TY - JOUR AU - Silva, G. Anabela AU - Caravau, Hilma AU - Martins, Ana AU - Almeida, Pisco Ana Margarida AU - Silva, Telmo AU - Ribeiro, Óscar AU - Santinha, Gonçalo AU - Rocha, P. Nelson PY - 2021/1/13 TI - Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults JO - JMIR Hum Factors SP - e22774 VL - 8 IS - 1 KW - mobile phone KW - user-centered design KW - aged KW - review KW - telemedicine N2 - Background: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. Objective: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. Methods: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. Results: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. Conclusions: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations. UR - http://humanfactors.jmir.org/2021/1/e22774/ UR - http://dx.doi.org/10.2196/22774 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439128 ID - info:doi/10.2196/22774 ER - TY - JOUR AU - Kim, Sunyoung PY - 2021/1/13 TI - Exploring How Older Adults Use a Smart Speaker?Based Voice Assistant in Their First Interactions: Qualitative Study JO - JMIR Mhealth Uhealth SP - e20427 VL - 9 IS - 1 KW - older adults KW - voice assistant KW - smart speaker KW - technology acceptance KW - quality of life N2 - Background: Smart speaker?based voice assistants promise support for the aging population, with the advantages of hands-free and eyes-free interaction modalities to handle requests. However, little is known about how older adults perceive the benefits of this type of device. Objective: This study investigates how older adults experience and respond to a voice assistant when they first interact with it. Because first impressions act as strong predictors of the overall attitude and acceptability of new technologies, it is important to understand the user experiences of first exposure. Methods: We conducted semistructured interviews with 18 people 74 years and older who had never used a smart speaker before, investigating the patterns of use, usability issues, and perspectives that older adults have when using a voice assistant for the first time. Results: The overall first response to a voice assistant was positive, thanks to the simplicity of a speech-based interaction. In particular, a positive and polite response to complete the interaction with a voice assistant was prevalent, such as expressing gratitude or giving feedback about the quality of answers. Two predominant topics of commands made in the first interaction include asking health care?related questions and streaming music. However, most of the follow-up reactions were unfavorable because of the difficulty in constructing a structured sentence for a command; misperceptions about how a voice assistant operates; and concerns about privacy, security, and financial burdens. Overall, a speech-based interaction was perceived to be beneficial owing to its efficiency and convenience, but no other benefits were perceived. Conclusions: On the basis of the findings, we discuss design implications that can positively influence older adults' first experiences with a voice assistant, including helping better understand how a voice assistant works, incorporating mistakes and common interaction patterns into its design, and providing features tailored to the needs of older adults. UR - http://mhealth.jmir.org/2021/1/e20427/ UR - http://dx.doi.org/10.2196/20427 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439130 ID - info:doi/10.2196/20427 ER - TY - JOUR AU - Hawley-Hague, Helen AU - Tacconi, Carlo AU - Mellone, Sabato AU - Martinez, Ellen AU - Chiari, Lorenzo AU - Helbostad, Jorunn AU - Todd, Chris PY - 2021/1/12 TI - One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study JO - JMIR Rehabil Assist Technol SP - e19690 VL - 8 IS - 1 KW - aged KW - postural balance KW - telerehabilitation KW - patient compliance KW - accidental falls KW - mobile phone N2 - Background: Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective: This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods: There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results: In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions: Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability. UR - http://rehab.jmir.org/2021/1/e19690/ UR - http://dx.doi.org/10.2196/19690 UR - http://www.ncbi.nlm.nih.gov/pubmed/33433398 ID - info:doi/10.2196/19690 ER - TY - JOUR AU - Mascret, Nicolas AU - Delbes, Lisa AU - Voron, Amélie AU - Temprado, Jean-Jacques AU - Montagne, Gilles PY - 2020/12/14 TI - Acceptance of a Virtual Reality Headset Designed for Fall Prevention in Older Adults: Questionnaire Study JO - J Med Internet Res SP - e20691 VL - 22 IS - 12 KW - technology acceptance model KW - acceptability KW - acceptance KW - virtual reality KW - elderly KW - fall KW - eHealth KW - self-efficacy KW - achievement goals N2 - Background: Falls are a common phenomenon among people aged 65 and older and affect older adults? health, quality of life, and autonomy. Technology-based intervention programs are designed to prevent the occurrence of falls and their effectiveness often surpasses that of more conventional programs. However, to be effective, these programs must first be accepted by seniors. Objective: Based on the technology acceptance model, this study aimed to examine the acceptance among older adults before a first use of a virtual reality headset (VRH) used in an intervention program designed to prevent falls. Methods: A sample of 271 French older adults (mean age 73.69 years, SD 6.37 years) voluntarily and anonymously filled out a questionnaire containing the focal constructs (perceived usefulness, perceived enjoyment, perceived ease of use, intention to use, fall-related self-efficacy, and self-avoidance goals) adapted to the VRH, which was designed to prevent falls. Results: The results of the structural equation modeling analysis showed that intention to use the VRH was positively predicted by perceived usefulness, perceived enjoyment, and perceived ease of use. Perceived usefulness of the VRH was also negatively predicted by fall-related self-efficacy (ie, the perceived level of confidence of an individual when performing daily activities without falling) and positively predicted by self-avoidance goals (ie, participating in a physical activity to avoid physical regression). Conclusions: A better understanding of the initial acceptance among older adults of this VRH is the first step to involving older adults in intervention programs designed to prevent falls using this kind of device. UR - http://www.jmir.org/2020/12/e20691/ UR - http://dx.doi.org/10.2196/20691 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315019 ID - info:doi/10.2196/20691 ER - TY - JOUR AU - Rai, Kaur Harleen AU - Schneider, Justine AU - Orrell, Martin PY - 2020/11/16 TI - An Individual Cognitive Stimulation Therapy App for People With Dementia: Development and Usability Study of Thinkability JO - JMIR Aging SP - e17105 VL - 3 IS - 2 KW - dementia KW - cognitive stimulation therapy KW - eHealth KW - development N2 - Background: There is a lack of technological resources for the mental stimulation and communication of people with dementia, which can be helpful in improving cognition and quality of life. Paper-based individual cognitive stimulation therapy (iCST) for people with dementia has the potential to be adapted to a touchscreen format. This can improve accessibility and provide mental stimulation using interactive features. There is a need for a rigorous and systematic approach toward development, leading to improved suitability and implementation of the intervention, so that more people can benefit from its use. Objective: This study aims to develop and investigate the usability of Thinkability, an iCST app that can be used by people with dementia and carers on touchscreen tablets. Methods: The Medical Research Council framework for evaluating complex interventions and the Centre for eHealth Research roadmap served as frameworks for the stages of intervention and technology development. The development of the iCST app itself adopted an agile approach with elements from action research. Hence, it was developed in 3 successive sprints and was evaluated by relevant stakeholders at each sprint. Sprint 1 included 2 patient and public involvement (PPI) consultation meetings, sprint 2 included 1 PPI consultation meeting, and 4 focus groups and 10 individual interviews were organized in sprint 3. A feasibility trial is currently underway. Results: The findings from each sprint were used to inform the development. Sprint 1 helped to identify the relevant evidence base and explored the attitudes of people with dementia and carers toward a potential iCST app. In sprint 2, an initial prototype was evaluated in a small PPI consultation meeting. In sprint 3, feedback was gathered through a qualitative study on the quality and perceived effectiveness of the iCST app. It was well received by people with dementia and carers. A need for more updated and personalized content was highlighted. Conclusions: This study proves that an agile approach toward technology development involving all relevant stakeholders is effective in creating suitable technology. Adding to our previous knowledge of noncomputerized cognitive stimulation therapy, the release of the iCST app will make this psychosocial intervention accessible to more users worldwide. UR - http://aging.jmir.org/2020/2/e17105/ UR - http://dx.doi.org/10.2196/17105 UR - http://www.ncbi.nlm.nih.gov/pubmed/33196451 ID - info:doi/10.2196/17105 ER - TY - JOUR AU - Choi, K. Yong AU - Thompson, J. Hilaire AU - Demiris, George PY - 2020/11/10 TI - Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study JO - JMIR Aging SP - e21964 VL - 3 IS - 2 KW - Internet of Things KW - smart home KW - independent living KW - aging KW - healthy aging N2 - Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents? safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined. Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart home devices in the actual residences of older adults to facilitate healthy aging. Methods: We conducted a 2-month feasibility study on community-dwelling older adults. Participants chose among different IoT devices to be installed and deployed within their homes. The IoT devices tested varied depending on the participant?s preference: a door and window sensor, a multipurpose sensor (motion, temperature, luminosity, and humidity), a voice-operated smart speaker, and an internet protocol (IP) video camera. Results: We recruited a total of 37 older adults for this study, with 35 (95%) successfully completing all procedures in the 2-month study. The average age of the sample was 78 (SD 9) years and primarily comprised women (29/37, 78%), those who were educated (31/37, 86%; bachelor?s degree or higher), and those affected by chronic conditions (33/37, 89%). The most widely chosen devices among the participants were multipurpose sensors and smart speakers. An IP camera was a significantly unpopular choice among participants in both phases. The participant feedback suggests that perceived privacy concerns, perceived usefulness, and curiosity to technology were strong factors when considering which device to have installed in their home. Conclusions: Overall, our deployment results revealed that the use of IoT smart home devices is feasible in actual residences of older adults. These findings may inform the follow-up assessment of IoT technologies and their impact on health-related outcomes and advance our understanding of the role of IoT home-based monitoring technologies to promote successful aging-in-place for older adults. Future trials should consider older adults? preferences for the different types of smart home devices to be installed in real-world residential settings. UR - http://aging.jmir.org/2020/2/e21964/ UR - http://dx.doi.org/10.2196/21964 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170128 ID - info:doi/10.2196/21964 ER - TY - JOUR AU - Compernolle, Sofie AU - Cardon, Greet AU - van der Ploeg, P. Hidde AU - Van Nassau, Femke AU - De Bourdeaudhuij, Ilse AU - Jelsma, J. Judith AU - Brondeel, Ruben AU - Van Dyck, Delfien PY - 2020/10/29 TI - Engagement, Acceptability, Usability, and Preliminary Efficacy of a Self-Monitoring Mobile Health Intervention to Reduce Sedentary Behavior in Belgian Older Adults: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e18653 VL - 8 IS - 10 KW - mHealth KW - older adults KW - self-monitoring KW - perceptions KW - engagement KW - acceptability KW - mixed methods N2 - Background: Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults? sedentary behavior. However, little is known about older adults? experiences with a self-monitoring?based intervention aimed at the reduction of sedentary behavior. Objective: The aim of this study is to evaluate engagement, acceptability, usability, and preliminary efficacy of a self-monitoring?based mHealth intervention developed to reduce older adults? sedentary behavior. Methods: A mixed methods study was performed among 28 community-dwelling older adults living in Flanders, Belgium. The 3-week intervention consisted of general sedentary behavior information as well as visual and tactile feedback on participants? sedentary behavior. Semistructured interviews were conducted to explore engagement with, and acceptability and usability of, the intervention. Sitting time was measured using the thigh-worn activPAL (PAL Technologies) accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired-samples t tests; qualitative data were thematically analyzed and presented using pen profiles. Results: Participants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (ie, they became more aware of their sedentary behavior) but not their actual behavior. There were mixed opinions on the kind of feedback (ie, tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants, ranging from 0 to 20 times a day. No significant reductions were found in objectively measured sitting time. Conclusions: Although the intervention was well perceived by the majority of older adults, no reductions in sitting time were found. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change. Trial Registration: ClinicalTrials.gov NCT04003324; https://tinyurl.com/y2p4g8hx UR - http://mhealth.jmir.org/2020/10/e18653/ UR - http://dx.doi.org/10.2196/18653 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118951 ID - info:doi/10.2196/18653 ER - TY - JOUR AU - Bartels, Laureen Sara AU - van Knippenberg, M. Rosalia J. AU - Malinowsky, Camilla AU - Verhey, J. Frans R. AU - de Vugt, E. Marjolein PY - 2020/10/16 TI - Smartphone-Based Experience Sampling in People With Mild Cognitive Impairment: Feasibility and Usability Study JO - JMIR Aging SP - e19852 VL - 3 IS - 2 KW - experience sampling method KW - mild cognitive impairment KW - cognition KW - feasibility KW - smartphones N2 - Background: Daily functioning of people with cognitive disorders such as mild cognitive impairment (MCI) is usually depicted by retrospective questionnaires, which can be memory-biased and neglect fluctuations over time or contexts. Objective: This study examines the feasibility and usability of applying the experience sampling method (ESM) in people with MCI to provide a detailed and dynamic picture of behavioral, emotional, and cognitive patterns in everyday life. Methods: For 6 consecutive days, 21 people with MCI used an ESM app on their smartphones. At 8 semi-random timepoints per day, participants filled in momentary questionnaires on mood, activities, social context, and subjective cognitive complaints. Feasibility was determined through self-reports and observable human-technology interactions. Usability was demonstrated on an individual and group level. Results: Of the 21 participants, 3 dropped out due to forgetting to carry their smartphones or forgetting the study instructions. In the remaining 18 individuals, the compliance rate was high, at 78.7%. Participants reported that momentary questions reflected their daily experiences well. Of the 18 participants, 13 (72%) experienced the increase in awareness of their own memory functions as pleasant or neutral. Conclusions: Support was found for the general feasibility of smartphone-based experience sampling in people with MCI. However, many older adults with MCI are currently not in possession of smartphones, and study adherence seems challenging for a minority of individuals. Momentary data can increase the insights into daily patterns and may guide the person-tailored development of self-management strategies in clinical settings. UR - http://aging.jmir.org/2020/2/e19852/ UR - http://dx.doi.org/10.2196/19852 UR - http://www.ncbi.nlm.nih.gov/pubmed/33064084 ID - info:doi/10.2196/19852 ER - TY - JOUR AU - Padala, P. Kalpana AU - Wilson, B. Kerrie AU - Gauss, Heath C. AU - Stovall, D. Jessica AU - Padala, R. Prasad PY - 2020/9/30 TI - VA Video Connect for Clinical Care in Older Adults in a Rural State During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e21561 VL - 22 IS - 9 KW - VA Video Connect KW - older adults KW - rural KW - COVID-19 KW - veterans KW - telehealth KW - elderly KW - disparity KW - veteran affairs KW - capabillity KW - cross-sectional N2 - Background: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. Objective: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. Methods: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans? willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. Results: Participants? mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. Conclusions: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas. UR - http://www.jmir.org/2020/9/e21561/ UR - http://dx.doi.org/10.2196/21561 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936773 ID - info:doi/10.2196/21561 ER - TY - JOUR AU - Wang, Hailiang AU - Zhao, Yang AU - Yu, Lisha AU - Liu, Jiaxing AU - Zwetsloot, Maria Inez AU - Cabrera, Javier AU - Tsui, Kwok-Leung PY - 2020/9/30 TI - A Personalized Health Monitoring System for Community-Dwelling Elderly People in Hong Kong: Design, Implementation, and Evaluation Study JO - J Med Internet Res SP - e19223 VL - 22 IS - 9 KW - telehealth monitoring KW - personalized health KW - technology acceptance KW - digital biomarkers KW - digital phenotyping KW - wearables KW - falls detection KW - fitness tracker KW - sensors KW - elderly population N2 - Background: Telehealth is an effective means to assist existing health care systems, particularly for the current aging society. However, most extant telehealth systems employ individual data sources by offline data processing, which may not recognize health deterioration in a timely way. Objective: Our study objective was two-fold: to design and implement an integrated, personalized telehealth system on a community-based level; and to evaluate the system from the perspective of user acceptance. Methods: The system was designed to capture and record older adults? health-related information (eg, daily activities, continuous vital signs, and gait behaviors) through multiple measuring tools. State-of-the-art data mining techniques can be integrated to detect statistically significant changes in daily records, based on which a decision support system could emit warnings to older adults, their family members, and their caregivers for appropriate interventions to prevent further health deterioration. A total of 45 older adults recruited from 3 elderly care centers in Hong Kong were instructed to use the system for 3 months. Exploratory data analysis was conducted to summarize the collected datasets. For system evaluation, we used a customized acceptance questionnaire to examine users? attitudes, self-efficacy, perceived usefulness, perceived ease of use, and behavioral intention on the system. Results: A total of 179 follow-up sessions were conducted in the 3 elderly care centers. The results of exploratory data analysis showed some significant differences in the participants? daily records and vital signs (eg, steps, body temperature, and systolic blood pressure) among the 3 centers. The participants perceived that using the system is a good idea (ie, attitude: mean 5.67, SD 1.06), comfortable (ie, self-efficacy: mean 4.92, SD 1.11), useful to improve their health (ie, perceived usefulness: mean 4.99, SD 0.91), and easy to use (ie, perceived ease of use: mean 4.99, SD 1.00). In general, the participants showed a positive intention to use the first version of our personalized telehealth system in their future health management (ie, behavioral intention: mean 4.45, SD 1.78). Conclusions: The proposed health monitoring system provides an example design for monitoring older adults? health status based on multiple data sources, which can help develop reliable and accurate predictive analytics. The results can serve as a guideline for researchers and stakeholders (eg, policymakers, elderly care centers, and health care providers) who provide care for older adults through such a telehealth system. UR - http://www.jmir.org/2020/9/e19223/ UR - http://dx.doi.org/10.2196/19223 UR - http://www.ncbi.nlm.nih.gov/pubmed/32996887 ID - info:doi/10.2196/19223 ER - TY - JOUR AU - Etingen, Bella AU - Amante, J. Daniel AU - Martinez, N. Rachael AU - Smith, M. Bridget AU - Shimada, L. Stephanie AU - Richardson, Lorilei AU - Patterson, Angela AU - Houston, K. Thomas AU - Frisbee, L. Kathleen AU - Hogan, P. Timothy PY - 2020/9/30 TI - 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 JO - J Participat Med SP - e21214 VL - 12 IS - 3 KW - eHealth KW - mobile health KW - patient engagement KW - telehealth KW - veterans N2 - 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. UR - http://jopm.jmir.org/2020/3/e21214/ UR - http://dx.doi.org/10.2196/21214 UR - http://www.ncbi.nlm.nih.gov/pubmed/33044944 ID - info:doi/10.2196/21214 ER - TY - JOUR AU - Hawley-Hague, Helen AU - Tacconi, Carlo AU - Mellone, Sabato AU - Martinez, Ellen AU - Ford, Claire AU - Chiari, Lorenzo AU - Helbostad, Jorunn AU - Todd, Chris PY - 2020/9/28 TI - Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study JO - JMIR Mhealth Uhealth SP - e15460 VL - 8 IS - 9 KW - aged KW - postural balance KW - telerehabilitation KW - patient compliance KW - accidental falls N2 - Background: Falls have implications for older adults? health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps? usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of ?Motivate Me? and ?My Activity Programme.? Key changes from the workshops included being able to add more details about the patients? exercise program and a wider selection of goals within ?Motivate Me.? The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. UR - http://mhealth.jmir.org/2020/9/e15460/ UR - http://dx.doi.org/10.2196/15460 UR - http://www.ncbi.nlm.nih.gov/pubmed/32985992 ID - info:doi/10.2196/15460 ER - TY - JOUR AU - Robinson, A. Stephanie AU - Wan, S. Emily AU - Shimada, L. Stephanie AU - Richardson, R. Caroline AU - Moy, L. Marilyn PY - 2020/9/9 TI - Age and Attitudes Towards an Internet-Mediated, Pedometer-Based Physical Activity Intervention for Chronic Obstructive Pulmonary Disease: Secondary Analysis JO - JMIR Aging SP - e19527 VL - 3 IS - 2 KW - aging KW - COPD KW - chronic conditions KW - physical activity KW - eHealth N2 - Background: Chronic obstructive pulmonary disease (COPD) is prevalent among older adults. Promoting physical activity and increasing exercise capacity are recommended for all individuals with COPD. Pulmonary rehabilitation is the standard of care to improve exercise capacity, although there are barriers that hinder accessibility. Technology has the potential to overcome some of these barriers, but it is unclear how aging adults with a chronic disease like COPD perceive technology-based platforms to support their disease self-management. Objective: Guided by the unified theory of acceptance and use of technology, the current retrospective secondary analysis explores if age moderates multiple factors that influence an individual with COPD?s openness toward an internet-mediated, pedometer-based physical activity intervention. Methods: As part of an efficacy study, participants with COPD (N=59) were randomly assigned to use an internet-mediated, pedometer-based physical activity intervention for 12 weeks. At completion, they were asked about their experience with the intervention using a survey, including their performance expectancy and effort expectancy, facilitating conditions (ie, internet use frequency and ability), and use of the intervention technology. Logistic regression and general linear modeling examined the associations between age and these factors. Results: Participants ranged in age from 49 to 89 years (mean 68.66, SD 8.93). Disease severity was measured by forced expiratory volume in the first second percent predicted (mean 60.01, SD 20.86). Nearly all participants (54/59) believed the intervention was useful. Regarding effort expectancy, increasing age was associated with reporting that it was easy to find the time to engage in the intervention. Regarding facilitating conditions, approximately half of the participants believed the automated step count goals were too high (23/59) and many did not feel comfortable reaching their goals (22/59). The probability of these perceptions increased with age, even after accounting for disease severity. Age was not associated with other facilitating conditions or use of the technology. Conclusions: Age does not influence performance expectancy or use of technology with an internet-mediated, pedometer-based physical activity intervention. Age is associated with certain expectations of effort and facilitating conditions. Consideration of age of the user is needed when personalizing step count goals and time needed to log in to the website. Trial Registration: ClinicalTrials.gov NCT01772082; https://clinicaltrials.gov/ct2/show/NCT01772082 UR - http://aging.jmir.org/2020/2/e19527/ UR - http://dx.doi.org/10.2196/19527 UR - http://www.ncbi.nlm.nih.gov/pubmed/32902390 ID - info:doi/10.2196/19527 ER - TY - JOUR AU - ter Stal, Silke AU - Broekhuis, Marijke AU - van Velsen, Lex AU - Hermens, Hermie AU - Tabak, Monique PY - 2020/9/4 TI - Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study JO - JMIR Hum Factors SP - e19987 VL - 7 IS - 3 KW - embodied conversational agent KW - appearance design KW - health status assessment KW - older adults KW - eHealth N2 - Background: Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. Objective: This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users? likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. Methods: The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent?s advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. Results: A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. Conclusions: Agent age and gender little influence users? impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps. UR - https://humanfactors.jmir.org/2020/3/e19987 UR - http://dx.doi.org/10.2196/19987 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886068 ID - info:doi/10.2196/19987 ER - TY - JOUR AU - Lai, Rhoda AU - Tensil, Maria AU - Kurz, Alexander AU - Lautenschlager, T. Nicola AU - Diehl-Schmid, Janine PY - 2020/7/31 TI - Perceived Need and Acceptability of an App to Support Activities of Daily Living in People With Cognitive Impairment and Their Carers: Pilot Survey Study JO - JMIR Mhealth Uhealth SP - e16928 VL - 8 IS - 7 KW - Aged KW - dementia KW - memory disorders KW - carers KW - mobile apps N2 - Background: Modern technologies, including smartphone apps, have the potential to assist people with cognitive impairment with activities of daily living, allowing them to maintain their independence and reduce carer burden. However, such tools have seen a slow rate of uptake in this population, and data on the acceptability of assistive technologies in this population are limited. Objective: This pilot study included older adults with cognitive impairment and their carers, and explored the perceived needs for and acceptability of an app that was designed to be a simple assistive tool for activities of daily living. In particular, this study aimed to assess the acceptability of common app functions such as communication, reminder, navigation, and emergency tools in this population, and to compare patients? and carers? responses to them. Methods: A total of 24 German participants with mild cognitive impairment or dementia and their family carers separately completed two short questionnaires. The first questionnaire asked the participants with cognitive impairment and their carers to self-rate the patients? cognitive impairment levels and affinity to technology. Following a demonstration of the app, participants rated the usability and acceptability of the app and its functions in a second questionnaire. Results: Participants rated themselves as much less cognitively impaired than their carers did (P=.01), and insight into the level of support they received was low. The majority of the participants (19/24, 79%) and their carers (20/24, 83%) had low affinity to technology, and even after the demonstration, 63% (15/24) of the participants had low interest in using the app. A breakdown of acceptability responses by app function revealed that participants were more amenable to the reminder function, the emergency feature, and a wearable form of the app. Features that centered around carers monitoring participants? movements were reported to be less acceptable to participants. Conclusions: This study highlights the importance of focusing on acceptability and the consumer?s perceptions in the development of assistive technology for older adults with cognitive impairment. Participants showed an aversion to functions they perceived as eroding their independence, while functions that more closely aligned with independence and autonomy were perceived as more acceptable. UR - http://mhealth.jmir.org/2020/7/e16928/ UR - http://dx.doi.org/10.2196/16928 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735223 ID - info:doi/10.2196/16928 ER - TY - JOUR AU - Kim, HyangHee AU - Lee, Sang-Ho AU - Cho, Nam-Bin AU - You, Heecheon AU - Choi, Teukgyu AU - Kim, Jinwon PY - 2020/7/27 TI - User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study JO - JMIR Mhealth Uhealth SP - e19585 VL - 8 IS - 7 KW - older adults KW - dysphagia KW - swallowing KW - mHealth KW - thematic analysis KW - usability KW - apps KW - education KW - experience KW - sociodemographic N2 - Background: Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective: The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults? self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods: A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results: The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=?2.023, P=.04). Additionally, the usability scores in the low-potential group were within the ?marginal acceptability? range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions: To the best of the authors? knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program. UR - http://mhealth.jmir.org/2020/7/e19585/ UR - http://dx.doi.org/10.2196/19585 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663161 ID - info:doi/10.2196/19585 ER - TY - JOUR AU - Mehra, Sumit AU - van den Helder, Jantine AU - Visser, Bart AU - Engelbert, H. Raoul H. AU - Weijs, M. Peter J. AU - Kröse, A. Ben J. PY - 2020/7/23 TI - Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study JO - J Med Internet Res SP - e16380 VL - 22 IS - 7 KW - frail elderly KW - aged KW - activities of daily living KW - exercise KW - health behavior KW - telemedicine KW - mobile devices KW - tablet computers KW - usability testing KW - evaluation N2 - Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. UR - http://www.jmir.org/2020/7/e16380/ UR - http://dx.doi.org/10.2196/16380 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459652 ID - info:doi/10.2196/16380 ER - TY - JOUR AU - Peterson, M. Colleen AU - Mikal, P. Jude AU - McCarron, R. Hayley AU - Finlay, M. Jessica AU - Mitchell, L. Lauren AU - Gaugler, E. Joseph PY - 2020/6/26 TI - The Feasibility and Utility of a Personal Health Record for Persons With Dementia and Their Family Caregivers for Web-Based Care Coordination: Mixed Methods Study JO - JMIR Aging SP - e17769 VL - 3 IS - 1 KW - Alzheimer disease KW - technology KW - disease management KW - personal health record KW - family caregiving KW - informal caregiving KW - caregiver burnout KW - web-based intervention KW - assistive technology N2 - Background: Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver?s burden by simplifying ADRD health care management Objective: This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach. Methods: Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants? characteristics as well as PHR-ADRD use and experiences based on overall favorability status. Results: Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants. Conclusions: Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system. UR - http://aging.jmir.org/2020/1/e17769/ UR - http://dx.doi.org/10.2196/17769 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589158 ID - info:doi/10.2196/17769 ER - TY - JOUR AU - Bennion, Russell Matthew AU - Hardy, E. Gillian AU - Moore, K. Roger AU - Kellett, Stephen AU - Millings, Abigail PY - 2020/5/27 TI - Usability, Acceptability, and Effectiveness of Web-Based Conversational Agents to Facilitate Problem Solving in Older Adults: Controlled Study JO - J Med Internet Res SP - e16794 VL - 22 IS - 5 KW - transdiagnostic KW - method of levels KW - system usability KW - acceptability KW - effectiveness KW - mental health KW - conversational agents KW - older adults KW - chatbots KW - web-based KW - N2 - Background: The usability and effectiveness of conversational agents (chatbots) that deliver psychological therapies is under-researched. Objective: This study aimed to compare the system usability, acceptability, and effectiveness in older adults of 2 Web-based conversational agents that differ in theoretical orientation and approach. Methods: In a randomized study, 112 older adults were allocated to 1 of the following 2 fully automated interventions: Manage Your Life Online (MYLO; ie, a chatbot that mimics a therapist using a method of levels approach) and ELIZA (a chatbot that mimics a therapist using a humanistic counseling approach). The primary outcome was problem distress and resolution, with secondary outcome measures of system usability and clinical outcome. Results: MYLO participants spent significantly longer interacting with the conversational agent. Posthoc tests indicated that MYLO participants had significantly lower problem distress at follow-up. There were no differences between MYLO and ELIZA in terms of problem resolution. MYLO was rated as significantly more helpful and likely to be used again. System usability of both the conversational agents was associated with helpfulness of the agents and the willingness of the participants to reuse. Adherence was high. A total of 12% (7/59) of the MYLO group did not carry out their conversation with the chatbot. Conclusions: Controlled studies of chatbots need to be conducted in clinical populations across different age groups. The potential integration of chatbots into psychological care in routine services is discussed. UR - http://www.jmir.org/2020/5/e16794/ UR - http://dx.doi.org/10.2196/16794 UR - http://www.ncbi.nlm.nih.gov/pubmed/32384055 ID - info:doi/10.2196/16794 ER - TY - JOUR AU - Zhong, Runting AU - Rau, Patrick Pei-Luen PY - 2020/5/26 TI - A Mobile Phone?Based Gait Assessment App for the Elderly: Development and Evaluation JO - JMIR Mhealth Uhealth SP - e14453 VL - 8 IS - 5 KW - aged KW - gait KW - mHealth KW - telemedicine KW - falls prevention N2 - Background: Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. Objective: This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. Methods: The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. Results: Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. Conclusions: This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone?based gait assessment app. The feedback of the participants would help to design more elderly-friendly products. UR - https://mhealth.jmir.org/2020/5/e14453 UR - http://dx.doi.org/10.2196/14453 UR - http://www.ncbi.nlm.nih.gov/pubmed/32473005 ID - info:doi/10.2196/14453 ER - TY - JOUR AU - Bergquist, Ronny AU - Vereijken, Beatrix AU - Mellone, Sabato AU - Corzani, Mattia AU - Helbostad, L. Jorunn AU - Taraldsen, Kristin PY - 2020/4/27 TI - App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16507 VL - 8 IS - 4 KW - physical function KW - mHealth app KW - usability KW - older people KW - seniors N2 - Background: Objective measures of physical function in older adults are widely used to predict health outcomes such as disability, institutionalization, and mortality. App-based clinical tests allow users to assess their own physical function and have objective tracking of changes over time by use of their smartphones. Such tests can potentially guide interventions remotely and provide more detailed prognostic information about the participant?s physical performance for the users, therapists, and other health care personnel. We developed 3 smartphone apps with instrumented versions of the Timed Up and Go (Self-TUG), tandem stance (Self-Tandem), and Five Times Sit-to-Stand (Self-STS) tests. Objective: This study aimed to test the usability of 3 smartphone app?based self-tests of physical function using an iterative design. Methods: The apps were tested in 3 iterations: the first (n=189) and second (n=134) in a lab setting and the third (n=20) in a separate home-based study. Participants were healthy adults between 60 and 80 years of age. Assessors observed while participants self-administered the tests without any guidance. Errors were recorded, and usability problems were defined. Problems were addressed in each subsequent iteration. Perceived usability in the home-based setting was assessed by use of the System Usability Scale, the User Experience Questionnaire, and semi-structured interviews. Results: In the first iteration, 7 usability problems were identified; 42 (42/189, 22.0%) and 127 (127/189, 67.2%) participants were able to correctly perform the Self-TUG and Self-Tandem, respectively. In the second iteration, errors caused by the problems identified in the first iteration were drastically reduced, and 108 (108/134, 83.1%) and 106 (106/134, 79.1%) of the participants correctly performed the Self-TUG and Self-Tandem, respectively. The first version of the Self-STS was also tested in this iteration, and 40 (40/134, 30.1%) of the participants performed it correctly. For the third usability test, the 7 usability problems initially identified were further improved. Testing the apps in a home setting gave rise to some new usability problems, and for Self-TUG and Self-STS, the rates of correctly performed trials were slightly reduced from the second version, while for Self-Tandem, the rate increased. The mean System Usability Scale score was 77.63 points (SD 16.1 points), and 80-95% of the participants reported the highest or second highest positive rating on all items in the User Experience Questionnaire. Conclusions: The study results suggest that the apps have the potential to be used to self-test physical function in seniors in a nonsupervised home-based setting. The participants reported a high degree of ease of use. Evaluating the usability in a home setting allowed us to identify new usability problems that could affect the validity of the tests. These usability problems are not easily found in the lab setting, indicating that, if possible, app usability should be evaluated in both settings. Before being made available to end users, the apps require further improvements and validation. UR - http://mhealth.jmir.org/2020/4/e16507/ UR - http://dx.doi.org/10.2196/16507 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338616 ID - info:doi/10.2196/16507 ER - TY - JOUR AU - Neil-Sztramko, E. Sarah AU - Coletta, Giulia AU - Dobbins, Maureen AU - Marr, Sharon PY - 2020/4/20 TI - Impact of the AGE-ON Tablet Training Program on Social Isolation, Loneliness, and Attitudes Toward Technology in Older Adults: Single-Group Pre-Post Study JO - JMIR Aging SP - e18398 VL - 3 IS - 1 KW - technology KW - older adults KW - tablet training KW - education N2 - Background: The internet and technology can help older adults connect with family and friends. However, many older adults face obstacles to internet and technology use, such as lack of knowledge or self-efficacy. Objective: The purpose of this study was to explore the impact of the AGE-ON tablet training program on social isolation, loneliness, and quality of life. Methods: Adults aged >60 years took part in a series of 6 weekly workshops covering the basic features of a tablet. Before and after the program, social isolation, loneliness, social support, and quality of life were assessed. In addition, data on current tablet use and attitudes toward technology use were collected. Satisfaction with the program was also assessed at the end of the study using 6 Likert scale questions. Results: The participants (N=32; mean age 76.3, SD 8.6 years) were predominantly female (n=20, 63%) and retired (n=30, 94%). The participants reported that they were highly satisfied with the program. After completing the program, no differences in social isolation, loneliness, social support, or quality of life were found. Frequency of tablet use increased and the attitudes of the participants toward technology improved. Conclusions: The AGE-ON program resulted in increased tablet use frequency and may improve comfort and attitudes toward tablet use among older adults. This program may assist older adults in overcoming obstacles to internet and technology use to better connect with family and friends; however, further work targeting older adults who are socially isolated or at risk of social isolation is needed to more fully understand whether tablet training programs are beneficial in this population. Trial Registration: ClinicalTrials.gov NCT03472729; https://clinicaltrials.gov/ct2/show/NCT03472729 UR - http://aging.jmir.org/2020/1/e18398/ UR - http://dx.doi.org/10.2196/18398 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310146 ID - info:doi/10.2196/18398 ER - TY - JOUR AU - Zheng, Yaguang AU - Weinger, Katie AU - Greenberg, Jordan AU - Burke, E. Lora AU - Sereika, M. Susan AU - Patience, Nicole AU - Gregas, C. Matt AU - Li, Zhuoxin AU - Qi, Chenfang AU - Yamasaki, Joy AU - Munshi, N. Medha PY - 2020/3/23 TI - Actual Use of Multiple Health Monitors Among Older Adults With Diabetes: Pilot Study JO - JMIR Aging SP - e15995 VL - 3 IS - 1 KW - mobile health KW - aged KW - lifestyle KW - self-management KW - diabetes mellitus, type 2 N2 - Background: Previous studies have reported older adults? perceptions of using health monitors; however, no studies have examined the actual use of multiple health monitors for lifestyle changes over time among older adults with type 2 diabetes (T2D). Objective: The primary aim of this study was to examine the actual use of multiple health monitors for lifestyle changes over 3 months among older adults with T2D. The secondary aim was to explore changes in caloric intake and physical activity (PA) over 3 months. Methods: This was a single-group study lasting 3 months. The study sample included participants who were aged ?65 years with a diagnosis of T2D. Participants were recruited through fliers posted at the Joslin Diabetes Center in Boston. Participants attended five 60-min, biweekly group sessions, which focused on self-monitoring, goal setting, self-regulation to achieve healthy eating and PA habits, and the development of problem-solving skills. Participants were provided with the Lose It! app to record daily food intake and devices such as a Fitbit Alta for monitoring PA, a Bluetooth-enabled blood glucose meter, and a Bluetooth-enabled digital scale. Descriptive statistics were used for analysis. Results: Of the enrolled participants (N=9), the sample was white (8/9, 89%) and female (4/9, 44%), with a mean age of 76.4 years (SD 6.0; range 69-89 years), 15.7 years (SD 2.0) of education, 33.3 kg/m2 (SD 3.1) BMI, and 7.4% (SD 0.8) hemoglobin A1c. Over the 84 days of self-monitoring, the mean percentage of days using the Lose It!, Fitbit Alta, blood glucose meter, and scale were 82.7 (SD 17.6), 85.2 (SD 19.7), 65.3 (SD 30.1), and 53.0 (SD 34.5), respectively. From baseline to completion of the study, the mean daily calorie intake was 1459 (SD 661) at week 1, 1245 (SD 554) at week 11, and 1333 (SD 546) at week 12, whereas the mean daily step counts were 5618 (SD 3654) at week 1, 5792 (SD 3814) at week 11, and 4552 (SD 3616) at week 12. The mean percentage of weight loss from baseline was 4.92% (SD 0.25). The dose of oral hypoglycemic agents or insulin was reduced in 55.6% (5/9) of the participants. Conclusions: The results from the pilot study are encouraging and suggest the need for a larger study to confirm the outcomes. In addition, a study design that includes a control group with educational sessions but without the integration of technology would offer additional insight to understand the value of mobile health in behavior changes and the health outcomes observed during this pilot study. UR - http://aging.jmir.org/2020/1/e15995/ UR - http://dx.doi.org/10.2196/15995 UR - http://www.ncbi.nlm.nih.gov/pubmed/32202506 ID - info:doi/10.2196/15995 ER - TY - JOUR AU - López Seguí, Francesc AU - de San Pedro, Marc AU - Aumatell Verges, Eva AU - Simó Algado, Salvador AU - Garcia Cuyŕs, Francesc PY - 2019/08/09 TI - An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation JO - JMIR Aging SP - e13939 VL - 2 IS - 2 KW - active aging KW - digital inclusion KW - ICT program KW - intergenerational relationships KW - civic participation KW - community service N2 - Background: ?Digital Partners? is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users? digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants? satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project?s strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals? free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project?s duration, if necessary. Conclusions: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion. UR - http://aging.jmir.org/2019/2/e13939/ UR - http://dx.doi.org/10.2196/13939 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518276 ID - info:doi/10.2196/13939 ER - TY - JOUR AU - Anderberg, Peter AU - Eivazzadeh, Shahryar AU - Berglund, Sanmartin Johan PY - 2019/05/23 TI - A Novel Instrument for Measuring Older People?s Attitudes Toward Technology (TechPH): Development and Validation JO - J Med Internet Res SP - e13951 VL - 21 IS - 5 KW - technophilia KW - aging KW - internet KW - health technology KW - eHealth N2 - Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons? technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (?28=21.2, ?2/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries. UR - http://www.jmir.org/2019/5/e13951/ UR - http://dx.doi.org/10.2196/13951 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124467 ID - info:doi/10.2196/13951 ER - TY - JOUR AU - Quinn, C. Charlene AU - Staub, Sheila AU - Barr, Erik AU - Gruber-Baldini, Ann PY - 2019/05/23 TI - Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study JO - JMIR Aging SP - e12276 VL - 2 IS - 1 KW - older adult KW - caregiver KW - mobile health KW - patient engagement N2 - Background: Evaluation of digital health applications to support older adults? independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers. Objective: The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ?65 years. The app was designed to improve engagement of the patient-informal caregiver team. Methods: This observational usability study was conducted in participants? homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ?65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS). Results: The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1). Conclusions: Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping. UR - http://aging.jmir.org/2019/1/e12276/ UR - http://dx.doi.org/10.2196/12276 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518271 ID - info:doi/10.2196/12276 ER - TY - JOUR AU - Wang, Jing AU - Du, Yan AU - Coleman, Deidra AU - Peck, Michelle AU - Myneni, Sahiti AU - Kang, Hong AU - Gong, Yang PY - 2019/05/15 TI - Mobile and Connected Health Technology Needs for Older Adults Aging in Place: Cross-Sectional Survey Study JO - JMIR Aging SP - e13864 VL - 2 IS - 1 KW - mobile health KW - connected health KW - wearable technology KW - remote monitoring KW - independent living KW - aging in place N2 - Background: An increasing number of mobile and wearable devices are available in the market. However, the extent to which these devices can be used to assist older adults to age in place remains unclear. Objective: This study aimed to assess older adults? perceptions of using mobile and connected health technologies. Methods: Using a cross-sectional design, a total of 51 participants were recruited from a senior community center. Demographics and usage of mobile or wearable devices and online health communities were collected using a survey questionnaire. Descriptive statistics assessed usage of devices and online health communities. The Fisher exact test was used to examine the relationship between technology usage and having access to a smartphone. Results: The sample was primarily comprised non-Hispanic white (35/51, 69%), educated (39/51, 76% any college), and female (36/51, 71%) participants, with an average age of 70 (SD 8) years. All participants were insured and nearly all lived at home (49/51, 94%). A total of 86% (44/51) of the participants had heard of wearable health devices, but only 18 out of 51 (35%) had ever used them. Over 80% (42/51) expressed interest in using such devices and were interested in tracking exercise and physical activity (46/51, 90%), sleep (38/51, 75%), blood pressure (34/51, 67%), diet (31/51, 61%), blood sugar (28/51, 55%), weight (26/51, 51%), and fall risk (23/51, 45%). The greatest concerns about using wearable devices were cost (31/51, 61%), safety (14/51, 28%), and privacy (13/51, 26%); one-fourth (12/51) reported having no concerns. They were mostly interested in sharing data from mobile and connected devices with their health care providers followed by family, online communities, friends, and no one. About 41% (21/51) of the older adults surveyed reported having ever heard of an online health community, and roughly 40% (20/51) of the participants reported being interested in joining such a community. Most participants reported having access to a smartphone (38/51, 74%), and those with such access were significantly more likely to show interest in using a wearable health device (P<.001) and joining an online health community (P=.05). Conclusions: Our findings suggest that, although few older adults are currently using mobile and wearable devices and connected health technologies for managing health, they are open to this idea and are mostly interested in sharing such data with their health care providers. Further studies are warranted to explore strategies to balance the data sharing preference of older adults and how to best integrate mobile and wearable device data with clinical workflow for health care providers to promote healthy aging in place. UR - http://aging.jmir.org/2019/1/e13864/ UR - http://dx.doi.org/10.2196/13864 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518283 ID - info:doi/10.2196/13864 ER - TY - JOUR AU - Ding, Y. Eric AU - Han, Dong AU - Whitcomb, Cody AU - Bashar, Khairul Syed AU - Adaramola, Oluwaseun AU - Soni, Apurv AU - Saczynski, Jane AU - Fitzgibbons, P. Timothy AU - Moonis, Majaz AU - Lubitz, A. Steven AU - Lessard, Darleen AU - Hills, True Mellanie AU - Barton, Bruce AU - Chon, Ki AU - McManus, D. David PY - 2019/05/15 TI - Accuracy and Usability of a Novel Algorithm for Detection of Irregular Pulse Using a Smartwatch Among Older Adults: Observational Study JO - JMIR Cardio SP - e13850 VL - 3 IS - 1 KW - mobile health KW - mHealth KW - atrial fibrillation KW - screening KW - photoplethysmography KW - electrocardiography KW - smartwatch N2 - Background: Atrial fibrillation (AF) is often paroxysmal and minimally symptomatic, hindering its diagnosis. Smartwatches may enhance AF care by facilitating long-term, noninvasive monitoring. Objective: This study aimed to examine the accuracy and usability of arrhythmia discrimination using a smartwatch. Methods: A total of 40 adults presenting to a cardiology clinic wore a smartwatch and Holter monitor and performed scripted movements to simulate activities of daily living (ADLs). Participants? clinical and sociodemographic characteristics were abstracted from medical records. Participants completed a questionnaire assessing different domains of the device?s usability. Pulse recordings were analyzed blindly using a real-time realizable algorithm and compared with gold-standard Holter monitoring. Results: The average age of participants was 71 (SD 8) years; most participants had AF risk factors and 23% (9/39) were in AF. About half of the participants owned smartphones, but none owned smartwatches. Participants wore the smartwatch for 42 (SD 14) min while generating motion noise to simulate ADLs. The algorithm determined 53 of the 314 30-second noise-free pulse segments as consistent with AF. Compared with the gold standard, the algorithm demonstrated excellent sensitivity (98.2%), specificity (98.1%), and accuracy (98.1%) for identifying irregular pulse. Two-thirds of participants considered the smartwatch highly usable. Younger age and prior cardioversion were associated with greater overall comfort and comfort with data privacy with using a smartwatch for rhythm monitoring, respectively. Conclusions: A real-time realizable algorithm analyzing smartwatch pulse recordings demonstrated high accuracy for identifying pulse irregularities among older participants. Despite advanced age, lack of smartwatch familiarity, and high burden of comorbidities, participants found the smartwatch to be highly acceptable. UR - http://cardio.jmir.org/2019/1/e13850/ UR - http://dx.doi.org/10.2196/13850 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758787 ID - info:doi/10.2196/13850 ER - TY - JOUR AU - Portz, Dickman Jennifer AU - Bayliss, A. Elizabeth AU - Bull, Sheana AU - Boxer, S. Rebecca AU - Bekelman, B. David AU - Gleason, Kathy AU - Czaja, Sara PY - 2019/04/08 TI - Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study JO - J Med Internet Res SP - e11604 VL - 21 IS - 4 KW - multiple chronic conditions KW - personal health record KW - patient portals KW - aging KW - health information technology N2 - Background: Patient portals offer modern digital tools for older adults with multiple chronic conditions (MCC) to engage in their health management. However, there are barriers to portal adoption among older adults. Understanding portal user interface and user experience (UI and UX) preferences of older adults with MCC may improve the accessibility, acceptability, and adoption of patient portals. Objective: The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UI and UX, intent to use, and use behaviors among older patients with MCC. Methods: We carried out a qualitative descriptive study of Kaiser Permanente Colorado?s established patient portal, My Health Manager. Older patients (N=24; mean 78.41 (SD 5.4) years) with MCC participated in focus groups. Stratified random sampling was used to maximize age and experience with the portal among participants. The semistructured focus groups used a combination of discussion and think-aloud strategies. A total of 2 coders led the theoretically driven analysis based on the TAM to determine themes related to use behavior, portal usefulness and ease of use, and intent to use. Results: Portal users commonly used email, pharmacy, and lab results sections of the portal. Although, generally, the portal was seen to be easy to use, simple, and quick, challenges related to log-ins, UI design (color and font), and specific features were identified. Such challenges inhibited participants? intent to use the portal entirely or specific features. Participants indicated that the portal improved patient-provider communication, saved time and money, and provided relevant health information. Participants intended to use features that were beneficial to their health management and easy to use. Conclusions: Older adults are interested in using patient portals and are already taking advantage of the features available to them. We have the opportunity to better engage older adults in portal use but need to pay close attention to key considerations promoting usefulness and ease of use. UR - https://www.jmir.org/2019/4/e11604/ UR - http://dx.doi.org/10.2196/11604 UR - http://www.ncbi.nlm.nih.gov/pubmed/30958272 ID - info:doi/10.2196/11604 ER - TY - JOUR AU - Kononova, Anastasia AU - Li, Lin AU - Kamp, Kendra AU - Bowen, Marie AU - Rikard, RV AU - Cotten, Shelia AU - Peng, Wei PY - 2019/04/05 TI - The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change JO - JMIR Mhealth Uhealth SP - e9832 VL - 7 IS - 4 KW - aging KW - wearable electronic devices KW - biobehavioral sciences KW - transtheoretical model of behavior change KW - exercise KW - physical activity N2 - Background: Wearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse. Objective: The aim of this study was to investigate older adults? perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage. Methods: Data for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type). Results: The results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior. Conclusions: The results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology?s limitations and gaining awareness of one?s physical activity without changing the physical activity level itself. UR - https://mhealth.jmir.org/2019/4/e9832/ UR - http://dx.doi.org/10.2196/mhealth.9832 UR - http://www.ncbi.nlm.nih.gov/pubmed/30950807 ID - info:doi/10.2196/mhealth.9832 ER - TY - JOUR AU - Manini, Matthew Todd AU - Mendoza, Tonatiuh AU - Battula, Manoj AU - Davoudi, Anis AU - Kheirkhahan, Matin AU - Young, Ellen Mary AU - Weber, Eric AU - Fillingim, Benton Roger AU - Rashidi, Parisa PY - 2019/03/26 TI - Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study JO - JMIR Mhealth Uhealth SP - e10044 VL - 7 IS - 3 KW - smartwatch KW - focus group KW - ecological momentary assessment (EMA) KW - patient-reported outcomes (PRO) N2 - Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient?s long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants? attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. Results: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. Conclusions: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales. UR - http://mhealth.jmir.org/2019/3/e10044/ UR - http://dx.doi.org/10.2196/10044 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912756 ID - info:doi/10.2196/10044 ER - TY - JOUR AU - Mehra, Sumit AU - Visser, Bart AU - Cila, Nazli AU - van den Helder, Jantine AU - Engelbert, HH Raoul AU - Weijs, JM Peter AU - Kröse, JA Ben PY - 2019/02/01 TI - Supporting Older Adults in Exercising With a Tablet: A Usability Study JO - JMIR Hum Factors SP - e11598 VL - 6 IS - 1 KW - frail elderly KW - aged KW - activities of daily living KW - exercise KW - health behavior KW - telemedicine KW - mobile devices KW - tablet computers KW - usability testing KW - mobile phone N2 - Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. UR - http://humanfactors.jmir.org/2019/1/e11598/ UR - http://dx.doi.org/10.2196/11598 UR - http://www.ncbi.nlm.nih.gov/pubmed/30707106 ID - info:doi/10.2196/11598 ER - TY - JOUR AU - Backman, Chantal AU - Harley, Anne AU - Peyton, Liam AU - Kuziemsky, Craig AU - Mercer, Jay AU - Monahan, Anne Mary AU - Schmidt, Sandra AU - Singh, Harvinder AU - Gravelle, Deborah PY - 2018/9/24 TI - Development of a Path to Home Mobile App for the Geriatric Rehabilitation Program at Bruyčre Continuing Care: Protocol for User-Centered Design and Feasibility Testing Studies JO - JMIR Res Protoc SP - e11031 VL - 7 IS - 9 KW - patient discharge KW - care transition KW - user-centered design KW - geriatric rehabilitation KW - mHealth KW - transitional care KW - rehabilitation KW - health services for the aged KW - telemedicine N2 - Background: As the population ages, the need for appropriate geriatric rehabilitation services will also increase. Pressures faced by hospitals to reduce length of stay and reduce costs have driven the need for more complex care being delivered in the home or community setting. As a result, a multifaceted approach that can provide geriatric rehabilitation patients with safe and effective person- and family-centered care during transitions from hospital to home is required. We hypothesize that a technology-supported person- and family-centered care transition could empower geriatric rehabilitation patients, engage them in shared decision making, and ultimately help them to safely manage their personalized needs during care transitions from hospital to home. Objective: The purpose of this study is to design and test the feasibility of a novel Path to Home mobile app to manage the personalized needs of geriatric rehabilitation patients during their transitions from hospital to home. Methods: This study will consist of (1) codesigning a patient- and provider-tailored mobile app, and (2) feasibility pilot testing of the mobile app to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we will follow a user-centered design process integrated with a modern agile software development methodology to iteratively codesign the personalized care transition Path to Home mobile app. In phase 2, we will conduct a single-arm feasibility pilot test with geriatric rehabilitation patients using the personalized care transition Path to Home mobile app to manage their needs during the transition from hospital to home. Results: The project was funded in May 2018, and enrollment and data analysis are underway. First results are expected to be submitted for publication in 2019. Conclusions: Our findings will help validate the use of this technology for geriatric rehabilitation patients discharged from the hospital to home. Future research will more rigorously evaluate the health and economic benefits to inform wide-scale adoption of the technology. Registered Report Identifier: RR1-10.2196/11031 UR - http://www.researchprotocols.org/2018/9/e11031/ UR - http://dx.doi.org/10.2196/11031 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249591 ID - info:doi/10.2196/11031 ER - TY - JOUR AU - Theis, Sabine AU - Rasche, Victor Peter Wilhelm AU - Bröhl, Christina AU - Wille, Matthias AU - Mertens, Alexander PY - 2018/07/09 TI - Task-Data Taxonomy for Health Data Visualizations: Web-Based Survey With Experts and Older Adults JO - JMIR Med Inform SP - e39 VL - 6 IS - 3 KW - classification KW - data display KW - computer graphics KW - task performance and analysis KW - medicine KW - telemedicine KW - user/machine systems KW - human factors N2 - Background: Increasingly, eHealth involves health data visualizations to enable users to better understand their health situation. Selecting efficient and ergonomic visualizations requires knowledge about the task that the user wants to carry out and the type of data to be displayed. Taxonomies of abstract tasks and data types bundle this knowledge in a general manner. Task-data taxonomies exist for visualization tasks and data. They also exist for eHealth tasks. However, there is currently no joint task taxonomy available for health data visualizations incorporating the perspective of the prospective users. One of the most prominent prospective user groups of eHealth are older adults, but their perspective is rarely considered when constructing tasks lists. Objective: The aim of this study was to construct a task-data taxonomy for health data visualizations based on the opinion of older adults as prospective users of eHealth systems. eHealth experts served as a control group against the bias of lacking background knowledge. The resulting taxonomy would then be used as an orientation in system requirement analysis and empirical evaluation and to facilitate a common understanding and language in eHealth data visualization. Methods: Answers from 98 participants (51 older adults and 47 eHealth experts) given in an online survey were quantitatively analyzed, compared between groups, and synthesized into a task-data taxonomy for health data visualizations. Results: Consultation, diagnosis, mentoring, and monitoring were confirmed as relevant abstract tasks in eHealth. Experts and older adults disagreed on the importance of mentoring (?24=14.1, P=.002) and monitoring (?24=22.1, P<.001). The answers to the open questions validated the findings from the closed questions and added therapy, communication, cooperation, and quality management to the aforementioned tasks. Here, group differences in normalized code counts were identified for ?monitoring? between the expert group (mean 0.18, SD 0.23) and the group of older adults (mean 0.08, SD 0.15; t96=2431, P=.02). Time-dependent data was most relevant across all eHealth tasks. Finally, visualization tasks and data types were assigned to eHealth tasks by both experimental groups. Conclusions: We empirically developed a task-data taxonomy for health data visualizations with prospective users. This provides a general framework for theoretical concession and for the prioritization of user-centered system design and evaluation. At the same time, the functionality dimension of the taxonomy for telemedicine?chosen as the basis for the construction of present taxonomy?was confirmed. UR - http://medinform.jmir.org/2018/3/e39/ UR - http://dx.doi.org/10.2196/medinform.9394 UR - http://www.ncbi.nlm.nih.gov/pubmed/29986844 ID - info:doi/10.2196/medinform.9394 ER - TY - JOUR AU - Zheng, Hua AU - Rosal, C. Milagros AU - Li, Wenjun AU - Borg, Amy AU - Yang, Wenyun AU - Ayers, C. David AU - Franklin, D. Patricia PY - 2018/04/30 TI - A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design JO - JMIR Hum Factors SP - e17 VL - 5 IS - 2 KW - usability evaluation KW - patient decision support KW - knee osteoarthritis KW - total knee replacement KW - outcome prediction N2 - Background: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants? responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results: Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra ?next page? click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions: We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients? use. UR - http://humanfactors.jmir.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/humanfactors.8568 UR - http://www.ncbi.nlm.nih.gov/pubmed/29712620 ID - info:doi/10.2196/humanfactors.8568 ER - TY - JOUR AU - Harte, Richard AU - Hall, Tony AU - Glynn, Liam AU - Rodríguez-Molinero, Alejandro AU - Scharf, Thomas AU - Quinlan, R. Leo AU - ÓLaighin, Gearóid PY - 2018/04/26 TI - Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study JO - JMIR Hum Factors SP - e18 VL - 5 IS - 2 KW - smartphone KW - aged KW - elderly KW - wearable electronic devices KW - telemedicine KW - user-computer interface KW - education KW - user centered-design KW - usability KW - connected health KW - human factors KW - falls detection N2 - Background: Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one?s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status. Objective: The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology. Methods: All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks. Results: The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system. Conclusions: Supplementary basic smartphone training may be critical in trials where a smartphone app?based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system. UR - http://humanfactors.jmir.org/2018/2/e18/ UR - http://dx.doi.org/10.2196/humanfactors.7718 UR - http://www.ncbi.nlm.nih.gov/pubmed/29699969 ID - info:doi/10.2196/humanfactors.7718 ER -