Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings

Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review

BACKGROUND

People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians.

OBJECTIVE

We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities.

METHODS

Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus.

RESULTS

We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record.

CONCLUSIONS

Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination.

iCare - a self-directed, interactive online program to improve health and wellbeing for people living with upper gastrointestinal or hepato-pancreato-biliary cancers, and their informal carers: the study protocol for a Phase II randomised controlled trial

BACKGROUND

Up to 70% of people diagnosed with upper gastrointestinal (GI) tract or hepato-pancreato-biliary (HPB) cancers experience substantial reductions in quality of life (QoL), including high distress levels, pain, fatigue, sleep disturbances, weight loss and difficulty swallowing. With few advocacy groups and support systems for adults with upper GI or HPB cancers (i.e. pancreas, liver, stomach, bile duct and oesophageal) and their carers, online supportive care programs may represent an alternate cost-effective mechanism to support this patient group and carers. iCare is a self-directed, interactive, online program that provides information, resources, and psychological packages to patients and their carers from the treatment phase of their condition. The inception and development of iCare has been driven by consumers, advocacy groups, government and health professionals. The aims of this study are to determine the feasibility and acceptability of iCare, examine preliminary efficacy on health-related QoL and carer burden at 3- and 6-months post enrolment, and the potential cost-effectiveness of iCare, from health and societal perspectives, for both patients and carers.

METHODS AND ANALYSIS

A Phase II randomised controlled trial. Overall, 162 people with newly diagnosed upper GI or HPB cancers and 162 carers will be recruited via the Upper GI Cancer Registry, online advertisements, or hospital clinics. Patients and carers will be randomly allocated (1:1) to the iCare program or usual care. Participant assessments will be at enrolment, 3- and 6-months later. The primary outcomes are i) feasibility, measured by eligibility, recruitment, response and attrition rates, and ii) acceptability, measured by engagement with iCare (frequency of logins, time spent using iCare, and use of features over the intervention period). Secondary outcomes are patient changes in QoL and unmet needs, and carer burden, unmet needs and QoL. Linear mixed models will be fitted to obtain preliminary estimates of efficacy and variability for secondary outcomes. The economic analysis will include a cost-consequences analysis where all outcomes will be compared with costs.

DISCUSSION

iCare provides a potential model of supportive care to improve QoL, unmet needs and burden of disease among people living with upper GI or HPB cancers and their carers.

AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY

ACTRN12623001185651. This protocol reflects Version #1 26 April 2023.

The design of the Deaf in Touch Everywhere (DITE)TM mobile application with Deaf and interpreter communities in Malaysia

Background

Ineffective communication with Deaf individuals in healthcare settings has led to poor outcomes including miscommunication, waste, and errors. To help address these challenges, we developed a mobile app, Deaf in Touch Everywhere (DITETM) which aims to connect the Deaf community in Malaysia with a pool of off-site interpreters through secure video conferencing.

Objectives

The aims of this study were to (a) assess the feasibility and acceptability of measuring unified theory of acceptance and use of technology (UTAUT) constructs for DITETM with the Deaf community and Malaysian sign language (BIM) interpreters and (b) seek input from Deaf people and BIM interpreters on DITETM to improve its design.

Methods

Two versions of the UTAUT questionnaire were adapted for BIM interpreters and the Deaf community. Participants were recruited from both groups and asked to test the DITE app features over a 2-week period. They then completed the questionnaire and participated in focus group discussions to share their feedback on the app.

Results

A total of 18 participants completed the questionnaire and participated in the focus group discussions. Ratings of performance expectancy, effort expectancy, facilitating conditions and behavioural intention were high across both groups, and suggestions were provided to improve the app. High levels of engagement suggest that measurement of UTAUT constructs with these groups (through a modified questionnaire) is feasible and acceptable.

Conclusions

The process of engaging end users in the design process provided valuable insights and will help to ensure that the DITETM app continues to address the needs of both the Deaf community and BIM interpreters in Malaysia.

Young informal carers’ information needs communicated online: Professional and personal growth, finance, health and relationships

Young informal carers (YICs) are non-professional young individuals providing care and support in various forms, usually to immediate family members, afflicted from a diverse range of both long- and short-term health conditions. Although there is significant knowledge about the information needs of adult carers in general, information needs and information seeking characteristics of the YICs’ community are understudied and are different. This study aims to identify the information needs of YICs communicated over the Internet and understanding their information seeking characteristics through a three-stage qualitative content analysis of posts written by YICs on two notable Internet forums. The analysis of 323 posts dated between March 2010 and April 2019 finds YICs’ needs are categorised by two types of online expression of needs, situational and information. Situational needs are illustrations of current difficult conditions and information needs are direct requests for information. Under situational and information needs, we identify four types of needs expressed: personal and professional growth, health (self and caree), finance and relationships. In addition, the findings indicate 94.36% posts in the sample as situational needs, which depict the uncertainty experienced by YICs under caring circumstances. The findings can assist government organisations and charities by improving the indexing of advice pages of their websites appropriate to the YICs’ search words, better availability of information and advertising, in addition to building quality mobile applications or digital support tools.

Development and Usability Assessment of a Mobile App (Demensia KITA) to Support Dementia Caregivers in Malaysia: A Study Protocol

The impact of dementia on caregivers is complex and multi-dimensional. In low- and middle-income settings, caregivers are often left without adequate support, despite their multiple needs. These include health information, caregiving skills, social and emotional support, and access to local resources-all of which can be partially fulfilled by technology. In recent years, mobile apps have emerged and proven useful for caregivers. We found a few existing apps suitable for Malaysian users in terms of affordability and cultural and linguistic compatibility. Our study aims to design a mobile app that suits dementia caregivers in Malaysia and consists of three phases. Phase I is content development that employs Focus Group Discussion (FGD) and Nominal Group Technique (NGT) involving field experts. Phase II comprises a mobile app (Demensia KITA) designed in collaboration with a software developer specializing in mobile health apps. Phase III entails testing the usability of the app using the Malay version of the mHealth App Usability Questionnaire (M-MAUQ). This study protocol elaborates on the rigorous steps of designing a mobile app and testing its usability, along with anticipated challenges. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for better use of digital technology in the field of aging and caregiving.

Smartphone applications for informal caregivers of chronically ill patients: a scoping review

Mobile-health applications can be used to deliver timely and personalized health information to family and friends of chronically ill adults living in the community. This scoping review aims to investigate the nature and extent of native smartphone applications for informal caregivers. Six databases were searched for articles on applications across ten chronic conditions, namely heart disease, stroke, cancer, chronic obstructive respiratory disease, asthma, diabetes, Alzheimer’s disease or other dementia, rheumatoid arthritis, hypertension, and mood or anxiety disorders. In total, 36 articles were included, encompassing 26 applications. Of these, smartphone applications were designed for use only by caregivers (n = 15), with a few applications also intended to be used with patients (n = 5), healthcare providers (n = 4), or all three roles (n = 2). Most applications targeted a single chronic condition (n = 25), with Alzheimer’s and other dementia being the most common (n = 18). Only one application was designed for management of multiple chronic conditions. Long-term evaluation methods are needed to continually assess the impact of applications on a range of process and health outcomes, such as usability, caregiver burden, and quality of life. Additional directions to advance native smartphone applications for caregivers are discussed, including personalization and expansion of eligibility criteria.

A psycho-oncological online intervention supporting partners of patients with cancer (PartnerCARE): Results from a randomized controlled feasibility trial

OBJECTIVE

Partners of cancer patients are the primary supporters and burdened at the same time. Support for partners is hitherto scarce and existing offers are rarely used. The PartnerCARE online intervention was specifically developed to address the caregiving partners' needs. This two-arm parallel randomized controlled trial evaluates the feasibility, acceptability, and potential efficacy of PartnerCARE.

METHODS

Sixty German-speaking partners of patients with various cancer entities were randomized into two conditions: intervention group with PartnerCARE (N=30) or waitlist-control group (N=30). Participants completed online questionnaires at baseline (T0), post-treatment (T1) and four-months follow-up (T2). Feasibility and acceptability outcomes included dropout rates, use and acceptance of PartnerCARE, individual user/e-coach feedback as well as negative effects. Relevant efficacy outcomes were assessed to test for potential intervention effects.

RESULTS

Recruitment success illustrates demand for and acceptability of PartnerCARE. Satisfaction with the intervention was high (CSQ-I, T1: M=24.66, SD=6.42) and 73.3 % of participants completed the intervention. Study dropout rate was low (T1: 17%, T2: 29%). More positive than negative side effects of the intervention were identified, and negative ones were mainly related to 'intrapersonal change'. For efficacy outcomes we found effects over time, with strongest effects within the intervention group from T0 to T1 in psychological distress (d=0.73, 95%-CI: [0.34; 1.12]) and anxiety (0.66, [0.26; 1.04]), but no group effects were significant at T1 and T2.

CONCLUSIONS

PartnerCARE is feasible, acceptable and potentially efficacious. Based on received feedback, PartnerCARE is currently undergoing further development and subsequently efficacy will be investigated in a randomized controlled trial. This article is protected by copyright. All rights reserved.

Designing Supportive e-Interventions for Partners of Men With Prostate Cancer Using Female Partners’ Experiences: Qualitative Exploration Study

Background

Partners of men living with prostate cancer (PCa) can experience a variety of unmet needs that are largely unaddressed by health care professionals. There is limited evidence to suggest which approach may be most effective in supporting partners’ unmet needs and further research is required to determine how to provide support to caregivers and how technology solutions can be designed.

Objective

This study aims to explore the experience of partners of men living with PCa and their perceptions of the potential role of information technology in supporting their needs.

Methods

A qualitative descriptive methodology using focus groups and phone interviews was used. Purposive sampling was used to recruit people attending a national conference supported by a national PCa organization. Interview guides were adapted from an existing evidence-based smartphone app for caregivers of people with colorectal cancer. Sessions were audio recorded and transcribed verbatim. A coding framework was developed, and transcripts were coded line by line into the framework. Codes within the framework were grouped into descriptive categories that were then developed into analytical themes.

Results

A total of 17 female partners participated in the study, with an average age of 64 (SD 8.5) years. The following two main themes emerged: In the first theme, that is, How technology can be shaped to support female partners of prostate cancer survivors, the content and design of the smartphone app was discussed in addressing female partners’ needs. The following four subthemes were developed: getting support from social networks and resources, the lack of relevant information, demystifying future care expectations during and following a PCa diagnosis, and delivering the smartphone app—to whom and from whom. In the second theme, that is, The benefits and barriers of technology, the suitability of smartphone apps as a supportive modality for female partners was described. This included three subthemes: the smartphone app as an appropriate modality for supporting female partners, the future anticipated benefits of using the smartphone app, and concerns for storing and accessing information on the internet.

Conclusions

A smartphone app may be a suitable modality for providing information and peer support to female partners of men living with PCa. There is a need to provide peer support for female partners in future interventions to ensure that female partners’ intimacy and daily practical needs are met.

Assessment of Data Usage of Cancer e-Interventions (ADUCI) Framework for Health App Use of Cancer Patients and Their Caregivers: Framework Development Study

Background

Multimedia interventions can provide a cost-effective solution to public health needs; however, user engagement is low. Multimedia use within specific populations such as those affected by cancer differs from that of the general population. To our knowledge, there are no frameworks on how to accurately assess usage within this population to ensure that interventions are appropriate for the end users. Therefore, a framework was developed to improve the accuracy of determining data usage. Formative work included creating a data usage framework during target audience testing for smartphone app development and analysis in a pilot study.

Objective

The purpose of this study was to develop a framework for assessing smartphone app usage among people living with cancer and their caregivers.

Methods

The frequency and duration of use were compared based on manual data extraction from two previous studies and the newly developed Assessment of Data Usage of Cancer e-Interventions (ADUCI) Framework.

Results

Manual extraction demonstrated that 279 logins occurred compared with 241 when the ADUCI Framework was applied. The frequency of use in each section of the app also decreased when the ADUCI Framework was used. The total duration of use was 91,256 seconds (25.3 hours) compared with 53,074 seconds (14.7 hours) when using the ADUCI Framework. The ADUCI Framework identified 38 logins with no navigation, and there were 15 discrepancies in the data where time on a specific page of the app exceeded the login time. Practice recommendations to improve user engagement and capturing usage data include tracking data use in external websites, having a login function on apps, creating a five-star page rating functionality, using the ADUCI Framework to thoroughly clean usage data, and validating the Framework between expected and observed use.

Conclusions

Applying the ADUCI Framework may eliminate errors and allow for more accurate analysis of usage data in e-research projects. The Framework can also improve the process of capturing usage data by providing a guide for usage data analysis to facilitate evidence-based assessment of user engagement with apps.

Empowering caregivers in the radiotherapy process: the results of a randomized controlled trial

PURPOSE

The present study aims to evaluate the effectiveness of a mobile-assisted empowerment program developed specifically for caregivers of cancer patients undergoing radiotherapy.

METHODS

In this study, seventy-four individuals who gave care for cancer patients that received radiotherapy between September 2019 and May 2020 were randomized to receive a mobile-assisted empowerment program or standard care. The mobile-assisted empowerment program comprised of education and information related to the radiotherapy process, videos, activities, and question-and-answer modules to support caregivers during the radiotherapy process. Outcome measures were collected at baseline (day 1 of radiotherapy) and on day 21 and included caregiver demographics, distress, quality of life, and coping style using validated questionnaires.

RESULTS

Compared with baseline, individuals' mean scores of distress were lower in the empowerment group than the control group (p < 0.001). General quality of life and sub-dimension mean scores were higher in the empowerment group than the control group (p ≤ 0.05). There was no difference in the coping style average scores (p ≥ 0.05) between the two groups.

CONCLUSIONS

This study supports the findings that a mobile-supported empowerment program reduced the level of caregiver distress and increased quality of life during their loved one's treatment with radiotherapy.