Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module

Abstract

BackgroundSeniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible.ObjectiveThe study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home.MethodsThe approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics.ResultsIn phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it.ConclusionsOur interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders.

Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study

“…Our team is a multidisciplinary group of experts in shared decision making, primary care, rehabilitation, architecture, intensive care, and caregiving. We have been working together for 6 years on research studies aiming to develop tools and strategies to facilitate the engagement of older adults and caregivers in shared decision-making processes related to housing decisions [ 13 , 14 , 17 - 21 ].…”

“…Technology can provide an easy and fast way to gain access to this information. In a previous study [ 14 ], we used a user-centered design with older adults, caregivers, and health professionals to develop an interactive decision support website called Supporting Seniors and Caregivers to Stay Mobile at Home (SPINACH) for older adults, caregivers, and health professionals in two Canadian provinces (Quebec and Alberta). We define interactive as providing a 2-way information flow between the user and the site [ 15 ].…”

“…The video page provides information on how different providers (1 video per provider type) can help older adults to stay independent at home. The resource page provides additional information (in text form) for staying independent at home [ 14 ]. Users can either watch only the videos relevant to their current needs or watch others if their needs change over time.…”

“…They can also submit comments and information. According to an earlier quantitative usability survey, the website was deemed acceptable and potentially helpful for all kinds of end users [ 14 ]. However, it also required modifications, and we sought further insights from users as to what these might entail.…”

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

“…[1][2][3] These decisions may be about medication, surgery, safety, care transitions, housing transitions, advance care planning and medical assistance in dying. [4][5][6] However, making health-related decisions may often lead to significant decisional conflict, or the feeling of personal uncertainty over which options are best for a specific individual facing a specific situation. In most real-world scenarios, it is difficult to establish one clear best option, and thus many health-related decisions are preference-sensitive.…”