FindMyApps eHealth intervention improves quality, not quantity, of home tablet use by people with dementia

Abstract

IntroductionFindMyApps is a tablet-based eHealth intervention, designed to improve social health in people with mild dementia or mild cognitive impairment.MethodsFindMyApps has been subject to a randomized controlled trial (RCT), Netherlands Trial Register NL8157. Following UK Medical Research Council guidance, a mixed methods process evaluation was conducted. The goal was to investigate the quantity and quality of tablet use during the RCT, and which context, implementation, and mechanisms of impact (usability, learnability and adoption) factors might have influenced this. For the RCT, 150 community dwelling people with dementia and their caregivers were recruited in the Netherlands. For the process evaluation, tablet-use data were collected by proxy-report instrument from all participants' caregivers, FindMyApps app-use data were registered using analytics software among all experimental arm participants, and semi-structured interviews (SSIs) were conducted with a purposively selected sample of participant-caregiver dyads. Quantitative data were summarized and between group differences were analyzed, and qualitative data underwent thematic analysis.ResultsThere was a trend for experimental arm participants to download more apps, but there were no statistically significant differences between experimental and control arm participants regarding quantity of tablet use. Qualitative data revealed that experimental arm participants experienced the intervention as easier to use and learn, and more useful and fun than control arm participants. Adoption of tablet app use was lower than anticipated in both arms.ConclusionsA number of context, implementation and mechanism of impact factors were identified, which might explain these results and may inform interpretation of the pending RCT main effect results. FindMyApps seems to have had more impact on the quality than quantity of home tablet use.

FindMyApps compared with usual tablet use to promote social health of community-dwelling people with mild dementia and their informal caregivers: a randomised controlled trial

“…Detailed observations regarding use of the tablet and FindMyApps app have been reported elsewhere. 11 Adherence rates to the advised training scheme were 66.7% in the experimental arm and 64.5% in the control arm (n tot = 122, chi-squared = 0.06, p = 0.80). No harms associated with the interventions were identified.…”

“…Another reason that no effects on a group level were found may be because FindMyApps appeared primarily associated with higher quality tablet interactions but not quantitatively more tablet use or adoption. 11 Many factors can limit technology adoption by people with dementia, including lack of perceived need for a device, or unwillingness or inability to invest time in learning technology. 5 , 7 , 11 Adherence rates in this study were similar in both arms (about 65%) and higher than the 56% average reported for eHealth interventions for non-communicable disease management.…”

“… 11 Many factors can limit technology adoption by people with dementia, including lack of perceived need for a device, or unwillingness or inability to invest time in learning technology. 5 , 7 , 11 Adherence rates in this study were similar in both arms (about 65%) and higher than the 56% average reported for eHealth interventions for non-communicable disease management. 28 However, the average frequency of use, or the three-month duration of the follow-up period, may have been insufficient to observe significant improvements in outcomes.…”

“…In addition to the three variables used to stratify randomisation (diagnosis, prior tablet use and cohabitation status), presence of apathy at baseline (yes or no) was investigated because, in the process evaluation accompanying this RCT, caregivers identified this as an implementation barrier. 11 Age of the person with dementia/MCI was also investigated, as increasing age has been associated with less tablet use in dementia. 26 Additionally, effect modification by whether or not participants adhered to the advised frequency of tablet use was also investigated.…”

“…Following the Medical Research Council framework for the evaluation of complex interventions, 9 pilot studies demonstrated that FindMyApps is feasible to implement, can be positively experienced by people with dementia/MCI and their caregivers, and may improve the quality, if not quantity of home tablet use. 10 , 11 …”