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Gerbaudo-González N, Rodríguez-González R, Facal-Mayo D, Gandoy-Crego M. Personalized interactive multimedia systems to support meaningful activities in dementia care: A systematic review To be published in: Archives of Gerontology and Geriatrics. Arch Gerontol Geriatr 2024; 127:105575. [PMID: 39038393 DOI: 10.1016/j.archger.2024.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Interactive multimedia systems are widely used to enhance participation in meaningful activities for older people living with dementia. This review aims to analyze and synthesize current evidence regarding personalization of these systems, by considering the type of content included, the selection process and the experience of people living with dementia when interacting with the content. MATERIALS AND METHODS In accordance with PRISMA guidelines (PROSPERO registration number blinded for review), a systematic search was undertaken across 4 databases. Meta-aggregation pooled data for synthesis. RESULTS A total of 520 articles were identified from searches in four databases, and 15 were included in this review. Two classes of content were identified: personal, often autobiographical; and curated, carefully chosen generic content appropriate for a wider group of people in the demographic. Variety of content can act as a trigger for autobiographical memories. Personalized music enhanced a desire to engage and prompted meaningful interactions among participants. DISCUSSION AND IMPLICATIONS Despite some differences in the selected studies, the findings enabled us outline key points to consider when personalizing interactive multimedia systems for people living with dementia. Further research should focus on studying the social condition of the target users during the personalization process and on the benefits for caregivers.
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Affiliation(s)
- Noelia Gerbaudo-González
- Department of Developmental Psychology, Faculty of Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Raquel Rodríguez-González
- Department of Psyquiatry, Radiology, Public Health, Nursing and Medicine, Faculty of Nursing, University of Santiago de Compostela, Spain
| | - David Facal-Mayo
- Department of Developmental Psychology, Faculty of Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Gandoy-Crego
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Faculty of Nursing, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
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Kiselica AM, Lin SSH, Ranum R, Mikula CM, Hermann G, Boone A, Scullin M, Mechanic-Hamilton D, Wolf T, Stevens A, Benge JF. The Technology in Caring Questionnaire: Development and Psychometric Properties. Alzheimer Dis Assoc Disord 2024; 38:77-84. [PMID: 38277628 PMCID: PMC10922679 DOI: 10.1097/wad.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE We developed the Technology in Caring Questionnaire (TCQ) to assess the use of technology-based strategies by dementia caregivers. METHODS One hundred caregivers completed a survey that included TCQ items along with measures of technology proficiency and patient and caregiver-centered outcomes. RESULTS The final 34-item TCQ scale had adequate to excellent internal consistency (raw Cronbach alpha = 0.75; standardized Cronbach alpha = 0.95; Guttman lambda-6 = 0.97). TCQ scores demonstrated modest convergent associations with scores from measures of smartphone ( r = 0.265, P < 0.01) and computer proficiency ( r = 0.230, P < 0.05) but a strong association with overall technology experience scores ( r = 0.578, P < 0.001). Elevated TCQ scores were associated with reduced informant-reported cognitive symptoms ( B = -0.003, P < 0.05), increased ability of caregivers to find support and information ( B = 0.03, P < 0.001), and increased direct care strain ( B = 0.03, P < 0.05), after controlling for dementia severity and demographics. CONCLUSION The TCQ has good psychometric properties for the assessment of technology-based care strategies among dementia caregivers. Findings imply that the use of technologies may aid in symptom management and finding support and information but may also increase caregiver strain.
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Affiliation(s)
| | | | - Rylea Ranum
- Department of Psychology, University of Houston—Austin
| | - Cynthia M. Mikula
- New York State Psychiatric Institute, Columbia University Irving Medical Center—Austin
| | - Greta Hermann
- Department of Health Psychology, University of Missouri—Austin
| | - Anna Boone
- Department of Occupational Therapy, University of Missouri—Austin
| | - Michael Scullin
- Department of Psychology & Neuroscience, Baylor University—Austin
| | | | - Timothy Wolf
- Department of Occupational Therapy, University of Missouri—Austin
| | - Alan Stevens
- Center for Applied Health Research, Baylor Scott and White Health—Austin
| | - Jared F. Benge
- Department of Neurology and Mulva Clinic for the Neurosciences, University of Texas—Austin
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Gris F, D’Amen B, Lamura G, Paciaroni L, Socci M, Melchiorre MG. Personalized Technological Support for Informal Caregivers of Older People with Dementia: A Co-Design Approach Involving Potential End Users and Healthcare Professionals in Three Focus Groups in Italy. Healthcare (Basel) 2023; 11:2640. [PMID: 37830677 PMCID: PMC10572801 DOI: 10.3390/healthcare11192640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Informal/family caregivers (ICs) of older people with dementia (PwD) can suffer from depression and burnout. However, digital solutions can potentially provide innovative ways to facilitate care provision. The aim of this study was to analyze the opinions of end users (EUs), i.e., PwD aged 65 years and over and their ICs and healthcare professionals (HPs), on the use of digital technology to support care activities. Qualitative data were collected during the co-design phase of the European project "DemiCare-Personalized support for informal caregivers of people with dementia". This study focused on the Italian context and included two PwD, three ICs, and seven HPs. Three focus groups were held in April-June 2022. Qualitative data were analyzed using MaxQDA 2020 software. Seven thematic areas were identified: daily activities, care tasks, information needs, support received, relationship with and expectations from technology, functionality of the DemiCare integrated system, and ethical issues. Smart devices seemed to be received positively by ICs and HPs, although older PwD seemed to have difficulty accepting the technology. Overall, despite the low number of participants, it seems important and potentially effective to consider the needs and preferences of PwD during exploratory co-design to allow social interactions with them. This study was not registered.
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Affiliation(s)
- Francesca Gris
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Barbara D’Amen
- Italian National Institute of Statistics—ISTAT, Via Cesare Balbo 39, 00184 Rome, Italy
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Lucia Paciaroni
- Neurology Unit, Centre for Cognitive Disorders and Dementias, IRCCS INRCA—National Institute of Health and Science on Ageing, 60129 Ancona, Italy;
| | - Marco Socci
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
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Daly-Lynn J, Ryan A, McCormack B, Martin S. Stakeholder's experiences of living and caring in technology-rich supported living environments for tenants living with dementia. BMC Geriatr 2023; 23:62. [PMID: 36726077 PMCID: PMC9889957 DOI: 10.1186/s12877-023-03751-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Technology innovation provides an opportunity to support the rising number of people living with dementia globally. The present study examines experiences of people who have dementia and live in technology enriched supported care models. Additionally, it explores caregiver's attitudes towards technology use with the housing scheme. METHODS A qualitative research design was adopted, and eight housing schemes consented to take part in the study. A technology audit was undertaken in addition to participant interviews and caregiver survey. Seven peer researchers conducted semi-structured interviews with 22 people living with dementia. Interviews were analysed using thematic analysis. Informal and formal caregivers were invited to complete a survey to capture their attitudes towards technology use. A total of 20 informal and 31 formal caregiver surveys were returned. All surveys were input into Survey Monkey and downloaded into excel for analysis. Closed questions were analysed using descriptive statistics and open-ended questions were organised into themes and described descriptively. RESULTS The technology audit identified that technologies were in place from as early as 2002. Technology heterogeneity of, both passive and active devices, was found within the housing schemes. Technologies such as wearable devices were reportedly used according to need, and mobile phone use was widely adopted. The themes that developed out of the tenant interviews were: Attitudes and Engagement with Technology; Technology Enhancing Tenants Sense of Security; Seeking Support and Digital Literacy; and Technology Enabled Connection. A lack of awareness about living alongside technology was a major finding. Technologies enabled a sense of reassurance and facilitated connections with the wider community. The interaction with technology presented challenges, for example, remembering passwords, access to Wi-Fi and the identification of its use in an emergency. The caregiver survey reported a range of facilitators and barriers for the use of technology within care. Both types of caregivers held relatively similar views around the benefits of technology, however their views on issues such as privacy and consent varied. Safety was considered more important than right to privacy by family caregivers. CONCLUSIONS The present study provides new insight into stakeholder's experiences of living, working and caregiving alongside technology in supported living environments. As the generation of people living with dementia become more tech savvy, harnessing everyday technologies to support care could enable holistic care and support the transition through the care continuum. Advance care planning and technology assessments are at the very core of future technology provision. It is evident that a paternalistic attitudes towards technology use could impact the multitude of benefits technology can play in both health and leisure for people living with dementia and their caregivers.
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Affiliation(s)
- Jean Daly-Lynn
- grid.12641.300000000105519715School of Health Sciences, Ulster University, Newtownabbey, Northern Ireland
| | - Assumpta Ryan
- School of Nursing, Ulster University, Magee, Northern Ireland
| | - Brendan McCormack
- grid.104846.fHead of Division of Nursing, Queen Margaret University, Scotland, UK
| | - Suzanne Martin
- grid.12641.300000000105519715School of Health Sciences, Ulster University, Newtownabbey, Northern Ireland
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Leung T, Turner NR, Liu L, Karras SW, Chen A, Fredriksen-Goldsen K, Demiris G. Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool. JMIR Aging 2022; 5:e39335. [PMID: 35896014 PMCID: PMC9377442 DOI: 10.2196/39335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes. OBJECTIVE We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. METHODS We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention. RESULTS The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. CONCLUSIONS This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits.
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Affiliation(s)
| | - Natalie R Turner
- School of Social Work, University of Washington, Seattle, WA, United States
| | - Liu Liu
- College of Education, University of Washington, Seattle, WA, United States
| | - Sierramatice W Karras
- Clinical Informatics Research Group, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Amy Chen
- Clinical Informatics Research Group, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | | | - George Demiris
- School of Nursing and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Gately ME, Tickle-Degnen L, McLaren JE, Ward N, Ladin K, Moo LR. Factors Influencing Barriers and Facilitators to In-home Video Telehealth for Dementia Management. Clin Gerontol 2022; 45:1020-1033. [PMID: 34096477 DOI: 10.1080/07317115.2021.1930316] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Quality dementia care, which recognizes caregivers as vital care partners, is a scarce resource. Innovative solutions like video telehealth may increase the reach of extant clinicians; however, little is known about perceived barriers and facilitators to in-home video telehealth for dementia management from the perspectives of caregivers. METHODS Twenty-four caregivers of community-dwelling Veterans with dementia participated in semi-structured interviews. Questions gathered perceived facilitators and barriers to in-home video telehealth for dementia management through experience with related technology. Transcripts were analyzed using directed content analysis which was guided by factors previously identified as influencing older adults' adoption of technology. RESULTS Caregiver experience with related technology was mostly facilitative to video telehealth, which was thought best suited for follow-up care. Increased access and decreased patient-caregiver stress were potential benefits. Barriers included perceived limitations of video and the belief that persons with dementia would have limited ability to manage technological aspects and to engage in video telehealth on their own. CONCLUSIONS This study improves our understanding of the factors that caregivers perceive as barriers and facilitators to in-home video telehealth for dementia management. CLINICAL IMPLICATIONS Strategies to optimize video telehealth include capitalizing on caregivers' social network and providing targeted training.
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Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Tickle-Degnen
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Jaye E McLaren
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Nathan Ward
- Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Lauren R Moo
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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Toward the Integration of Technology-Based Interventions in the Care Pathway for People with Dementia: A Cross-National Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910405. [PMID: 34639704 PMCID: PMC8508540 DOI: 10.3390/ijerph181910405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The integration of technology-based interventions into health and care provision in our aging society is still a challenge especially in the care pathway for people with dementia. OBJECTIVE The study aims to: (1) identify which socio-demographic characteristics are independently associated with the use of the embodied conversational agent among subjects with dementia, (2) uncover patient cluster profiles based on these characteristics, and (3) discuss technology-based interventions challenges. METHODS A virtual agent was used for four weeks by 55 persons with dementia living in their home environment. RESULTS Participants evaluated the agent as easy-to-use and quickly learnable. They felt confident while using the system and expressed the willingness to use it frequently. Moreover, 21/55 of the patients perceived the virtual agent as a friend and assistant who they could feel close to and who would remind them of important things. CONCLUSIONS Technology-based interventions require a significant effort, such as personalized features and patient-centered care pathways, to be effective. Therefore, this study enriches the open discussion on how such virtual agents must be evidence-based related and designed by multidisciplinary teams, following patient-centered care as well as user-centered design approaches.
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Beentjes KM, Neal DP, Kerkhof YJF, Broeder C, Moeridjan ZDJ, Ettema TP, Pelkmans W, Muller MM, Graff MJL, Dröes RM. Impact of the FindMyApps program on people with mild cognitive impairment or dementia and their caregivers; an exploratory pilot randomised controlled trial. Disabil Rehabil Assist Technol 2020; 18:253-265. [PMID: 33245000 DOI: 10.1080/17483107.2020.1842918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE FindMyApps is a web-based selection-tool and errorless learning training program to help people with mild dementia/Mild Cognitive Impairment (MCI) and caregivers find user-friendly apps. In preparation of a definitive trial, the impact and feasibility of the FindMyApps intervention on self-management and engagement in meaningful activities, including social participation, was explored. MATERIALS AND METHODS An exploratory pilot randomised controlled trial (trial registration approval number: NL7210) with pre/post measurements was conducted with community-dwelling people with mild dementia/MCI and their caregivers (n = 59) in the Netherlands. Dyads in the experimental group (n = 28) received training to use the tablet and FindMyApps, and the errorless learning method was taught to their caregivers. Control group dyads (n = 31) received a tablet (without FindMyApps), instructions on tablet-use and links to dementia-friendly apps. Validated instruments were used to assess person with dementia's self-management, meaningful activities and social participation, caregiver's sense of competence and both their quality of life. RESULTS AND CONCLUSIONS No statistical significant group differences on the outcomes were found. Small to moderate effect-sizes in favour of the FindMyApps group were found for self-management and social participation. Caregivers tended to have more positive care experiences. Subgroup analyses showed that people older than 70 benefitted more from FindMyApps regarding self-management and higher educated people benefitted more regarding social participation. FindMyApps is feasible for the target group and may have potential to improve self-management and social participation. For a future definitive effectiveness trial a larger sample size is recommended, as well as taking into account the possible impact of education and age.IMPLICATIONS FOR REHABILITATIONThe FindMyApps program is feasible for people with dementia/MCI and may have potential to improve their self-management and social participation.Informal caregivers may develop a more positive care experience when utilizing FindMyApps to find suitable apps for self-management and social participation for the person with dementia/MCI.
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Affiliation(s)
- Kim M Beentjes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - David P Neal
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Yvonne J F Kerkhof
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Centre for Nursing Research, Sector Health Care, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Caroline Broeder
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Faculty of Science, Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Zaïnah D J Moeridjan
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Faculty of Behavior and Movement Sciences, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Teake P Ettema
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Wiesje Pelkmans
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Majon M Muller
- Department of Internal Medicine, Section Geriatric Medicine, Center of Geriatric Medicine (COGA), Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Maud J L Graff
- Department of Rehabilitation and Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Øksnebjerg L, Woods B, Ruth K, Lauridsen A, Kristiansen S, Holst HD, Waldemar G. A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns. JMIR Mhealth Uhealth 2020; 8:e14694. [PMID: 31951217 PMCID: PMC6996756 DOI: 10.2196/14694] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/13/2019] [Accepted: 09/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. Objective This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. Methods The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days. Results Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. Conclusions For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.
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Affiliation(s)
- Laila Øksnebjerg
- Danish Dementia Research Centre, Department of Neurology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, United Kingdom
| | - Kathrine Ruth
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Annette Lauridsen
- Danish Dementia Research Centre, Department of Neurology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - Helle Dalsgaard Holst
- Dementia Clinic, Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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