Identifying Key Components of Paper-Based and Technology-Based Home Assessment Tools Using a Narrative Literature Review
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Cited by 4 publications
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Understanding Key Home and Community Environment Challenges Encountered by Older Adults Undergoing Total Knee or Hip Arthroplasty
Background and Objectives Older adults undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) experience significant challenges while navigating their homes post-surgery and are at higher risk for falls and injuries. This study explored specific home and community physical environment challenges faced by community-dwelling older adults while performing daily activities and actions taken to modify their homes before surgery. Research Design and Methods Using a qualitative descriptive methodology, semi-structured interviews were conducted with 22 older adult-care partner dyads pre- and post-surgery to identify key built environment barriers and facilitators in addition to home modifications made pre-and post-surgery. Results Challenges anticipated by participants to perform daily activities pre-surgery varied from those experienced post-surgery. Lack of support along stairs or in bathrooms, flooring material, and transitions were significant concerns raised by participants pre-surgery. Size and layout of home and ergonomics of resting furniture were recognized as issues post-surgery. Modifications ranged from easy fixes like rearranging furniture, removing clutter, installing grab bars to high-cost structural changes like remodeling critical spaces like bathrooms. Although participants agreed on the importance of conducting proactive home assessments and modifications before surgery, perceived costs, and lack of knowledge or services limit older adults from implementing some changes. Discussion and Implications Home modifications must be considered proactively before an event such as a THA or TKA. These should be done within the context of the specific needs, abilities, financial capabilities, and social and physical home environments of the individual and the residential caregivers.
Understanding Key Home and Community Environment Challenges Encountered by Older Adults Undergoing Total Knee or Hip Arthroplasty
Background and Objectives Older adults undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) experience significant challenges while navigating their homes post-surgery and are at higher risk for falls and injuries. This study explored specific home and community physical environment challenges faced by community-dwelling older adults while performing daily activities and actions taken to modify their homes before surgery. Research Design and Methods Using a qualitative descriptive methodology, semi-structured interviews were conducted with 22 older adult-care partner dyads pre- and post-surgery to identify key built environment barriers and facilitators in addition to home modifications made pre-and post-surgery. Results Challenges anticipated by participants to perform daily activities pre-surgery varied from those experienced post-surgery. Lack of support along stairs or in bathrooms, flooring material, and transitions were significant concerns raised by participants pre-surgery. Size and layout of home and ergonomics of resting furniture were recognized as issues post-surgery. Modifications ranged from easy fixes like rearranging furniture, removing clutter, installing grab bars to high-cost structural changes like remodeling critical spaces like bathrooms. Although participants agreed on the importance of conducting proactive home assessments and modifications before surgery, perceived costs, and lack of knowledge or services limit older adults from implementing some changes. Discussion and Implications Home modifications must be considered proactively before an event such as a THA or TKA. These should be done within the context of the specific needs, abilities, financial capabilities, and social and physical home environments of the individual and the residential caregivers.
Quality and Accessibility of Home Assessment mHealth Apps for Community Living: Systematic Review
Background Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility. Objective This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps. Methods mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps’ effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation. Results A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the “good” quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app’s functionality. Conclusions Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place.
BACKGROUND Most adults prefer to age-in-place. However, the majority of homes are not designed to support resident needs, specially of adults undergoing joint replacement surgeries such as total knee arthroplasty (TKA) or total hip arthroplasty (THA). It is of paramount importance to proactively assess and modify the homes of adults undergoing TKA/THA such that they can safely transition home following surgery. There are several tools that utilize emerging technology like virtual reality, augmented reality, or teleconferencing to assess home environments. These are meant to be used by professionals like occupational therapists. However, the acceptance and uptake of simple technology like phone applications for assessing homes proactively by residents has not been explored. OBJECTIVE A qualitative exploratory study was conducted to evaluate the feasibility and potential acceptance of technology as well as identify recommendations based on expectations of adults for development of a technology-based resident-initiated home assessment tool. METHODS Semi-structured interviews were conducted with 22 patient-care partner dyads before and after THA/TKA. The technology acceptance model (TAM) was used as a framework to understand the perceived usefulness, intention to use technology-based home assessment tools, as well as perceived barriers and facilitators of using of the tool. RESULTS About 68% of the patient-care partner dyads interviewed for this study perceived benefits of using a technology-based tool. All the participants who perceived the tool to be beneficial, showed positive behavioral intention of using it. A comparison of responses between pre- and post-surgery interviews revealed that around 50% of participants showed increased intention of using an assessment tool after experiencing challenges in their homes post-surgery. Participants provided recommendations for key content, potential features to include in the assessment tool, and preferred formats (e.g., checklists, visuals, and videos). CONCLUSIONS To increase acceptance of a technology-based home assessment tool, it is crucial that residents are made aware of the home environment challenges and the importance of an assessment tool to improve their safety and independence. The content, features, formats, and usability suggestions from the participants in this study provide a framework for health mobile application and interface developers to design a technology-based home assessment tool.
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