An interactive ICT platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing - development and feasibility

Digital home care interventions and quality of primary care for older adults: a scoping review

BACKGROUND

Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults.

METHODS

This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization.

RESULTS

The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care.

CONCLUSIONS

The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.

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.

The Role of Information and Communication Technology (ICT) for Older Adults' Decision-Making Related to Health, and Health and Social Care Services in Daily Life-A Scoping Review

Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults' decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults' decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults' use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives.

Mobile health applications for older adults: a systematic review of interface and persuasive feature design

OBJECTIVE

Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes.

MATERIALS AND METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort.

RESULTS

We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education.

DISCUSSION

Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously.

CONCLUSIONS

This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.

Older persons’ experience of eHealth services in home health care: A meta-ethnography eHealth services in home health care

This study aimed to describe older persons’ experiences of eHealth services in home health care. A meta-ethnographic approach was applied, and a systematic literature search was conducted in three databases. In total, 11 articles were included and analysed, which resulted in two themes and six sub-themes. The results show that for older persons to use the eHealth services, they must provide some additional value compared to current contacts with healthcare professionals. Those with regular healthcare contact do not experience the eHealth service as adding anything to the care they already receive. The introduction of eHealth services involves learning how to use the new technology, and some older persons experience the technology as motivating and inspiring. The eHealth service makes some feel safer while some do not trust the technology. In order to make the best use of eHealth services, it is important that the services are adjusted not only to each person’s needs but also to their personal capabilities and resources, while the older person must feel valued as an active partner in the care process. Thus, when using eHealth services, the older person’s perspective needs to be given priority and decisions should not only be based on organizational considerations.

An app for supporting older people receiving home care - usage, aspects of health and health literacy: a quasi-experimental study

Background

During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.

Methods

A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.

Results

The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.

Conclusions

The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.

Reduced symptom burden with the support of an interactive app during neoadjuvant chemotherapy for breast cancer - A randomized controlled trial

Objectives

Neoadjuvant chemotherapy causes distressing symptoms, which have to be managed by patients at home. Assessing and acting upon relevant patient-reported symptoms regularly with the support of mHealth such as apps, has shown to decrease symptom burden and improve health-related quality of life (HRQoL). There is a lack of apps for patients with breast cancer which are tested in rigorous trials and only a few include interactive components for immediate clinical management. The aim of this study was to evaluate whether the use of the interactive app Interaktor improves patients’ levels of symptom burden and HRQoL during neoadjuvant chemotherapy for breast cancer.

Materials and methods

This randomized controlled trial included patients in an intervention group (n = 74) and a control group (n = 75), recruited at two university hospitals in Stockholm, Sweden. The intervention group used Interaktor for symptom reporting, self-care advice and support from health-care professionals during treatment, and the control group received standard care alone. Self-reported symptoms and HRQoL were assessed at two time points to determine differences between the groups.

Results

The intervention group rated statistically significant less symptom prevalence in nausea, vomiting, feeling sad, appetite loss and constipation. Overall symptom distress and physical symptom distress were rated statistically significant lower in the intervention group. Further, emotional functioning was rated statistically significant higher in the intervention group.

Conclusions

By using the Interaktor app in clinical practice, patients get individual support when managing treatment-related symptoms during neoadjuvant chemotherapy for breast cancer, leading to decreased symptom burden and improved emotional functioning.

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Using the app Interaktor reduced symptom burden in patients with breast cancer.

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The use of Interaktor enhanced emotional functioning during treatment.

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Interaktor provided individual support during neoadjuvant chemotherapy.

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Use of Interaktor allowed breast cancer patients for daily reflection over symptoms.

What does integrated care mean from an older person's perspective? A scoping review

OBJECTIVE

To systematically map and synthesise the literature on older adults' perceptions and experiences of integrated care.

SETTING

Various healthcare settings, including primary care, hospitals, allied health practices and emergency departments.

PARTICIPANTS

Adults aged ≥60 years.

INTERVENTIONS

Integrated (or similarly coordinated) healthcare.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using scoping review methodology, four electronic databases (EMBASE, CINAHL, PubMed and ProQuest Dissertation and Theses) and the grey literature (Open Grey and Google Scholar) were searched to identify studies reporting on older adults' experiences of integrated care. Studies reporting on empirical, interpretive and critical research using any type of methodology were included. Four independent reviewers performed study selection, data extraction and analysis.

RESULTS

The initial search retrieved 436 articles, of which 30 were included in this review. Patients expressed a desire for continuity, both in terms of care relationships and management, seamless transitions between care services and/or settings, and coordinated care that delivers quick access, effective treatment, self-care support, respect for patient preferences, and involves carers and families.

CONCLUSIONS

Participants across the studies desired accessible, efficient and coordinated care that caters to their needs and preferences, while keeping in mind their rights and safety. This review highlights the salience of the relational, informational and organisational aspects of care from an older person's perspective. Findings are transferable and could be applied in various healthcare settings to derive patient-centred success measures that reflect the aspects of integrated care that are deemed important to older adults and their supporters.

Implementing eScreening technology in four VA clinics: a mixed-method study

Background

Technology-based self-assessment (TB-SA) benefits patients and providers and has shown feasibility, ease of use, efficiency, and cost savings. A promising TB-SA, the VA eScreening program, has shown promise for the efficient and effective collection of mental and physical health information. To assist adoption of eScreening by healthcare providers, we assessed technology-related as well as individual- and system-level factors that might influence the implementation of eScreening in four diverse VA clinics.

Methods

This was a mixed-method, pre-post, quasi-experimental study originally designed as a quality improvement project. The clinics were selected to represent a range of environments that could potentially benefit from TB-SA and that made use of the variety eScreening functions. Because of limited resources, the implementation strategy consisted of staff education, training, and technical support as needed. Data was collected using pre- and post-implementation interviews or focus groups of leadership and clinical staff, eScreening usage data, and post-implementation surveys. Data was gathered on: 1) usability of eScreening; 2) knowledge about and acceptability and 3) facilitators and barriers to the successful implementation of eScreening.

Results

Overall, staff feedback about eScreening was positive. Knowledge about eScreening ranged widely between the clinics. Nearly all staff felt eScreening would fit well into their clinical setting at pre-implementation; however some felt it was a poor fit with emergent cases and older adults at post-implementation. Lack of adequate personnel support and perceived leadership support were barriers to implementation. Adequate training and technical assistance were cited as important facilitators. One clinic fully implemented eScreening, two partially implemented, and one clinic did not implement eScreening as part of normal practice after 6 months as measured by usage data and self-report. Organizational engagement survey scores were higher among clinics with full or partial implementation and low in the clinic that did not implement.

Conclusions

Despite some added work load for some staff and perceived lack of leadership support, eScreening was at least partially implemented in three clinics. The technology itself posed no barriers in any of the settings. An implementation strategy that accounts for increased work burden and includes accountability may help in future eScreening implementation efforts.

Note. This abstract was previously published (e.g., Annals of Behavioral Medicine 53: S1–S842, 2019).

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4436-z) contains supplementary material, which is available to authorized users.

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.

Early detection and management of symptoms using an interactive smartphone application (Interaktor) during radiotherapy for prostate cancer

Purpose

Patients undergoing radiotherapy for prostate cancer suffer from a variety of symptoms which influence health-related quality of life. We have developed an application (Interaktor) for smartphones and tablets for early detection, reporting and management of symptoms, and concerns during treatment for prostate cancer. The study evaluates the effect on symptom burden and quality of life when using the application for real-time symptom assessment and management during radiotherapy for localized prostate cancer.

Methods

A non-randomized controlled study was used at two university hospitals in Sweden where 64 patients constituted a control group and 66 patients made up an intervention group. The intervention group was asked to report symptoms via the application daily during the treatment as well as 3 weeks after. The EORTC QLQ-C30 and its module PR25 and the Sense of Coherence questionnaire were administered at three time points in both groups.

Results

The intervention group rated significantly lower levels of fatigue and nausea at the end of radiotherapy. Moreover, they had significantly less burden in emotional functioning, insomnia, and urinary-related symptoms at the end of treatment as well as 3 months later compared with the control group. In the multivariate analyses, with education and sense of coherence as covariates, the intervention group still significantly rated emotional functioning (p = 0.007), insomnia (p = 0.017), and urinary-related symptoms (p = 0.008) as better than the control group at T2.

Conclusion

Study findings suggest that Interaktor could be an efficient mHealth tool for facilitating supportive care needs during cancer treatment.