A randomized controlled trial of an mHealth application with nursing interaction to promote quality of life among community-dwelling older adults

Abstract

SignificanceUsing mHealth apps alone at home without the support of healthcare experts could mean that older adults might not fully utilize the functions of the apps, recognize their benefits, and sustain their use. Incorporating an integrated health-social partnership model to support the app usage when further help is needed by the older adults might maximize the apps' benefits in the long term.ObjectivesThis study aimed to examine the benefits of adding nursing interaction supported by a health-social partnership model in the use of mHealth, and the sustained beneficial effects on psychological outcomes, including quality of life, self-efficacy, and depression, among older adults after the completion of the program.MethodsA three-arm, randomized controlled trial design was adopted. Community-dwelling older adults with chronic pain, hypertension, or diabetes, were randomly assigned to either the mHealth, mHealth with interactivity, or control group. Subjects in both the mHealth and the mHealth with interactivity groups received the mHealth application. In addition, the mHealth with interactivity group received support from a nurse case manager, who was supported by a health-social partnership team. mHealth apps and services from a nurse case manager were not provided to the control group. The primary outcome measure was quality of life, and secondary outcomes were self-efficacy and depression. Data were collected at pre-intervention (T1), post-intervention (T2), and at 3 months post-intervention to measure the sustained effect of the program.ResultsThere were 74 mHealth+I, 71 mHealth, and 76 control group subjects enrolled in the program. No statistically significant between-group, within-group, and interaction effects between group and time in both physical component summary (PCS) and mental component summary (MCS) scores were found among the three groups. The mHealth group showed an improvement in PCS and depression scores from T1 to T2, sustained at T3; while the mHealth+I group demonstrated improved self-efficacy from T1 to T2, with a decrease at T3.ConclusionAdding nurse-directed telephone calls may be of little to no benefit at all in the long term. Future studies may consider a longer intervention period to build and sustain quality of life and self-efficacy levels among community-dwelling older adults.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT03878212.

Effectiveness of a mHealth intervention on hypertension control in a low-resource rural setting: A randomized clinical trial

“…In line with our findings, a RCT on 1,372 hypertension patients reported that mobile phone text messages could resulted in a small reduction in SBP compared with usual care after 12 months intervention (6). Also, it was reported that observations, including in-person visits, telephone support, and text messaging may have important implications when conducting internet-based interventions (35,36). So we added mobile devices, including phone calls, short message service, face-to-face communication via video and in-person visits as our intervention methods.…”

Experiences of receiving an mHealth application with proactive nursing support among community-dwelling older adults: a mixed-methods study

“…Participants for this study were community-dwelling older adults who had taken part in an interventional study that sought to examine the effects of mHealth and nurse support [ 23 ]. The participants were recruited from five community and elderly centers that serve more than 50,000 older adults per year.…”

“…Following this, another 12-week period was set to ascertain the sustained effects of the combined intervention. The study observed that participants in the mHealth group demonstrated improvement in the Physical Component Summary (PCS) of the Quality-of-Life scale over the 12-week period and sustained to the 12-week follow-up period whereas the mHealth + I group demonstrated improved self-efficacy over the intervention period with a decrease at follow-up [ 23 ]. These beneficial effects notwithstanding, it is interesting to note that the mHealth + I group that received more support experienced minimal improvement which warrants a further study to ascertain how they experienced the use of the mHealth app and the proactive professional support.…”

Technology: A metaparadigm concept of nursing

“…New models of care are emerging to improve patient and family outcomes. Now more than ever, patients and community‐dwelling older adults are being empowered to partner with various advanced and low‐end technological applications to self‐manage even in the absence of a healthcare provider (Vaffis et al, 2023; Wong, Bayuo, Wong, Chow, et al, 2023; Wong, Wong, Bayuo, et al, 2022; Wong, Wong, Chow, et al, 2022).…”

“…The metaverse also offers a virtual environment enabled by technology to train nurses (De Gagne et al, 2022). In the communities, nurses continue to employ internet‐based resources and mobile health (mHealth) applications to promote the delivery of person‐centred care across varied population groups such as community‐dwelling older adults (Wong, Bayuo, et al, 2022; Wong, Bayuo, Wong, Chow et al, 2023; Wong, Wong, Bayuo et al, 2022; Wong, Wong, Chow, et al, 2022) and stroke survivors (Burns et al, 2021; Wong, Bayuo, Wong, Kwok, et al, 2023). In fact, as the world battled with the Coronavirus pandemic, these technologies were shown to be the ‘game changers’ in healthcare (Betriana et al, 2022).…”