The Effects of a Theory-Based Patient Portal e-Learning Program for Older Adults with Chronic Illnesses

Abstract

The ability to walk under normal and cognitive dual task conditions is essential for safe mobility in older adults. However, while assessments of gait provide important health information, they have been limited to laboratory settings. We aimed to create an easy-to-use smartphone App enabling remote dual task walking assessments, and to demonstrate its reliability and validity in relatively healthy younger and older adults. The iPhone-based App utilized multi-media instructions and the phone's internal motion sensors to record movements during normal walking and walking with simultaneous serial-subtractions, with the phone placed in the user's pants pocket. Fourteen younger and 12 older adults completed two lab visits, during which data were acquired by the App and GAITRite mat over multiple normal and dual task walking trials. Participants also used the App to complete assessments in their homes on three separate days. Outcomes included average stride time and the dual-task cost to stride time. Across all detected strides in laboratory trials, derived outcome measures from the App were highly correlated with those derived from the GAITRite mat (Stride Time: p<0.001, r2 =0.99. Dual-task cost: p<0.001, r2 =0.98). These correlations were unaffected by age group, walking condition, and pocket tightness. Moreover, across trials, gait metrics demonstrated excellent test-retest reliability, both within and between laboratory visits and home-based assessments (ICC: 0.79-0.90). These results suggest that dual task walking assessments are valid and can be reliably administered in remote settings in relatively healthy younger and older adults.

Theory-based E-health literacy interventions in older adults: a systematic review

“…On average, the studies fulfilled 65.7% of the assessment criteria (range = 54-81%). Hence, overall the studies had a moderate risk of bias and over half of the studies (n = 6 studies) had low risk of bias (range = 68-81%) [1,34,35,38,40,41]. The rest of the studies had a moderate risk of bias (range = 54-64%) [36,37,39,42,43].…”

“…Six studies used a NRSI designs [1,34,38,40,42,43]. The sample sizes varied from 11 [38] to 272 participants [41]. The participants' age ranged from 50 [40] to 101 [39], with the average age ranging between 68 and 75.…”

“…There were more women than men in nearly all the studies. Data collection in 11 studies took place in the United States [1,[34][35][36][37][38][39][41][42][43], and one study was conducted in Taiwan [40].…”

“…Several general conceptual frameworks were used across the studies to improve e-health literacy in older adults. Specifically, the Health Belief Model (HBM) in health behavior research [39], the self-efficacy theory [1,[32][33][34][35][36][37][38][39][40][41][42][43], and a combination of Technology Acceptance Model (TAM) and the Diffusion of Innovations model (DOI) [40]. Additionally, two studies used the Social Interdependence Theory [35,36], one study was guided by Cognitive Theory of Multimedia Learning [36], and another study applied Knowles' theory as the theoretical framework [39].…”

“…Fink and Beck (2015) collaborated with a multidisciplinary team of educators, health professionals, and community participants to develop an educational website to improve older adults' skills in identifying high-quality health information [39]. Nahm Program (T-PeP) on patients' knowledge about electronic portals, health decision-making self-efficacy for being proactive in health communication, patients' selfefficacy for using electronic portals, and e-health literacy in older adults [41]. Self-efficacy model was the common conceptual model used nearly in all the e-health literacy improvement interventions.…”