User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study

Abstract

Background Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

“…The participants in this study were identical to those who took part in the usability study of the mHealth app [ 34 ]. The data for the usability evaluation [ 34 ] and the current study (ie, swallowing training results) were collected from these participants in the same time frame.…”

“…The participants in this study were identical to those who took part in the usability study of the mHealth app [ 34 ]. The data for the usability evaluation [ 34 ] and the current study (ie, swallowing training results) were collected from these participants in the same time frame. A total of 11 older adults (10 women; mean age 75.7 years, SD 4.96; mean education 10.4 years, SD 3.83; mean Korean Mini-Mental State Examination score 28.1, SD 1.72) from 2 district-run senior welfare centers in Seoul participated in the program.…”

“…SM-P580; Samsung), and to be user-friendly for older adults. Examples of user interface designs for older adults with decreased cognitive and psychomotor functions include (1) tabs arranged by use sequence for ease of navigation, (2) buttons containing both icons and text for ease of understanding, and (3) apposite button activation ranges, button sizes, and interbutton spaces empirically identified for the trade-off between ease of activation and prevention of inadvertent activation [ 34 ]. Furthermore, the mHealth app supports a variety of features that could enable older adults to properly and effectively train themselves.…”

“…Furthermore, the mHealth app supports a variety of features that could enable older adults to properly and effectively train themselves. Examples of training compliance enablers include videos, animations, multimodal content, a biofeedback system for ease of understanding [ 38 ], and an automatic training data-logging system and training scheduler for ease of adherence monitoring [ 34 ]. A usability and feasibility test of the 365 Healthy Swallowing Coach app reported significantly higher usability scores from older adults with higher levels of education and smart device usage.…”

“…A usability and feasibility test of the 365 Healthy Swallowing Coach app reported significantly higher usability scores from older adults with higher levels of education and smart device usage. Moreover, an increase in favorable responses regarding app acceptability, training program utilization, emotional responses, and learning experience with the intervention program was observed as the participants continued to use the app [ 34 ].…”