Mobile phone apps for family caregivers: A scoping review and qualitative content analysis

Supporting caregivers of people with dementia: insights from Demensia KITA mobile application online content development

Dementia significantly impacts caregivers, particularly in low and middle-income countries where support is often inadequate. Given the gap in affordable and culturally relevant digital resources for Malaysian dementia caregivers, we developed "Demensia KITA," a mobile application (app) specifically tailored to their needs. This study utilized a theoretical framework proposed from existing literature and the "Model of Carer Stress and Burden". This paper discusses our app content development, highlighting key findings and challenges. To assess caregivers' needs, the Nominal Group Technique (NGT) with five dementia caregivers was conducted, followed by a Focus Group Discussion (FGD) with eight medical professionals. Both sessions were conducted online via Google Meet. In the NGT, ideas were generated, organized, prioritized, reviewed, and refined by medical professionals in the FGD. Content relevant to addressing the complexities of dementia caregiving was then discussed. Topics were either adapted from established modules or newly developed from credible sources. Subsequently, these were organized into modules and themes, and subsequently underwent expert validation. From the NGT, three key domains emerged: Knowledge, Services, and Support. These were further organized into two modules: 'Patient Care for Caregivers' and 'Caregiver Wellbeing'. Within these, twelve sub-modules were identified, covering a range of topics including basic knowledge on dementia, patient care, nutritional management, oral and dental care, simple exercises, daily activity and memory rehabilitation, service directories, support groups, emotional and stress management, welfare assistance, and daily motivation. This framework was developed to address the specific needs of dementia caregivers in terms of psychoeducation, psychosocial and caregiving skills, incorporating expert opinions in the field. This study corroborates the feasibility of online methods for mobile health app content development and encourages similar research. Future studies should evaluate Demensia KITA's effectiveness in alleviating caregiver burden across all regions, assess users' acceptance, and ensure it meets the evolving needs of Malaysian caregivers with regular updates.

Exploring Family Caregivers' Likelihood of Adopting a Novel App That Connects Care Teams of Persons Living With Dementia: A Mixed-Methods Study

Family caregivers of persons living with dementia (PLWD) are often expected to coordinate and manage all aspects of a loved one's day-to-day care across settings with limited modern, user-friendly resources to support them. We developed CareMOBI, a mHealth app prototype that aims to support improved care coordination and communication between care team members. A concurrent mixed-methods triangulation design was used to assess the acceptability and likelihood of adopting CareMOBI among family caregivers of PLWD. Caregivers (n = 13) completed the Technology Acceptance Model questionnaire (quantitative) and semi-structured interviews (qualitative). Integration occurred using the four themes of the Technology Acceptance Model. There was strong agreement among family caregivers that CareMOBI had a high perceived value for care (M = 6.23/7), was easy to use (M = 6.20/7), and enhanced current workflows (M = 5.86/7). However, training in utilizing mHealth apps and the need for a Spanish-language version were cited as necessary enhancements to increase the widespread adoption of CareMOBI.

Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study

BACKGROUND

The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care "Caretown for Medly," which empowers ICs to concurrently expand patients' self-care abilities while acknowledging ICs' eagerness to provide greater support.

OBJECTIVE

We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly.

METHODS

We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint's ability to quickly "solve big problems and test new ideas," which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the "KTA Sprint."

RESULTS

We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care's synergistic benefits. Features were designed for customizability to suit the patient's condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care.

CONCLUSIONS

These disease-invariant features were designed to address ICs' needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads.

Designing and Evaluating IT Applications for Informal Caregivers: Protocol for a Scoping Review

BACKGROUND

A growing number of informal caregivers in many countries are important for effective functioning of health care in our society. Hence, they must receive the required support and services to continue providing care. IT applications can be used to support informal caregivers in their caregiving activities. However, evidence-informed guidelines for developing such IT applications and their evaluation are scarce. Hence, this scoping review can aid researchers and designers by providing design recommendations for IT apps for caregivers and potentially improve the design of IT applications for caregivers to meet their needs better.

OBJECTIVE

This study aims to describe the proposal for a scoping review of current practices and recommendations in designing and evaluating IT applications for informal caregivers. The scoping review will also discuss the opportunities and challenges in designing these IT applications.

METHODS

We will use a 5-step scoping review methodology to map relevant literature published as follows: (1) identify the research question, (2) identify relevant studies, (3) select relevant studies for review, (4) chart the data from selected literature, and (5) summarize and report results. A structured search will be conducted in PubMed, Scopus, IEEE digital library, Web of Science, and ACM Digital Library databases. In addition, hand searches of reference lists and keyword searches in Google Scholar will also be conducted. Inclusion criteria will be researched (journal and conference) articles focused on IT applications designed for use by informal caregivers and study type to be qualitative studies. Two reviewers will independently identify articles for review and extract data. Conflicts will be discussed, and a third reviewer will be consulted if a consensus cannot be reached. These data will be analyzed using thematic analysis.

RESULTS

The results from this scoping review will be presented in a narrative form, and additional data on study characteristics will be presented in diagrams or tabular format. Uppsala University first initiated this scoping review protocol in December 2021 as part of the European Union-funded project ENTWINE. This work was also supported by the Swedish Research Council and the Swedish Cancer Society. The results will be presented in August 2023 and will be disseminated through a report to the European Union and a peer-reviewed journal publication. In addition, the team plans to share its findings on various public platforms, including social media, blog posts, and relevant conferences and workshops.

CONCLUSIONS

This is, to our knowledge, the first study to map the literature on the design and evaluation of IT applications for informal caregivers. The scoping review's results will detail the requirements, design suggestions, and user preferences, as well as the usability criteria and features of IT applications for informal caregivers. A mapping of studies could inform the design and implementation of future IT applications for informal caregivers.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47650.

Design suggestions for a persuasive e-coaching application: A study on informal caregivers' needs

Objective

Informal caregivers such as relatives or close friends of patients are essential for caregiving at home. However, caregiving is a complex experience that may affect the caregivers' well-being. Therefore, there is a need to provide support for caregivers, which we address in this article by proposing design suggestions for an e-coaching application. This study identifies the unmet needs of caregivers in Sweden and provides design suggestions for an e-coaching application using the persuasive system design (PSD) model. The PSD model offers a systematic approach to designing IT interventions.

Methods

A qualitative research design was used, and semi-structured interviews were conducted with 13 informal caregivers from different municipalities in Sweden. A thematic analysis was performed to analyze the data. The PSD model was used to map the needs emerging from this analysis to propose design suggestions for an e-coaching application for caregivers.

Results

Six needs were identified, and based on them, we proposed design suggestions for an e-coaching application using the PSD model. These unmet needs are monitoring and guidance, assistance to avail formal care services, access to practical information without being overwhelmed, feeling of community, access to informal support, and grief acceptance. The last two needs could not be mapped using the existing PSD model, resulting in an extended PSD model.

Conclusion

This study revealed the important needs of informal caregivers based on which design suggestions for an e-coaching application were presented. We also proposed an adapted PSD model. This adapted PSD model can be further used for designing digital interventions in caregiving.

Dealing with Loved Ones' Addiction: Development of an App to Cope with Caregivers' Stress

Caregivers remain the primary source of attachment, nurturing, and socialization for human beings in our current society. Family caregivers provide 11 to 100 h of care per week to their loved ones, including emotional and social support, assistance with transportation, home care, and so on. However, caregivers find the workload challenging due to fatigue, burnout, depression, anxiety, and sleep disturbances, and sometimes also from an excessive burden. Caregiver burden and stress ultimately negatively affect family members and caregivers. The caregiver is then at risk of developing deleterious physical, psychological, social, and emotional problems such as mood and anxiety disorders. Mobile health applications (mHealth applications) can be a solution to help family caregivers care for their loved ones and also for themselves. In this study, we present the development of an mHealth application for caregivers of persons with substance use and tested its usability. We used a user-centered design and intervention (UCDI) approach to develop the app by conducting a focus group with parents of individuals with addiction problems. Four key themes were identified during the focus group: (i) information section, (ii) self-care section, (iii) how-to: stress-reduction section, and (iv) chat section. The final app was developed with the software vendor and divided into several sections that were useful for managing psychological problems (such as stress or anxiety), informing about addiction and behavioral dependency problems, and helping users find a professional or services nearby. An analysis of the results of a usability test related to the app administered to a subsample of the focus group showed that the app provided ease of use, usefulness, and satisfaction.

An app-based just-in-time-adaptive self-management intervention for care partners: The CareQOL feasibility pilot study

PURPOSE/OBJECTIVE

The primary objective of this study was to establish the feasibility and acceptability of an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention (JITAI) in three distinct groups of care partners (care partners of persons with spinal cord injury [SCI], Huntington's disease [HD], or hematopoietic cell transplantation [HCT]).

RESEARCH METHOD/DESIGN

Seventy care partners were enrolled in this study (n = 19 SCI; n = 21 HD, n = 30 HCT). This three-month (90 day) randomized control trial involved wearing a Fitbit to track sleep and steps, providing daily reports of health-related quality of life (HRQOL), and completing end of month HRQOL surveys. Care partners in the JITAI group also received personalized pushes (i.e., text-based phone notifications that include brief tips or suggestions for improving self-care). At the end of three-months, care partners in both groups completed a feasibility and acceptability questionnaire.

RESULTS

Most (98.6%) care partners completed the study, average compliance was 88% for daily HRQOL surveys, 96% for daily steps, and 85% for daily sleep (from wearing the Fitbit), and all monthly surveys were completed with the exception of one missed 3-month assessment. The acceptability of the protocol was high; ratings exceeded 80% agreement for the different elements of the study. Improvements were seen for the majority of the HRQOL measures. There was no evidence of measurement reactivity.

CONCLUSIONS/IMPLICATIONS

Findings provide strong support for the acceptability and feasibility of an intensive data collection protocol that involved the administration of a JITAI. Although this trial was not powered to establish efficacy, findings indicated improvements across a variety of different HRQOL measures (~1/3 of which were statistically significant). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Growth in the development of health and fitness mobile apps amid COVID-19 pandemic

Objectives

Technology in the form of mobile apps has played an essential role in facilitating, tracking, and maintaining health and fitness activities during the pandemic. When countries opted for partial or complete lockdowns to contain the spread of the coronavirus disease 2019 virus, it led to people working on their health and fitness-related activities from their homes, just as they continued working from home. This paper aims to quantify the impact of coronavirus disease 2019 on the development of health and fitness mobile apps. Specifically, we compute the effect of coronavirus disease 2019 on the growth of different sub-categories of health and fitness apps.

Methods

We scraped data about a population of 78,890 health and fitness apps from the iOS App Store. First, categories of health and fitness apps are identified using text analysis on the descriptions of apps. Second, the rise in the development of new apps is analyzed. To quantify the impact of coronavirus disease 2019 on the growth of the health and fitness apps, multiple time-series forecasting models are created for different categories of health and fitness apps.

Results

The text analysis identified twelve different types of health and fitness apps on the app market. Our models estimated that the number of health and fitness apps on the iOS app market exceeded the expected growth by 29.9% after the pandemic. The results of all categories of health and fitness are discussed in the paper.

Conclusions

Our analysis found significant growth in the development of new health and fitness apps after the pandemic outbreak. The post hoc study of the population of health and fitness apps presented the current state of this particular area of the app market. In addition, it provided potential growth areas in app markets where there are fewer apps.

The value of technology to support dyadic caregiving for individuals living with heart failure: A qualitative descriptive study (Preprint)

Background

The demand for health services to meet the chronic health needs of the aging population is significant and remains unmet because of the limited supply of clinical resources. Specifically, in managing heart failure (HF), digital health sought to address this gap during the COVID-19 pandemic but highlighted an access issue for those who could not use technology-mediated health care services without the support of their informal caregivers (ICs). The complexity of managing HF symptoms and recurrent exacerbations requires many patients to comanage their illness with their ICs in a care dyad, working together to optimize patient outcomes and health-related quality of life. However, most HF programs have missed the opportunity to consider the dyadic perspective despite interdependencies on HF outcomes.

Objective

This study aims to characterize the value of technology in supporting caregiving for individuals living with HF.

Methods

Motivated by an observed unique pattern of engagement in patients enrolled in our Medly HF management program at the Peter Munk Cardiac Centre in Toronto, Canada, we conducted 20 semistructured interviews with a convenience sample of ICs. All interviews were analyzed using the iterative refinement of a codeveloped codebook. The team maintained reflexivity journals to reflect the impact of their positionality on their coding. Themes were first derived deductively using HF typologies (patient-oriented dyads, caregiver-oriented dyads, and collaboratively oriented dyads) and then inductively refined and recategorized based on concepts from the van Houtven et al framework.

Results

We believe that there is a need to formally and intentionally expand HF technologies to include dyadic needs and goals. We suggest defining 3 opportunities in which value can be added to technological design. First, identify how technology may be leveraged to increase psychological bandwidth by reducing uncertainty and providing peace of mind. We found that actionable feedback was highly desired by both partners. Second, develop technology that can serve as a member of the dyad’s support system. In our experience, automated prompts for patients to take measurements can mimic the support typically provided by ICs and ease their workload. Third, consider how technology can mitigate the dyad’s clinical knowledge requirements and learning curve. Our approach includes real-time actionable feedback paired with a human-in-the-loop, nurse-led model of care.

Conclusions

Our findings identified a need to focus on improving the dyadic experience as a whole by building IC functionality into digital health self-management interventions. Through a shared model of care that supports the role of the patient in their own HF management, includes ICs to expand and enhance the patient’s capacity to care, and acknowledges the need of ICs to care for themselves, we anticipate improved outcomes for both partners.