the range of definitions, synonyms, and antonyms of the term bother in the English language. Definitions and synonyms were examined by the first two authors and collaboratively clustered thematically. A literature search of the Scopus abstract database was then undertaken. Scopus was selected as it hosts the largest database of abstracts across a wide range of disciplines, thereby further facilitating exploration of the concept usage across multiple contexts [10]. Search criteria (Fig. 1 ) included the term bother found in the title and/or abstract of peer-reviewed, open-access, English language academic journals, published between 1994 and 2024. It was deemed that thirty years was a reasonable publication timeframe to generate a body of current literature for review. To include digital health literature, a search was also conducted of the IEEE Xplore database for the term bother in the metadata of journal articles also published between 1994 and 2024. The title and abstract of all papers were reviewed for relevance. Articles were deemed relevant for inclusion if the abstract and text body included data describing the experience of bother and if examples of the dimensions (antecedents, attributes, or consequences) of bother could be identified in the body of the paper. The final selection of articles (n = 17) was reviewed in detail (Fig. 2 ). An inductive thematic analysis approach [15, 16] was used whereby text segments of data were initially coded to thematic parent codes (antecedents, attributes, consequences, and other), using NVivo software ( https://lumivero.com ), before being inductively coded by SCS with descriptive labels. Codes were reviewed and discussed by SCS and CvL and final codes agreed once consensus was reached. Limiting exploration of a concept to familiar contexts or narrow dimensions should be avoided and it is recommended to use a wide range of channels to find uses of the concept under analysis, such as talking to colleagues [10]. Given the vast data sources on which generative artificial intelligence (Gen AI) large language models (LLMs) are modelled, it was decided to explore the concept of bother using such tools. Following the literature review, a series of prompts were entered to Gen AI platforms LLaMa ( www.huggingface.ai ) and ChatGPT ( www.chatGPT.ai ) : ‘Provide 20 complex sentences including the conjunction ‘because’ for each of the words bother , bothersome and bothered .’ Once each set of sentences were generated, a prompt requested the replication of the sentences replacing the bother word with a different word of similar meaning. All sentences were transferred to an Excel worksheet and a content analysis of the sentences was undertaken to identify attributes. Attributes of bother/ed/some from the content analysis were then compared and triangulated with the attributes identified in the dictionary and literature analysis. 4 Overview of the Concept The first two steps [10] of concept analysis, selection of the concept and stating the objective, have been addressed in the introduction to this paper. Each of the remaining steps are addressed in the sub-sections below, though not necessarily in order, as the process of concept analysis is iterative, a process that ‘results in a much cleaner, more precise analysis’ [10] (p160). Results first present how the concept of bother is used and the defining characteristics, before identifying illustrative cases of digital bother. 4.1 Dictionary uses of the concept According to dictionary (collinsdictionary.com; oed.com) and thesaurus searches (Thesaurus.com) bother is found in the forms of noun, verb, adjective and convention. Bother as a noun includes being a bother, botherment, or botheration. As a verb, to bother means ‘actively annoying’. Meanwhile bothered (past tense of bother) means the passive experience of being annoyed or troubled. Used as an adjective, bothersome emphasizes the quality of being irritating or annoying rather than the act of annoying or irritating. An additional use of bother is as a convention, such as in the phrase ‘it is no bother at all’. Definitions identified in the dictionary and thesaurus searches were aggregated for analysis [17]. Clusters of defining terms were assigned a thematic label with attributes of bother broadly including interruption, emotions, judgement, and effort (Table 1 ). Related antonyms listed in Table 1 offer additional texture to the descriptive thematic labels. The range of descriptors illustrate that the understanding and lived experience of bother is multi-dimensional including emotions, behaviors, attitudes, and relationships. Table 1 Synonyms and antonyms of bother Summary Label Definitions and Synonyms Antonyms Interruption Inconvenience, put out, badger, disturb/ance, fuss, hassle, nuisance, plague, pester, trouble/some, startle, shock, needle, provoke, disrupt Satisfaction, peace, order, flow, mindfulness, progress, persistence, continuation, regulate, Emotions Annoying, aggravate, upset, panic, irritate/irritating, worry, frustration, concern, distress, alarm, mither, dismay, disconcert, vex, perturb, grief, bedevil, exasperation, peeve, frighten, terrify, unnerve, anger Ease, happiness, tranquility, serenity, contentment, calmness, acceptance, delight Judgement Foolish, confused, difficulty, unimportant, bewildered, gall, overwhelm, strain, problem, get on someone’s nerves/wick, nuisance, tease Confidence, competence, self-efficacy, valid, pleasure, joy Effort Concern yourself, make the effort, take the time, go to the trouble, harass, trouble/burden yourself, bend someone’s ear Easy, not work, smoothness, fluency *Sources: oed.com, collinsdictionary.com, thesaurus.com 4.2 Literature review Articles identified from the literature search (Table 2 ) were reviewed to identify characteristics of bother, such as defining attributes, antecedents, and consequences. These are outlined next. Table 2 Articles from literature searches Paper Title Sample & Country Design It doesn't bother me: An intersectional analysis of discrimination among white women farmers in the US Corn Belt [18] 43 women farmers USA Semi-structured interviews If it Bothers Someone it’s a Mistake! How Chinese College Students Conceptualize Transgressions [19] Chinese college students China 6 focus groups (n = 40) and codebook based thematic analysis. What bothers severe asthma patients most? A paired patient–clinician study across seven European countries [20] 126 patients with severe asthma 7 countries Open-ended survey responses linked with a free-text survey by treating clinicians. Content analysis. Comparison of findings with asthma registries. Population-based study of prevalence, bother and behaviour related to treatment for lower urinary tract symptoms and overactive bladder among Polish neurogenic patients [21] 1166 men and women, aged ≥ 40 years. Poland Statistical analysis of data from LUTS POLAND, a computer-assisted and population-representative telephone survey Do Writing Errors Bother Professionals? An Analysis of the Most Bothersome Errors and How the Writer’s Ethos is Affected [22] 99 business professionals whose roles are not primarily writing and communication USA A quasi-replication study:17-question survey including open questions. Overactive bladder symptom severity, bother, help-seeking behavior, and quality of life in patients with type 2 diabetes: A path analysis [23] 127 diabetic patients, aged at least 18 years, with overactive bladder China Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder Questionnaire Short Form (OAB-q SF). Help-seeking survey. A two-step path analysis was performed to analyze the data. Table 2 Articles from literature searches cont’d The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie’s disease [24] 119 men with a clinical diagnosis of PD Germany Self-administered Peyronie Disease Questionnaire (PDQ), SCS-M (male sexual complaint scale), International Index for Erectile Function (IIEF), and Aging Male´s Symptom Scale (AMS) Through Their Words: Sources of Bother for Hospitalized Children and Adolescents with Cancer [25] 50 children and adolescents (7–18 years; mean 12.6 years) admitted as inpatients USA Comparative, descriptive design. Written responses to questions. ‘Don’t bother with that’: the use of negative imperative directives for defusing student conflict in a special support classroom [26] 5 teachers and 9 students at a special support unit Sweden Video ethnographic field study. Comprising video documentation and field notes. Dispositional and Situational Avoidance and Approach as Predictors of Physical Symptom Bother Following Breast Cancer Diagnosis [27] 460 women diagnosed with breast cancer within the previous 3 months. 68% non-Latina white, 19% Latina. Average age 56 years. USA Five assessment points over 6 months. Difficulties in Emotion Regulation Scale; Control of Feelings Scale; COPE; Emotional Approach Coping (EAC); The Breast Cancer Prevention Trial (BCPT) Symptom Scales; chart review; and self-report On the argument structures of the transitive verb fan 'annoy; Be annoyed; Bother to do': A study based on two comparable corpora [28] Data from Gigaword corpus, containing data from Mainland China (XIN) and Taiwan (CNA) China Theta System Theory to probe argument structures of the transitive verb ‘fan’ Table 2 . Articles from literature searches cont’d A user modelling approach for reasoning about interaction sensitive to bother and its application to hospital decision scenarios [29] 3 separate hospital emergency room simulations Canada Presents a framework for interacting with users that is sensitive to the cost of bother and then focuses on its theoretical application to decision making in hospital emergency room scenarios. Moderating perceptions of bother reports by individuals experiencing lower urinary tract symptoms [30] 123 men and women with LUTS. USA One-to-one in-depth interviews. Grounded theory-based data analysis. "What bothers you the most?" initial responses from patients receiving palliative care consultation [31] 226 palliative care patients. 81% White, 50% male USA A retrospective descriptive content analysis of first-person responses routinely recorded during initial interview Lower urinary tract symptoms in men: Self-perceptions and the concept of bother [32] 16 men with LUTS England Completed IPSS and HADS self-report scales before or shortly after first appointment with urologist. Repertory Grid method used for analysis. Men's experiences of having lower urinary tract symptoms: Factors relating to bother [33] 75 men with LUTS England A questionnaire survey method was used in a cross-sectional design. Over a consecutive 7-month period. Defining attributes. The primary objective of a concept analysis is to identify the defining attributes of the concept for broad application [10]. From the analysis of the literature searches, four core attributes of bother were identified as an emotional reaction, judgement, temporality, and effort. Emotional reaction. A range of emotions were identified across the dataset from anxiety, fear or worry in patients [21, 24, 25, 30, 31, 32, 33] to irritation or annoyance, such as in women farmers, adolescents, and professionals [26, 22, 25, 26, 29]. Emotions, such as concerns about what the future would bring, and fear about being unable to carry on as usual were reactions to events or circumstances outside the respondents’ control, such as for women farmers when a male partner died [26] or irreversible illness symptoms [24, 25, 30, 31, 33]. Stress or distress was described in psychological terms such as being fatigued, or depressed [21, 26, 24, 25, 26, 31, 33], as well as being evoked due to anticipated outcomes or judgement by others [26, 19, 20, 22, 24, 25, 26, 30, 32, 33]. Non-specific stress was also identified by men with LUTS, women farmers and others in response to experienced or anticipated interpersonal interactions [26, 19, 24, 25, 26, 29, 31, 32, 33]. Furthermore, frustration was related to not being taken seriously [26] and by being overwhelmed [26, 31]. Irritation was linked to waiting, by patients [25, 31], and annoyance with being interrupted [21, 26, 20, 23, 25, 26, 29, 31, 33], such as for inpatients interrupted by nurses [25] or people with LUTS whose sleep was interrupted by symptoms [21, 23, 33]. Being bothered is, therefore, a complex emotional reaction triggered by the meaning ascribed to an interruption or disruption. Judgement. One of the reactions identified, following an interruption, was judgement of the severity or meaning of the interruption and its potential consequences, such as for men with Peyronie’s Disease (PD) concerned with the impact on their sexual relationship with partners or spouses [24] or interruption costs in ER departments [29]. This was central to whether an interruption resulted in bother. For example, whether a knock on the front door comes just as a favorite TV program is starting, or after spending the morning alone wishing for someone to talk to, may determine if an interruption is judged as bothersome or welcome. At other times, bother may occur where action is required in response to the interruption, such as micturition urges during the night [24, 30, 32, 33]. Whether judgement of self (or one’s actions) as being out-of-step with social expectations [18, 19, 20, 22, 24, 25, 30, 32,33] or as unlikely to demonstrate adequate self-efficacy [24, 26, 27, 33], judgement of others [19, 22, 25, 26, 29] was also an attribute of defining something as bothersome. Across the literature, the cluster of emotions linked with self-judgement included shame, embarrassment, loss of confidence, and helplessness [21, 21, 24, 26, 32, 33]. These emotions were also linked to expectations about how self-inefficacy might impact relationships, both intimate and social [18, 19, 24, 31 32, 33]. Judgement, by oneself or others, may deem a bother triggering experience as insignificant or trivial. Indeed, ‘explicitly framing the event as a frivolous parenthesis, which can and should be ignored’ [26, p. 242] is characteristic of bother. A widely used phrase in Ireland is ‘no bother!’. Similarly in Spanish ‘çe nada’, or ‘de rien’ in French means ‘it was nothing!’ suggesting little time or effort of significance was required or expended. By contrast, a bothersome interruption is experienced as disruptive or significant even though it may be expected that others might judge the issue as trivial, as reflected in the expression ‘it is not worth bothering them about’. Even ‘little inconveniences’ [19, p. 1387] have the potential to bother, contributing to a social expectation that causing bother for others should be avoided. Indeed, being bothersome is to personify the trivial and irrelevant, ‘the nuisance factor represents the annoyance caused to the user [healthcare provider] due to irrelevant questions [from colleagues or patients]’ [29, p. 450]. Anticipating judgement, by self or others, was identified and experienced as an attribute of bother potentially contributing to stigma [20]. Such judgement included that an incident or concern is insignificant, such as worries about being able to locate toilets when out [33], or that the bother trigger could be easily avoided, like perceptions about writing errors among professionals [22]. Furthermore, ‘how the other feels, was presented as essential in deciding whether behaviors are acceptable or not’ [19, p.387] and, therefore, likely to be considered bothersome. Temporality. The third attribute of bother is temporality, including timing, frequency, and duration. For example, the timing of symptoms or care routines [20, 23, 25, 33] as well as other types of inconvenient interruptions [18, 24, 25, 26, 29] was noted in the literature as causing bother. In addition to timing, the frequency of triggers was linked with bother, especially recurring triggers such as being woken at night [23, 25, 30, 33] or repetitive interruptions such as questions [29], errors [22], or problematic interpersonal encounters [18, 26]. The third temporal dimension of bother is duration. Indeed, bother has been identified as meaning ‘a chronic hindrance and something that is always there’ [21, p. 4]. This temporal dimension, of bothersome circumstances lasting over time, was identified in relation to chronic illness symptom impact on quality of life [24, 25, 30, 32, 33], hospitalization [25,31] and waiting to die (for those receiving palliative care) [31]. Effort. Responding or reacting to something bothersome requires effort (to bother). At a minimum it involves stopping (when interrupted) and starting again, as when managing work interruptions [29], reacting to writing errors [22], or recovering from a health symptom such as an asthma flare-up [20]. However, the effort required to do something, in the first instance, can also be the source of bother, such as the effort to mask symptoms or overcome challenges [18, 27, 20, 25, 27, 30, 33]. Indeed, common language use of the term bother include the phrases ‘don’t bother’ or ‘why bother?’, found in articles (n = 12) across the literature review. These phrases mean ‘don’t or why bother putting any time or effort into …’. This attribute is linked to the judgement attribute where the bother trigger may be considered of a trivial nature or where self-efficacy to respond may be deemed as inadequate. Sentence use of bother. Across the sample sentences generated by Gen AI tools (LLaMa and ChatGPT) [17] the four variations of bother were identified. As in Table 2 above, being bothered was a term used to express emotions experienced, such as irritation, frustration, or concern, ‘They were bothered (frustrated) by the constant interruptions, because they couldn't finish their meeting on time’ (ChatGPT). Being bothered was identified as due to an interruption, ‘I was bothered (disturbed) by the noise outside, because it made it hard to concentrate on my work’ (ChatGPT). Judgement was a feature of something being bothersome, ‘The rude behaviour of the customer was bothersome (off-putting), because it affected the entire team’s mood’ (ChatGPT). Meanwhile, bother was linked with time and effort expended or required, ‘I bother (make the time/effort) to learn a new language because I want to travel’ (LLaMa). The attributes identified from analysis of the AI generated sentences were emotions, judgement, time, and effort. These were also identified in the literature review, as outlined above. Antecedents. When considering the attributes of bother, it is necessary to present the circumstances required to trigger bother in individuals. These circumstances are referred to as antecedents [10, 12]. Two primary antecedents identified in the literature review are change and uncertainty. Interruptions, mentioned above, reflect a change in the status quo, such as: being woken at night [23, 25, 30, 33], an illness symptom event [20], being treated or needing to behave differently because of changed contextual circumstances such as illness or marital status [18, 25, 31, 33], or interruptions in work flow [18, 22, 26, 29, 33]. Uncertainty was also identified as a trigger for bother, whether due to a lack of knowledge, such as information about an illness [30], knowing what to expect or, as noted above, how long bothersome circumstances would persist [18, 25, 30, 31]. Likewise, uncertainty about how to proceed [31], what to do next [18], or if one can even proceed [20] also contributed to triggering bother. A linked experience was of having unmet expectations, whether such expectations were considered reasonable or not, such as writing accuracy among professionals [22], having control over one’s dying process [31], maintaining social status when a male spouse dies [18], that symptoms could be cured [23], or that medications and interactions with clinical staff would be trouble-free [25, 31]. Whether expectations were reasonable or unrealistic had less influence on bother compared to not having such expectations met [22, 23, 31]. A contextual dimension of antecedents to bother is relationships. While not evident in all cases, how something might impact others contributed to the conceptualization and experience of bother, such as how writing errors could reflect on organizational image [22], how antagonistic behaviors impact others [19, 26], or the impact of illness symptoms on relationships [21, 27, 31, 33]. Consequently, uncertainty about the perceptions or reactions of others can also trigger bother, as noted above [21, 24, 29, 30, 33] and may influence individual reactions to bother. Consequences. Consequences are events or circumstance resulting from instances of the concept [10, 12]. The experience of bother results in both reactions and consequent impacts. Immediate behavioral reactions included avoidance, help-seeking, resignation, or a combination of these over time. Avoidance of the cause of bother or withdrawal from situations where bother was likely to occur [18, 27, 33] could include altered personal, intimate, or social relationships [18, 19, 43, 25, 31, 33]. Withdrawal from activities that support wellbeing could also occur in response to bother [27, 33]. Another response is seeking help from others, though this occurred only when bother was judged as significant by oneself and/or others [23, 25, 27, 30]. For some, acceptance of a new normality was a response to bother, such as making necessary adjustments to accommodate new limitations, routines, or circumstances [20, 30]. However, for others acceptance manifested as resignation, such as where illness symptoms perceived as (or assumed to be) normal were experienced as bothersome but resulted in resignation [30, 32, 33], on the basis that such experiences would be considered insignificant by others or not worth seeking a resolution or help to address. Meanwhile long-term consequences were also present where bother was recurring or sustained, impacting on personal quality of life [21, 29, 31, 33]. As noted above, bother could manifest and impact individuals in different ways, including emotional reactions (irritability, frustration, or anxiety) [18, 24, 25, 29, 33], physical reactions (tension, restlessness, fatigue, or striking out) [21, 18, 25, 26, 31], or cognitive effects (difficulty concentrating, rumination, depression, helplessness, or mental preoccupation) [18, 24, 25, 31, 33]. Consequently, repetitive bother, experienced over time, impacted quality of life [33]. Recurring bother could also impact personal relationships, especially where a person was worried about becoming a burden on others if seeking help repeatedly when bothered [31, 33]. Furthermore, recurring bother could result in sustained experiences of unpleasant emotions such as worry, annoyance, fear, embarrassment, or distress as a long-term consequence. Sustained bother could thus become burdensome [18, 23, 24, 31, 33]. As options to avoid bothersome experiences diminished, withdrawal leading to exclusion and further reduced quality of life and relationships were identified as potential impacts of long-term bother. 4.3 Empirical referents There remains a need for a measure of bother to be developed to further test and validate the attributes, antecedents and consequences of bother identified here, in specific contexts. Such a tool (or tools) should consider evaluation of: Triggering factors or bother stimuli (type and nature) Emotions experienced Range and intensity of current emotions Appraisals or judgements being made in response to the bother trigger (self-efficacy, self-image, social expectations) Salient temporal dimensions (timing, duration, frequency) The extent of effort implicated by the experience of bother Type of reaction to bother (expected versus actual) Attitude towards and beliefs about help-seeking to manage the bother incident Acceptance or adjustment strategies employed or considered Physiological measures, such as heart rate, blood pressure, or skin conductance could provide useful data on levels of stress or anxiety related to bother, however, no reliable biomarker evaluation tool for stress has yet been established [34] suggesting physiological measures may be unreliable at this time. In line with the proposed Bother Concept Model (Fig. 3 ) where bother is a highly personal and individual experience, empirical measurement tools should include self-report elements. Questionnaires that incorporate nuanced responses within specific concepts, such as Likert or numerical scales [35], may be useful quantifiable means of measurement for validation. Measures such as behavioral observations and qualitative interviews also have potential to provide useful contextual data for the design of relevant measurement scales of bother attributes. However, given the multi-layered and complex nature of bother, empirical tools that combine means of measurement may offer the most comprehensive understanding of the phenomenon. 4.4 Digital bother case construction Applying the above concept of bother, digital bother is an uncomfortable emotional reaction to a temporal (timing, duration, frequency) interruption in digital technology use requiring effort or action by self or others that is judgement laden. Walker and Avant [10] advise researchers to construct a series of cases to illustrate the central attributes of a concept under analysis. In place of constructing fictional illustrative cases, the following are scenarios drawn from an aggregation of participants encountered across digital health research engagements by the authors. A model case represents all attributes of the concept. A borderline case looks like the concept but fails to meet the criteria or attributes of the concept. A contrary case is an example that is ‘clearly not the concept’ because it does not contain any of the attributes [10]. The attributes of bother are highlighted in bold in the following case descriptions, presented in the context of digital health technology (DHT) use. Model case. Following a hospitalization , Joe was enrolled in a Smart-Care pilot program offered by his doctor. The program provided Joe with a wellbeing management app, as well as a smart watch to keep track of his steps, sleep, and heartrate. Unsure he would be able to learn to use the new technology, Joe closely followed the suggested routine during the first two weeks , including checking readings before breakfast, and updating his medication app three times a day . However, as Joe felt better, he returned to his usual social activities, thereby disrupting his Smart-Care routine. By week four, Joe was stressed about the program and worried about what his doctor would think about his incomplete readings. He then began to receive messages requiring him to update the app he was using. Unsure what to do, Joe felt foolish and irritated . He thought of calling his son for help , but didn’t want to interrupt him at work with something so trivial . By the time he returned to see his doctor at week six, Joe was frustrated and ready to withdraw from the Smart-Care program, because it was taking too much time and effort , and he expected he would never get used to the technology. Borderline case. Matt picked up his iPad to check the readings from his smartwatch and found the battery was dead. Momentarily irritated , he plugged it in and finished reading a book instead, during the hour it took to charge. In this example the interrupted expectation (of being able to use the iPad) required some time to resolve (charge the iPad). However, the time was spent in an alternative acceptable activity. Moreover, the solution was simple, and Matt knew what to do. It did not require much effort and did not result in any judgement of self or the technology. Instead, Matt adjusted to the situation, without bother, understanding what was required. Contrary case. Nora recently began taking digital skills classes at her old primary school, now the local community center. Nora is delighted with her new device on which she can make calls, send texts, and use some apps. She has even developed a trick for remembering passwords. Always one to enjoy a challenge, she is enjoying learning new skills as well as the social aspect of the drop-in classes. When she decides to do something new on her phone, she tells her partner, ‘I need to go back to school!’ and plans to attend the next drop-in session. Nora may continue to discover new features on her smartphone, but instead of having an uncomfortable emotional reaction, she still finds pleasure and novelty at the opportunities provided for further learning and socialization. Concerns about time, effort and judgement are not present in this example, thereby illustrating that Nora is not experiencing bother in this situation currently. 4.5 Comparison with similar concepts The remaining step in the process of concept analysis is comparison of the concept under analysis with other similar concepts [10]. The term bother began to be used in the 1800’s and is believed to have originated in Ireland [36]. Burden is a second concept like, and often conflated with, bother. There are instances when the terms might be effectively used interchangeably, such as ‘I don’t want to bother/burden her with my worries’. However, the concept of burden in health contexts refer to an ongoing heavy workload that is constant, difficult, and has negative personal consequences [37]. A key contrasting attribute of bother is that it is characterized as something judged to be of low importance or seriousness and only temporarily disturbing [13]. The consequences of a burden may also differ from those of bother, for example it may be easier to avoid or adapt to something bothersome than in the case of an ongoing burden, which requires not just effort but is ‘hard work’ [38]. Nonetheless, sustained bother may ultimately become burdensome, such as with the ongoing workload of symptom management in chronic illness [37, 38] and pressure to use DHTs in older age [5]. This suggests both concepts may be part of a continuum, a proposition that warrants further examination. The multi-dimensionality of bother may also distinguish it from other similar concepts; however, further comparison is required to establish if this is the case. 5 Discussion In the Baseline Report for the Decade of Healthy Ageing, it is proposed that ‘fundamental changes in the clinical focus of care’ and how it is organized and delivered will be necessary in response to population ageing [1, p.8]. Reorganization of care is set to include widespread deployment of DHTs. It is already recognized that digital inclusion in older age is influenced by various factors, from a lack of digital technology access [39] to ageism [40, 41], insufficient skills [42, 43], dependency [44], and support [45, 46]. Putting older persons under pressure to use DHTs for health and wellbeing monitoring and self-management will undoubtedly add to these challenges and exacerbate incidences of bother. Consequently, increased stress can be expected [47]. Chen et al. [2] suggest that ‘future wearable devices will likely be designed to reduce the burden of interaction and the complexity of the devices, to improve adherence’ (p. 1626). However, even if other digital exclusion factors are addressed, such designs will require better understanding of the factors that cause bother, as a precursor to burden. Based on our findings, bother is a negatively experienced reaction to a change or interruption causing uncertainty. Including an emotional reaction, as well as judgement of self and circumstances, bother is influenced by temporality and the effort demanded to cope with it. When bother triggers are experienced only intermittently, and evaluated as inconveniently disruptive, help-seeking behaviors can result in bother self-management, thereby mitigating potential negative consequences. However, bother experienced repeatedly, over a sustained period, may result in adaptive behaviors borne out of resignation, with the risk of becoming an unmanageable significant threat or burden [5]. In these instances, overall consequences of bother can include reduced quality of life as well as social or other exclusions. Over the long-term, repeated bother may result in experienced burden impacting quality of life and personal wellbeing. Our findings align with the position of Sallis et al. [48] who identified bother as a ‘global contributor to quality of life’ (p. 476) and argued that clinicians owe it to patients to examine the concept further and identify how to mitigate and reduce experienced bother. It has been suggested that within the next decade, most older persons will have familiarity with digital technologies rendering concerns about the digital divide moot [49]. However, this perspective takes little account of the constantly evolving nature of digital technologies and the ongoing learning demands on end-users regardless of age. Furthermore, even use of only a narrow range of technologies, such as video calling resulting in fatigue and experienced vulnerability, represents antecedents to both bother and technostress for older DHT users [47]. Sustained bother and related stress can result, over time, in use of DHTs becoming burdensome. Such experiences can result in refusal to use or adopt such tools [5, 50]. A consequence of avoidance or withdrawal from DHT use presents a risk of digital exclusion. However, refusal to use DHTs further risks exclusion from health and care services that increasingly require digital engagement not only for health self-management but also for care access, such as scheduling appointments. There is, therefore, an imperative to understand bother and identify digital bother mitigation strategies for a range of health and wellbeing contexts facing people into older age. This paper is the first analysis of the widely used concept of bother, for a health and care context that is rapidly including a widening array of digital care and wellbeing monitoring elements. Critics of concept analyses have suggested that much scholarship in this area is little more than an intellectual exercise with little to offer either nursing specifically (as the field in which most concept analysis work is located) or science more generally [51, 52]. Cohen et al. [53] have shown there is value in modeling the cost of bother for users within multi-actor systems, such as health care, to resolve system use problems. However, their description of bother is limited to interruption and annoyance. By contrast, the value of the concept analysis presented in this paper lies in its recognition of the relational and multi-dimension aspects of the bother experience. Consequently, this paper contributes to the understanding of bother and can inform mitigation measures for digital health care delivery as well as engagement and adoption challenges in older age. 5.1 Limitations The main limitation of this paper is that the concept of bother was not defined in most of the articles reviewed, despite the term found in either the title and/or abstract of each paper. The absence of digital health papers may also represent a gap to be further explored in the context of the objectives for the analysis. However, by reflecting a range of contexts, the dataset provided a basis for examination of the attributes, antecedents and consequences of the bother experience across a range of contexts. As a concept used in nursing and healthcare, further exploration of the specific experience of bother, as presented in this paper, would support greater clarity for its use in further studies. The absence of existing empirical measures of bother for analysis is also a limitation. However, this paper offers a framework to support the development of new measures to add clarity and utility for the application of the concept of bother in both digital health research and practice. 6 Conclusion Further research is needed to validate the bother attributes identified and develop tools to empirically measure both the presence and extent of bother across health and care settings. Furthermore, socio-economic or socio-cultural factors beyond age may exacerbate the contextual antecedents of digital health bother, as is the case for both digital and social exclusion. There is, therefore, a need to apply a broader lens in further research to explore the relationship between older age and digital bother, digital inclusion, and potential health inclusion as health care provision becomes increasingly digitalized. However, the findings presented in this concept analysis provide a foundation on which to build a better understanding of how bother influences health, care, inclusion, and ageing in a digitalized world. Declarations The authors have no competing interests to declare. No funding was received for conducting this study. The authors have no financial or non-financial competing interests to declare. Patient or public contribution The study focus was informed by discussions with older members of citizen panels at Living Labs in Belgium and Ireland. Members of the public (n = 3) reviewed the interpretation of findings and provided feedback on the final draft of the manuscript. Author Contribution The study conception, design, material preparation, data collection was performed by S.C.S. Data analysis was conducted by S.C.S. and C.V.L.. The first draft of the manuscript text was written by S.C.S. All authors contributed to and commented on subsequent versions of the manuscript text. S.C.S. prepared all tables and figures. A.J. supervised the work. All authors read and approved the final manuscript. Acknowledgement Patient or public contribution The study focus was informed by discussions with older members of citizen panels at LiCalab Living Labs, Belgium and NetwellCASALA Living Lab, Ireland. Members of the public (n=3) reviewed the interpretation of findings and provided feedback on the final draft of the manuscript. Data Availability Data is provided within the manuscript or supplementary information files available at: https://zenodo.org/records/15034407 References World Health Organization: Decade of healthy ageing: baseline report. World Health Organization (2021) Chen, C., Ding, S., Wang, J.: Digital health for aging populations. Nat. Med. 29 , 1623–1630 (2023). https://doi.org/10.1038/s41591-023-02391-8 Tyler, M., De George-Walker, L., Simic, V.: Motivation matters: Older adults and information communication technologies. Stud. Educ. Adults. 52 (2), 175–194 (2020). 10.1080/02660830.2020.1731058 Moore, K., O'Shea, E., Kenny, L., Barton, J., Tedesco, S., Sica, M., Crowe, C., Alamäki, A., Condell, J., Nordström, A., Timmons, S.: Older Adults’ Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7087419","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":483894205,"identity":"ed15c35c-8293-43e5-a4b7-237c29e880b3","order_by":0,"name":"Suzanne Cullen-Smith","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIie2PMQrCMBhG/1DI1DgLBXOFSMGl4lksBTO7OThEAnFxlkpFbyGOlYBTDyC4KIKz4CIoaCMOTrGjQ96UIY//fQAOx3+DhAcDj+HymVdVRhKKUsHVFUASKY8B/vGNpvx47a/bQKd6fOovorBGBcovFoXtukkwK3rA9vFIzla8ZcI2qU2pd/OAKA0sKBWy0m2jaN8aFss7UU+gmVHmH+VhG7NLcHklBzBhROh3mLYZrDjjiKjEN1syf8tDjGOxmdjCxvy0J6rToBk/XP1h1FxKrS8325kP33uRqCA4HA6Hw8YLrpFIxlBHm6sAAAAASUVORK5CYII=","orcid":"","institution":"Dundalk Institute of Technology","correspondingAuthor":true,"prefix":"","firstName":"Suzanne","middleName":"","lastName":"Cullen-Smith","suffix":""},{"id":483894206,"identity":"9c6be575-feb5-4fd4-9701-68dee9646d3d","order_by":1,"name":"Cora van Leeuwen","email":"","orcid":"","institution":"imec-SMIT, Vrije Universiteit Brussel","correspondingAuthor":false,"prefix":"","firstName":"Cora","middleName":"van","lastName":"Leeuwen","suffix":""},{"id":483894207,"identity":"7eb47129-a9ef-4f9a-9f2a-cc4f83ba0176","order_by":2,"name":"An Jacobs","email":"","orcid":"","institution":"imec-SMIT, Vrije Universiteit Brussel","correspondingAuthor":false,"prefix":"","firstName":"An","middleName":"","lastName":"Jacobs","suffix":""}],"badges":[],"createdAt":"2025-07-09 22:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7087419/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7087419/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87860466,"identity":"dc5a0ec3-8ae6-4eb6-8205-7efe81472686","added_by":"auto","created_at":"2025-07-29 18:08:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7705,"visible":true,"origin":"","legend":"\u003cp\u003eScopus literature search criteria\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7087419/v1/09dfd7530f54f40f07a28785.png"},{"id":87860465,"identity":"fa923658-ff0b-4870-9aa3-dac50bdfdf44","added_by":"auto","created_at":"2025-07-29 18:08:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":11885,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of literature selection process\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7087419/v1/572bfb2496919af78438b1c4.png"},{"id":87861678,"identity":"347e6ace-ae32-4c6a-ae88-02cd11c06ae8","added_by":"auto","created_at":"2025-07-29 18:32:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16789,"visible":true,"origin":"","legend":"\u003cp\u003eBother concept model\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7087419/v1/8a8e4993c3fc577de0e2c369.png"},{"id":87862184,"identity":"cb7eeb4f-fa12-4792-8fb1-7b9bda7aa883","added_by":"auto","created_at":"2025-07-29 18:40:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1159825,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7087419/v1/b0bee9f9-0e03-4cec-ab70-28155979bf26.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bother: a concept analysis and implications for digital health inclusion in older age","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIncreased health and care support demands are anticipated in line with ageing populations due to chronic and complex care needs in older age [1]. \u0026nbsp;Adoption of digital health technologies (DHTs) is expected to transform care delivery as well as how people self-manage their health and wellbeing by offering convenient, continuous health monitoring and remote medical care [2]. However, the benefits of DHTs are not uniformly experienced by all older persons, and some encounter difficulties or frustrations when using these technologies. Intrinsic motivation, ease of use, extrinsic support, and specificity of purpose of the DHT are factors deemed necessary for sustained use or adoption of DHTs, as older persons are less likely to adopt DHTs based on novelty alone [3,4]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe nursing literature is often concerned with how symptom bother influences treatment compliance by patients. Likewise, experiences of bother can influence interactions with, openness to, and use of DHTs: \u0026lsquo;an awful lot of older people have shared to me that they couldn\u0026rsquo;t be bothered with technology, how their life is affected as they get older, \u0026lsquo;oh I couldn\u0026rsquo;t be bothering asking people again [to help with technology]\u0026rsquo;\u0026rsquo; ([5], p. 10). \u0026nbsp;Similarly, technostress, stress resulting from technology use, has potential to result in psychological, behavioral, and physical consequences including affecting the ability to use digital technology [6-8]. Understanding the nature and consequences of bother, as a concept as well as an experience, may offer insights on how to support people to use DHTs into older age and mitigate digital health exclusion.\u0026nbsp;\u003c/p\u003e"},{"header":"2 Background","content":"\u003cp\u003eAccording to Glasser [9], \u0026lsquo;a concept is the naming of an emergent social pattern grounded in research data\u0026rsquo; (p. 24). Concepts are, therefore, abstract units of meaning representing some aspect of human experience. Unlike ideas, which are more general, concepts are derived from occurrences and serve as building blocks for theories [10]. Concept analysis is a process of interrogating the characteristics of a concept for effective application in nursing research and practice. The process aims to provide clarity of definition as well as a means of identifying and measuring instances of the concept, to assess its strengths and weaknesses [11]. However, a range of different factors influence the attributes of a concept in different contexts and at different times [12].\u003c/p\u003e\u003cp\u003eBother is a term used across a range of disciplines relating to human behavior, emotions, and interactions. Yet, there has been no attempt to date to provide a robust operational definition for bother. Gawlicki et al. [13] identified limitations in representing symptom bother using patient recorded outcomes (PRO) instruments, highlighting a problematic lack of a clear definition and differing cultural meanings across countries and languages. Furthermore, studies using PRO instruments to measure bothersome symptoms have made limited attempts to define the concept of bother within instrument design or in their application in clinical practice or research. A concept analysis of bother is, therefore, timely. However, such analysis is only worthwhile if it can contribute to a greater understanding of connected scientific concerns [12].\u003c/p\u003e\u003cp\u003eAs a colloquial term, the word bother is widely used, though with somewhat vague and variable representations. With a push to achieve DHT adoption to support people in older age, and common language references to bother found among quotes in qualitative studies, this analysis seeks to examine and clarify the meaning of bother. We propose that a realist ontological approach [14] may offer value in defining a concept of digital bother for practical application in nursing as well as in digital health research and innovation contexts. A clear understanding of the concept will also provide another perspective for human computer interaction researchers and DHT designers to consider when developing interventions for those in older age and those providing care.\u003c/p\u003e\u003cp\u003eThe aim of this paper is to answer the question: What is the definition of bother, in the context of digital health and older age? To address this question a landscape review and content analysis of bother definitions was completed, followed by a structured analysis of the concept of bother [10]. An operational conceptual definition of digital bother was then derived from the analysis and supported by illustrative model and contradictory cases. Finally, the implications of the newly defined concept of bother are discussed in relation to digital health in older age.\u003c/p\u003e"},{"header":"3 Method","content":"\u003cp\u003eCritical to ensuring concept analyses contribute to scholarship is ensuring a rigorous and systematic methodology is implemented [12]. This study followed eight steps [10] to provide an operational frame for use in the definition of bother. After selecting the concept and clarifying the objective (above), the next step required identifying all uses of the concept. A review of two online dictionaries (oed.com, collinsdictionary.com) and thesaurus.com was conducted to identify the range of definitions, synonyms, and antonyms of the term bother in the English language. Definitions and synonyms were examined by the first two authors and collaboratively clustered thematically.\u003c/p\u003e\u003cp\u003eA literature search of the Scopus abstract database was then undertaken. Scopus was selected as it hosts the largest database of abstracts across a wide range of disciplines, thereby further facilitating exploration of the concept usage across multiple contexts [10]. Search criteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) included the term bother found in the title and/or abstract of peer-reviewed, open-access, English language academic journals, published between 1994 and 2024. It was deemed that thirty years was a reasonable publication timeframe to generate a body of current literature for review.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTo include digital health literature, a search was also conducted of the IEEE Xplore database for the term bother in the metadata of journal articles also published between 1994 and 2024. The title and abstract of all papers were reviewed for relevance. Articles were deemed relevant for inclusion if the abstract and text body included data describing the experience of bother and if examples of the dimensions (antecedents, attributes, or consequences) of bother could be identified in the body of the paper. The final selection of articles (n\u0026thinsp;=\u0026thinsp;17) was reviewed in detail (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). An inductive thematic analysis approach [15, 16] was used whereby text segments of data were initially coded to thematic parent codes (antecedents, attributes, consequences, and other), using NVivo software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://lumivero.com\u003c/span\u003e\u003cspan address=\"https://lumivero.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), before being inductively coded by SCS with descriptive labels. Codes were reviewed and discussed by SCS and CvL and final codes agreed once consensus was reached.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eLimiting exploration of a concept to familiar contexts or narrow dimensions should be avoided and it is recommended to use a wide range of channels to find uses of the concept under analysis, such as talking to colleagues [10]. Given the vast data sources on which generative artificial intelligence (Gen AI) large language models (LLMs) are modelled, it was decided to explore the concept of bother using such tools. Following the literature review, a series of prompts were entered to Gen AI platforms LLaMa (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.huggingface.ai\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.huggingface.ai\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e and ChatGPT (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.chatGPT.ai\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.chatGPT.ai\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e: \u0026lsquo;Provide 20 complex sentences including the conjunction \u0026lsquo;because\u0026rsquo; for each of the words \u003cem\u003ebother\u003c/em\u003e, \u003cem\u003ebothersome\u003c/em\u003e and \u003cem\u003ebothered\u003c/em\u003e.\u0026rsquo; Once each set of sentences were generated, a prompt requested the replication of the sentences replacing the bother word with a different word of similar meaning. All sentences were transferred to an Excel worksheet and a content analysis of the sentences was undertaken to identify attributes. Attributes of bother/ed/some from the content analysis were then compared and triangulated with the attributes identified in the dictionary and literature analysis.\u003c/p\u003e"},{"header":"4 Overview of the Concept","content":"\u003cp\u003eThe first two steps [10] of concept analysis, selection of the concept and stating the objective, have been addressed in the introduction to this paper. Each of the remaining steps are addressed in the sub-sections below, though not necessarily in order, as the process of concept analysis is iterative, a process that \u0026lsquo;results in a much cleaner, more precise analysis\u0026rsquo; [10] (p160). Results first present how the concept of bother is used and the defining characteristics, before identifying illustrative cases of digital bother.\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Dictionary uses of the concept\u003c/h2\u003e\u003cp\u003eAccording to dictionary (collinsdictionary.com; oed.com) and thesaurus searches (Thesaurus.com) bother is found in the forms of noun, verb, adjective and convention. Bother as a noun includes being a bother, botherment, or botheration. As a verb, to bother means \u0026lsquo;actively annoying\u0026rsquo;. Meanwhile bothered (past tense of bother) means the passive experience of being annoyed or troubled. Used as an adjective, bothersome emphasizes the quality of being irritating or annoying rather than the act of annoying or irritating. An additional use of bother is as a convention, such as in the phrase \u0026lsquo;it is no bother at all\u0026rsquo;. Definitions identified in the dictionary and thesaurus searches were aggregated for analysis [17].\u003c/p\u003e\u003cp\u003eClusters of defining terms were assigned a thematic label with attributes of bother broadly including interruption, emotions, judgement, and effort (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Related antonyms listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e offer additional texture to the descriptive thematic labels. The range of descriptors illustrate that the understanding and lived experience of bother is multi-dimensional including emotions, behaviors, attitudes, and relationships.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSynonyms and antonyms of bother\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSummary Label\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDefinitions and Synonyms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAntonyms\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterruption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInconvenience, put out, badger, disturb/ance, fuss, hassle, nuisance, plague, pester, trouble/some, startle, shock, needle, provoke, disrupt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction, peace, order, flow, mindfulness, progress, persistence, continuation, regulate,\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnnoying, aggravate, upset, panic, irritate/irritating, worry, frustration, concern, distress, alarm, mither, dismay, disconcert, vex, perturb, grief, bedevil, exasperation, peeve, frighten, terrify, unnerve, anger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEase, happiness, tranquility, serenity, contentment, calmness, acceptance, delight\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJudgement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFoolish, confused, difficulty, unimportant, bewildered, gall, overwhelm, strain, problem, get on someone\u0026rsquo;s nerves/wick, nuisance, tease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConfidence, competence, self-efficacy, valid, pleasure, joy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConcern yourself, make the effort, take the time, go to the trouble, harass, trouble/burden yourself, bend someone\u0026rsquo;s ear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEasy, not work, smoothness, fluency\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Sources: oed.com, collinsdictionary.com, thesaurus.com\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Literature review\u003c/h2\u003e\u003cp\u003eArticles identified from the literature search (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e) were reviewed to identify characteristics of bother, such as defining attributes, antecedents, and consequences. These are outlined next.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eArticles from literature searches\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePaper Title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample \u0026amp; Country\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIt doesn't bother me: An intersectional analysis of discrimination among white women farmers in the US Corn Belt [18]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 women farmers\u003c/p\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSemi-structured interviews\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf it Bothers Someone it\u0026rsquo;s a Mistake! How Chinese College Students Conceptualize Transgressions [19]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChinese college students\u003c/p\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 focus groups (n\u0026thinsp;=\u0026thinsp;40) and codebook based thematic analysis.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat bothers severe asthma patients most? A paired patient\u0026ndash;clinician study across seven European countries [20]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 patients with severe asthma\u003c/p\u003e\u003cp\u003e7 countries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOpen-ended survey responses linked with a free-text survey by treating clinicians. Content analysis. Comparison of findings with asthma registries.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePopulation-based study of prevalence, bother and behaviour related to treatment for lower urinary tract symptoms and overactive bladder among Polish neurogenic patients [21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1166 men and women, aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years.\u003c/p\u003e\u003cp\u003ePoland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStatistical analysis of data from LUTS POLAND, a computer-assisted and population-representative telephone survey\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo Writing Errors Bother Professionals? An Analysis of the Most Bothersome Errors and How the Writer\u0026rsquo;s Ethos is Affected [22]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99 business professionals whose roles are not primarily writing and communication\u003c/p\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA quasi-replication study:17-question survey including open questions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOveractive bladder symptom severity, bother, help-seeking behavior, and quality of life in patients with type 2 diabetes: A path analysis [23]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127 diabetic patients, aged at least 18 years, with overactive bladder\u003c/p\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOveractive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder Questionnaire Short Form (OAB-q SF). \u0026nbsp;Help-seeking survey. A two-step path analysis was performed to analyze the data.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eArticles from literature searches cont\u0026rsquo;d\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie\u0026rsquo;s disease [24]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 men with a clinical diagnosis of PD\u003c/p\u003e\u003cp\u003eGermany\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSelf-administered Peyronie Disease Questionnaire (PDQ), SCS-M (male sexual complaint scale),\u003c/p\u003e\u003cp\u003eInternational Index for Erectile Function (IIEF), and Aging Male\u0026acute;s Symptom Scale (AMS)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThrough Their Words: Sources of Bother for Hospitalized Children and Adolescents with Cancer [25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 children and adolescents (7\u0026ndash;18 years; mean 12.6 years) admitted as inpatients\u003c/p\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComparative, descriptive design. Written responses to questions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lsquo;Don\u0026rsquo;t bother with that\u0026rsquo;: the use of negative imperative directives for defusing student conflict in a special support classroom [26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 teachers and 9 students at a special support unit\u003c/p\u003e\u003cp\u003eSweden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVideo ethnographic field study. Comprising video documentation and field notes.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDispositional and Situational Avoidance and Approach as Predictors of Physical Symptom Bother Following Breast Cancer Diagnosis [27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e460 women diagnosed with breast cancer within the previous 3 months. 68% non-Latina white, 19% Latina. Average age 56 years.\u003c/p\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFive assessment points over 6 months. Difficulties in Emotion Regulation Scale; Control of Feelings Scale; COPE; Emotional Approach Coping (EAC); The Breast Cancer Prevention Trial (BCPT) Symptom Scales; chart review; and self-report\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOn the argument structures of the transitive verb fan 'annoy; Be annoyed; Bother to do': A study based on two comparable corpora [28]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eData from Gigaword corpus, containing data from Mainland China (XIN) and Taiwan (CNA)\u003c/p\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTheta System Theory to probe argument structures of the transitive verb \u0026lsquo;fan\u0026rsquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Articles from literature searches cont\u0026rsquo;d\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA user modelling approach for reasoning about interaction sensitive to bother and its application to hospital decision scenarios [29]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 separate hospital emergency room simulations\u003c/p\u003e\u003cp\u003eCanada\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePresents a framework for interacting with users that is sensitive to the cost of bother and then focuses on its theoretical application to decision making in hospital emergency room scenarios.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerating perceptions of bother reports by individuals experiencing lower urinary tract symptoms [30]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 men and women with LUTS.\u003c/p\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne-to-one in-depth interviews. Grounded theory-based data analysis.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\"What bothers you the most?\" initial responses from patients receiving palliative care consultation [31]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e226 palliative care patients. 81% White, 50% male\u003c/p\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA retrospective descriptive content analysis of first-person responses routinely recorded during initial interview\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower urinary tract symptoms in men: Self-perceptions and the concept of bother [32]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 men with LUTS\u003c/p\u003e\u003cp\u003eEngland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCompleted IPSS and HADS self-report scales before or shortly after first appointment with urologist. Repertory Grid method used for analysis.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMen's experiences of having lower urinary tract symptoms: Factors relating to bother [33]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75 men with LUTS\u003c/p\u003e\u003cp\u003eEngland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA questionnaire survey method was used in a cross-sectional design. Over a consecutive 7-month period.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDefining attributes.\u003c/b\u003e The primary objective of a concept analysis is to identify the defining attributes of the concept for broad application [10]. From the analysis of the literature searches, four core attributes of bother were identified as an emotional reaction, judgement, temporality, and effort.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eEmotional reaction.\u003c/em\u003e A range of emotions were identified across the dataset from anxiety, fear or worry in patients [21, 24, 25, 30, 31, 32, 33] to irritation or annoyance, such as in women farmers, adolescents, and professionals [26, 22, 25, 26, 29]. Emotions, such as concerns about what the future would bring, and fear about being unable to carry on as usual were reactions to events or circumstances outside the respondents\u0026rsquo; control, such as for women farmers when a male partner died [26] or irreversible illness symptoms [24, 25, 30, 31, 33]. Stress or distress was described in psychological terms such as being fatigued, or depressed [21, 26, 24, 25, 26, 31, 33], as well as being evoked due to anticipated outcomes or judgement by others [26, 19, 20, 22, 24, 25, 26, 30, 32, 33]. Non-specific stress was also identified by men with LUTS, women farmers and others in response to experienced or anticipated interpersonal interactions [26, 19, 24, 25, 26, 29, 31, 32, 33]. Furthermore, frustration was related to not being taken seriously [26] and by being overwhelmed [26, 31]. Irritation was linked to waiting, by patients [25, 31], and annoyance with being interrupted [21, 26, 20, 23, 25, 26, 29, 31, 33], such as for inpatients interrupted by nurses [25] or people with LUTS whose sleep was interrupted by symptoms [21, 23, 33]. Being bothered is, therefore, a complex emotional reaction triggered by the meaning ascribed to an interruption or disruption.\u003c/p\u003e\u003cp\u003e\u003cem\u003eJudgement.\u003c/em\u003e One of the reactions identified, following an interruption, was judgement of the severity or meaning of the interruption and its potential consequences, such as for men with Peyronie\u0026rsquo;s Disease (PD) concerned with the impact on their sexual relationship with partners or spouses [24] or interruption costs in ER departments [29]. This was central to whether an interruption resulted in bother. For example, whether a knock on the front door comes just as a favorite TV program is starting, or after spending the morning alone wishing for someone to talk to, may determine if an interruption is judged as bothersome or welcome. At other times, bother may occur where action is required in response to the interruption, such as micturition urges during the night [24, 30, 32, 33]. Whether judgement of self (or one\u0026rsquo;s actions) as being out-of-step with social expectations [18, 19, 20, 22, 24, 25, 30, 32,33] or as unlikely to demonstrate adequate self-efficacy [24, 26, 27, 33], judgement of others [19, 22, 25, 26, 29] was also an attribute of defining something as bothersome. Across the literature, the cluster of emotions linked with self-judgement included shame, embarrassment, loss of confidence, and helplessness [21, 21, 24, 26, 32, 33]. These emotions were also linked to expectations about how self-inefficacy might impact relationships, both intimate and social [18, 19, 24, 31 32, 33].\u003c/p\u003e\u003cp\u003eJudgement, by oneself or others, may deem a bother triggering experience as insignificant or trivial. Indeed, \u0026lsquo;explicitly framing the event as a frivolous parenthesis, which can and should be ignored\u0026rsquo; [26, p. 242] is characteristic of bother. A widely used phrase in Ireland is \u0026lsquo;no bother!\u0026rsquo;. Similarly in Spanish \u0026lsquo;\u0026ccedil;e nada\u0026rsquo;, or \u0026lsquo;de rien\u0026rsquo; in French means \u0026lsquo;it was nothing!\u0026rsquo; suggesting little time or effort of significance was required or expended. By contrast, a bothersome interruption is experienced as disruptive or significant even though it may be expected that others might judge the issue as trivial, as reflected in the expression \u0026lsquo;it is not worth bothering them about\u0026rsquo;. Even \u0026lsquo;little inconveniences\u0026rsquo; [19, p. 1387] have the potential to bother, contributing to a social expectation that causing bother for others should be avoided. Indeed, being bothersome is to personify the trivial and irrelevant, \u0026lsquo;the nuisance factor represents the annoyance caused to the user [healthcare provider] due to irrelevant questions [from colleagues or patients]\u0026rsquo; [29, p. 450]. Anticipating judgement, by self or others, was identified and experienced as an attribute of bother potentially contributing to stigma [20]. Such judgement included that an incident or concern is insignificant, such as worries about being able to locate toilets when out [33], or that the bother trigger could be easily avoided, like perceptions about writing errors among professionals [22]. Furthermore, \u0026lsquo;how the other feels, was presented as essential in deciding whether behaviors are acceptable or not\u0026rsquo; [19, p.387] and, therefore, likely to be considered bothersome.\u003c/p\u003e\u003cp\u003e\u003cem\u003eTemporality.\u003c/em\u003e The third attribute of bother is temporality, including timing, frequency, and duration. For example, the timing of symptoms or care routines [20, 23, 25, 33] as well as other types of inconvenient interruptions [18, 24, 25, 26, 29] was noted in the literature as causing bother. In addition to timing, the frequency of triggers was linked with bother, especially recurring triggers such as being woken at night [23, 25, 30, 33] or repetitive interruptions such as questions [29], errors [22], or problematic interpersonal encounters [18, 26]. The third temporal dimension of bother is duration. Indeed, bother has been identified as meaning \u0026lsquo;a chronic hindrance and something that is always there\u0026rsquo; [21, p. 4]. This temporal dimension, of bothersome circumstances lasting over time, was identified in relation to chronic illness symptom impact on quality of life [24, 25, 30, 32, 33], hospitalization [25,31] and waiting to die (for those receiving palliative care) [31].\u003c/p\u003e\u003cp\u003e\u003cem\u003eEffort.\u003c/em\u003e Responding or reacting to something bothersome requires effort (to bother). At a minimum it involves stopping (when interrupted) and starting again, as when managing work interruptions [29], reacting to writing errors [22], or recovering from a health symptom such as an asthma flare-up [20]. However, the effort required to do something, in the first instance, can also be the source of bother, such as the effort to mask symptoms or overcome challenges [18, 27, 20, 25, 27, 30, 33]. Indeed, common language use of the term bother include the phrases \u0026lsquo;don\u0026rsquo;t bother\u0026rsquo; or \u0026lsquo;why bother?\u0026rsquo;, found in articles (n\u0026thinsp;=\u0026thinsp;12) across the literature review. These phrases mean \u0026lsquo;don\u0026rsquo;t or why bother putting any time or effort into \u0026hellip;\u0026rsquo;. This attribute is linked to the judgement attribute where the bother trigger may be considered of a trivial nature or where self-efficacy to respond may be deemed as inadequate.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSentence use of bother.\u003c/b\u003e Across the sample sentences generated by Gen AI tools (LLaMa and ChatGPT) [17] the four variations of bother were identified. As in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e above, being bothered was a term used to express emotions experienced, such as irritation, frustration, or concern, \u0026lsquo;They were bothered (frustrated) by the constant interruptions, because they couldn't finish their meeting on time\u0026rsquo; (ChatGPT). Being bothered was identified as due to an interruption, \u0026lsquo;I was bothered (disturbed) by the noise outside, because it made it hard to concentrate on my work\u0026rsquo; (ChatGPT). Judgement was a feature of something being bothersome, \u0026lsquo;The rude behaviour of the customer was bothersome (off-putting), because it affected the entire team\u0026rsquo;s mood\u0026rsquo; (ChatGPT). Meanwhile, bother was linked with time and effort expended or required, \u0026lsquo;I bother (make the time/effort) to learn a new language because I want to travel\u0026rsquo; (LLaMa). The attributes identified from analysis of the AI generated sentences were emotions, judgement, time, and effort. These were also identified in the literature review, as outlined above.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAntecedents.\u003c/b\u003e When considering the attributes of bother, it is necessary to present the circumstances required to trigger bother in individuals. These circumstances are referred to as antecedents [10, 12]. Two primary antecedents identified in the literature review are change and uncertainty. Interruptions, mentioned above, reflect a change in the status quo, such as: being woken at night [23, 25, 30, 33], an illness symptom event [20], being treated or needing to behave differently because of changed contextual circumstances such as illness or marital status [18, 25, 31, 33], or interruptions in work flow [18, 22, 26, 29, 33]. Uncertainty was also identified as a trigger for bother, whether due to a lack of knowledge, such as information about an illness [30], knowing what to expect or, as noted above, how long bothersome circumstances would persist [18, 25, 30, 31]. Likewise, uncertainty about how to proceed [31], what to do next [18], or if one can even proceed [20] also contributed to triggering bother.\u003c/p\u003e\u003cp\u003eA linked experience was of having unmet expectations, whether such expectations were considered reasonable or not, such as writing accuracy among professionals [22], having control over one\u0026rsquo;s dying process [31], maintaining social status when a male spouse dies [18], that symptoms could be cured [23], or that medications and interactions with clinical staff would be trouble-free [25, 31]. Whether expectations were reasonable or unrealistic had less influence on bother compared to not having such expectations met [22, 23, 31].\u003c/p\u003e\u003cp\u003eA contextual dimension of antecedents to bother is relationships. While not evident in all cases, how something might impact others contributed to the conceptualization and experience of bother, such as how writing errors could reflect on organizational image [22], how antagonistic behaviors impact others [19, 26], or the impact of illness symptoms on relationships [21, 27, 31, 33]. Consequently, uncertainty about the perceptions or reactions of others can also trigger bother, as noted above [21, 24, 29, 30, 33] and may influence individual reactions to bother.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsequences.\u003c/b\u003e Consequences are events or circumstance resulting from instances of the concept [10, 12]. The experience of bother results in both reactions and consequent impacts. Immediate behavioral reactions included avoidance, help-seeking, resignation, or a combination of these over time. Avoidance of the cause of bother or withdrawal from situations where bother was likely to occur [18, 27, 33] could include altered personal, intimate, or social relationships [18, 19, 43, 25, 31, 33]. Withdrawal from activities that support wellbeing could also occur in response to bother [27, 33]. Another response is seeking help from others, though this occurred only when bother was judged as significant by oneself and/or others [23, 25, 27, 30]. For some, acceptance of a new normality was a response to bother, such as making necessary adjustments to accommodate new limitations, routines, or circumstances [20, 30]. However, for others acceptance manifested as resignation, such as where illness symptoms perceived as (or assumed to be) normal were experienced as bothersome but resulted in resignation [30, 32, 33], on the basis that such experiences would be considered insignificant by others or not worth seeking a resolution or help to address.\u003c/p\u003e\u003cp\u003eMeanwhile long-term consequences were also present where bother was recurring or sustained, impacting on personal quality of life [21, 29, 31, 33]. As noted above, bother could manifest and impact individuals in different ways, including emotional reactions (irritability, frustration, or anxiety) [18, 24, 25, 29, 33], physical reactions (tension, restlessness, fatigue, or striking out) [21, 18, 25, 26, 31], or cognitive effects (difficulty concentrating, rumination, depression, helplessness, or mental preoccupation) [18, 24, 25, 31, 33]. Consequently, repetitive bother, experienced over time, impacted quality of life [33]. Recurring bother could also impact personal relationships, especially where a person was worried about becoming a burden on others if seeking help repeatedly when bothered [31, 33]. Furthermore, recurring bother could result in sustained experiences of unpleasant emotions such as worry, annoyance, fear, embarrassment, or distress as a long-term consequence. Sustained bother could thus become burdensome [18, 23, 24, 31, 33]. As options to avoid bothersome experiences diminished, withdrawal leading to exclusion and further reduced quality of life and relationships were identified as potential impacts of long-term bother.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Empirical referents\u003c/h2\u003e\u003cp\u003eThere remains a need for a measure of bother to be developed to further test and validate the attributes, antecedents and consequences of bother identified here, in specific contexts. Such a tool (or tools) should consider evaluation of:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTriggering factors or bother stimuli (type and nature)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEmotions experienced\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRange and intensity of current emotions\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAppraisals or judgements being made in response to the bother trigger (self-efficacy, self-image, social expectations)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSalient temporal dimensions (timing, duration, frequency)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe extent of effort implicated by the experience of bother\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eType of reaction to bother (expected versus actual)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAttitude towards and beliefs about help-seeking to manage the bother incident\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAcceptance or adjustment strategies employed or considered\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePhysiological measures, such as heart rate, blood pressure, or skin conductance could provide useful data on levels of stress or anxiety related to bother, however, no reliable biomarker evaluation tool for stress has yet been established [34] suggesting physiological measures may be unreliable at this time. In line with the proposed Bother Concept Model (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) where bother is a highly personal and individual experience, empirical measurement tools should include self-report elements. Questionnaires that incorporate nuanced responses within specific concepts, such as Likert or numerical scales [35], may be useful quantifiable means of measurement for validation. Measures such as behavioral observations and qualitative interviews also have potential to provide useful contextual data for the design of relevant measurement scales of bother attributes. However, given the multi-layered and complex nature of bother, empirical tools that combine means of measurement may offer the most comprehensive understanding of the phenomenon.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Digital bother case construction\u003c/h2\u003e\u003cp\u003eApplying the above concept of bother, digital bother is an uncomfortable emotional reaction to a temporal (timing, duration, frequency) interruption in digital technology use requiring effort or action by self or others that is judgement laden. Walker and Avant [10] advise researchers to construct a series of cases to illustrate the central attributes of a concept under analysis. In place of constructing fictional illustrative cases, the following are scenarios drawn from an aggregation of participants encountered across digital health research engagements by the authors. A model case represents all attributes of the concept. A borderline case looks like the concept but fails to meet the criteria or attributes of the concept. A contrary case is an example that is \u0026lsquo;clearly not the concept\u0026rsquo; because it does not contain any of the attributes [10]. The attributes of bother are highlighted in bold in the following case descriptions, presented in the context of digital health technology (DHT) use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eModel case.\u003c/b\u003e Following a \u003cb\u003ehospitalization\u003c/b\u003e, Joe was enrolled in a Smart-Care pilot program offered by his doctor. The program provided Joe with a wellbeing management app, as well as a smart watch to keep track of his steps, sleep, and heartrate. \u003cb\u003eUnsure\u003c/b\u003e he would be able to learn to use the \u003cb\u003enew\u003c/b\u003e technology, Joe closely followed the suggested routine during the first two \u003cb\u003eweeks\u003c/b\u003e, including \u003cb\u003echecking readings\u003c/b\u003e before breakfast, and updating his medication app \u003cb\u003ethree times a day\u003c/b\u003e. However, as Joe felt better, he returned to his usual social activities, thereby \u003cb\u003edisrupting\u003c/b\u003e his Smart-Care routine. By week four, Joe was \u003cb\u003estressed\u003c/b\u003e about the program and \u003cb\u003eworried\u003c/b\u003e about \u003cb\u003ewhat his doctor would think\u003c/b\u003e about his incomplete readings. He \u003cb\u003ethen\u003c/b\u003e began to receive messages requiring him to update the app he was using. \u003cb\u003eUnsure\u003c/b\u003e what to do, Joe felt \u003cb\u003efoolish\u003c/b\u003e and \u003cb\u003eirritated\u003c/b\u003e. He thought of calling his son for \u003cb\u003ehelp\u003c/b\u003e, but \u003cb\u003edidn\u0026rsquo;t want to interrupt\u003c/b\u003e him at work with something so \u003cb\u003etrivial\u003c/b\u003e. By the time he returned to see his doctor at week six, Joe was \u003cb\u003efrustrated\u003c/b\u003e and ready to \u003cb\u003ewithdraw\u003c/b\u003e from the Smart-Care program, because it was taking too much \u003cb\u003etime\u003c/b\u003e and \u003cb\u003eeffort\u003c/b\u003e, and he \u003cb\u003eexpected\u003c/b\u003e he would \u003cb\u003enever\u003c/b\u003e get used to the technology.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBorderline case.\u003c/b\u003e Matt picked up his iPad to check the readings from his smartwatch and found the battery was dead. \u003cb\u003eMomentarily irritated\u003c/b\u003e, he plugged it in and finished reading a book instead, during the \u003cb\u003ehour\u003c/b\u003e it took to charge. In this example the interrupted expectation (of being able to use the iPad) required some time to resolve (charge the iPad). However, the time was spent in an alternative acceptable activity. Moreover, the solution was simple, and Matt knew what to do. It did not require much effort and did not result in any judgement of self or the technology. Instead, Matt adjusted to the situation, without bother, understanding what was required.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContrary case.\u003c/b\u003e Nora recently began taking digital skills classes at her old primary school, now the local community center. Nora is delighted with her new device on which she can make calls, send texts, and use some apps. She has even developed a trick for remembering passwords. Always one to enjoy a challenge, she is enjoying learning new skills as well as the social aspect of the drop-in classes. When she decides to do something new on her phone, she tells her partner, \u0026lsquo;I need to go back to school!\u0026rsquo; and plans to attend the next drop-in session. Nora may continue to discover new features on her smartphone, but instead of having an uncomfortable emotional reaction, she still finds pleasure and novelty at the opportunities provided for further learning and socialization. Concerns about time, effort and judgement are not present in this example, thereby illustrating that Nora is not experiencing bother in this situation currently.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e4.5 Comparison with similar concepts\u003c/h2\u003e\u003cp\u003eThe remaining step in the process of concept analysis is comparison of the concept under analysis with other similar concepts [10]. The term bother began to be used in the 1800\u0026rsquo;s and is believed to have originated in Ireland [36]. Burden is a second concept like, and often conflated with, bother. There are instances when the terms might be effectively used interchangeably, such as \u0026lsquo;I don\u0026rsquo;t want to bother/burden her with my worries\u0026rsquo;. However, the concept of burden in health contexts refer to an ongoing heavy workload that is constant, difficult, and has negative personal consequences [37]. A key contrasting attribute of bother is that it is characterized as something judged to be of low importance or seriousness and only temporarily disturbing [13]. The consequences of a burden may also differ from those of bother, for example it may be easier to avoid or adapt to something bothersome than in the case of an ongoing burden, which requires not just effort but is \u0026lsquo;hard work\u0026rsquo; [38]. Nonetheless, sustained bother may ultimately become burdensome, such as with the ongoing workload of symptom management in chronic illness [37, 38] and pressure to use DHTs in older age [5]. This suggests both concepts may be part of a continuum, a proposition that warrants further examination. The multi-dimensionality of bother may also distinguish it from other similar concepts; however, further comparison is required to establish if this is the case.\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Discussion","content":"\u003cp\u003eIn the Baseline Report for the Decade of Healthy Ageing, it is proposed that \u0026lsquo;fundamental changes in the clinical focus of care\u0026rsquo; and how it is organized and delivered will be necessary in response to population ageing [1, p.8]. Reorganization of care is set to include widespread deployment of DHTs. It is already recognized that digital inclusion in older age is influenced by various factors, from a lack of digital technology access [39] to ageism [40, 41], insufficient skills [42, 43], dependency [44], and support [45, 46]. Putting older persons under pressure to use DHTs for health and wellbeing monitoring and self-management will undoubtedly add to these challenges and exacerbate incidences of bother. Consequently, increased stress can be expected [47]. Chen et al. [2] suggest that \u0026lsquo;future wearable devices will likely be designed to reduce the burden of interaction and the complexity of the devices, to improve adherence\u0026rsquo; (p. 1626). However, even if other digital exclusion factors are addressed, such designs will require better understanding of the factors that cause bother, as a precursor to burden.\u003c/p\u003e\u003cp\u003eBased on our findings, bother is a negatively experienced reaction to a change or interruption causing uncertainty. Including an emotional reaction, as well as judgement of self and circumstances, bother is influenced by temporality and the effort demanded to cope with it. When bother triggers are experienced only intermittently, and evaluated as inconveniently disruptive, help-seeking behaviors can result in bother self-management, thereby mitigating potential negative consequences. However, bother experienced repeatedly, over a sustained period, may result in adaptive behaviors borne out of resignation, with the risk of becoming an unmanageable significant threat or burden [5]. In these instances, overall consequences of bother can include reduced quality of life as well as social or other exclusions. Over the long-term, repeated bother may result in experienced burden impacting quality of life and personal wellbeing. Our findings align with the position of Sallis et al. [48] who identified bother as a \u0026lsquo;global contributor to quality of life\u0026rsquo; (p. 476) and argued that clinicians owe it to patients to examine the concept further and identify how to mitigate and reduce experienced bother.\u003c/p\u003e\u003cp\u003eIt has been suggested that within the next decade, most older persons will have familiarity with digital technologies rendering concerns about the digital divide moot [49]. However, this perspective takes little account of the constantly evolving nature of digital technologies and the ongoing learning demands on end-users regardless of age. Furthermore, even use of only a narrow range of technologies, such as video calling resulting in fatigue and experienced vulnerability, represents antecedents to both bother and technostress for older DHT users [47]. Sustained bother and related stress can result, over time, in use of DHTs becoming burdensome. Such experiences can result in refusal to use or adopt such tools [5, 50]. A consequence of avoidance or withdrawal from DHT use presents a risk of digital exclusion. However, refusal to use DHTs further risks exclusion from health and care services that increasingly require digital engagement not only for health self-management but also for care access, such as scheduling appointments. There is, therefore, an imperative to understand bother and identify digital bother mitigation strategies for a range of health and wellbeing contexts facing people into older age.\u003c/p\u003e\u003cp\u003eThis paper is the first analysis of the widely used concept of bother, for a health and care context that is rapidly including a widening array of digital care and wellbeing monitoring elements. Critics of concept analyses have suggested that much scholarship in this area is little more than an intellectual exercise with little to offer either nursing specifically (as the field in which most concept analysis work is located) or science more generally [51, 52]. Cohen et al. [53] have shown there is value in modeling the cost of bother for users within multi-actor systems, such as health care, to resolve system use problems. However, their description of bother is limited to interruption and annoyance. By contrast, the value of the concept analysis presented in this paper lies in its recognition of the relational and multi-dimension aspects of the bother experience. Consequently, this paper contributes to the understanding of bother and can inform mitigation measures for digital health care delivery as well as engagement and adoption challenges in older age.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Limitations\u003c/h2\u003e\u003cp\u003eThe main limitation of this paper is that the concept of bother was not defined in most of the articles reviewed, despite the term found in either the title and/or abstract of each paper. The absence of digital health papers may also represent a gap to be further explored in the context of the objectives for the analysis. However, by reflecting a range of contexts, the dataset provided a basis for examination of the attributes, antecedents and consequences of the bother experience across a range of contexts. As a concept used in nursing and healthcare, further exploration of the specific experience of bother, as presented in this paper, would support greater clarity for its use in further studies. The absence of existing empirical measures of bother for analysis is also a limitation. However, this paper offers a framework to support the development of new measures to add clarity and utility for the application of the concept of bother in both digital health research and practice.\u003c/p\u003e\u003c/div\u003e"},{"header":"6 Conclusion","content":"\u003cp\u003eFurther research is needed to validate the bother attributes identified and develop tools to empirically measure both the presence and extent of bother across health and care settings. Furthermore, socio-economic or socio-cultural factors beyond age may exacerbate the contextual antecedents of digital health bother, as is the case for both digital and social exclusion. There is, therefore, a need to apply a broader lens in further research to explore the relationship between older age and digital bother, digital inclusion, and potential health inclusion as health care provision becomes increasingly digitalized. However, the findings presented in this concept analysis provide a foundation on which to build a better understanding of how bother influences health, care, inclusion, and ageing in a digitalized world.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no competing interests to declare. No funding was received for conducting this study.\u003c/p\u003e\u003cp\u003eThe authors have no financial or non-financial competing interests to declare.\u003c/p\u003e\u003ch2\u003ePatient or public contribution\u003c/h2\u003e\u003cp\u003eThe study focus was informed by discussions with older members of citizen panels at Living Labs in Belgium and Ireland. Members of the public (n\u0026thinsp;=\u0026thinsp;3) reviewed the interpretation of findings and provided feedback on the final draft of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe study conception, design, material preparation, data collection was performed by S.C.S. Data analysis was conducted by S.C.S. and C.V.L.. The first draft of the manuscript text was written by S.C.S. All authors contributed to and commented on subsequent versions of the manuscript text. S.C.S. prepared all tables and figures. A.J. supervised the work. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003ePatient or public contribution The study focus was informed by discussions with older members of citizen panels at LiCalab Living Labs, Belgium and NetwellCASALA Living Lab, Ireland. Members of the public (n=3) reviewed the interpretation of findings and provided feedback on the final draft of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files available at: https://zenodo.org/records/15034407\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization: Decade of healthy ageing: baseline report. World Health Organization (2021)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, C., Ding, S., Wang, J.: Digital health for aging populations. Nat. 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(2005)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"universal-access-in-the-information-society","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"uais","sideBox":"Learn more about [Universal Access in the Information Society](http://link.springer.com/journal/10209)","snPcode":"10209","submissionUrl":"https://submission.nature.com/new-submission/10209/3","title":"Universal Access in the Information Society","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Digital Health, Concept Analysis, Ageing, Bother","lastPublishedDoi":"10.21203/rs.3.rs-7087419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7087419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eChallenges persist in the implementation of digital health technologies to support health and wellbeing care and self-management in older age. Perceiving such technologies as bothersome, older persons are often reluctant to adopt these new approaches to care. Experienced bother can contribute to a sense of inefficacy, exclusion, and vulnerability in older age. However, the core characteristics of bother, and their implications for nursing, healthcare, and the digital health transition have not been examined to date. The aim of this paper is to examine the concept of bother in the context of digital health engagement in older age.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eUsing the concept analysis method of Walker and Avant, the antecedents, attributes, and consequences of bother were identified from a range of sources. The outcomes of a literature review, entries retrieved from dictionaries and thesauri, and outputs from a generative AI language exploration were thematically analyzed using an inductive approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFindings indicate that bother is an emotion-based reaction to an interruption and uncertainty. Bother attributes include emotions, judgement, time, and effort. Consequences of bother can include exclusion as well as having a negative impact on relationships and quality of life.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eApplication and further evaluation of these characteristics of the concept, in the context of digital health adoption in older age, is necessary to inform the design of digital health interventions and care delivery.\u003c/p\u003e","manuscriptTitle":"Bother: a concept analysis and implications for digital health inclusion in older age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-29 18:08:36","doi":"10.21203/rs.3.rs-7087419/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"101183784449953043267919778803880799001","date":"2026-05-15T00:45:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-13T14:00:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T13:56:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-11T07:26:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Universal Access in the Information Society","date":"2025-07-09T21:56:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"universal-access-in-the-information-society","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"uais","sideBox":"Learn more about [Universal Access in the Information Society](http://link.springer.com/journal/10209)","snPcode":"10209","submissionUrl":"https://submission.nature.com/new-submission/10209/3","title":"Universal Access in the Information Society","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3a3aad53-3090-4337-a0ba-4e917d0477b6","owner":[],"postedDate":"July 29th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"101183784449953043267919778803880799001","date":"2026-05-15T00:45:32+00:00","index":17,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-13T14:08:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-29 18:08:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7087419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7087419","identity":"rs-7087419","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}