Population aging threatens the sustainability of welfare systems since it is not accompanied by an extended healthy and independent period in the last years of life. The Comprehensive Geriatric Assessment (CGA) has been shown to be efficient in maintaining the healthy period at the end of the life. Frailty monitoring is typically carried out for an average period of 6 months in clinical settings, while more regular monitoring could prevent the transition to disability. We present the design process of a system for frailty home monitoring based on an adapted CGA and the rationale behind its User eXperience (UX) design. The resulting home monitoring system consists of two devices based on ultrasound sensors, a weight scale, and a mobile application for managing the devices, administering CGA-related questionnaires, and providing alerts. Older users may encounter barriers in their usage of technology. For this reason, usability and acceptability are critical for health monitoring systems addressed to geriatric patients. In the design of our system, we have followed a user-centered process, involving geriatricians and older frail patients by means of co-creation methods. In the iterative process of design and usability testing, we have identified the most effective way of conducting the home-based CGA, not just by replicating the dialogue between the physician and the patient, but by adapting the design to the possibilities and limitations of mobile health for this segment of users. The usability evaluation, carried out with 14 older adults, has proved the feasibility of users older than 70 effectively using our monitoring system, additionally showing an intention over 80% for using the system. It has also provided some insights and recommendations for the design of mobile health systems for older users.
Background POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults. Methods The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried’s criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants’ physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants’ perception of health and level of care received, and healthcare professionals’ workload and satisfaction. A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period. Discussion The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design. Trial registration ClinicalTrials.gov. Registration number: NCT04592146. October 19, 2020.
Frailty predisposes older persons to adverse events, and information and communication technologies can play a crucial role to prevent them. CAPACITY provides a means to remotely monitor variables with high predictive power for adverse events, enabling preventative personalized early interventions. This study aims at evaluating the usability, user experience, and acceptance of a novel mobile system to prevent disability. Usability was assessed using the system usability scale (SUS); user experience using the user experience questionnaire (UEQ); and acceptance with the technology acceptance model (TAM) and a customized quantitative questionnaire. Data were collected at baseline (recruitment), and after three and six months of use. Forty-six participants used CAPACITY for six months; nine dropped out, leaving a final sample of 37 subjects. SUS reached a maximum averaged value of 83.68 after six months of use; no statistically significant values have been found to demonstrate that usability improves with use, probably because of a ceiling effect. UEQ, obtained averages scores higher or very close to 2 in all categories. TAM reached a maximum of 51.54 points, showing an improvement trend. Results indicate the success of the participatory methodology, and support user centered design as a key methodology to design technologies for frail older persons. Involving potential end users and giving them voice during the design stage maximizes usability and acceptance.
BACKGROUND Frailty is a highly prevalent condition that predisposes older persons to adverse events. According to the WHO, there is a pressing need to develop comprehensive community-based approaches, and to introduce interventions to prevent functional decline. In this regards, Information and Communication Technologies can play a crucial role to promote ageing in place, for instance by collecting fresh and periodic information on variables associated to poor health outcomes. The CAPACITY technological ecosystem tackles this problem, providing a means to remotely monitor variables with high predictive power for adverse events (ie, gait speed, muscle power and involuntary weight loss) that enable personalized early interventions aimed to prevent disability. OBJECTIVE This study aims to present a novel mobile app designed using a participatory methodology to be used by frail older persons to interact with the services offered by the CAPACITY technological ecosystem, Furthermore, this research work pursues evaluating its usability, user experience and acceptance. METHODS Usability, User Experience and acceptance were assessed at 3 different sampling points during 6 months of continued use of CAPACITY to receive a multicomponent intervention to prevent/reverse frailty. Usability was assessed using the System Usability Scale (SUS); User Experience using the User Experience Questionnaire (UEQ); and acceptance with the Technology Acceptance Model (TAM) and a customized quantitative questionnaire. Data were collected at baseline (recruitment), and after 3 and 6 months of use. RESULTS Forty-six participants used the technology for six months at their homes, and 9 dropped out during the follow-up, leaving a final sample of 37 subjects. All of them completed the questionnaires about usability, user experience and acceptance evaluation in the intermediate and final sample collection points; 25 subjects completed the whole evaluation set at baseline. Usability, measured as SUS reached a maximum averaged value of 83.68 after 6 months of use; no statistically significant values have been found to demonstrate that usability improves with use. User experience, measured as UEQ, obtained averages scores higher or very close to 2 in all 6 categories. Finally, acceptance in terms of TAM reached a maximum of 51.54 points, showing an improvement trend. CONCLUSIONS Results indicate the success of the participatory methodology, and support User Centered Design as the key methodology to follow when designing technologies for frail older persons. Involving potential end users and giving them voice during the design stage maximizes usability and acceptance.
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