A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns

Abstract

Background Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. Objective This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. Methods The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days. Results Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. Conclusions For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.

Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions

“…The application of technology may be the most realistic solution to address the need for non-pharmacological supporting the cognitively impaired elderly. However, despite some enthusiastic reports ( 67 ), findings are generally mixed. One limitation of technological applications is the inability to train caregivers on the use of computer-based support strategies ( 68 ) due to lockdown-related restrictions or a lack of skilled staff in nursing homes.…”

Exploring the Role of Web-Based Interventions in the Self-management of Dementia: Systematic Review and Narrative Synthesis

“…Table S3 (Multimedia Appendix 3 [31][32][33][34][35][36][37][38][39][40][41]) outlines the outcomes and key findings of each of the included studies.…”

“…Participants were mainly recruited from day and activity centers for people living with dementia (n=6) or from memory clinics (n=3). Supporters were recruited in 4 studies, 2 as part of a dyad [32,33], and 2 as supporters [31,34]. Of the 121 supporters recruited, 119 (98.3%) were informal and 2 (1.7%) were formal (see Tables S1 and S2 of Multimedia Appendix 1 [31][32][33][34][35][36][37][38][39][40][41] and Multimedia Appendix 2 [31][32][33][34][35][36][37][38][39][40][41], respectively, for further details of the study and participant characteristics).…”

“…The outcomes of the other 5 studies [31][32][33][34]40] explored the wider impact and experiences of app-based and wearable technology in dementia care. Interventions in 2 studies led to increased activity levels and a sense of independence in participants, which promoted positive engagement with daily activities [32,33].…”

Impact of the FindMyApps program on people with mild cognitive impairment or dementia and their caregivers; an exploratory pilot randomised controlled trial

“…Apps could support people with dementia for the same purposes [12][13][14][15][16]. This includes apps to support memory and structure in daily life [17], apps to play games for cognitive stimulation [18] or as a pleasant and meaningful activity [19], and apps to view art to improve people's wellbeing [20]. Whilst many potentially useful apps already exist, it may be difficult for people with dementia to find apps that suit their interests, needs and abilities [13,14,21].…”