The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.

The study’s rationale The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons’ preferences. Aims and objectives To describe and evaluate the experiences of self‐care support and sense of security among older persons using an interactive app to report health concerns. Methodological design and justification The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding. Ethical issues and approval Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent. Research methods Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6‐month follow‐up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach. Measurements and intervention The questionnaire included the Appraisal of Self‐care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self‐care advice, graphs and a risk assessment model that generated alerts directly to the nurses. Results The older persons described how self‐care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards. Study limitations The small sample size for statistical analysis. Conclusions This study shows that an app can be a complementary tool to conventional home care that can increase older persons’ sense of security and self‐care ability. The results mirror the older persons’ awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.

Background Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. Objective Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. Methods We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. Results The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. Conclusions This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement.

Background During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time. Methods A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics. Results The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time. Conclusions The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.

Background: Patients with chronic obstructive pulmonary disease (COPD) might suffer from severe dyspnea, which importantly impacts on the performance of activities of daily living (ADL). Patient training of energy conservation techniques (ECTs) might be useful to improve the tolerance and execution of these ADL, but objective studies evaluating the effect of teaching ECTs on the metabolic equivalent of task (MET) in patients with COPD are sparse. Objectives: The aim of this study was to test the hypothesis that practicing ECTs after a 2-week ECT teaching period would reduce the energy expenditure (MET) in performing an activity in patients with severe COPD. Methods: Energy expenditure was assessed with a gas exchange system (Oxycon TM Mobile) during one out of five standardized ADL before and after a 2-week intervention period in which ECTs were taught. These ECTs comprised a good breathing technique, an ergonomic way of performing the activity, and the use of assistive devices. Re-sults: Thirty-two patients with COPD (mean FEV 1 : 39 ± 14%; female: n = 18; age: 68 ± 7 years) were included. A significantly lower MET (2.3 ± 0.6 to 2.1 ± 0.5; p < 0.05) and less desaturation (89.7 ± 5.2 vs. 91.1 ± 5.5% HbO 2 ; p < 0.05) were seen while performing the same activity after the intervention. However, there was no significant difference in the time spent on the task performed (6.0 ± 3.9 vs. 6.7 ± 4.0 min; p > 0.05). Conclusions: A 2-week educative program on ECTs successfully reduces the energy spent for performing ADL relevant to the patient without any significant increase in the time spent on the activity.

Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.

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BACKGROUND Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. OBJECTIVE Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. METHODS We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. RESULTS The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. CONCLUSIONS This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement.