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Murabito JM, Faro JM, Zhang Y, DeMalia A, Hamel A, Agyapong N, Liu H, Schramm E, McManus DD, Borrelli B. Smartphone App Designed to Collect Health Information in Older Adults: Usability Study. JMIR Hum Factors 2024; 11:e56653. [PMID: 38815261 PMCID: PMC11176875 DOI: 10.2196/56653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Studies evaluating the usability of mobile-phone assessments in older adults are limited. OBJECTIVE This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. METHODS We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). RESULTS In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. CONCLUSIONS Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences.
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Affiliation(s)
- Joanne M Murabito
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Framingham Heart Study, Boston University, Framingham, MA, United States
| | - Jamie M Faro
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Yuankai Zhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Angelo DeMalia
- Framingham Heart Study, Boston University, Framingham, MA, United States
| | - Alexander Hamel
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nakesha Agyapong
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Hongshan Liu
- Framingham Heart Study, Boston University, Framingham, MA, United States
| | - Eric Schramm
- CareEvolution, Inc, Ann Arbour, MI, United States
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Cardiology Division, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Belinda Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, United States
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Sien SW, Kobekyaa FK, Puts M, Currie L, Tompson M, Hedges P, McGrenere J, Mariano C, Haase KR. Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing. JMIR Aging 2024; 7:e53163. [PMID: 38717806 PMCID: PMC11112470 DOI: 10.2196/53163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. OBJECTIVE We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. METHODS This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. RESULTS In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. CONCLUSIONS This app has the potential to support the complex health care needs of older adults with cancer, creating a "home base" for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation.
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Affiliation(s)
- Sang-Wha Sien
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Leanne Currie
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Margaret Tompson
- Saskatchewan Center for Patient Oriented Research, Saskatoon, SK, Canada
| | | | - Joanna McGrenere
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Böttinger MJ, Litz E, Gordt-Oesterwind K, Jansen CP, Memmer N, Mychajliw C, Radeck L, Bauer JM, Becker C. Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study. JMIR Aging 2023; 6:e46738. [PMID: 37751274 PMCID: PMC10565622 DOI: 10.2196/46738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/10/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. OBJECTIVE This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. METHODS A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. RESULTS The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. CONCLUSIONS The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment.
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Affiliation(s)
- Melissa J Böttinger
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Elena Litz
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Katharina Gordt-Oesterwind
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Carl-Philipp Jansen
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Nicole Memmer
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Christian Mychajliw
- Geriatric Center, University Hospital of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Leon Radeck
- Institute for Computer Science, Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Clemens Becker
- Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
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Ioannou E, Chen HL, Bromley V, Fosker S, Ali K, Fernando A, Mensah E, Fowler-Davis S. The key values and factors identified by older adults to promote physical activity and reduce sedentary behaviour using co-production approaches: a scoping review. BMC Geriatr 2023; 23:371. [PMID: 37328734 PMCID: PMC10276377 DOI: 10.1186/s12877-023-04005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/26/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Inactivity and sedentary behaviour in older adults adversely impacts physical function, reduces social networks, and could contribute to population healthcare costs. To encourage and support the planning and uptake of physical activity by older adults, it is important to understand what physical activity means to older adults. Therefore, the aim of this scoping review was to collate what older adults have self-identified as the key factors for sustaining and increasing their physical activities. METHODS Arksey and O'Malley's Scoping Review framework was used to guide the review process. SCOPUS, ASSIA, PsychINFO and MEDLINE databases were searched. Studies were eligible for inclusion if they were peer-reviewed, the target population were older adults (aged 55 and above), co-production related research approaches were explicitly stated in the methods and there was a focus on design of physical activity interventions or products to support or enhance physical activity. Assets and values important for physical activity were first extracted from included studies and were subsequently thematically analysed. Themes are presented to provide an overview of the literature synthesis. RESULTS Sixteen papers were included in the analysis. Data from these papers were gathered via designing interventions or services (n = 8), products (n = 2), 'exergames' (n = 2) or mobile applications (n = 4). Outcomes were varied but common themes emerged across papers. Overarching themes identified by older adults were associated with a desire to increase activity when it was accessible, motivational, and safe. In addition, older adults want to enjoy their activities, want independence and representation, want to stay connected with families and friends, be outdoors, familiarity, activities to be tailored and resulting in measurable/observed progress. CONCLUSIONS Population demographics, personal attributes, and life experiences all affect preferences for physical activity. However, the key factors identified by older adults for increasing physical activity were common-even in separate co-production contexts. To promote physical activities in older adults, activities must fundamentally feel safe, provide a sense of social connectedness, be enjoyable and be accessible in terms of cost and ability.
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Affiliation(s)
- Elysa Ioannou
- Sport and Physical Activity Research Centre (SPARC), Sheffield Hallam University, Sheffield, UK
| | - Henglien Lisa Chen
- University of Sussex (Social Work and Social Care), Brighton and Hove, UK
| | - Vicky Bromley
- University of Sussex (Social Work and Social Care), Brighton and Hove, UK
| | - Sam Fosker
- Royal London Hospital, London; Founder, Cush Health, London, UK
| | - Khalid Ali
- Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Avanka Fernando
- University of Sussex (Social Work and Social Care), Brighton and Hove, UK
| | - Ekow Mensah
- University Hospitals NHS Trust, Nottingham, UK
| | - Sally Fowler-Davis
- Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, UK.
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An Q, Sandlund M, Agnello D, McCaffrey L, Chastin S, Helleday R, Wadell K. A scoping review of co-creation practice in the development of non-pharmacological interventions for people with Chronic Obstructive Pulmonary Disease: A health CASCADE study. Respir Med 2023; 211:107193. [PMID: 36889517 DOI: 10.1016/j.rmed.2023.107193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/28/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Incorporating co-creation processes may improve the quality of outcome interventions. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for people with Chronic Obstructive Pulmonary Disease (COPD), that could inform future co-creation practice and research for rigorously improving the quality of care. OBJECTIVE This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD. METHODS This review followed Arksey and O'Malley scoping review framework and was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science Core Collection. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included. RESULTS 13 articles complied with the inclusion criteria. Limited creative methods were reported in the studies. Facilitators described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report including implementation considerations as a discussion point in their co-creation workshops. CONCLUSION Evidence-based co-creation in COPD care is critical for guiding future practice and improving the quality of care delivered by NPIs. This review provides evidence for improving systematic and reproducible co-creation. Future research should focus on systematically planning, conducting, evaluating, and reporting co-creation practices in COPD care.
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Affiliation(s)
- Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden.
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
| | - Danielle Agnello
- School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lauren McCaffrey
- School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Sebastien Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, UK; Department of Movement and Sports Sciences, Ghent University, 9000, Ghent, Belgium
| | - Ragnberth Helleday
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
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Ren P, Klausen SH. Smartphone use, intergenerational support and older adults’ wellbeing. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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7
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Deliv C, Devane D, Putnam E, Healy P, Hall A, Rosenbaum S, Toomey E. Development of a video-based evidence synthesis knowledge translation resource: Drawing on a user-centred design approach. Digit Health 2023; 9:20552076231170696. [PMID: 37152241 PMCID: PMC10159242 DOI: 10.1177/20552076231170696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives We aimed to develop a video animation knowledge translation (KT) resource to explain the purpose, use and importance of evidence synthesis to the public regarding healthcare decision-making. Methods We drew on a user-centred design approach to develop a spoken animated video (SAV) by conducting two cycles of idea generation, prototyping, user testing, analysis, and refinement. Six researchers identified the initial key messages of the SAV and informed the first draft of the storyboard and script. Seven members of the public provided input on this draft and the key messages through think-aloud interviews, which we used to develop an SAV prototype. Seven additional members of the public participated in think-aloud interviews while watching the video prototype. All members of the public also completed a questionnaire on perceived usefulness, desirability, clarity and credibility. We subsequently synthesised all data to develop the final SAV. Results Researchers identified the initial key messages as 1) the importance of evidence synthesis, 2) what an evidence synthesis is and 3) how evidence synthesis can impact healthcare decision-making. Members of the public rated the initial video prototype as 9/10 for usefulness, 8/10 for desirability, 8/10 for clarity and 9/10 for credibility. Using their guidance and feedback, we produced a three-and-a-half-minute video animation. The video was uploaded on YouTube, has since been translated into two languages, and viewed over 12,000 times to date. Conclusions Drawing on user-centred design methods provided a structured and transparent approach to the development of our SAV. Involving members of the public enhanced the credibility and usefulness of the resource. Future work could explore involving the public from the outset to identify key messages in developing KT resources explaining methodological topics. This study describes the systematic development of a KT resource with limited resources and provides transferrable learnings for others wishing to do similar.
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Affiliation(s)
- Cristian Deliv
- School of Medicine, University of Galway, Galway, Ireland
| | - Declan Devane
- Cochrane Ireland and Evidence Synthesis
Ireland, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - El Putnam
- School of English and Creative Arts, University of Galway, Galway, Ireland
| | - Patricia Healy
- Cochrane Ireland and Evidence Synthesis
Ireland, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Amanda Hall
- Primary Healthcare Research Unit,
Faculty of Medicine, Memorial University,
Newfoundland, Canada
| | - Sarah Rosenbaum
- Centre for Informed Health Choices, Norwegian Institute of Public
Health, Oslo, Norway
| | - Elaine Toomey
- Cochrane Ireland and Evidence Synthesis
Ireland, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Dening J, Zacharia K, Ball K, George ES, Islam SMS. Exploring engagement with a web-based dietary intervention for adults with type 2 diabetes: A mixed methods evaluation of the T2Diet study. PLoS One 2022; 17:e0279466. [PMID: 36584072 PMCID: PMC9803196 DOI: 10.1371/journal.pone.0279466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Improved understanding of participant engagement in web-based dietary interventions is needed. Engagement is a complex construct that may be best explored through mixed methods to gain comprehensive insight. To our knowledge, no web-based dietary intervention in people with type 2 diabetes (T2D) has previously used a mixed methods approach. The aim of this study was to explore factors that may contribute to effective engagement in a web-based dietary program for people with T2D. METHODS This study employed a mixed methods intervention design, with a convergent design embedded for post-intervention evaluation. The convergent design collected and analyzed quantitative and qualitative data independent of each other, with the two datasets merged/compared during results/interpretation. Quantitative data collected from intervention group participants (n = 40) were self-administered questionnaires and usage data with average values summarized. Qualitative data were participant semi-structured interviews (n = 15) incorporating a deductive-inductive thematic analysis approach. RESULTS The results from the quantitative and qualitative data indicated positive overall engagement with the web-based dietary program. Factors that contributed to effective engagement were sustained frequency and intensity of engagement; structured weekly program delivery; participants affective engagement prior to and during the intervention, with positive affective states enhancing cognitive and behavioral engagement; and participants experience of value and reward. In addition, the user-centered development process employed prior to intervention delivery played an important role in facilitating positive engagement outcomes. CONCLUSION This study yielded novel findings by integrating qualitative and quantitative data to explore engagement with a web-based dietary program involving people with T2D. Effective engagement occurred in this intervention through a combination of factors related to usage and participants' affective, cognitive and behavioral states. The engagement outcomes that emerged will be useful to current and future researchers using digital technologies to deliver lifestyle interventions for T2D or other chronic health conditions.
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
- * E-mail:
| | - Karly Zacharia
- Faculty of Health & Medicine, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
| | - Elena S. George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood, Victoria, Australia
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Yusupov I, Vandermorris S, Plunkett C, Astell A, Rich JB, Troyer AK. An Agile Development Cycle of an Online Memory Program for Healthy Older Adults. Can J Aging 2022; 41:647-656. [PMID: 35256025 DOI: 10.1017/s0714980821000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Online interventions for older adults should be tailored to their unique needs to increase the efficacy of and adherence to the intervention. The agile development cycle is a dynamic model to solicit and incorporate feedback from older adults during the design process. We combined this approach with the framework of Harvard University's clinical and translational phases that provide a clear structure for evaluating new health programs before they are offered in the community. We based our online memory program on the empirically validated in-person Memory and Aging Program. The aim of the present study was to combine the agile development cycle with the clinical and translational phases framework to develop and pilot an online memory program tailored to the unique needs of older adults. Study 1 involved piloting individual program modules on site and integrating participant feedback into the program's design to optimize usability. Study 2 involved two sequential pilots of the program accessed remotely to evaluate preliminary clinical outcomes and obtain feedback for iterative modifications. Plans for further validation and limitations are discussed. The successful application of the agile development cycle implemented in this series of studies can be adapted by others seeking to offer online content for targeted end users.
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Affiliation(s)
- Iris Yusupov
- Baycrest Health Sciences, North York, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | | | - Cindy Plunkett
- Baycrest Health Sciences, North York, Ontario, Canada
- PointClickCare, Mississauga, Ontario, Canada
| | - Arlene Astell
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Canada
- University of Reading, Reading, UK
| | - Jill B Rich
- Baycrest Health Sciences, North York, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Angela K Troyer
- Baycrest Health Sciences, North York, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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Constantin N, Edward H, Ng H, Radisic A, Yule A, D'Asti A, D'Amore C, Reid JC, Beauchamp M. The use of co-design in developing physical activity interventions for older adults: a scoping review. BMC Geriatr 2022; 22:647. [PMID: 35941570 PMCID: PMC9358386 DOI: 10.1186/s12877-022-03345-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults. METHODS We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims. RESULTS Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability. CONCLUSIONS There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field. TRIAL REGISTRATION osf.io/vsw2m.
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Affiliation(s)
- Natalie Constantin
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Holly Edward
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Hayley Ng
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Anna Radisic
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Amy Yule
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Alina D'Asti
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Cassandra D'Amore
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Julie C Reid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
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11
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Cole AC, Adapa K, Khasawneh A, Richardson DR, Mazur L. Codesign approaches involving older adults in the development of electronic healthcare tools: a systematic review. BMJ Open 2022; 12:e058390. [PMID: 35793923 PMCID: PMC9260797 DOI: 10.1136/bmjopen-2021-058390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The primary aim was to review and synthesise the current evidence of how older adults are involved in codesign approaches to develop electronic healthcare tools (EHTs). The secondary aim was to identify how the codesign approaches used mutual learning techniques to benefit older adult participants. DESIGN Systematic review following the Preferred Reporting Items for Systematic Reviews 2020 checklist. DATA SOURCES PubMed, Embase and Scopus databases were searched for studies from January 2010 to March 2021. ELIGIBILITY CRITERIA Inclusion criteria were studies employing codesign approaches to develop an EHTs, and the study population was aged 60 years and older. DATA EXTRACTION AND SYNTHESIS Data were extracted for analysis and risk of bias. We evaluated the quality of studies using the Agency for Healthcare Research and Quality Evidence-based Practice Center approach. RESULTS Twenty-five studies met the inclusion criteria for this review. All studies used at least two involvement processes, with interviews and prototypes used most frequently. Through cross-classification, we found an increased utilisation of functional prototypes in studies reaching the 'empower' level of participation and found that studies which benefitted from mutual learning had a higher utilisation of specific involvement processes such as focus groups and functional prototyping. CONCLUSIONS We found gaps to support which involvement processes, participation levels and learning models should be employed when codesigning with older adults. This is important because higher levels of participation may increase the user's knowledge of technology, enhance learning and empower participants. To ensure studies optimise participation and learning of older adults when developing EHTs, there is a need to place more emphasis on the approaches promoting mutual learning. PROSPERO REGISTRATION NUMBER CRD42021240013.
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Affiliation(s)
- Amy C Cole
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Karthik Adapa
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Amro Khasawneh
- Department of Industrial Engineering, School of Engineering, Mercer University, Macon, Georgia, USA
| | - Daniel R Richardson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lukasz Mazur
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Hsieh KL, Chen L, Sosnoff JJ. Mobile Technology for Falls Prevention in Older Adults. J Gerontol A Biol Sci Med Sci 2022; 78:861-868. [PMID: 35640254 PMCID: PMC10172979 DOI: 10.1093/gerona/glac116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 11/14/2022] Open
Abstract
Falls are the leading cause of accidental death in older adults that result from a complex interplay of risk factors. Recently, the need for person-centered approach utilizing personalization, prediction, prevention and participation, known as the P4 model, in fall prevention has been highlighted. Features of mobile technology make it a suitable technological infrastructure to employ such an approach. This narrative review aims to review the evidence for using mobile technology for personalized fall risk assessment and prevention since 2017 in older adults. We aim to identify lessons learned and future directions for using mobile technology as a fall risk assessment and prevention tool. Articles were searched in PubMed and Web of Science with search terms related to older adults, mobile technology, and falls prevention. A total of 23 articles were included. Articles were identified as those examining aspects of the P4 model including prediction (measurement of fall risk), personalization (usability), prevention, and participation. Mobile technology appears to be comparable to gold-standard technology in measuring well-known fall risk factors including static and dynamic balance. Seven applications were developed to measure different fall risk factors and tested for personalization, and/or participation aspects, and four were integrated into a falls prevention program. Mobile health technology offers an innovative solution to provide tailored fall risk screening, prediction, and participation. Future studies should incorporate multiple, objective fall risk measures and implement them in community settings to determine if mobile technology can offer tailored and scalable interventions.
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Affiliation(s)
- Katherine L Hsieh
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine
| | - Lingjun Chen
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center
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Hsieh KL, Frechette ML, Fanning J, Chen L, Griffin A, Sosnoff JJ. The Developments and Iterations of a Mobile Technology-Based Fall Risk Health Application. Front Digit Health 2022; 4:828686. [PMID: 35574255 PMCID: PMC9091349 DOI: 10.3389/fdgth.2022.828686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
Falls are a prevalent and serious health concern across clinical populations. A critical step in falls prevention is identifying modifiable risk factors, but due to time constraints and equipment costs, fall risk screening is rarely performed. Mobile technology offers an innovative approach to provide personalized fall risk screening for clinical populations. To inform future development, this manuscript discusses the development and testing of mobile health fall risk applications for three unique clinical populations [older adults, individuals with Multiple Sclerosis (MS), and wheeled-device users]. We focus on key lessons learned and future directions to improve the field of fall risk mHealth. During the development phase, we first identified fall risk factors specific to each population that are measurable with mobile technology. Second, we determined whether inertial measurement units within smartphones can measure postural control within the target population. Last, we developed the interface of each app with a user-centered design approach with usability testing through iterative semi-structured interviews. We then tested our apps in real-world settings. Our cumulative work demonstrates that mobile technology can be leveraged to provide personalized fall risk screening for different clinical populations. Fall risk apps should be designed and tailored for the targeted group to enhance usefulness and feasibility. In addition, fall risk factors measured with mobile technology should include those that are specific to the population, are measurable with mobile technology, and can accurately measure fall risk. Future work should improve fall risk algorithms and implement mobile technology into fall prevention programs.
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Affiliation(s)
- Katherine L. Hsieh
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Mikaela L. Frechette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Lingjun Chen
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
| | - Aileen Griffin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
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14
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Jaworski BK, Taylor K, Ramsey KM, Heinz AJ, Steinmetz S, Owen JE, Tsai J, Pietrzak RH. Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel. JMIR Ment Health 2022; 9:e36217. [PMID: 35245204 PMCID: PMC8985691 DOI: 10.2196/36217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. OBJECTIVE The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. RESULTS We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. CONCLUSIONS The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.
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Affiliation(s)
- Beth K Jaworski
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Katherine Taylor
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Kelly M Ramsey
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Adrienne J Heinz
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Sarah Steinmetz
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Jason E Owen
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Jack Tsai
- National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Tampa, FL, United States.,School of Public Health, San Antonio Campus, University of Texas Health Science Center at Houston, San Antonio, TX, United States
| | - Robert H Pietrzak
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, US Department of Veterans Affairs, New Haven, CT, United States.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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Chen J, Wijesundara JG, Enyim GE, Lombardini LM, Gerber BS, Houston TK, Sadasivam RS. Understanding Patients' Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study. JMIR Hum Factors 2022; 9:e34452. [PMID: 35254269 PMCID: PMC8938838 DOI: 10.2196/34452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective This study aimed to assess ACS patients’ intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as “If this app were available to me, I would use it.” Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results Among 100 respondents (response rate 8.1%), 45 (45%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90% (90/100) White, 39% (39/100) women, and 88% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65%) agreed or strongly agreed that they would use the app, among which 53 (82%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75% among those aged 65-74 years and dropped to 44% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality.
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Affiliation(s)
- Jinying Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Gabrielle E Enyim
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lisa M Lombardini
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Thomas K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Mansson L, Pettersson B, Rosendahl E, Skelton DA, Lundin-Olsson L, Sandlund M. Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community. BMC Geriatr 2022; 22:147. [PMID: 35193495 PMCID: PMC8862529 DOI: 10.1186/s12877-022-02851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Little is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults. Methods Independent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants’ mean age was 76 ± 4 years and 72% were women. Results Ceiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21–56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users. Conclusion The LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02851-9.
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Affiliation(s)
- Linda Mansson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden.
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Dening J, George ES, Ball K, Islam SMS. User-centered development of a digitally-delivered dietary intervention for adults with type 2 diabetes: The T2Diet study. Internet Interv 2022; 28:100505. [PMID: 35242592 PMCID: PMC8861390 DOI: 10.1016/j.invent.2022.100505] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Web-based interventions can help address challenges of accessibility and availability of dietary support for people with type 2 diabetes (T2D). However, concerns regarding adherence and engagement in web-based interventions have been noted. Implementing a user-centered approach to intervention development has been shown to encourage better participant engagement. The overarching aim of this paper was to describe the user-centered approach used in the T2Diet Study to develop a new web-based dietary intervention for adults with T2D, exploring strategies for enhancing adherence and engagement. METHODS Intervention development was based on a flexible iterative user-centered approach to enable new product development. Twenty-one adults with T2D were engaged in six guided discussion groups across four iterative development phases, alongside reference to evidence and theory throughout the process. The phases of user inquiry progressed from broad discussion on areas to support dietary needs; to design feedback on aspects of site layout; through to further feedback on aesthetics and functionality; then into a two-week field test followed by final user inquiry and participation in user experience polls. A hybrid approach of thematic data analysis was used, incorporating both a data-driven inductive approach and a deductive approach based on a priori identification of themes. RESULTS Group discussion across the four phases highlighted factors the participants considered may motivate them to adhere and engage, which predominantly included relevance of resources, clear and simple positive communication, and flexibility for personal tailoring. Participant feedback provided an actionable list of intervention developments and input to inform intervention structure and theoretical framework. The two-week field test highlighted factors participants valued in terms of the user experience, most notably usability and accessibility. Additionally, the field test indicated a positive user experience, with no significant usability issues identified. CONCLUSION This paper provided the first detailed report of a user-centered approach to iterative development in the context of a web-based T2D dietary intervention. The insights will be useful to inform future digitally-delivered dietary interventions for adults with T2D or to inform a similar user-centered approach for other chronic health conditions.
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Affiliation(s)
- Jedha Dening
- Corresponding author at: Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia.
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Cestari VRF, Florêncio RS, Garces TS, Souza LCD, Negreiros FDDS, Pessoa VLMDP, Moreira TMM. CODESING DE APLICATIVO CUIDATIVO-EDUCACIONAL PARA PESSOAS COM INSUFICIÊNCIA CARDÍACA: IDEAÇÃO, PROTOTIPAGEM E CO-IMPLANTAÇÃO. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0163pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo descrever o processo de ideação, prototipagem e co-implantação do protótipo de aplicativo cuidativo-educacional à pessoa com insuficiência cardíaca em vulnerabilidade, seus familiares/cuidadores e equipe de saúde. Método estudo metodológico, com cinco fases: Constructo; Ideação; Prototipagem; Co-implantação e Adequação, realizadas de setembro de 2020 a julho de 2021. A equipe do Codesign envolveu 72 atores (15 pacientes com IC, 19 familiares/cuidadores, 35 profissionais da saúde, dois pesquisadores e um designer e desenvolvedor), que contribuíram com dados linguísticos e visuais. Resultados foi produzido o protótipo InCare®, representado pelo fluxograma de interação do usuário e esboços estruturais. Foram definidas cores para composição das telas e escolhidos recursos do protótipo, com delineamento da descrição, proposta e requisitos funcionais. O aplicativo envolveu temáticas relevantes (definição da doença e vulnerabilidade, etiologia, classificação, sinais e sintomas, cuidados diários e abordagens paliativistas, tratamentos, alimentação, atividade física e redes de suporte, benefícios) e aglutinou funcionalidades conforme necessidades e preferências da equipe, sendo considerado inovador e um incentivo ao autocuidado. Conclusão O Codesign permitiu a ideação de recursos, conteúdos, esboços das telas, fluxo do usuário, prototipagem e nome do protótipo, em processo criativo e participativo, para promoção da saúde da pessoa com insuficiência cardíaca em situação de vulnerabilidade em saúde.
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Cestari VRF, Florêncio RS, Garces TS, Souza LCD, Negreiros FDDS, Pessoa VLMDP, Moreira TMM. CODESIGN OF A CARE-EDUCATIONAL APP FOR PEOPLE WITH HEART FAILURE: DESIGN, PROTOTYPING AND CO-IMPLEMENTATION. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0163en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective to describe the process corresponding to the design, prototyping and co-implementation of a care-educational app prototype for vulnerable people with heart failure, their family members/caregivers and the health team. Method a methodological study with five phases: Construct, Design, Prototyping, Co-implementation and Adaptation, all performed from September 2020 to July 2021. The Codesign team involved 72 actors (15 patients with HF, 19 family members/caregivers, 35 health professionals, two researchers and a designer and developer), who contributed with linguistic and visual data. Results the InCare® prototype was produced, represented by the flowchart corresponding to the user's interaction and structural sketches. Colors were defined to compose the screens and the prototype resources were chosen, outlining the description, proposal and functional requirements. The app involved relevant themes (definition of the disease and vulnerability, etiology, classification, signs and symptoms, daily care measures and palliative approaches, treatments, diet, physical activity and support networks, benefits) and gathered functionalities according to the team's needs and preferences, being considered innovative and encouraging for self-care. Conclusion codesign allowed designing resources, contents, screen sketches, user flow, prototyping and prototype name, in a creative and participatory process to promote the health of people with heart failure in vulnerable health situations.
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Mansson L, Bäckman P, Öhberg F, Sandlund J, Selling J, Sandlund M. Evaluation of Concurrent Validity between a Smartphone Self-Test Prototype and Clinical Instruments for Balance and Leg Strength. SENSORS (BASEL, SWITZERLAND) 2021; 21:1765. [PMID: 33806379 PMCID: PMC7961526 DOI: 10.3390/s21051765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/26/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
The evolving use of sensors to objectively assess movements is a potentially valuable addition to clinical assessments. We have developed a new self-test application prototype, MyBalance, in the context of fall prevention aimed for use by older adults in order to independently assess balance and functional leg strength. The objective of this study was to investigate the new self-test application for concurrent validity between clinical instruments and variables collected with a smartphone. The prototype has two test procedures: static standing balance test in two positions, and leg strength test performed as a sit-to-stand test. Thirty-one older adults were assessed for balance and functional leg strength, in an outpatient physiotherapy setting, using seven different clinical assessments and three sensor-tests. The results show that clinical instruments and sensor measurements correlate to a higher degree for the smartphone leg strength test. For balance tests, only a few moderate correlations were seen in the Feet Together position and no significant correlations for the Semi Tandem Stance. This study served as a first step to develop a smartphone self-test application for older adults to assess functional balance at home. Further research is needed to test validity, reliability, and user-experience of this new self-test application.
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Affiliation(s)
- Linda Mansson
- Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden; (L.M.); (P.B.); (J.S.); (J.S.)
| | - Pernilla Bäckman
- Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden; (L.M.); (P.B.); (J.S.); (J.S.)
| | - Fredrik Öhberg
- Department of Radiation Science, Umeå University, 901 87 Umeå, Sweden;
| | - Jonas Sandlund
- Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden; (L.M.); (P.B.); (J.S.); (J.S.)
| | - Jonas Selling
- Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden; (L.M.); (P.B.); (J.S.); (J.S.)
| | - Marlene Sandlund
- Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden; (L.M.); (P.B.); (J.S.); (J.S.)
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Finley N, Swartz TH, Cao K, Tucker JD. How to make your research jump off the page: Co-creation to broaden public engagement in medical research. PLoS Med 2020; 17:e1003246. [PMID: 32925970 PMCID: PMC7489547 DOI: 10.1371/journal.pmed.1003246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Nina Finley and co-authors discuss public involvement in planning and reporting medical research.
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Affiliation(s)
- Nina Finley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Talia H. Swartz
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kevin Cao
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
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