Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal

V3+ extends the V3 framework to ensure user-centricity and scalability of sensor-based digital health technologies

We propose the addition of usability validation to the extended V3 framework, now "V3+", and describe a pragmatic approach to ensuring that sensor-based digital health technologies can be used optimally at scale by diverse users. Alongside the original V3 components (verification; analytical validation; clinical validation), usability validation will ensure user-centricity of digital measurement tools, paving the way for more inclusive, reliable, and trustworthy digital measures within clinical research and clinical care.

Human Factors, Human-Centered Design, and Usability of Sensor-Based Digital Health Technologies: Scoping Review

BACKGROUND

Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly.

OBJECTIVE

This review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability.

METHODS

We conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured.

RESULTS

Our literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86%) sDHTs were wearable tools while the remaining 23 (14%) sDHTs were ambient tools. The majority of studies (55/83, 66%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99%) captured data from targeted end users, but only 18 (22%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83% (136/164) and 91% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7%), 4 (2%), and 2 (1%) out of 164 sDHTs, respectively. A total of 14 (9%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25% of all studies and 17/55, 31% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17% of studies).

CONCLUSIONS

Based on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use.

Development of the Japanese version of the Mobile Device Proficiency Questionnaire: A cross-sectional validation study

AIM

In response to the growing popularity of mobile devices among older adults in Japan, this study aimed to establish a reliable and valid measure of mobile device proficiency by developing a Japanese version of the Mobile Device Proficiency Questionnaire (MDPQ-J) for the Japanese population.

METHODS

To evaluate the reliability and validity of the MDPQ-J, we administered the questionnaire to 100 young or middle-aged participants (37.78 ± 13.90 years, 57.00% women), and 62 older participants (75.90 ± 6.01 years; 59.68% women).

RESULTS

The MDPQ-J showed a high degree of internal consistency (Cronbach's α = 0.98). Moreover, MDPQ-J scores in older participants tended to be lower than those in young or middle-aged participants. In terms of validity, the MDPQ-J score of older participants was significantly associated with age (ρ = -0.31), the amount of time using a mobile device per day (ρ = 0.64), and the system usability scale (ρ = 0.39). Additionally, the MDPQ-J scores were significantly positively associated with the importance (ρ = 0.37), performance (ρ = 0.57), and satisfaction (ρ = 0.29) associated with daily mobile device use in older participants.

CONCLUSIONS

The high reliability and validity of the MDPQ-J in the Japanese population highlight its utility in adapting mobile devices for older adults, which is crucial in an increasingly digital society. Further research should explore the mediating role of mobile device proficiency in various health-related outcomes. Geriatr Gerontol Int 2024; 24: 1223-1232.

Effects of wearable device training on upper limb motor function in patients with stroke: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes.

METHODS

The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633).

RESULTS

This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl-Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI -0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI -0.54, 0.33), and modified Ashworth scale (MD -0.08, 95% CI -0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11.

CONCLUSIONS

Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.

Navigating Challenges and Opportunities in Community-Based Interventions for Promoting Active Aging: A Systematic Review of the Roles of Technology

Background and Objectives

Researchers from different fields are increasingly interested in incorporating technology into community-based interventions that promote active aging. Yet, there lacks a comprehensive understanding of technology roles, posing challenges for designers seeking to maximize the intended impacts of such interventions. This systematic review aims to fill the gap by examining existing community-based interventions that integrate digital technologies to promote active aging.

Research Design and Methods

Thirteen studies were screened, with a total of 14 interventions examined, following the PRISMA Guideline.

Results

The challenges in designing and operating community-based interventions, the roles of technology in the interventions, and the caveats of utilizing technology during the process were identified. The review emphasizes the importance of overcoming challenges in community-based interventions and leveraging technology to enhance the intended impacts.

Discussion and Implications

The findings underscore the need to understand technology's nuanced roles in community-based interventions for active aging. The article provides a starting point for accumulating knowledge and practice in utilizing technology to navigate the challenges and opportunities encountered in such interventions. It also sheds light on a notable gap: the lack of innovative and strategic approaches that harness digital interventions appropriately in community-based interventions. This emphasizes a crucial requirement for guidelines to assist designers, policymakers, and community staff in integrating technology appropriately into community-based interventions or implementing interventions that incorporate digital technologies at the community level.

Putting the usability of wearable technology in forensic psychiatry to the test: a randomized crossover trial

Introduction

Forensic psychiatric patients receive treatment to address their violent and aggressive behavior with the aim of facilitating their safe reintegration into society. On average, these treatments are effective, but the magnitude of effect sizes tends to be small, even when considering more recent advancements in digital mental health innovations. Recent research indicates that wearable technology has positive effects on the physical and mental health of the general population, and may thus also be of use in forensic psychiatry, both for patients and staff members. Several applications and use cases of wearable technology hold promise, particularly for patients with mild intellectual disability or borderline intellectual functioning, as these devices are thought to be user-friendly and provide continuous daily feedback.

Method

In the current randomized crossover trial, we addressed several limitations from previous research and compared the (continuous) usability and acceptance of four selected wearable devices. Each device was worn for one week by staff members and patients, amounting to a total of four weeks. Two of the devices were general purpose fitness trackers, while the other two devices used custom made applications designed for bio-cueing and for providing insights into physiological reactivity to daily stressors and events.

Results

Our findings indicated significant differences in usability, acceptance and continuous use between devices. The highest usability scores were obtained for the two fitness trackers (Fitbit and Garmin) compared to the two devices employing custom made applications (Sense-IT and E4 dashboard). The results showed similar outcomes for patients and staff members.

Discussion

None of the devices obtained usability scores that would justify recommendation for future use considering international standards; a finding that raises concerns about the adaptation and uptake of wearable technology in the context of forensic psychiatry. We suggest that improvements in gamification and motivational aspects of wearable technology might be helpful to tackle several challenges related to wearable technology.

Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach

BACKGROUND

Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear.

OBJECTIVE

We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements.

METHODS

We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50% (20/40) of the participants received regular prompts, and 50% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants' reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches.

RESULTS

Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76%). Only a few participants (6/40, 15%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80%). In different qualitative analyses, participants' responses were, in most cases, plausible. Only 8% (3/40) of the participants were completely unaware of their irregular task performance.

CONCLUSIONS

People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features.

Scoping Review of Technological Solutions for Community Dwelling Older Adults and Implications for Instrumental Activities of Daily Living

Aging in place is not without its challenges, with physical, psychological, social, and economic burdens on caregivers and seniors. To address these challenges and promote active aging, technological advancements offer a range of digital tools, applications, and devices, enabling community dwelling older adults to live independently and safely. Despite these opportunities, the acceptance of technology among the older adults remains low, often due to a mismatch between technology development and the actual needs and goals of seniors. The aim of this review is to identify recent technological solutions that monitor the health and well-being of aging adults, particularly within the context of instrumental activities of daily living (IADL). A scoping review identified 52 studies that meet specific inclusion criteria. The outcomes were classified based on social connectedness, autonomy, mental health, physical health, and safety. Our review revealed that a predominant majority (82%) of the studies were observational in design and primarily focused on health-related IADLs (59%) and communication-related IADLs (31%). Additionally, the study highlighted the crucial role of involving older adults in study design processes, with only 8 out of the 52 studies incorporating this approach. Our review also established the interview method as the most favoured technology evaluation tool for older adults' studies. The metrics of 'usability' and 'acceptance' emerged as the most frequently employed measures for technology assessment. This study contributes to the existing literature by shedding light on the implications of technological solutions for community dwelling older adults, emphasizing the types of technologies employed and their evaluation results.

The most used questionnaires for evaluating the usability of robots and smart wearables: A scoping review

Background

As the field of robotics and smart wearables continues to advance rapidly, the evaluation of their usability becomes paramount. Researchers may encounter difficulty in finding a suitable questionnaire for evaluating the usability of robotics and smart wearables. Therefore, the aim of this study is to identify the most commonly utilized questionnaires for assessing the usability of robots and smart wearables.

Methods

A comprehensive search of databases, including PubMed, Web of Science, and Scopus, was conducted for this scoping review. Two authors performed the selection of articles and data extraction using a 10-field data extraction form. In cases of disagreements, a third author was consulted to reach a consensus. The inclusions were English-language original research articles that utilized validated questionnaires to assess the usability of healthcare robots and smart wearables. The exclusions comprised review articles, non-English publications, studies not focused on usability, those assessing clinical outcomes, articles lacking questionnaire details, and those using non-validated or researcher-made questionnaires. Descriptive statistics methods (frequency and percentage), were employed to analyze the data.

Results

A total of 314 articles were obtained, and after eliminating irrelevant and duplicate articles, a final selection of 50 articles was included in this review. A total of 17 questionnaires were identified to evaluate the usability of robots and smart wearables, with 10 questionnaires specifically for wearables and 7 questionnaires for robots. The System Usability Scale (50%) and Post-Study System Usability Questionnaire (19.44%) were the predominant questionnaires utilized to assess the usability of smart wearables. Moreover, the most commonly used questionnaires for evaluating the usability of robots were the System Usability Scale (56.66%), User Experience Questionnaire (16.66%), and Quebec User Evaluation of Satisfaction with Assistive Technology (10%).

Conclusion

Commonly employed questionnaires serve as valuable tools in assessing the usability of robots and smart wearables, aiding in the refinement and optimization of these technologies for enhanced user experiences. By incorporating user feedback and insights, designers can strive towards creating more intuitive and effective robotic and wearable solutions.

The user experience of violinists playing with a novel ergonomic chinrest: An evaluation on motivation, usage behaviour, usability and acceptance

BACKGROUND

This study focuses on the user experience of a novel developed ergonomic chinrest (EC), customised to accommodate the individual violinist's anthropometry and playing style. The EC was recently tested for biomechanical effect, but the violin player's motivation, usage behaviour, usability and acceptability may be equally important.

OBJECTIVE

To explore the user experience of violinists who used the novel EC with a low shoulder rest for two weeks. Through that experience, we wanted to learn about the potential user barriers and facilitators related to their motivation, usage behaviour, usability, and acceptability, when trying a new product.

METHODS

Thirty-eight professional violinists participated and evaluated motivation, user behaviour, usability and acceptance using a 5-point Likert scale and open-ended questions.

RESULTS

Participants showed high motivation hoping to improve posture, reduce muscle tension and enhance performance. Usage behaviour was also high, while product appearance, adjustment time, and sound impact were negatively evaluated. However, 37% planned to continue to use EC after the study.

CONCLUSION

Participants showed high motivation and usage behaviour but faced challenges with product appearance, adjustment time, and sound impact compared to their usual chinrest. Incorporating user feedback and addressing design and usability challenges can enhance the user experience.

Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies

BACKGROUND

Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies.

OBJECTIVE

This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies.

METHODS

A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design.

RESULTS

We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features.

CONCLUSIONS

Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies.

Factors associated with use of wearable technology to support activity, well-being, or a healthy lifestyle in the adult population and among older adults

The use of wearable technology, which is often acquired to support well-being and a healthy lifestyle, has become popular in Western countries. At the same time, healthcare is gradually taking the first steps to introduce wearable technology into patient care, even though on a large scale the evidence of its' effectiveness is still lacking. The objective of this study was to identify the factors associated with use of wearable technology to support activity, well-being, or a healthy lifestyle in the Finnish adult population (20-99) and among older adults (65-99). The study utilized a cross-sectional population survey of Finnish adults aged 20 and older (n = 6,034) to analyse non-causal relationships between wearable technology use and the users' characteristics. Logistic regression models of wearable technology use were constructed using statistically significant sociodemographic, well-being, health, benefit, and lifestyle variables. Both in the general adult population and among older adults, wearable technology use was associated with getting aerobic physical activity weekly according to national guidelines and with marital status. In the general adult population, wearable technology use was also associated with not sleeping enough and agreeing with the statement that social welfare and healthcare e-services help in taking an active role in looking after one's own health and well-being. Younger age was associated with wearable technology use in the general adult population but for older adults age was not a statistically significant factor. Among older adults, non-use of wearable technology went hand in hand with needing guidance in e-service use, using a proxy, or not using e-services at all. The results support exploration of the effects of wearable technology use on maintaining an active lifestyle among adults of all ages.