Emerging ICT implementation issues in aged care

"It's a Very Good Second Option": Older Adults' Experience of Telehealth

INTRODUCTION

The growing ability to provide online services has enabled the proliferation of exercise-based telehealth interventions; however, adoption in older adults may be impacted by low digital literacy and "technophobia."

OBJECTIVES

The aim of this study was to explore the experience of community and aged-care dwelling older adults following exercise-based telehealth services to provide insights that could guide future telehealth exercise delivery.

DESIGN

Semi-structured interviews for qualitative analysis.

METHODS

Participants (age ≥60) who had completed at least one online exercise session from a registered health professional were recruited through a combination of purposeful and snowball sampling methods via their exercise facility or provider. A semi-structured interview guide was used by 2 interviewers to investigate participants' experiences and a "critical friends" approach used to identify common themes.

RESULTS

Thirteen interviews with 21 participants were conducted from 2 different facilities. Analysis identified meaning units within 3 themes and subthemes. Technology subthemes related to digital confidence prior to telehealth and changes during interventions, as well as the usability of technology for telehealth. Clinical practice subthemes described the different motivations to exercise, perceived benefits of telehealth, important implications for practitioners, and perceptions of safety. The social connection theme related to the social benefits of telehealth.

CONCLUSIONS

Older adults in our sample were technologically confident and capable of performing exercise sessions delivered via telehealth. They notice benefits from this form of exercise delivery however, prefer face-to-face exercise delivery.

What are the determinants of older people adopting communicative e-health services: a meta-ethnography

BACKGROUND

Gradually, society has shifted more services online, with COVID-19 highlighting digital inequalities in access to services such as healthcare. Older adults can experience such digital inequalities, yet this group is also more likely to need medical appointments, compared to younger people. With the growing digitalisation of healthcare, it is increasingly important to understand how older people can best use communicative e-health services to interact with healthcare services. This is especially if older adults are to access, and actively interact with health professionals/clinicians due to their general health decline. This review aims to synthesise older adults' experiences and perceptions of communicative e-health services and, in turn, identify barriers and facilitators to using communicative e-health services.

METHODS

A meta-ethnography was conducted to qualitatively synthesise literature on older adults' experiences of using communicative e-health services. A systematic search, with terms relating to 'older adults', 'e-health', 'technology', and 'communication', was conducted on six international databases between January 2014 and May 2022. The search yielded a total of 10 empirical studies for synthesis.

RESULTS

The synthesis resulted in 10 themes that may impact older adults' perceptions and/or experiences of using communicative e-health services. These were: 1) health barriers, 2) support networks, 3) application interface/design, 4) digital literacy, 5) lack of awareness, 6) online security, 7) access to digital devices and the internet, 8) relationship with healthcare provider(s), 9) in-person preference and 10) convenience. These themes interlink with each other.

CONCLUSION

The findings suggest older adults' experiences and perceptions of communicative e-health services are generally negative, with many reporting various barriers to engaging with online services. However, many of these negative experiences are related to limited support networks and low digital literacy, along with complicated application interfaces. This supports previous literature identifying barriers and facilitators in which older adults experience general technology adoption and suggests a greater emphasis is needed on providing support networks to increase the adoption and usage of communicative e-health services.

Home-based exercise interventions delivered by technology in older adults: A scoping review of technological tools usage

BACKGROUND

Despite technology-based systems being considered promising tools to stimulate and increase physical function at home, most older adults are unfamiliar with technology, which may pose some difficulties. Technology-related parameters, such as adherence, acceptance, and acceptability, are crucial to achieving higher efficacy levels of home-based exercise interventions delivered by technology. In this scoping review, we aimed to revise the use of home-based technological tools to improve physical function in the older population, focusing on the user's experience and perspective. Methods This scoping review was conducted following PRISMA guidelines. The search was conducted in April 2022 and updated in April 2023. A total of 45 studies were included in the review. Results Most studies (95.5%) met the technology usage levels defined by the research team or reported satisfactory technology usage levels. Positive health-related outcomes were reported in 80% of studies. Although the existence of guidelines to correctly define and use measures associated with technology use, including adherence, acceptance and acceptability, some terms are still being used interchangeably. Some concerns related to the lack of an international consensus regarding technology usage measures and the exclusion of older adults who did not own or have previous experience with technology in a large percentage of the included studies may have limited the results obtained. Conclusions Altogether, home-based exercise interventions delivered through technology were associated with positive health-related outcomes in older adults, and technology usage levels are considered satisfactory. Older adults are willing and able to use technology autonomously if adequate support is provided.

Factors that influence the implementation of innovation in aged care: a scoping review

OBJECTIVE

The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care.

INTRODUCTION

Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care.

INCLUSION CRITERIA

This review included studies of any design, that examined the implementation of innovations in aged care settings.

METHODS

Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops.

RESULTS

Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies.

CONCLUSIONS

Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.

Wheelchair-mounted robotic arms: a survey of occupational therapists' practices and perspectives

PURPOSE

Despite the benefits of wheelchair-mounted robotic arms (WMRAs), occupational therapists are not yet widely involved in the recommendation or implementation of these assistive devices. The purpose of this study was to investigate and compare the current practices and perspectives of occupational therapists who had and had not recommended a WMRA on the recommendation, training, and implementation of WMRAs.

METHODS

This was a descriptive cross-sectional study. An online survey was sent to Canadian, European, and American occupational therapists who had or had not worked with WMRAs. Respondents were asked close-ended questions about their experience, role, barriers, motivations, and future needs regarding WMRAs. We compared results between respondents who had and had not recommended WMRAs using descriptive statistics.

RESULTS

Ninety-three North American and European occupational therapists completed the survey. Of those, 29 (31.2%) had recommended a WMRA, mostly the JACO robotic arm (n = 26, 89.7%) in rehabilitation centres (n = 18, 62.1%). Their perspectives on their role and barriers related to WMRAs were similar to those who had never recommended a WMRA. All respondents recognised the relevance of occupational therapists' contribution, and most reported interest in WMRAs (n = 76, 81.7%). However, many barriers emerged, mainly related to limited funding (n = 49, 76.6%), lack of training and knowledge (n = 38, 59.4%), and resource constraints (n = 37, 54.4%). Future needs identified matched these barriers.

CONCLUSION

This survey provides novel insight into occupational therapists' perspectives on WMRAs. It highlights that health professionals need to have easier access to funding, formal training, and resources to support their involvement with WMRAs.Implications for rehabilitationMost occupational therapists are interested in working with WMRAs, considering the potential of these devices to support individuals with upper extremity impairments in their daily activities. They also recognise their unique contribution to the assessment, recommendation, and implementation process among multidisciplinary teams.WMRA recommendation is relevant in various clinical settings and with a wide range of client populations. Nevertheless, it appears that occupational therapists working with adults, in rehabilitation centres or specialised clinics, may have more opportunities to get involved in this process and to attend formal training on this technology, as compared to other settings.Many barriers remain, impeding occupational therapists' role in the recommendation and implementation of WMRAs. Addressing these barriers may increase the number of devices that are successfully adopted and utilised by individuals with upper extremity impairments. In particular, future research and health policies should focus on access to sufficient funding, formal training, and resources for occupational therapists relative to their role in recommending and implementing WMRAs.

Usability and Acceptability of Clinical Dashboards in Aged Care: Systematic Review

BACKGROUND

The use of clinical dashboards in aged care systems to support performance review and improve outcomes for older adults receiving care is increasing.

OBJECTIVE

Our aim was to explore evidence from studies of the acceptability and usability of clinical dashboards including their visual features and functionalities in aged care settings.

METHODS

A systematic review was conducted using 5 databases (MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL) from inception to April 2022. Studies were included in the review if they were conducted in aged care environments (home-based community care, retirement villages, and long-term care) and reported a usability or acceptability evaluation of a clinical dashboard for use in aged care environments, including specific dashboard visual features (eg, a qualitative summary of individual user experience or metrics from a usability scale). Two researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review, and the risk of bias was measured using the Mixed Methods Appraisal Tool.

RESULTS

In total, 14 articles reporting on 12 dashboards were included. The quality of the articles varied. There was considerable heterogeneity in implementation setting (home care 8/14, 57%), dashboard user groups (health professionals 9/14, 64%), and sample size (range 3-292). Dashboard features included a visual representation of information (eg, medical condition prevalence), analytic capability (eg, predictive), and others (eg, stakeholder communication). Dashboard usability was mixed (4 dashboards rated as high), and dashboard acceptability was high for 9 dashboards. Most users considered dashboards to be informative, relevant, and functional, highlighting the use and intention of using this resource in the future. Dashboards that had the presence of one or more of these features (bar charts, radio buttons, checkboxes or other symbols, interactive displays, and reporting capabilities) were found to be highly acceptable.

CONCLUSIONS

A comprehensive summary of clinical dashboards used in aged care is provided to inform future dashboard development, testing, and implementation. Further research is required to optimize visualization features, usability, and acceptability of dashboards in aged care.

Managing changes in the environment of human-robot interaction and welfare services

The purpose of this study was to investigate decision-makers' views on changes that robotics will create in welfare services. The purpose was also to discover what the opportunities and challenges are in human-robot interaction during these changes and how to manage these changes. As a research method, an online survey was used. The survey was sent to Finnish decision-makers (N = 184). They were divided into three groups: Techno-positive (n = 66), Techno-neutral (n = 47), and Techno-critical (n = 71). According to the results, more than 80% of the respondents saw that robots can offer support in existing work tasks, and more than 70% saw that the robots can do existing tasks. The most often mentioned challenges were the reduction of interaction and the reduction of human touch. Further, there are various knowledge needs among the respondents. Most of the knowledge needs were not based on the technical use of the robots; rather, they were quite scattered. The results suggest that successful use and implementation of robots in welfare services require a comprehensive plan and change agents. This study suggests that techno-positive people could act as change agents, assisting in implementing the changes. In addition, to manage change in the welfare services it is essential to improve the quality of the information, solve the resistance to change, create organizational awareness, and understanding, and establish a psychological commitment to change the processes.

A study on the quality evaluation index system of smart home care for older adults in the community --based on Delphi and AHP

BACKGROUND

In the context of the "silver wave" and "technology wave", smart home care for older adults in the community provide new ways for China and other countries to support ageing in place. Yet, only very few studies have focused on developing a quality index system of smart care. This study attempted to draw on the SERVQUAL model to establish a quality evaluation index system for smart senior care for older adults in the community.

METHODS

On the basis of the service quality model, this paper has integrated qualitative and quantitative analyses using the Delphi and Analytic Hierarchy Process (AHP) methods to construct the index system of smart home care in the community and obtain the weights. These were based on literature research and field interviews in Guangzhou and Shenzhen pilot districts.

RESULTS

A quality evaluation indexes system of smart home care for older adults in the community was developed, with 5 primary indices and 33 secondary indices. The weights of the 5 stair indices from high to low were smart emergency assistance 0.332, smart meal assistance 0.272, smart medical assistance 0.229, smart cleaning assistance 0.110 and smart amusement assistance 0.057.

CONCLUSION

The results from the weight allocation revealed smart emergency assistance, smart meal assistance, and smart medical care assistance were the most important and crucial aspects of community-based smart home care. The study also suggested that "timeliness", "reliability", and "ease of use" should be given more attention. It is recommended to use this index system as a regulatory benchmark to guide the government bodies, senior care enterprises and communities to take measures to enhance the quality.

A Study on Technology Acceptance of Digital Healthcare among Older Korean Adults Using Extended Tam (Extended Technology Acceptance Model)

The use of digital health and wrist-worn wearable technologies have been increasingly utilized, especially during COVID-19 surge, to help monitor patients and vulnerable groups such as elderly people. As one of the countries with highest aging population, South Korean older adults are expected to be familiarized with these healthcare technologies. However, there have been a few studies on the investigation of Korean older adults’ attitude towards the acceptance of wearable technologies, such as a smart health watch after the COVID-19 curve flattened in South Korea. Thus, the purpose of this study is to investigate the acceptability of digital health wearable technology in healthcare by the Korean older adults and their attitude towards the use of smart health watches by using an extended Technology Acceptance Model while considering the context of the COVID-19 pandemic. We performed a cross-sectional survey of Korean adults aged 56 years and older who are living in Busan, and a total of 170 respondents were received. Results reveal that perceived usefulness, perceived ease of use, and facilitating conditions have a significant impact on older Korean’s attitudes towards the use of a smart health watch, while the relationship between social influence and attitude towards its use was found to not be statistically significant. The attitude towards the use of smart health watches had an effect on their intention to use the smartwatch. By using the findings from the study, the digital wearables providers, manufacturers, and promotors can enhance their strategy to elevate the use of digital healthcare wearables among Korean elderly people while ensuring these products are of good quality and affordable, as well as ensuring necessary assistance is provided to the elderly people when utilizing and adopting these wearables in their everyday lives. Moreover, the results of this study can be utilized to accommodate the needs of Korean elderly people regarding their use of smart health watches and help promote the benefits of healthcare wearable technologies after the pandemic subsides.

Hospitals' Adoption of Mobile-Based Personal Health Record Systems and Patients' Characteristics: A Cross-Sectional Study Analyzing National Healthcare Big Data

Insufficient information exists on the associations between hospitals' adoption of mobile-based personal health record (mPHR) systems and patients' characteristics. This study explored the associations between patients' characteristics and hospitals' adoption of mPHR systems in Korea. This cross-sectional study used 316 hospitals with 100 or more beds as the unit of analysis. Previously collected data on mPHR adoption from May 1 to June 30, 2020 were analyzed. National health insurance claims data for 2019 were also used to analyze patients' characteristics. The dependent variable was mPHR system adoption (0 vs 1) and the main independent variables were the number of patients, age distribution, and proportions of patients with cancer, diabetes, and hypertension among inpatients and outpatients. The number of inpatients was significantly associated with mPHR adoption (adjusted odds ratio [aOR]: 1.174; 1.117-1.233, P < .001), as was the number of outpatients (aOR: 1.041; 1.028-1.054, P < .001). The proportion of inpatients aged 31 to 60 years to those aged 31 years and older was also associated with hospital mPHR adoption (aOR: 1.053; 1.022-1.085, P = .001). mPHR system adoption was significantly associated with the proportion of inpatients (aOR: 1.089; 1.012-1.172, P = .024) and outpatients (aOR: 1.138; 1.026-1.263, P = .015) with cancer and outpatients (aOR: 1.271; 1.101-1.466, P = .001) with hypertension. Although mPHR systems are useful for the management of chronic diseases such as diabetes and hypertension, the number of patients, younger age distribution, and the proportion of cancer patients were closely associated with hospitals' introduction of mPHR systems.

Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review

BACKGROUND

Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies.

OBJECTIVE

This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks.

METHODS

A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented.

RESULTS

The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied.

CONCLUSIONS

Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.

Investigating a Work System Approach to Implement an Emergency Department Surge Management System: Case Study

BACKGROUND

Emergency department (ED) crowding is a global health care issue. eHealth systems have the potential to reduce crowding; however, the true benefits are seldom realized because the systems are not integrated into clinicians' work. We sought a deep understanding of how an eHealth system implementation can be structured to truly integrate the system into the workflow.

OBJECTIVE

The specific objectives of this study were to examine whether work system theory (WST) is a good approach to structure the implementation of an eHealth system by incorporating the entire work system, and not just the eHealth system, in the implementation framework; identify the role that specific elements of WST's static framework and dynamic work system life cycle model play in the implementation; and demonstrate how WST can be applied in the health care setting to guide the implementation of an eHealth system.

METHODS

Through a case study of an ED in a rural hospital, we used a mixed methods approach to examine the implementation of a surge management system through the lens of WST. We conducted 14 hours of observation in the ED; 20 interviews with clinicians, management, and members of the implementation team; and a survey of 23 clinicians; reviewed related documentation; and analyzed ED data to measure wait times. We used template analysis based on WST to structure our analysis of qualitative data and descriptive statistics for quantitative data.

RESULTS

The surge management system helped to reduce crowding in the ED, staff was satisfied with the implementation, and wait time improvements have been maintained for several years. Although study participants indicated changes to their workflow, 72% (13/18) of survey participants were satisfied with their use of the system, and 82% (14/17) indicated that it was integrated with their workflow. Examining the implementation through the lens of WST enabled us to identify the aspects of the implementation that made it so successful. By applying the WST static framework, we saw how the implementation team incorporated the elements of the ED work system, assessed their alignment, and designed interventions to address areas of misalignment. The dynamic work system life cycle model captured how planned and unplanned changes were managed throughout the iterative implementation cycle-83% (15/18) of participants indicated that there was sufficient management support for the changes and 80% (16/20) indicated the change served an important purpose.

CONCLUSIONS

The broad scope and holistic approach of WST is well suited to guide eHealth system implementations as it focuses efforts on the entire work system and not just the IT artifact. We broaden the focus of WST by applying it to the implementation of an ED surge management system. These findings will guide further studies and implementations of eHealth systems using WST.

Use of Information and Communication Technology by South Korean Occupational Therapists Working in Hospitals: A Cross-Sectional Study

The convergence and development of information and communication technology (ICT) have brought changes to occupational therapy practices, posing novel challenges for occupational therapists (OTs). This study aimed to investigate current practices of ICT use and factors affecting the clinical use of ICT among Korean OTs. An online survey was conducted among 158 domestic OTs working in hospitals. Participants reported that the therapeutic use of ICT positively affected client outcomes, ICT choice, and continued use. Participants highlighted the necessity to assess the ability of clients to use smart devices and ensure familiarity in the OT process. Of respondents, 31% reported the application of ICT-based interventions or recommendations in clinical practice. The use of ICT was predominantly associated with cognitive function, leisure activities, and information access and communication. A significant difference in barriers to ICT use was observed between familiar users and non-users. Familiar users reported a lack of knowledge and training as major barriers, whereas non-users reported expensive products or technology. Ease of use and usefulness were facilitators of ICT use among familiar users. Information and training opportunities are required to promote ICT use by OTs, and the usefulness of ICT must be realized via client-centered, customized approaches.

Tailoring mHealth Apps on Users to Support Behavior Change Interventions: Conceptual and Computational Considerations

Personalization is an important factor to increase the user experience (UX) and effectiveness of mHealth solutions. In this paper, we present an innovative approach to the personalization of mHealth apps. A profiling function has been developed based on the physical and psychological characteristics of users, with the final aim to cluster them acting as a guideline to the design and implementation of new functionalities to improve the overall acceptance degree of the app. A preliminary analysis case study has been proposed to evaluate the impact on user experience according to the state of the art to draw useful lessons for future works.

ICT-based integrated framework for smart facility management: an industry perspective

Purpose

Current facility management (FM) practices are inefficient and ineffective, partially because of missing information and communication issues. Information and communications technologies (ICT) are asserted to provide a promising solution for managing and operating facilities. However, the impact of ICT applications on current FM practices needs to be validated and the perception of FM professionals on ICT-based FM needs to be understood. Therefore, this paper aims to investigate the impacts and the perception of ICT application on FM practice and further develop an ICT-based integrated framework for smart FM practices.

Design/methodology/approach

To achieve the objective, the research starts with reviewing several promising ICT for FM, including building information modeling, geographic information systems, unmanned aerial vehicle and augmented reality. On this basis, a conceptional framework was synthesized in consideration of the benefits of each technology. A survey questionnaire to FM professionals was conducted to evaluate the proposed framework and identify the challenges of adopting ICT in the FM industry. Furthermore, return on investment and strength, weakness, opportunities and threats analysis have been used in this paper as evaluation methods for ICT industry adoption.

Findings

The survey results are validated by FM professionals for the future engagement of the integrated ICT applications. Also, the proposed framework can assist the decision-makers to have comprehensive information about facilities and systematize the communication among stakeholders.

Originality/value

This research provides an integrated framework for smart FM to improve decision-making, capitalizing on the ICT applications. Apart from this, the study sheds light on future research endeavors for other ICT applications.

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol

INTRODUCTION

There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.

METHODS

This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.

ETHICS AND DISSEMINATION

This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.

Mechanism Influencing Older People's Willingness to Use Intelligent Aged-Care Products

Background: With the continuous integration of information technology in the aged-care industry, intelligent aged-care products have gradually appeared, positively promoting the development of the industry. To support the use of these products and to help older people to improve their own health literacy, we built a theoretical model of the mechanism influencing older people’s willingness to use intelligent aged-care products. Methods: A total of 241 valid questionnaires were collected through surveys in aged-care institutions in Anhui Province, China, for empirical analysis. Results: Older people’s perception of quality can significantly affect their emotional attachment and willingness to use these products. Emotional attachment has a significant positive impact on the willingness to use. Self-perceived ageing can also significantly affect the emotional attachment and willingness of older people to use these products. Conclusion: Through empirical analysis, the comprehensive mechanism influencing older people on the willingness to use intelligent aged-care products is clarified, which can help older people to better deal with the problems caused by ageing and help aged-care institutions better relieve the pressure on nursing staff.

Mediating Effects of Smartphone Utilization between Attitude and Willingness to Use Home-Based Healthcare ICT among Older Adults

OBJECTIVES

This study explored the direct and indirect effects of knowledge of new technology (e.g., artificial intelligence, the Internet of Things, and the Fourth Industrial Revolution), attitudes towards technology use, and smartphone utilization skills on older adults' willingness to use home-based information and communication technology (ICT) for self-health management.

METHODS

A phone survey was conducted among 300 older adults aged 65 or older in Gangwon Province, Republic of Korea. A path analysis was performed to identify the direct and indirect effects of knowledge of new technology, attitudes towards technology use, and smartphone utilization skills on willingness to use home-based healthcare ICT. Socioeconomic variables were used as control variables.

RESULTS

Knowledge of new technology, but not attitudes towards technology use, had a direct impact on smartphone utilization skills. Attitude towards technology use and smartphone utilization skills showed significant effects on willingness to use home-based healthcare ICT. One standard unit change in attitudes towards technology use contributed to a 0.172 unit change in willingness (p = 0.001), and one standard unit change in smartphone utilization skills changed willingness by 0.246 units (p < 0.001). In addition, older adults with a higher education level and economic status, and lower self-related health status, were more willing to use home-based healthcare ICT.

CONCLUSIONS

These findings underscore the necessity of enhancing the smartphone utilization skills of older adults and attitudes towards technology use. Providing more user-friendly services and increasing smartphone utilization skills among older adults would contribute to willingness to use home-based ICT for healthcare management.

Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals

Background

Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies.

Objective

The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being.

Methods

Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed.

Results

The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns.

Conclusions

The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation

Introduction

Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation.

Methods

This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool.

Results

Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings.

Conclusion

This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems

OBJECTIVES

To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives.

METHODS

We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth.

RESULTS

Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts.

CONCLUSIONS

Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.

Advancing health information technology roadmaps in long term care

BACKGROUND

Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services.

METHODS

This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions.

RESULTS

Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains.

CONCLUSIONS

The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.

Enablers and obstacles to implementing remote monitoring technology in cardiac care: A report from an interactive workshop

An ageing population and chronic disease are putting pressure on the Irish health system. The field of eHealth is rapidly evolving and has the potential to become an important component of healthcare, but there appears to be a gap currently between research in this field and the integration of eHealth technology into clinical practice. During the eHealth Ireland Ecosystem Conference held in April 2018, a workshop was conducted to explore the barriers and facilitators to the adoption of eHealth technology, particularly remote monitoring systems in community and home cardiac care. Participants included clinicians, academic researchers, technologists, patient advocates, policy makers, and representatives from the health service. The conversations in the workshop pivoted around why technology systems in cardiac care rarely moved beyond the research project stage and what can be done to address this issue. The discussions in the workshop focused around the lack of funding available, the need for reimbursement models, the lack of awareness about remote monitoring, the angst about who is responsible for the data generated, the design of systems, regulatory standards, and the increasing demand on services, education, and patient empowerment.

Personal and Interpersonal Drivers that Contribute to the Intention to Use Gerontechnologies

BACKGROUND

Over the past few years, various new types of technologies have been introduced, which have been tailored to meet the specific needs of older adults by incorporating gerontological design principles (i.e., "gerontechnologies"). However, it has been difficult to motivate older adults to adopt and use these new technologies. Therefore, it is crucial to better understand not only the role of personal drivers but also the family influences on older adults.

OBJECTIVE

This research goes beyond traditional technology acceptance theories by investigating the role of personal (e.g., inherent novelty seeking) and interpersonal drivers (e.g., influence of family) in stimulating older adults to use gerontechnologies. Nine hypotheses, building on traditional and new technology acceptance theories, were developed and tested.

METHODS

This research applies a cross-sectional study design. Therefore, a face-to-face survey instrument was developed building on a qualitative pilot study and validated scales. Three hundred and four older adults (minimum age = 70 years) were willing to participate as well as one of their family members. Structural equation modeling was applied to analyze the hypothesized conceptual model.

RESULTS

Our results extend the seminal technology acceptance theories by adding personal (i.e., inherent novelty seeking p = 0.017) and interpersonal drivers. More specifically, it was found that the attitude toward gerontechnologies was influenced by family tech savviness (i.e., people who often use technology), as this relationship is fully mediated through the social norms of older adults (p = 0.014). The same was found for older adults' trust in the family member's technology knowledge (p ≤ 0.001). Here, the relationship with older adults' attitude toward gerontechnologies was partially mediated by the older adults' trust in technology.

CONCLUSION

This study identified important personal and interpersonal drivers that influence attitudes toward and intentions to use gerontechnologies. To foster technology acceptance among older adults, it was found that it is important to strengthen the trust in and the attitude toward gerontechnologies. Furthermore, family members' knowledge and beliefs in technology were the keys to promoting the actual use of gerontechnologies among older adults. Furthermore, the families' trust in gerontechnologies and the provision of access to technology can improve their attitudes toward technology and usage intentions for the older relative.

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Background

Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.

Aim

To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.

Objectives

(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?

Data sources

Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.

Design

Mapping review and rapid, systematic evidence syntheses.

Setting

Care homes with and without nursing in high-income countries.

Review methods

Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.

Results

Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.

Limitations

This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.

Conclusions

This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.

Future work

Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.

Study registration

This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia

Background

Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers’ workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice.

Methods

In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data.

Results

The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service.

Conclusion

Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.

“Robots do not replace a nurse with a beating heart”

Purpose

The purpose of this paper is to investigate the publicity around the implementation of the Zora robot in elderly-care services in Lahti, Finland. The aim is to discover opinions concerning the use of robots in elderly care as well as the arguments and justifications behind those opinions. Zora is a humanoid robot intended to promote mobility and rehabilitation. The Lahti pilot was the first Zora pilot in Finland in public elderly-care services. It received much publicity, both regionally and nationally.

Design/methodology/approach

This study is based on an empirical case study on the implementation of the Zora robot in elderly-care services. The data consist of interviews with personnel who operated Zora and comments from the general public about the “Zora” robot. Two data sources were used: 107 comments were collected from online and print media, and the personnel (n=39) who worked with Zora were interviewed. The data were analysed by means of interpretative content analysis.

Findings

The results show that public opinion is mainly negative, but that the commentators apparently have little information about the robot and its tasks. The personnel had more positive views; they saw it as a recreational tool, not as a replacement for their own roles.

Originality/value

There is clearly a need for more information, for a better informed discussion on how robots can be used in elderly care and how to involve the general public in this discussion in a constructive way.

User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks

Background

Informal support is essential for enabling many older people to age in place. However, there is limited research examining the information needs of older adults’ informal support networks and how these could be met through home monitoring and information and communication technologies.

Objective

The purpose of this study was to investigate how technologies that connect older adults to their informal and formal support networks could assist aging in place and enhance older adults’ health and well-being.

Methods

Semistructured interviews were conducted with 10 older adults and a total of 31 members of their self-identified informal support networks. They were asked questions about their information needs and how technology could support the older adults to age in place. The interviews were transcribed and thematically analyzed.

Results

The analysis identified three overarching themes: (1) the social enablers theme, which outlined how timing, informal support networks, and safety concerns assist the older adults’ uptake of technology, (2) the technology concerns theme, which outlined concerns about cost, usability, information security and privacy, and technology superseding face-to-face contact, and (3) the information desired theme, which outlined what information should be collected and transferred and who should make decisions about this.

Conclusions

Older adults and their informal support networks may be receptive to technology that monitors older adults within the home if it enables aging in place for longer. However, cost, privacy, security, and usability barriers would need to be considered and the system should be individualizable to older adults’ changing needs. The user requirements identified from this study and described in this paper have informed the development of a technology that is currently being prototyped.

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

Background

eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality.

Objective

Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure.

Methods

We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles.

Results

Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1).

Conclusions

The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes

Background

The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs’ success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance.

Objective

The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality.

Methods

Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships.

Results

Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns.

Conclusions

Trust in health information and belief in the effectiveness of information security safeguards increases perceptions of patient care quality. Privacy concerns reduce patients’ frequency of accessing health records, patients’ positive attitudes toward HIE exchange, and overall perceived patient care quality. Health care organizations are encouraged to implement security safeguards to increase trust, the frequency of health record use, and reduce privacy concerns, consequently increasing patient care quality.

Testing an app for reporting health concerns-Experiences from older people and home care nurses

AIMS AND OBJECTIVES

To explore the experiences of using an app among older people with home-based health care and their nurses.

BACKGROUND

Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed.

DESIGN

Explorative qualitative design.

METHODS

For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis.

RESULTS

The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement.

CONCLUSIONS

The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future.

IMPLICATIONS FOR PRACTICE

The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.

Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data

Background

Patients undergoing radiotherapy for prostate cancer experience symptoms related to both the cancer itself and its treatment, and it is evident that patients with prostate cancer have unmet supportive care needs related to their disease. Over the past decade, there has been an increase in the amount of research within the field of mobile health and the use of apps as tools for managing illness. The main challenge is to develop a mobile technology to its full potential of being interactive in real time. The interactive app Interaktor, which aims to identify and manage symptoms in real time includes (1) a function for patients’ assessment of the occurrence, frequency, and distress of symptoms; (2) a connection to a monitoring Web interface; (3) a risk assessment model that sends alerts via text message to health care providers; (4) continuous access to evidence-based self-care advice and links to relevant websites for more information; and (5) graphs for the patients and health care providers to view the history of symptom reporting.

Objective

The aim of the study was to investigate user behavior, adherence to reporting, and the patients’ experiences of using Interaktor during radiotherapy for localized advanced prostate cancer.

Methods

The patients were instructed to report daily during the time of treatment and then for an additional 3 weeks. Logged data from patients’ use of the app were analyzed with descriptive statistics. Interview data about experiences of using the app were analyzed with content analysis.

Results

A total of 66 patients participated in the study. Logged data showed that adherence to daily reporting of symptoms was high (87%). The patients used all the symptoms included in the app. Of the reports, 15.6% generated alerts to the health care providers. Overall, the patients found that it was easy and not particularly time-consuming to send a daily report, and many described it as becoming a routine. Reporting symptoms facilitated reflection on their symptoms and gave them a sense of security. Few technological problems were reported.

Conclusions

The use of Interaktor increased patients’ sense of security and their reflections on their own well-being and thereby served as a supportive tool for the self-management of symptoms during treatment of prostate cancer. Some further development of the app’s content might be beneficial for future use.

Change, Connectivity, and Challenge: Exploring the Role of Health Technology in Shaping Health Care for Aging Populations in Asia Pacific

Aflthough the rapid increase in population aging observed across the globe poses significant challenges to the sustainability of health systems it has been paralleled by an exponential growth in health technologies. This article reviews the literature surrounding health technologies and explores how the future of aging and health care could be shaped by health technologies, with a particular focus on the Asia Pacific region. It shows that the field is wide in scope. The current expansion of information and communication technologies have brought a growing capacity to support health care, while future technology applications, such as robotics and 3D printing, offer a range of potential benefits to elderly populations. However, the uptake and level of development of health technologies varies widely throughout the region. Governments have begun developing frameworks to guide the implementation and monitoring of health technologies. However, a dearth of robust, evaluative studies, combined with the rapidly evolving nature of health technologies, present policy makers with a range of policy and implementation challenges, including issues surrounding infrastructure, funding, and the acceptability of technologies among older users. As health technologies play an increasingly pivotal part in health systems, there is a need to create robust mechanisms for ongoing assessment of health technology development.