Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior

Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study

BACKGROUND

Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity.

OBJECTIVE

This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older.

METHODS

In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed.

RESULTS

The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%).

CONCLUSIONS

The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/29675.

A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study

BACKGROUND

People aged ≥65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age.

OBJECTIVE

The aim of this study is to assess an app's utility in promoting health-related knowledge in people aged ≥65 years.

METHODS

We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimão or the Family Health Unit of Portas do Arade (ACeS Algarve II - Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ≥65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool's utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app's ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2.

RESULTS

This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II - Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021.

CONCLUSIONS

Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/29675.

Facilitators and barriers to using smart TV among older adults in care settings: a scoping review protocol

INTRODUCTION

The objective of the scoping review is to understand what has been reported in the literature regarding facilitators and barriers to using smart television (smart TV) among older adults in care settings.

METHODS AND ANALYSIS

The scoping review will adopt the Joanna Briggs Institute scoping review methodology. It will occur between March and August 2022. It will consider literature on using smart TV with older adults in care settings. A three-step search strategy will be applied: (1) to identify keywords and index terms from MEDLINE and CINAHL; (2) to do a search using identified keywords and index terms across chosen databases (MEDLINE, CINAHL, Embase, Web of Science, Scopus, AgeLine, PsycINFO, Web of Science, ProQuest and Google) and (3) to hand search the reference lists of all selected literature for additional literature. Further, we will search using Google for grey literature. Two research assistants will independently screen the titles and abstracts by referring to the inclusion criteria. After that, two researchers will independently assess the full text of selected literature by referring to the inclusion criteria. We will present the data in a table with narratives that answer the questions of the scoping review.

ETHICS AND DISSEMINATION

The scoping review does not require ethics approval because it collects data from the publicly available literature. The findings will offer insights to inform the use of smart TV among older adults in care settings for education, practice, policy and future research. The scoping review results will also be disseminated through conference presentations and an open-access publication in a peer-reviewed journal.

A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study

BACKGROUND

Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users.

OBJECTIVE

This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity.

METHODS

A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet).

RESULTS

A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean -3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean -0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean -1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet.

CONCLUSIONS

The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants' fatigue and physical function.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/resprot.6626.

Technologies for Monitoring Lifestyle Habits Related to Brain Health: A Systematic Review

Brain health refers to the preservation of brain integrity and function optimized for an individual’s biological age. Several studies have demonstrated that our lifestyles habits impact our brain health and our cognitive and mental wellbeing. Monitoring such lifestyles is thus critical and mobile technologies are essential to enable such a goal. Three databases were selected to carry out the search. Then, a PRISMA and PICOTS based criteria for a more detailed review on the basis of monitoring lifestyle aspects were used to filter the publications. We identified 133 publications after removing duplicates. Fifteen were finally selected from our criteria. Many studies still use questionnaires as the only tool for monitoring and do not apply advanced analytic or AI approaches to fine-tune results. We anticipate a transformative boom in the near future developing and implementing solutions that are able to integrate, in a flexible and adaptable way, data from technologies and devices that users might already use. This will enable continuous monitoring of objective data to guide the personalized definition of lifestyle goals and data-driven coaching to offer the necessary support to ensure adherence and satisfaction.

Functional Status and Quality of Life Determinants of a Group of Elderly People With Food Insecurity

Background: A good functionality is appointed by the elderly as one of the most important factors for a good quality of life, since it is associated with independency and autonomy. Studies show that elderly with food insecurity have greater limitations in daily living activities (DLA) when compared to food security elderly. Moreover, food insecure elderly are 60% more likely to be diagnosed with depression. We aimed to investigate the potential determinants of functional status (HAQ) and quality of life (EQ-5D-3L) in a sample of elderly with food insecurity.

Methods: Forty-one participants with food insecurity were evaluated by a multidisciplinary team, in April and May of 2016 (a baseline cross-sectional study prior to the intervention program).

Results: This study demonstrates correlations of functional status and quality of life to such aspects of elderly assessment as age, BMI, manual strength, among others. It was found that manual strength, gender, family income, anxiety, and depression were correlated to quality of life; and that mobility, manual strength, anxiety and gender were correlated to the functional status. After multivariable adjustment, only mobility (β = −0.220; p ≤ 0.01) and quality of life (β = −1.457; p ≤ 0.01) remained significantly associated with higher levels of functional disability. With regard to quality of life, only the functional status (β = −0.242; p ≤ 0.01), the presence of depression (β = −0.169; p ≤ 0.05), and family income (β = 0.185; p ≤ 0.05) remained significantly associated with health-related quality of life.

Conclusions: The study aims to verify the potential determinants of functional status (HAQ) and quality of life (EQ-5D-3L) in a sample of elderly with food insecurity. Even in a small cohort, the study demonstrated that in an elderly population with food insecurity, functional status is associated with mobility and quality of life, and that health-related quality of life is also associated with symptoms of depression and family income. Larger studies in other populations may be useful to confirm these observations.