%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66180 %T Applications of Self-Driving Vehicles in an Aging Population %A Shu,Sara %A Woo,Benjamin K P %K self-driving %K driverless %K driver %K autonomous vehicles %K car %K transportation %K mobility %K travel %K vehicle %K driving %K artificial intelligence %K gerontology %K geriatric %K older %K elderly %K aging %K healthy aging %K older adult %K autonomy %K independence %K aging in place %K health equity %D 2025 %7 28.4.2025 %9 %J JMIR Form Res %G English %X The proportion of older adult drivers is increasing and represents a growing population that must contemplate reducing driving and eventually stopping driving. The advent of self-driving vehicles opens vast possibilities with practical and far-reaching applications for our aging population. Advancing technologies in transportation may help to overcome transportation barriers for less mobile individuals, transcend social and geographical isolation, and improve resource and medical access. Herein, we propose various applications and benefits that self-driving vehicles have in maintaining independence and autonomy specifically for our aging population to preserve aging. %R 10.2196/66180 %U https://formative.jmir.org/2025/1/e66180 %U https://doi.org/10.2196/66180 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69952 %T Longitudinal and Combined Smartwatch and Ecological Momentary Assessment in Racially Diverse Older Adults: Feasibility, Adherence, and Acceptability Study %A Holmqvist,Sophia %A Kaplan,Marina %A Chaturvedi,Riya %A Shou,Haochang %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, United States, 1 215 204 7000, sophia.holmqvist@temple.edu %K cognitive impairment %K smartwatch %K longitudinal monitoring %K ecological momentary assessment %K aging %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Due to the rising prevalence of Alzheimer disease and related dementias, easily deployable tools to quantify risk are needed. Smartphones and smartwatches enable unobtrusive and continuous monitoring, but there is limited information regarding the feasibility, adherence, and acceptability of digital data collection among racially diverse older adults. Objective: This paper examined the feasibility, adherence, and acceptability of a 4-week combined smartwatch monitoring and ecological momentary assessment (EMA) study in a racially diverse sample of older adults. Methods: A total of 44 older adults (aged ≥55 y) with either mild cognitive impairment or healthy cognition completed an informed consent comprehension quiz, baseline cognitive testing, training regarding digital data collection, and questionnaires. Participants were instructed to wear a Garmin Vivosmart 4 smartwatch for 23 h/d for 4 weeks, sync 2 smartphone apps (Garmin and Labfront) daily, and complete a daily EMA survey with automated prompts for surveys and charging. Training time, smartwatch adherence (eg, wear time), daily EMA survey response rate, and performance on the consent quiz were quantified. Associations between feasibility and adherence metrics and participant factors were evaluated. Self-reported usability of the apps and smartwatch was collected at study end. Results: Consent comprehension quiz scores were high (mean 97.33%, SD 6.86% correct), and training sessions lasted on average 17.93 (SD 6.89) minutes. During the 4-week study, participants wore the smartwatch for an average of 21 h/d (SD 1.53) and showed an average response rate of 94% (SD 9.58%) to daily EMA surveys. In unadjusted bivariate analyses, age, race, and cognition were associated with feasibility and adherence measures, but only age and race remained significant in multivariate models. After accounting for all participant factors, older age was a significant predictor of longer training time, and Black race was a significant predictor of lower daily wear time. On the usability survey, all participants (45/45, 100%) indicated willingness to participate in future smartwatch studies, >80% (37/45) had a positive experience, and >90% (41/45) were satisfied with smartphone app syncing. Conclusions: Smartwatch monitoring, requiring daily wear, smartphone syncing, and daily EMA survey completion, is highly feasible in older adults because adherence to daily wear and EMA surveys was high, as was general satisfaction on usability surveys. Although older participants may require more training on smartwatch and smartphone procedures and automated prompting during the study period, longitudinal monitoring with the Garmin Vivosmart 4 smartwatch and Labfront app is acceptable and feasible for collecting nearly continuous data in Black and White older adults, including those with mild cognitive impairment and those without. %M 40198914 %R 10.2196/69952 %U https://humanfactors.jmir.org/2025/1/e69952 %U https://doi.org/10.2196/69952 %U http://www.ncbi.nlm.nih.gov/pubmed/40198914 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64661 %T Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool %A Connelly,Jenni %A Swingler,Kevin %A Rodriguez-Sanchez,Nidia %A Whittaker,Anna C %+ Faculty of Health Sciences and Sport, University of Stirling, 3a74a Cottrell Building, Stirling, FK9 4LA, United Kingdom, 44 1786 466399, jenni.connelly1@stir.ac.uk %K ageing %K digital technology %K dietary measurement %K care homes %K co-design %K dietary intake %K food diary %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57%; and residents: n=6, 43%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool’s needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home–personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. %M 40053797 %R 10.2196/64661 %U https://aging.jmir.org/2025/1/e64661 %U https://doi.org/10.2196/64661 %U http://www.ncbi.nlm.nih.gov/pubmed/40053797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55082 %T Online-Based Recruitment Methods for Community-Dwelling Older Adults: Scoping Review and Lessons Learned From the PLAN Trial %A Min,Deborah %A Yun,Ji-Young %A Parslow,Chad %A Jajodia,Anushka %A Han,Hae-Ra %+ School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 14106142669, hhan3@jhu.edu %K older adults %K online %K online recruitment %K community-dwelling %K strategies %K America %K Americans %K technology adoption %K digital technologies %K COVID-19 %K pandemic %K digital health %K dementia %K caregivers %K healthcare system %K community health workers %K consultants %K mobile phone %D 2025 %7 25.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Despite rapid technological advancement and a considerably aging US population, there remains a gap in the literature pertaining to online-based recruitment strategies for older adults. Objective: This study aimed to describe the lessons learned from the authors’ experience of recruiting a sample for PLAN (Preparing successful aging through dementia Literacy education And Navigation), an ongoing, community-based randomized controlled trial designed to promote the transition of community-dwelling Korean American older adults with probable dementia and their caregivers into the health care system. The authors also present online-based recruitment strategies focused on older adults reported in relevant published studies to compare with their experiences. Methods: Data sources included PLAN recruitment tracking files, study team meeting minutes, and interviews with community consultants. We also conducted a scoping review of published studies, searching PubMed in July 2021, and updated our search in September 2023. Eligibility criteria included (1) focus on older adults aged more than 65 years, (2) sample recruited from a community setting, and (3) inclusion and description of online-based recruitment strategies. Exclusion criteria (1) did not focus on adults older than 65 years in a community setting, (2) did not include or describe online-based recruitment strategies, or (3) used online-based methods but not for the purpose of recruitment. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Information was extracted using a data charting table and synthesized by conducting a thematic analysis. Results: In total, 8 articles were included in the scoping review and primarily addressed health promotion and recruitment strategy evaluation. When compared with PLAN data sources, five key themes emerged as relevant to the online-based recruitment of community-dwelling older adults: (1) unfamiliarity with technology—limited digital literacy, (2) differences in internet access and use across older age groups, (3) providing technological support to promote recruitment, (4) successful and unsuccessful recruitment using social media, and (5) other diverse online-based methods of recruitment. In particular, direct quotes from multiple sources for the PLAN trial revealed technological challenges that were common among immigrant older adults as the study team used various online-based recruitment activities. Conclusions: The literature was limited in the discussion of online-based recruitment among older participants. Data sources revealed the digital divide and limited digital literacy, particularly among non–English-speaking immigrant older adults and their caregivers. The usefulness of online-based recruitment of older adults is uncertain due, in large part, to limited sociodemographic diversity noted in the samples recruited in the included studies. Future research should explore the role of race and ethnicity and other characteristics, such as socioeconomic status, sex, education, access to technology, and digital literacy, in relation to online-based recruitment for adequate representation of diverse older adults in research. Trial Registration: ClinicalTrials.gov NCT03909347; https://clinicaltrials.gov/study/NCT03909347 %M 39998873 %R 10.2196/55082 %U https://www.jmir.org/2025/1/e55082 %U https://doi.org/10.2196/55082 %U http://www.ncbi.nlm.nih.gov/pubmed/39998873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52834 %T Exploring Older Adults’ Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study %A Choukou,Mohamed-Amine %A Banihani,Jasem %A Azizkhani,Sarah %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R111, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada, 1 204 333 4778, amine.choukou@umanitoba.ca %K agetech %K attitude %K opinion %K perception %K perspective %K home based %K community based %K research %K strategic planning %K gerontechnology %K geriatric %K older adults %K aging %K co-construction %K workshop %K inductive analysis %K development %K aging-in-place %K independent %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. %M 39671577 %R 10.2196/52834 %U https://formative.jmir.org/2024/1/e52834 %U https://doi.org/10.2196/52834 %U http://www.ncbi.nlm.nih.gov/pubmed/39671577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56091 %T Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study %A Takashi,Naoki %A Fujisawa,Misaki %A Ohtera,Shosuke %+ Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430, Morioka-Cho, Aichi, 474-8511, Japan, 81 562 46 2311, takashi@ncgg.go.jp %K health services research %K health policy %K quality of care %K access to care %K outcome assessment %K public health %K health service %K accessible %K accessibility %K care coordination %K health outcome %K surveillance %K regional disparities %K nonstandardized care %K nonstandardization %K hospital discharge %K hospital care %K analysis %K Japan %K older adults %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. Objective: This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. Methods: This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. Results: The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). Conclusions: The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms. %R 10.2196/56091 %U https://formative.jmir.org/2024/1/e56091 %U https://doi.org/10.2196/56091 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58895 %T Disaster Preparedness Intervention for Older Adults (Seniors’ Positive Involvement in Community Emergencies): Protocol for a Quasi-Experimental Study %A White-Lewis,Sharon %A Lightner,Joseph %A Crowley,Julia %A Grimes,Amanda %A Spears,Kathleen %A Chesnut,Steven %+ School of Nursing and Health Sciences, University of Missouri Kansas City, Kansas City, MO, United States, 1 913 592 4477, whitelewiss@umkc.edu %K older adults %K disaster preparedness %K emergency preparedness %K disaster protocol %K disaster engagement %K disaster recovery %K personal preparedness %K community dwelling older adults %K elderly %K aging in place %K activities in daily life %K resiliency %K community health %D 2024 %7 4.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults comprise a substantial proportion of the US population requiring support during disaster events. Previous research demonstrates that older adults are resilient but deficient in disaster preparedness and lacking in community engagement. There is a gap in high-quality research in this area. Objective: This study aims to fill this gap by developing a 4-phase intervention to improve mobility and balance, decrease fall risks (mitigation), increase knowledge of disaster preparedness (preparedness), improve community emergency operation plans (response), and improve self-efficacy in disaster recovery (recovery) for older adults. Methods: This is a community-based, 10-month study in a large Midwestern urban and suburban location targeting community-dwelling older adults. The 4 phases of interventions address mitigation, preparedness, response, and recovery—aspects improving outcomes from disaster events. In total, 4 to 6 one-hour seminars each month are provided to community-dwelling older adults to improve disaster preparedness and recovery planning. A critical incident packet with resources on essential information such as medications, a communication plan, evacuation resources, and supplies was started and is being reviewed. Preintervention surveys are orally given, with research assistants aiding in any difficulties the participants have. After the surveys, 2 individual 20-minute presentations separated by a short break for snacks and initial completion of their disaster plan preserve the older adult’s attention. Mitigation efforts to improve mobility and safety are offered with 10 visits to the older adults’ residences, adapting physical activity and balance exercises to the individual’s needs. To address response needs, the emergency operations plans for 2 of the major cities are being amended for specific functional needs and access guidelines. Measurements include accelerometers to assess improvement in mobility, fall risk assessments, an abbreviated Federal Emergency Management Association Household Survey, an assessment for disaster engagement with partners tool, a brief pain inventory assessment, and the General Self-Efficacy Scale. We analyze data descriptively and compare pre- and postintervention data for each phase with paired-samples t test and other nonparametric techniques (proportion tests and Wilcoxon signed-rank tests). Overarching objectives prioritized during this intervention include underscoring respect for the experience and resilience found in older adults and engaging them in specialized roles to support their communities during disaster events. Results: The intervention was funded in July 2023; enrollment began in November 2023 and is continuing. We will conclude data collection by July 2025. Published study results can be expected in early 2025. Conclusions: With improved disaster preparedness, mobility, recovery planning, and inclusion as a resource in community disasters, older adults are expected to be safer and be able to age in place. If successful, future studies will focus on outreach and sustainability. This study will serve as a model for older adult disaster preparedness and community involvement. International Registered Report Identifier (IRRID): DERR1-10.2196/58895 %R 10.2196/58895 %U https://www.researchprotocols.org/2024/1/e58895 %U https://doi.org/10.2196/58895 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e60949 %T Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study %A Hammarberg,Karin %A Bandyopadhyay,Mridula %A Nguyen,Hau %A Cicuttini,Flavia %A Stanzel,Karin Andrea %A Brown,Helen %A Hickey,Martha %A Fisher,Jane %+ School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, 3004, Australia, 61 418306023, karin.hammarberg@monash.edu %K health promotion %K healthy aging %K self-management %K midlife %K menopause %K internet %K video %K animation %K survey %K questionnaire %K education %K women %K gynecology %D 2024 %7 2.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72%) completed all questions. Almost all (from 321/353, 91% to 334/363, 92%) agreed that the information in the videos was “very easy to understand.” The proportions reporting that all or some of the information in the video was new to them varied between videos from 36% (137/386) to 66% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70% (271/386) to 89% (331/373), and between 61% (235/386) and 70% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80% vs 208/318, 65%; P=.051 for video 3; and 36/44, 80% vs 197/309, 64%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. %M 39621404 %R 10.2196/60949 %U https://www.i-jmr.org/2024/1/e60949 %U https://doi.org/10.2196/60949 %U http://www.ncbi.nlm.nih.gov/pubmed/39621404 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56923 %T Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model %A Cotter,Lynne M %A Shah,Dhavan %A Brown,Kaitlyn %A Mares,Marie-Louise %A Landucci,Gina %A Saunders,Sydney %A Johnston,Darcie C %A Pe-Romashko,Klaren %A Gustafson,David %A Maus,Adam %A Thompson,Kasey %A Gustafson,David H %+ School of Journalism and Mass Communication, University of Wisconsin - Madison, 821 University Ave, 5115 Vilas Communication Hall, Madison, WI, 53706, United States, 1 608 262 0388, dshah@wisc.edu %K self-determination theory %K usability %K mobile technology model %K aging %K eHealth %K mobile health %K mHealth %K smart displays %K video calls %K older adult %K chronic conditions %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults’ autonomy, competence, and relatedness. Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results: Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants’ experiences with the smart displays. Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization. %M 39476377 %R 10.2196/56923 %U https://aging.jmir.org/2024/1/e56923 %U https://doi.org/10.2196/56923 %U http://www.ncbi.nlm.nih.gov/pubmed/39476377 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57219 %T Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study %A Strandberg,Susanna %A Ekstedt,Mirjam %A Fagerström,Cecilia %A Backåberg,Sofia %+ Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar/Växjö, 35195, Sweden, 46 725673309, susanna.strandberg@lnu.se %K chronic illness %K eHealth %K experience-based co-design %K older adults %K self-care %K video feedback %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. Results: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, “Breathing exercises” and “Picking up from the floor,” revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support. %M 39466305 %R 10.2196/57219 %U https://formative.jmir.org/2024/1/e57219 %U https://doi.org/10.2196/57219 %U http://www.ncbi.nlm.nih.gov/pubmed/39466305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58312 %T Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial %A Valdés-Aragonés,Myriam %A Pérez-Rodríguez,Rodrigo %A Carnicero,José Antonio %A Moreno-Sánchez,Pedro A %A Oviedo-Briones,Myriam %A Villalba-Mora,Elena %A Abizanda-Soler,Pedro %A Rodríguez-Mañas,Leocadio %+ Intelligent Robotics Lab, Universidad Rey Juan Carlos, Camino del Molino 5, 28942, Fuenlabrada, Spain, 34 914888401, rodrigo.perez@urjc.es %K frailty %K functional status %K older adults %K new technologies %K sensor %K monitoring system %K information and communication technologies %K mobile app %K sensor kit %K sensors %K technological ecosystem %K clinical intervention %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients’ frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention. Objective: The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up. Methods: This randomized clinical trial involved 90 older adults aged ≥70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant. Results: The mean age of the participants was 82.33 years, with 28% (25/90) being males. Participants allocated to the intervention group showed a 74% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months. Conclusions: The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency. Trial Registration: ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145 %M 39436684 %R 10.2196/58312 %U https://www.jmir.org/2024/1/e58312 %U https://doi.org/10.2196/58312 %U http://www.ncbi.nlm.nih.gov/pubmed/39436684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54916 %T Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework %A Pack,Allison P %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %+ Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0274, allison.pack@northwestern.edu %K older adults %K polypharmacy %K medication adherence %K intervention development %K qualitative research %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. %M 39418094 %R 10.2196/54916 %U https://formative.jmir.org/2024/1/e54916 %U https://doi.org/10.2196/54916 %U http://www.ncbi.nlm.nih.gov/pubmed/39418094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54977 %T Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study %A Juhl,Marie Haase %A Soerensen,Ann Lykkegaard %A Vardinghus-Nielsen,Henrik %A Mortensen,Lea Sinding %A Kolding Kristensen,Jette %A Olesen,Anne Estrup %+ Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, Gartnerboligen, ground floor, Aalborg, 9000, Denmark, 45 26281305, aneso@dcm.aau.dk %K intervention development %K nursing home %K frontline professionals %K medication safety %K quality improvement %K patient safety culture %K experiential knowledge %K cocreation %K resilient health care systems %K safety II perspective %K human resources %K integrated knowledge translation %D 2024 %7 9.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. Objective: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. Methods: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. Results: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) “Medication safety reflexive spaces” focused on social and health care assistants. Conclusions: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. International Registered Report Identifier (IRRID): RR2-10.2196/43538 %M 39383532 %R 10.2196/54977 %U https://formative.jmir.org/2024/1/e54977 %U https://doi.org/10.2196/54977 %U http://www.ncbi.nlm.nih.gov/pubmed/39383532 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63222 %T Co-Designing a Conversational Agent With Older Adults With Chronic Obstructive Pulmonary Disease Who Age in Place: Qualitative Study %A Wegener,Emilie Kauffeldt %A M Bergschöld,Jenny %A Kramer,Tina %A Schmidt,Camilla Wong %A Borgnakke,Karen %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, København, 1353, Denmark, 45 26202168, emiliewegener@gmail.com %K eHealth %K aging in place %K digital health technology %K health literacy %K everyday life %K co-design %K co-designing %K conversational agent %K older adults %K elderly %K COPD %K thematic analysis %K design %K development %K interview data %K cocreation %K chronic obstructive pulmonary disease %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As a reaction to the global demographic increase in older adults (aged 60+ years), policy makers call for initiatives to enable healthy aging. This includes a focus on person-centered care and access to long-term care for older adults, such as developing different services and digital health technologies. This can enable patients to engage in their health and reduce the burden on the health care systems and health care professionals. The European Union project Smart Inclusive Living Environments (SMILE) focuses on well-being and aging in place using new digital health technologies. The novelty of the SMILE project is the use of a cocreational approach focused on the needs and preferences of older adults with chronic obstructive pulmonary disease (COPD) in technology development, to enhance access, adaptation, and usability and to reduce stigma. Objective: The study aimed to describe the perspective, needs, and preferences of older adults living with COPD in the context of the design and development of a conversational agent. Methods: This study carried out a data-driven thematic analysis of interview data from 11 cocreation workshops with 33 older adults living with COPD. Results: The three particular features that the workshop participants wanted to implement in a new technology were (1) a “my health” function, to use technology to manage and learn more about their condition; (2) a “daily activities” function, including an overview and information about social and physical activities in their local area; and (3) a “sleep” function, to manage circadian rhythm and enhance sleep quality, for example, through online video guides. In total, 2 overarching themes were identified for the 3 functions: measurements, which were actively discussed and received mixed interest among the participants, and health literacy, due to an overall interest in learning more about their condition in relation to everyday life. Conclusions: The future design of digital health technology must embrace the complexities of the everyday life of an older adult living with COPD and cater to their needs and preferences. Measurements should be optional and personalized, and digital solutions should be used as a supplement to health care professionals, not as substitute. %M 39378067 %R 10.2196/63222 %U https://humanfactors.jmir.org/2024/1/e63222 %U https://doi.org/10.2196/63222 %U http://www.ncbi.nlm.nih.gov/pubmed/39378067 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50847 %T Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Randomized Controlled Trial %A Xie,Yanhong %A Shen,Shanshan %A Liu,Caixia %A Hong,Hong %A Guan,Huilan %A Zhang,Jingmei %A Yu,Wanqi %K dementia %K family caregiver %K web-based training %K care burden %K care ability %K caregivers %K carer %K caregiving %K informal care %K RCT %K controlled trial %K randomized %K gerontology %K geriatric %K older adult %K elder %K elderly %K older person %K older people %K ageing %K aging %K dementia care %K randomized controlled trial %K internet-based training %D 2024 %7 4.10.2024 %9 %J JMIR Aging %G English %X Background: As dementia progresses, patients exhibit various psychological and behavioral symptoms, imposing a significant burden on families and society, including behavioral and psychological symptoms of dementia. However, caregivers lack professional care knowledge and skills, making it difficult for them to effectively cope with the diverse challenges of caregiving. Therefore, it is necessary to provide caregivers with professional knowledge and skills guidance. Objective: This study aimed to analyze the impact of internet-based training on behavioral and psychological symptoms of dementia in patients, and explore how this training model affects the caregiving abilities and caregiving burden of the family caregivers of patients with dementia. Methods: Using a consecutive enrollment method, the Department of Geriatrics at Zhejiang Hospital (Zhejiang, China) recruited 72 informal caregivers of patients with dementia. These caregivers were randomly divided into an intervention group and a control group, with 36 participants in each group. The intervention group underwent caregiver skill training via a web-based platform, whereas the control group initially received face-to-face follow-up guidance and was subsequently offered web-based training after 6 months. To assess the effectiveness of the intervention program, we used the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Chinese version of the Zarit Burden Interview (CZBI), and the Sense of Competence in Dementia Care Staff Scale (SCIDS) for evaluations conducted before the intervention, 3 months after the intervention, and 6 months after the intervention. Results: Between July 2019 and December 2020, a total of 66 patients successfully completed the intervention and follow-up. After 6 months of intervention, the NPI-Q score of the intervention group was 3.18 (SD 3.81), the CZBI score was 10.97 (SD 5.43), and the SCIDS score was 71.88 (SD 4.78). The NPI-Q score of the control group was 8.09 (SD 8.52), the CZBI score was 30.30 (SD 13.05), and the SCIDS score was 50.12 (SD 9.10). There were statistically significant differences in NPI-Q (P=.004), CZBI (P<.001), and SCIDS scores (P<.001) between the intervention group and the control group. Repeated measures analysis of variance showed that compared with before the intervention, there were statistically significant differences in CZBI (P<.001) and SCIDS (P<.001) scores 3 months after the intervention, while the difference in NPI-Q (P=.11) scores was not significant. The total scores of NPI-Q (P<.001), CZBI (P<.001), and SCIDS (P<.001) were significantly improved 6 months after the intervention. In addition, the results of the covariance analysis showed that after excluding the time effect, the web-based training intervention significantly reduced the NPI-Q score (−2.79, 95% CI −4.38 to −1.19; P<.001) of patients with dementia and the CZBI score (−13.52, 95% CI −15.87 to −11.16; P<.001) of caregivers, while increasing the SCIDS score (12.24, 95% CI 9.02-15.47; P<.001). Conclusions: Internet-based training could significantly reduce the level of behavioral symptoms in older patients with dementia and alleviate the burden on caregivers, enhancing their caregiving abilities. Our results confirmed the effectiveness and feasibility of web-based training, which was of great significance in providing caregiving knowledge training for informal caregivers of persons with dementia. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200057858; https://www.chictr.org.cn/showproj.html?proj=136442 %R 10.2196/50847 %U https://aging.jmir.org/2024/1/e50847 %U https://doi.org/10.2196/50847 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57651 %T Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study %A Josendal,Anette Vik %A Bergmo,Trine Strand %K home care %K medication management %K adherence %K self-management %K multidose drug dispensing %K Norway %K primary care %K older adults %D 2024 %7 4.10.2024 %9 %J JMIR Aging %G English %X Background: Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. Objective: The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. Methods: We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants’ homes, and the interview transcripts were analyzed thematically. Results: All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. Conclusions: MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy. %R 10.2196/57651 %U https://aging.jmir.org/2024/1/e57651 %U https://doi.org/10.2196/57651 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51520 %T Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study %A Teano,Anthony L %A Scott,Ashley %A Gipson,Cassandra %A Albert,Marilyn %A Pettigrew,Corinne %+ Department of Neurology, Johns Hopkins University School of Medicine, 550 N. Broadway St., Suite 415, Baltimore, MD, 21205, United States, 1 410 614 0363, cpettigrew@jhmi.edu %K education %K social media %K outreach %K recruitment %K Alzheimer’s disease %K Alzheimer disease %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media–based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center’s social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform’s native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P≤.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. %M 38981112 %R 10.2196/51520 %U https://aging.jmir.org/2024/1/e51520 %U https://doi.org/10.2196/51520 %U http://www.ncbi.nlm.nih.gov/pubmed/38981112 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e54128 %T A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study %A Roberts,R Lynae %A Cherry,Katelin D %A Mohan,Desh P %A Statler,Tiffany %A Kirkendall,Eric %A Moses,Adam %A McCraw,Jennifer %A Brown III,Andrew E %A Fofanova,Tatiana Y %A Gabbard,Jennifer %K advance care planning %K ACP %K digital health tools %K system usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K adoption %K acceptance %K usability %K digital health %K platform %K website %K websites %D 2024 %7 6.5.2024 %9 %J JMIR Aging %G English %X Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. %R 10.2196/54128 %U https://aging.jmir.org/2024/1/e54128 %U https://doi.org/10.2196/54128 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57878 %T Patient Partnership Tools to Support Medication Safety in Community-Dwelling Older Adults: Protocol for a Nonrandomized Stepped Wedge Clinical Trial %A Xiao,Yan %A Fulda,Kimberley G %A Young,Richard A %A Hendrix,Z Noah %A Daniel,Kathryn M %A Chen,Kay Yut %A Zhou,Yuan %A Roye,Jennifer L %A Kosmari,Ludmila %A Wilson,Joshua %A Espinoza,Anna M %A Sutcliffe,Kathleen M %A Pitts,Samantha I %A Arbaje,Alicia I %A Chui,Michelle A %A Blair,Somer %A Sloan,Dawn %A Jackson,Masheika %A Gurses,Ayse P %+ College of Nursing and Health Innovation, University of Texas at Arlington, 411 S. Nedderman Drive, Arlington, TX, 76019, United States, 1 817 272 5781, yan.xiao@uta.edu %K primary care %K medication safety %K communication %K patient engagement %K human factors %K medication %K safety %K engagement %K support %K community dwelling %K older adults %K elderly %K protocol %K patient safety %K self-management %K ambulatory %K medications %K tool %K tools %K effective %K medication safety %K data collection %K decision %K decision making %K care %K self-efficacy %K engagement tool %D 2024 %7 29.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources. Objective: This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety. Methods: The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients’ self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits. Results: The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024. Conclusions: This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits. Trial Registration: ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368 International Registered Report Identifier (IRRID): DERR1-10.2196/57878 %M 38684080 %R 10.2196/57878 %U https://www.researchprotocols.org/2024/1/e57878 %U https://doi.org/10.2196/57878 %U http://www.ncbi.nlm.nih.gov/pubmed/38684080 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56346 %T Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review %A Jabin,Md Shafiqur Rahman %A Samuriwo,Ray %A Chilaka,Marcus %A Yaroson,Emilia Vann %+ Department of Medicine and Optometry, Linnaeus University, Linnéuniversitetet Box 451, Växjö, 351 06, Sweden, 44 07915673612, mjabin@bradford.ac.uk %K patient safety %K acceptability %K accessibility %K appropriateness %K timeliness %K equitability %K social care %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective: This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods: The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results: A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. Conclusions: This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. International Registered Report Identifier (IRRID): PRR1-10.2196/56346 %M 38635311 %R 10.2196/56346 %U https://www.researchprotocols.org/2024/1/e56346 %U https://doi.org/10.2196/56346 %U http://www.ncbi.nlm.nih.gov/pubmed/38635311 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53564 %T Strategies to Mitigate Age-Related Bias in Machine Learning: Scoping Review %A Chu,Charlene %A Donato-Woodger,Simon %A Khan,Shehroz S %A Shi,Tianyu %A Leslie,Kathleen %A Abbasgholizadeh-Rahimi,Samira %A Nyrup,Rune %A Grenier,Amanda %+ Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada, 1 416 946 0217, charlene.chu@utoronto.ca %K age %K ageing %K ageism %K aging %K algorithm %K algorithmic bias %K artificial intelligence %K bias %K digital ageism %K elder %K elderly %K geriatric %K gerontology %K machine learning %K older adult %K older people %K older person %K review methodology %K review methods %K scoping %K search %K searching %K synthesis %D 2024 %7 22.3.2024 %9 Review %J JMIR Aging %G English %X Background: Research suggests that digital ageism, that is, age-related bias, is present in the development and deployment of machine learning (ML) models. Despite the recognition of the importance of this problem, there is a lack of research that specifically examines the strategies used to mitigate age-related bias in ML models and the effectiveness of these strategies. Objective: To address this gap, we conducted a scoping review of mitigation strategies to reduce age-related bias in ML. Methods: We followed a scoping review methodology framework developed by Arksey and O’Malley. The search was developed in conjunction with an information specialist and conducted in 6 electronic databases (IEEE Xplore, Scopus, Web of Science, CINAHL, EMBASE, and the ACM digital library), as well as 2 additional gray literature databases (OpenGrey and Grey Literature Report). Results: We identified 8 publications that attempted to mitigate age-related bias in ML approaches. Age-related bias was introduced primarily due to a lack of representation of older adults in the data. Efforts to mitigate bias were categorized into one of three approaches: (1) creating a more balanced data set, (2) augmenting and supplementing their data, and (3) modifying the algorithm directly to achieve a more balanced result. Conclusions: Identifying and mitigating related biases in ML models is critical to fostering fairness, equity, inclusion, and social benefits. Our analysis underscores the ongoing need for rigorous research and the development of effective mitigation approaches to address digital ageism, ensuring that ML systems are used in a way that upholds the interests of all individuals. Trial Registration: Open Science Framework AMG5P; https://osf.io/amg5p %M 38517459 %R 10.2196/53564 %U https://aging.jmir.org/2024/1/e53564 %U https://doi.org/10.2196/53564 %U http://www.ncbi.nlm.nih.gov/pubmed/38517459 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e48292 %T Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review %A Kirby,Pippa %A Lai,Helen %A Horrocks,Sophie %A Harrison,Matthew %A Wilson,Danielle %A Daniels,Sarah %A Calvo,Rafael A %A Sharp,David J %A Alexander,Caroline M %+ UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), 9th Floor, Sir Michael Uren Hub, White City Campus, Imperial College London, 86 Wood Lane, London, W12 0BZ, United Kingdom, 44 20 7594 9755, h.lai18@imperial.ac.uk %K dementia %K technology %K patient and public involvement and engagement %K co-design %K coproduction %D 2024 %7 4.3.2024 %9 Review %J JMIR Aging %G English %X Background: Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care–related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. Objective: This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. Methods: A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. Results: The search yielded 1694 papers, with 31 (1.83%) being analyzed after screening. Most (21/31, 68%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13%) papers used formal methods for evaluating impact. Conclusions: Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved—researchers, patients, and other stakeholders—can learn how we can best conduct research together. %M 38437014 %R 10.2196/48292 %U https://aging.jmir.org/2024/1/e48292 %U https://doi.org/10.2196/48292 %U http://www.ncbi.nlm.nih.gov/pubmed/38437014 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52117 %T Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic %A McDermott,Katherine %A Levey,Nadine %A Brewer,Julie %A Ehmann,Madison %A Hooker,Julia E %A Pasinski,Roger %A Yousif,Neda %A Raju,Vidya %A Gholston,Milton %A Greenberg,Jonathan %A Ritchie,Christine S %A Vranceanu,Ana-Maria %+ Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, 02114, United States, 1 617 724 4977, avranceanu@mgh.harvard.edu %K chronic pain %K mind-body %K underserved %K musculoskeletal pain %K pain %K older adults %K pain management %K feasibility %K intervention %D 2023 %7 29.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). Objective: We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. Methods: We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function—self-reported, performance based (6-minute walk test), and objective (step count)—and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). Results: We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. Conclusions: We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. Trial Registration: ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231 International Registered Report Identifier (IRRID): DERR1-10.2196/52117 %M 38157234 %R 10.2196/52117 %U https://www.researchprotocols.org/2023/1/e52117 %U https://doi.org/10.2196/52117 %U http://www.ncbi.nlm.nih.gov/pubmed/38157234 %0 Journal Article %@ 2561-7605 %I %V 6 %N %P e51844 %T Joint Modeling of Social Determinants and Clinical Factors to Define Subphenotypes in Out-of-Hospital Cardiac Arrest Survival: Cluster Analysis %A Abbott,Ethan E %A Oh,Wonsuk %A Dai,Yang %A Feuer,Cole %A Chan,Lili %A Carr,Brendan G %A Nadkarni,Girish N %K out-of-hospital-cardiac arrest %K machine learning %K social determinants of health %K SDOH %K cluster %K cardiac %K heart %K cardiology %K myocardial %K phenotype %K phenotypes %K subphenotype %K subphenotypes %K mortality %K death %K survive %K survival %K survivor %K survivors %K retrospective %K observational %K cohort %K algorithm %K algorithms %K k-means %K clustering %K association %K associations %D 2023 %7 6.12.2023 %9 %J JMIR Aging %G English %X Background: Machine learning clustering offers an unbiased approach to better understand the interactions of complex social and clinical variables via integrative subphenotypes, an approach not studied in out-of-hospital cardiac arrest (OHCA). Objective: We conducted a cluster analysis for a cohort of OHCA survivors to examine the association of clinical and social factors for mortality at 1 year. Methods: We used a retrospective observational OHCA cohort identified from Medicare claims data, including area-level social determinants of health (SDOH) features and hospital-level data sets. We applied k-means clustering algorithms to identify subphenotypes of beneficiaries who had survived an OHCA and examined associations of outcomes by subphenotype. Results: We identified 27,028 unique beneficiaries who survived to discharge after OHCA. We derived 4 distinct subphenotypes. Subphenotype 1 included a distribution of more urban, female, and Black beneficiaries with the least robust area-level SDOH measures and the highest 1-year mortality (2375/4417, 53.8%). Subphenotype 2 was characterized by a greater distribution of male, White beneficiaries and had the strongest zip code–level SDOH measures, with 1-year mortality at 49.9% (4577/9165). Subphenotype 3 had the highest rates of cardiac catheterization at 34.7% (1342/3866) and the greatest distribution with a driving distance to the index OHCA hospital from their primary residence >16.1 km at 85.4% (8179/9580); more were also discharged to a skilled nursing facility after index hospitalization. Subphenotype 4 had moderate median household income at US $51,659.50 (IQR US $41,295 to $67,081) and moderate to high median unemployment at 5.5% (IQR 4.2%-7.1%), with the lowest 1-year mortality (1207/3866, 31.2%). Joint modeling of these features demonstrated an increased hazard of death for subphenotypes 1 to 3 but not for subphenotype 4 when compared to reference. Conclusions: We identified 4 distinct subphenotypes with differences in outcomes by clinical and area-level SDOH features for OHCA. Further work is needed to determine if individual or other SDOH domains are specifically tied to long-term survival after OHCA. %R 10.2196/51844 %U https://aging.jmir.org/2023/1/e51844 %U https://doi.org/10.2196/51844 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e45177 %T Digital Microlearning for Training and Competency Development of Older Adult Care Personnel: Mixed Methods Intervention Study to Assess Needs, Effectiveness, and Areas of Application %A Richardson,Matt X %A Aytar,Osman %A Hess-Wiktor,Katarzyna %A Wamala-Andersson,Sarah %+ Department of Health and Welfare Technology, School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, 721 23, Sweden, 46 21 101300, matt.richardson@mdu.se %K digital microlearning %K elderly care %K older adult care %K competency development %K implementation research %K dementia %K COVID-19 %D 2023 %7 4.12.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Older adult care organizations face challenges today due to high personnel turnover and pandemic-related obstacles in conducting training and competence development programs in a time-sensitive and fit-for-purpose manner. Digital microlearning is a method that attempts to meet these challenges by more quickly adapting to the educational needs of organizations and individual employees in terms of time, place, urgency, and retention capacity more than the traditional competency development methods. Objective: This study aimed to determine if and how an app-based digital microlearning intervention can meet older adult care organizations’ personnel competency development needs in terms of knowledge retention and work performance. Methods: This study assessed the use of a digital microlearning app, which was at the testing stage in the design thinking model among managerial (n=4) and operational (n=22) employees within 3 older adult care organizations. The app was used to conduct predetermined competency development courses for the staff. Baseline measurements included participants’ previous training and competency development methods and participation, as well as perceived needs in terms of time, design, and channel. They then were introduced to and used a digital microlearning app to conduct 2 courses on one or more digital devices, schedules, and locations of their own choice during a period of ~1 month. The digital app and course content, perceived knowledge retention, and work performance and satisfaction were individually assessed via survey upon completion. The survey was complemented with 4 semistructured focus group interviews, which allowed participants (in total 16 individuals: 6 managerial-administrative employees and 10 operational employees) to describe their experiences with the app and its potential usefulness within their organizations. Results: The proposed advantages of the digital microlearning app were largely confirmed by the participants’ perceptions, particularly regarding the ease of use and accessibility, and efficiency and timeliness of knowledge delivery. Assessments were more positive among younger or less experienced employees with more diverse backgrounds. Participants expressed a positive inclination toward using the app, and suggestions provided regarding its potential development and broader use suggested a positive view of digitalization in general. Conclusions: Our results show that app-based digital microlearning appears to be an appropriate new method for providing personnel competency development within the older adult care setting. Its implementation in a larger sample can potentially provide more detailed insights regarding its intended effects. %M 38048152 %R 10.2196/45177 %U https://mededu.jmir.org/2023/1/e45177 %U https://doi.org/10.2196/45177 %U http://www.ncbi.nlm.nih.gov/pubmed/38048152 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e49154 %T Older Persons’ and Health Care Professionals’ Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study %A Holmqvist,Malin %A Johansson,Linda %A Lindenfalk,Bertil %A Thor,Johan %A Ros,Axel %+ Department of Public Health and Healthcare, Region Jönköping County, Box 1024, Jönköping, 551 11, Sweden, 46 706702569, malin.m.holmqvist@rjl.se %K co-design %K engagement %K medications %K medication plan %K older people %K older adults %K participatory %K patient experience %K patient safety %K remote %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. Objective: This study aimed to identify participants’ needs and requirements for a medication plan and explore their reasoning for different design choices. Methods: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. Results: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. Conclusions: After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step. %M 37796569 %R 10.2196/49154 %U https://aging.jmir.org/2023/1/e49154 %U https://doi.org/10.2196/49154 %U http://www.ncbi.nlm.nih.gov/pubmed/37796569 %0 Journal Article %@ 2561-7605 %I %V 6 %N %P e45799 %T Offering Outworld Experiences to In-Patients With Dementia Through Virtual Reality: Mixed Methods Study %A Matsangidou,Maria %A Solomou,Theodoros %A Frangoudes,Fotos %A Papayianni,Ersi %A Pattichis,Constantinos S %K virtual reality %K dementia %K patient-centered design %K psychophysiological responses %K behavioral and psychological symptoms %K in-patient %K VR %K symptom management %K quality of life %K intervention %K mental health %K mental disorder %K dementia care %D 2023 %7 31.8.2023 %9 %J JMIR Aging %G English %X Background: Research has suggested that institutionalization can increase the behavioral and psychological symptoms of dementia. To date, recent studies have reported a growing number of successful deployments of virtual reality for people with dementia to alleviate behavioral and psychological symptoms of dementia and improve quality of life. However, virtual reality has yet to be rigorously evaluated, since the findings are still in their infancy, with nonstatistically significant and inconclusive results. Objective: Unlike prior works, to overcome limitations in the current literature, our virtual reality system was co-designed with people with dementia and experts in dementia care and was evaluated with a larger population of patients with mild to severe cases of dementia. Methods: Working with 44 patients with dementia and 51 medical experts, we co-designed a virtual reality system to enhance the symptom management of in-patients with dementia residing in long-term care. We evaluated the system with 16 medical experts and 20 people with dementia. Results: This paper explains the screening process and analysis we used to identify which environments patients would like to receive as an intervention. We also present the system’s evaluation results by discussing their impact in depth. According to our findings, virtual reality contributes significantly to the reduction of behavioral and psychological symptoms of dementia, especially for aggressive, agitated, anxious, apathetic, depressive, and fearful behaviors. Conclusions: Ultimately, we hope that the results from this study will offer insight into how virtual reality technology can be designed, deployed, and used in dementia care. %R 10.2196/45799 %U https://aging.jmir.org/2023/1/e45799 %U https://doi.org/10.2196/45799 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41950 %T How Older Persons and Health Care Professionals Co-designed a Medication Plan Prototype Remotely to Promote Patient Safety: Case Study %A Holmqvist,Malin %A Ros,Axel %A Lindenfalk,Bertil %A Thor,Johan %A Johansson,Linda %+ Department of Public Health and Healthcare, Region Jönköping County, Box 1024, Jönköping, 55111, Sweden, 46 706702569, malin.m.holmqvist@rjl.se %K co-design %K remote %K older people %K medications %K medication plan %K patient safety %K patient experience %K participatory %K engagement %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Harm from medications is a major patient safety challenge. Most adverse drug events arise when a medication is prescribed or reevaluated. Therefore, interventions in this area may improve patient safety. A medication plan, that is, a plan for continued treatment with medications, may support patient safety. Participation of patients in the design of health care products or services may improve patient safety. Co-design, as in the Double Diamond framework from the Design Council, England, can emphasize patient involvement. As the COVID-19 pandemic brought restrictions to face-to-face co-design approaches, interest in remote approaches increased. However, it is uncertain how best to perform remote co-design. Therefore, we explored a remote approach, which brought together older persons and health care professionals to co-design a medication plan prototype in the electronic health record, aiming to support patient safety. Objective: This study aimed to describe how remote co-design was applied to create a medication plan prototype and to explore participants’ experiences with this approach. Methods: Within a case study design, we explored the experiences of a remote co-design initiative with 14 participants in a regional health care system in southern Sweden. Using descriptive statistics, quantitative data from questionnaires and web-based workshop timestamps were analyzed. A thematic analysis of the qualitative data gathered from workshops, interviews, and free-text responses to the survey questions was performed. Qualitative and quantitative data were compared side by side in the discussion. Results: The analysis of the questionnaires revealed that the participants rated the experiences of the co-design initiative very high. In addition, the balance between how much involved persons expressed their wishes and were listened to was considered very good. Marked timestamps from audio recordings showed that the workshops proceeded according to the plan. The thematic analysis yielded the following main themes: Everyone’s perspective matters, Learning by sharing, and Mastering a digital space. The themes encompassed what helped to establish a permissive environment that allowed the participants to be involved and share viewpoints. There was a dynamic process of learning and understanding, realizing that despite different backgrounds, there was consensus about the requirements for a medication plan. The remote co-design process seemed appealing, by balancing opportunities and challenges and building an inviting, creative, and tolerant environment. Conclusions: Participants experienced that the remote co-design initiative was inclusive of their perspectives and facilitated learning by sharing experiences. The Double Diamond framework was applicable in a digital context and supported the co-design process of the medication plan prototype. Remote co-design is still novel, but with attentiveness to power relations between all involved, this approach may increase opportunities for older persons and health care professionals to collaboratively design products or services that can improve patient safety. %M 37027205 %R 10.2196/41950 %U https://aging.jmir.org/2023/1/e41950 %U https://doi.org/10.2196/41950 %U http://www.ncbi.nlm.nih.gov/pubmed/37027205 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e37785 %T Involving Older People With Frailty or Impairment in the Design Process of Digital Health Technologies to Enable Aging in Place: Scoping Review %A Wegener,Emilie Kauffeldt %A Bergschöld,Jenny M %A Whitmore,Carly %A Winters,Marjolein %A Kayser,Lars %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 26202168, emilie.wegener@sund.ku.dk %K eHealth %K cognitive decline %K frail %K aging %K cocreation %K user involvement %K mobile phone %D 2023 %7 27.1.2023 %9 Review %J JMIR Hum Factors %G English %X Background: With an increase in life expectancy globally, the focus on digital health technologies that can enhance physical and mental health among older people with frailty and impairment has increased. Similarly, research interest in how digital health technology can promote well-being and self-management of health in older age has increased, including an increased focus on methods for designing digital health technologies that meet the various medical, psychological, and social needs of older population. Despite the increased focus, there remains a necessity to further understand the needs of this population group to ensure uptake and to avoid introduction of additional challenges when introducing technologies, for example, because of poor technological design. The scope is limited to digital health technologies meant to enable older people with frailty and impairment to age in place. Objective: In this study, we aimed to explore how older people with frailty and impairment are involved in various parts of the design processes of digital health technologies and identify gaps or neglected steps in a user-involving design process. This included a focus on recruitment strategies, contributions, and methods used to address the perspectives, needs, and desires of older people with frailty and impairment in the development of digital health technologies. Methods: A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting from February 2021 to April 2021. Literature searches were conducted in PubMed, Scopus, Embase, and IEEE using a search string covering the concepts of health technology, older people, frailty and impairment, user-centered design, and self-management. Results: In total, 1891 studies were imported for screening from the initial search. A total of 22 studies were included in this review after full-text screening and manual search. Invitation through partners was the most reported recruitment strategy to involve older people with frailty and impairment in the design process of digital health technologies. Furthermore, they were commonly involved in the final evaluation of the development process. Three main gaps identified were the use of outreach approaches to recruit older people with frailty and impairment in the design process of digital health technologies, description of the value of involvement and outcome of the contribution of participants, and knowledge regarding involvement in all parts of the design process. Conclusions: Although there is literature on methods for involving older people with frailty and impairment in the design of digital health technology, there is little methodological dialogue on the nuances of how different methods for involvement relate to and shape the outcome of the development process. %M 36705959 %R 10.2196/37785 %U https://humanfactors.jmir.org/2023/1/e37785 %U https://doi.org/10.2196/37785 %U http://www.ncbi.nlm.nih.gov/pubmed/36705959 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39386 %T Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial %A Adisso,Évèhouénou Lionel %A Taljaard,Monica %A Stacey,Dawn %A Brière,Nathalie %A Zomahoun,Hervé Tchala Vignon %A Durand,Pierre Jacob %A Rivest,Louis-Paul %A Légaré,France %+ Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525 Chemin de la Canardière bureau A-3421, Québec, QC, G1J0A4, Canada, 1 4188219481, france.legare@fmed.ulaval.ca %K shared decision-making %K home care %K nursing homes %K patient engagement %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods: We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results: A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10). Conclusions: Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration: ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525 %M 35759791 %R 10.2196/39386 %U https://aging.jmir.org/2022/3/e39386 %U https://doi.org/10.2196/39386 %U http://www.ncbi.nlm.nih.gov/pubmed/35759791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32453 %T The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study %A Frechette,Mikaela %A Fanning,Jason %A Hsieh,Katherine %A Rice,Laura %A Sosnoff,Jacob %+ Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66103, United States, 1 913 588 5235, jsosnoff@kumc.edu %K usability testing %K mobile health %K wheeled device user %K fall risk %K telehealth %K mHealth %K mobile device %K smartphone %K health applications %K older adults %K elderly population %K device usability %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app’s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk. %M 36112405 %R 10.2196/32453 %U https://formative.jmir.org/2022/9/e32453 %U https://doi.org/10.2196/32453 %U http://www.ncbi.nlm.nih.gov/pubmed/36112405 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39016 %T Scaling Up Citizen Workshops in Public Libraries to Disseminate and Discuss Primary Care Research Results: Quasi-Experimental Study %A Massougbodji,José %A Zomahoun,Hervé Tchala Vignon %A Adisso,Evehouenou Lionel %A Sawadogo,Jasmine %A Borde,Valérie %A Cameron,Cynthia %A Moisan,Hélène %A Paquette,Jean-Sébastien %A Akbaraly,Zamzam %A Châteauneuf,Lëa-Kim %A David,Geneviève %A , %A Légaré,France %+ VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, 2480, chemin de la Canardière, Québec, QC, G1G 2G1, Canada, 1 418 663 5713, France.Legare@mfa.ulaval.ca %K scaling up %K knowledge translation %K dissemination strategies %K integrated knowledge translation %K public libraries %K citizen workshops %K potentially inappropriate medicines %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Little is known about engaging patients and stakeholders in the process of scaling up effective knowledge translation interventions targeting the public. Objective: Using an integrated knowledge translation approach, we aimed to scale up and evaluate an effective pilot program to disseminate research results in public libraries. Methods: We conducted a scaling-up study targeting the public. On the basis of our successful pilot project, we codeveloped and implemented a large-scale program of free citizen workshops in public libraries, in a close research partnership with stakeholders and patient representatives. Citizen workshops, each facilitated by 1 participating physician and 1 science communicator, consisted of a 45-minute computer-assisted presentation and a 45-minute open exchange. The intervention outcome was knowledge gained. The scale-up outcomes were satisfaction, appropriateness, coverage, and costs. An evaluation questionnaire was used to collect data of interest. Both quantitative and qualitative analyses were performed. Results: The workshop theme chosen by the patient and stakeholder representatives was the high prevalence of medication overuse among people aged ≥65 years. From April to May 2019, 26 workshops were conducted in 25 public libraries reaching 362 people. The mean age of participants was 64.8 (SD 12.5) years. In total, 18 participating physicians and 6 science communicators facilitated the workshops. Participants reported significant knowledge gain (mean difference 2.1, 95% CI 2.0-2.2; P<.001). The median score for overall public satisfaction was 9 out of 10 (IQR 8-10). The public participants globally rated the workshops as having a high level of appropriateness. Coverage was 92% (25/27) of the total number of public libraries targeted. Costs were CAD $6051.84 (US $4519.69) for workshop design and CAD $22,935.41 (US $17,128.85) for scaling them up. Conclusions: This project successfully established a large-scale and successful implementation science or knowledge translation bridge among researchers, clinicians, and citizens via public libraries. This study provides a model for a dissemination practice that benefits the public by both engaging them in the dissemination process and targeting them directly. %M 35690963 %R 10.2196/39016 %U https://aging.jmir.org/2022/3/e39016 %U https://doi.org/10.2196/39016 %U http://www.ncbi.nlm.nih.gov/pubmed/35690963 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34764 %T Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore %A Lim,Haikel A %A Lee,Joanne Sze Win %A Lim,Meng Han %A Teo,Lynn Pei Zhen %A Sin,Natalene Siew Wen %A Lim,Rou Wei %A Chua,Si Min %A Yeo,Jia Qi %A Ngiam,Nerice Heng Wen %A Tey,Angeline Jie-Yin %A Tham,Celine Yi Xin %A Ng,Kennedy Yao Yi %A Low,Lian Leng %A Tang,Kai Wen Aaron %+ Population Health and Integrated Care Office, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore, 65 62223322, aaron_kw_tang@nhg.com.sg %K COVID-19 %K digital literacy %K digital literacy training %K digital disparities %K digital divide %K social construction of health technologies %K health technology %K COVID-19 pandemic %K pandemic %K COVID %K social isolation %K elder %K older adult %K Asia %K access %K barrier %K empower %K volunteer %K vulnerable %K digital skill %K low income %D 2022 %7 3.5.2022 %9 Viewpoint %J JMIR Aging %G English %X This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives. %M 35503520 %R 10.2196/34764 %U https://aging.jmir.org/2022/2/e34764 %U https://doi.org/10.2196/34764 %U http://www.ncbi.nlm.nih.gov/pubmed/35503520 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31823 %T Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study %A Happe,Lisa %A Sgraja,Marie %A Hein,Andreas %A Diekmann,Rebecca %+ Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, Haarentor Campus, Building V04, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, 49 441798 ext 2354, lisa.happe@uol.de %K older adults %K rehabilitation %K physical activity %K nutrition %K e-coach %K usability testing %K tablet computers %K health behavior %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one’s nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. Objective: This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting. Methods: Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). Results: In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%). Conclusions: The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change. %M 35293874 %R 10.2196/31823 %U https://humanfactors.jmir.org/2022/1/e31823 %U https://doi.org/10.2196/31823 %U http://www.ncbi.nlm.nih.gov/pubmed/35293874 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e29224 %T The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites %A Koh,Wei Qi %A Whelan,Sally %A Heins,Pascale %A Casey,Dympna %A Toomey,Elaine %A Dröes,Rose-Marie %+ School of Nursing and Midwifery, College of Medicine, Nursing & Health Sciences, National University of Ireland, University Road, Galway, H91TK33, Ireland, 353 91493687, weiqi.koh@nuigalway.ie %K social robot %K pet robots %K low-cost robot %K dementia %K older adults %K qualitative research %K qualitative content analysis %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to “older adults,” “dementia,” and “institutional care” and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets. %M 35191844 %R 10.2196/29224 %U https://aging.jmir.org/2022/1/e29224 %U https://doi.org/10.2196/29224 %U http://www.ncbi.nlm.nih.gov/pubmed/35191844 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e33118 %T Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study %A Wu,Vivien Xi %A Dong,Yanhong %A Tan,Poh Choo %A Gan,Peiying %A Zhang,Di %A Chi,Yuchen %A Chao,Felicia Fang Ting %A Lu,Jinhua %A Teo,Boon Heng Dennis %A Tan,Yue Qian %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K eHealth %K self-management %K older adults %K chronic disease %K community care %K elderly %K community %K innovation %K development %K pilot %K evaluation %K health literacy %K empowerment %K feasibility %K engagement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic diseases may impact older adults’ health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. %M 35037882 %R 10.2196/33118 %U https://aging.jmir.org/2022/1/e33118 %U https://doi.org/10.2196/33118 %U http://www.ncbi.nlm.nih.gov/pubmed/35037882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e29512 %T Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis %A Nimmanterdwong,Zethapong %A Boonviriya,Suchaya %A Tangkijvanich,Pisit %+ Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Padtayapatana Building, 11th Floor, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand, 66 868622188, zethapong@gmail.com %K connected health %K development %K elderly %K HCD %K mHealth %K older adults %K review %K telehealth %K UCD %K usability %K design %K human-centered %K app %D 2022 %7 14.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality. Objective: This systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population. Methods: We conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies’ qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed. Results: Eight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210. Conclusions: Findings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted. %M 35029535 %R 10.2196/29512 %U https://mhealth.jmir.org/2022/1/e29512 %U https://doi.org/10.2196/29512 %U http://www.ncbi.nlm.nih.gov/pubmed/35029535 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e19543 %T Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study %A Davies,Karen %A Cheraghi-Sohi,Sudeh %A Ong,Bie Nio %A Cheraghi-Sohi,Sudeh %A Perryman,Katherine %A Sanders,Caroline %+ National Institute for Health Research Patient Safety Research Translation Centre, University of Manchester, Oxford Rd, Manchester, United Kingdom, 44 1612767665, sudeh.cheraghi-sohi@manchester.ac.uk %K design research %K co-design %K dementia %K mobile app %K communication %K safety %K mobile phone %D 2021 %7 20.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice—championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 %M 34932011 %R 10.2196/19543 %U https://www.researchprotocols.org/2021/12/e19543 %U https://doi.org/10.2196/19543 %U http://www.ncbi.nlm.nih.gov/pubmed/34932011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26886 %T Identifying Opportunities, and Motivation to Enhance Capabilities, Influencing the Development of a Personalized Digital Health Hub Model of Care for Hip Fractures: Mixed Methods Exploratory Study %A Yadav,Lalit %A Gill,Tiffany K %A Taylor,Anita %A De Young,Jennifer %A Chehade,Mellick J %+ NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, University of Adelaide, Level 5G 581, Royal Adelaide Hospital, Adelaide, 5000, Australia, 61 870742006, Lalit.yadav@adelaide.edu.au %K digital health %K mixed-methods %K hip fractures %K behavior change %K patient education %K model of care %K mobile phone %K patient networked units %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation. Objective: This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub. Methods: We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use. Results: This study recruited 100 participants—55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=–0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub–enabled model of care. Conclusions: This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios. %M 34709183 %R 10.2196/26886 %U https://www.jmir.org/2021/10/e26886 %U https://doi.org/10.2196/26886 %U http://www.ncbi.nlm.nih.gov/pubmed/34709183 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27499 %T Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data %A Maruster,Laura %A van der Zee,Durk-Jouke %A Buskens,Erik %+ Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, Netherlands, 31 50 3637316, l.maruster@rug.nl %K process mining %K frequent users %K hospital care %K emergency medical services %K regional care networks %K elderly %K Netherlands %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective: This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users’ health care consumption patterns. Methods: A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results: Frail elderly users aged 70 years or more represented over 50% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions: This efficient approach exploits the role of EMS as the unique regional “ferryman,” while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users’ utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations. %M 34612834 %R 10.2196/27499 %U https://www.jmir.org/2021/10/e27499 %U https://doi.org/10.2196/27499 %U http://www.ncbi.nlm.nih.gov/pubmed/34612834 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e18777 %T Uncovering the Bone-Muscle Interaction and Its Implications for the Health and Function of Older Adults (the Wellderly Project): Protocol for a Randomized Controlled Crossover Trial %A Smith,Cassandra %A Lin,Xuzhu %A Scott,David %A Brennan-Speranza,Tara C %A Al Saedi,Ahmed %A Moreno-Asso,Alba %A Woessner,Mary %A Bani Hassan,Ebrahim %A Eynon,Nir %A Duque,Gustavo %A Levinger,Itamar %+ Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, Australia, 61 399195343, itamar.levinger@vu.edu.au %K acute exercise %K clinical trial %K bone %K adult %K aging %K osteocalcin %K muscles %K sarcopenia %K progenitor cells %K stem cells %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bone and muscle are closely linked anatomically, biochemically, and metabolically. Acute exercise affects both bone and muscle, implying a crosstalk between the two systems. However, how these two systems communicate is still largely unknown. We will explore the role of undercarboxylated osteocalcin (ucOC) in this crosstalk. ucOC is involved in glucose metabolism and has a potential role in muscle maintenance and metabolism. Objective: The proposed trial will determine if circulating ucOC levels in older adults at baseline and following acute exercise are associated with parameters of muscle function and if the ucOC response to exercise varies between older adults with low muscle quality and those with normal or high muscle quality. Methods: A total of 54 men and women aged 60 years or older with no history of diabetes and warfarin and vitamin K use will be recruited. Screening tests will be performed, including those for functional, anthropometric, and clinical presentation. On the basis of muscle quality, a combined equation of lean mass (leg appendicular skeletal muscle mass in kg) and strength (leg press; one-repetition maximum), participants will be stratified into a high or low muscle function group and randomized into the controlled crossover acute intervention. Three visits will be performed approximately 7 days apart, and acute aerobic exercise, acute resistance exercise, and a control session (rest) will be completed in any order. Our primary outcome for this study is the effect of acute exercise on ucOC in older adults with low muscle function and those with high muscle function. Results: The trial is active and ongoing. Recruitment began in February 2018, and 38 participants have completed the study as of May 26, 2019. Conclusions: This study will provide novel insights into bone and muscle crosstalk in older adults, potentially identifying new clinical biomarkers and mechanistic targets for drug treatments for sarcopenia and other related musculoskeletal conditions. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618001756213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375925. International Registered Report Identifier (IRRID): DERR1-10.2196/18777 %M 33835038 %R 10.2196/18777 %U https://www.researchprotocols.org/2021/4/e18777 %U https://doi.org/10.2196/18777 %U http://www.ncbi.nlm.nih.gov/pubmed/33835038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e22463 %T Investigating Users' and Other Stakeholders' Needs in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People with Dementia or Parkinson Disease: Protocol for a Mixed Methods Study %A Ahmed,Mona %A Marín,Mayca %A Bouça-Machado,Raquel %A How,Daniella %A Judica,Elda %A Tropea,Peppino %A Bentlage,Ellen %A Brach,Michael %+ Institute of Sport and Exercise Sciences, Münster University, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 83 ext 34889, mona.ahmad@uni-muenster.de %K dementia %K older adults %K neurodegenerative diseases %K integrated care %K health care technologies %K user-centered design %D 2021 %7 12.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementias—including Alzheimer disease—and Parkinson disease profoundly impact the quality of life of older population members and their families. PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older Adults) is a European project that recognizes the benefit of technology-based integrated care models in improving the care coordination and the quality of life of these target groups. This project proposes an integrated, scalable, and interactive care platform targeting older people suffering from neurodegenerative diseases, their caregivers, and socio-health professionals. PROCare4Life adopts a user-centered design approach from the early stage and throughout platform development and implementation, during which the platform is designed and adapted to the needs and requirements of all the involved users. Objective: This paper presents the study protocol for investigating users’ needs and requirements regarding the design of the proposed PROCare4Life platform. Methods: A mixed qualitative and quantitative study design is utilized, including online surveys, interviews, and workshops. The study aimed to recruit approximately 200 participants, including patients diagnosed with dementia or Parkinson disease, caregivers, socio-health professionals, and other stakeholders, from five different European countries: Germany, Italy, Portugal, Romania, and Spain. Results: The study took place between April and September 2020. Recruitment is now closed, and all the data have been collected and analyzed in order to be used in shaping the large-scale pilot phase of the PROCare4Life project. Results of the study are expected to be published in spring 2021. Conclusions: This paper charts the protocol for a user-centered design approach at the early stage of the PROCare4Life project in order to shape and influence an integrated health platform suitable for its intended target group and purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/22463 %M 33433394 %R 10.2196/22463 %U https://www.researchprotocols.org/2021/1/e22463 %U https://doi.org/10.2196/22463 %U http://www.ncbi.nlm.nih.gov/pubmed/33433394 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 3 %P e21214 %T Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort %A Etingen,Bella %A Amante,Daniel J %A Martinez,Rachael N %A Smith,Bridget M %A Shimada,Stephanie L %A Richardson,Lorilei %A Patterson,Angela %A Houston,Thomas K %A Frisbee,Kathleen L %A Hogan,Timothy P %+ Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, 5000 5th Ave, Hines, IL, 60141, United States, 1 708 202 4922, bella.etingen@va.gov %K eHealth %K mobile health %K patient engagement %K telehealth %K veterans %D 2020 %7 30.9.2020 %9 Original Paper %J J Participat Med %G English %X Background: Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. Objective: The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. Methods: Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA’s patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. Results: The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). Conclusions: The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies. %M 33044944 %R 10.2196/21214 %U http://jopm.jmir.org/2020/3/e21214/ %U https://doi.org/10.2196/21214 %U http://www.ncbi.nlm.nih.gov/pubmed/33044944 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e12813 %T Profiling Clinical Research Activity at an Academic Medical Center by Using Institutional Databases: Content Analysis %A Langford,Aisha %A Sherman,Scott %A Thornton,Rachel %A Nightingale,Kira %A Kwon,Simona %A Chavis-Keeling,Deborah %A Link,Nathan %A Cronstein,Bruce %A Hochman,Judith %A Trachtman,Howard %+ New York University Langone Health, 403 E34th St, New York, NY, 10016, United States, 1 914 563 1580, howard.trachtman@nyulangone.org %K database %K clinical studies as topic %K vulnerable populations %K pediatrics %K geriatrics %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is important to monitor the scope of clinical research of all types, to involve participants of all ages and subgroups in studies that are appropriate to their condition, and to ensure equal access and broad validity of the findings. Objective: We conducted a review of clinical research performed at New York University with the following objectives: (1) to determine the utility of institutional administrative data to characterize clinical research activity; (2) to assess the inclusion of special populations; and (3) to determine if the type, initiation, and completion of the study differed by age. Methods: Data for all studies that were institutional review board–approved between January 1, 2014, and November 2, 2016, were obtained from the research navigator system, which was launched in November 2013. One module provided details about the study protocol, and another module provided the characteristics of individual participants. Research studies were classified as observational or interventional. Descriptive statistics were used to assess the characteristics of clinical studies across the lifespan, by type, and over time. Results: A total of 22%-24% of studies included children (minimum age <18 years) and 4%-5% focused exclusively on pediatrics. Similarly, 64%-72% of studies included older patients (maximum age >65 years) but only 5%-12% focused exclusively on geriatrics. Approximately 85% of the studies included both male and female participants. Of the remaining studies, those open only to girls or women were approximately 3 times as common as those confined to boys or men. A total of 56%-58% of projects focused on nonvulnerable patients. Among the special populations studied, children (12%-15%) were the most common. Noninterventional trial types included research on human data sets (24%), observational research (22%), survey research (16%), and biospecimen research (8%). The percentage of projects designed to test an intervention in a vulnerable population increased from 17% in 2014 to 21% in 2015. Conclusions: Pediatric participants were the special population that was most often studied based on the number of registered projects that included children and adolescents. However, they were much less likely to be successfully enrolled in research studies compared with adults older than 65 years. Only 20% of the studies were interventional, and 20%-35% of participants in this category were from vulnerable populations. More studies are exclusively devoted to women’s health issues compared with men’s health issues. %M 32831180 %R 10.2196/12813 %U http://publichealth.jmir.org/2020/3/e12813/ %U https://doi.org/10.2196/12813 %U http://www.ncbi.nlm.nih.gov/pubmed/32831180