Social networking-based personal home telehealth system: A pilot study

Integrating a Mobile App to Enhance Atrial Fibrillation Care: Key Insights From an Implementation Study Guided by the Consolidated Framework for Implementation Research

BACKGROUND

Despite the growing use of mobile health apps in managing chronic heart disease, their integration into routine care remains challenging due to dynamic, context-specific barriers.

OBJECTIVE

This study aimed to identify the key enablers and challenges of implementing a mobile app for cardiac rehabilitation and healthy lifestyles in patients with atrial fibrillation at an Australian cardiology clinic.

METHODS

We interviewed both clinicians and patients to understand their perspectives about the mobile app and what factors affected the implementation. The two semistructured interview guides used, one for clinicians and one for patients, were developed based on the Consolidated Framework for Implementation Research (CFIR) and nonadoption abandonment, scale-up, spread, and sustainability complexity assessment tool. All interviews were recorded and transcribed, and the transcripts were analyzed inductively to generate codes using a constructionist perspective. These codes were subsequently mapped onto the constructs within the CFIR across its five domains. This framework analysis was followed by examining the interconnections among the constructs to understand their collective impact on the implementation process, thereby identifying key enablers and challenges for the integration efforts.

RESULTS

We interviewed 24 participants including 18 patients, whose mean age was 69 (SD 9.2) years, and 6 clinicians, comprising 4 specialist cardiac electrophysiologists and 2 nurses. Patient engagement with the app varied: 3 participants completed the cardiac rehabilitation plan, 1 participant was still actively engaged, 2 participants had partial use, 10 participants downloaded but never used the app, and 2 participants did not download the app. We identified a complex interplay between key determinants across all five CFIR domains, collectively impacting two main elements in the implementation process: (1) acceptability and user engagement with the app and (2) the clinic's implementation readiness. The app was more likely to be accepted and used by patients who needed to establish healthy lifestyle habits. Those with established healthy lifestyle habits did not indicate that the app provided sufficient added value to justify adoption. Interoperability with other devices and design issues, for example, limited customization options, also negatively impacted the uptake. The clinic's implementation readiness was limited by various challenges including limited staff availability, insufficient internal communication processes, the absence of an implementation evaluation plan, and lack of clarity around who is funding the app's use beyond the initial trial. Despite the clinician's overall inclination toward technology use, diverse opinions on the evidence for short-term cardiac rehabilitation programs in atrial fibrillation critically reduced their commitment to app integration.

CONCLUSIONS

Mobile health apps have seen rapid expansion and offer clear benefits, yet their integration into complex health systems remains challenging. Whilst our findings are from a single app implementation, they highlight the importance of embedding contextual analysis and proactive strategic planning in the integration process.

The association between information and communication technologies, loneliness and social connectedness: A scoping review

Older adults are at a higher risk of loneliness, compared to other demographics. The use of Internet Communication and Technologies (ICTs) among older adults is steadily increasing and given ICTs provide a means of enhancing social connectedness suggests they may have positive effects on reducing loneliness. Therefore, the aim of this scoping review was to examine the research that explores how ICTs may be implicated in mitigating loneliness and increasing social connectedness among older adults. After the examination of 54 articles, we identified three major themes within the literature: (1) ICTs were associated with a reduction in loneliness and increase in wellbeing. (2) ICTs promoted social connectedness by facilitating conversations. (3) Factors such as training, self-efficacy, self-esteem, autonomy, and the design/features, or affordances, of ICTs contribute toward the associations between ICT use and wellbeing. The heterogeneity of methodologies, statistical reporting, the small sample sizes of interventional and observational studies, and the diversity of the experimental contexts underline the challenges of quantitative research in this field and highlights the necessity of tailoring ICT interventions to the needs and contexts of the older users.

What's behind the Dashboard? Intervention Mapping of a Mobility Outcomes Monitoring System for Rehabilitation

Training and follow-up for older adults who received new assistive technology can improve device use adoption and function, but there is a lack of systematic and coordinated services. To address this gap, the Internet-based MOvIT+™ was designed to provide remote monitoring and support for assistive technology users and their caregivers. This paper presents the intervention mapping approach that was used. In step 1, we established a project governance structure and a logic model emerged from interviews with stakeholders and a systematic review of literature. In step 2, a modified TRIAGE consensus process led to the prioritization of thirty-six intervention components. In step 3, we created use cases for all intervention end users. In step 4, the intervention interface was created through iterative lab testing, and we gathered training resources. In step 5, a two-stage implementation plan was devised with the recruited rehabilitation sites. In step 6, we proposed an evaluation protocol. This detailed account of the development of MOvIT+™ demonstrates how the combined use of an intervention mapping approach and participatory processes with end users can help linking evidence-based, user-centered, and pragmatic reasoning. It makes visible the complexities behind the development of Internet-based interventions, while guiding future program developers.

Scalable Telehealth Services to Combat Novel Coronavirus (COVID-19) Pandemic

An ongoing pandemic, the novel coronavirus disease 2019 (COVID-19) is threatening the nations of the world regardless of health infrastructure conditions. In the age of digital electronic information and telecommunication technology, scalable telehealth services are gaining immense importance by helping to maintain social distances while providing necessary healthcare services. This paper aims to review the various types of scalable telehealth services used to support patients infected by COVID-19 and other diseases during this pandemic. Recently published research papers collected from various sources such as Google Scholar, ResearchGate, PubMed, Scopus, and IEEE Xplore databases using the terms "Telehealth", "Coronavirus", "Scalable" and "COVID-19" are reviewed. The input data and relevant reports for the analysis and assessment of the various aspects of telehealth technology in the COVID-19 pandemic are taken from official websites. We described the available telehealth systems based on their communication media such as mobile networks, social media, and software based models throughout the review. A comparative analysis among the reviewed systems along with necessary challenges and possible future directions are also drawn for the proper selection of affordable technologies. The usage of scalable telehealth systems improves the quality of the healthcare system and also reduces the infection rate while keeping both patients and doctors safe during the pandemic.

Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation

Background

In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up.

Objective

This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians.

Methods

On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts.

Results

A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up.

Conclusions

On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.

Adaptive, Multisensorial, Physiological and Social: The Next Generation of Telerehabilitation Systems

Some people require special treatments for rehabilitating physical, cognitive or even social capabilities after an accident or degenerative illness. However, the ever-increasing costs of looking after an aging population, many of whom suffer chronic diseases, is straining the finances of healthcare systems around Europe. This situation has given rise to a great deal of attention being paid to the development of telerehabilitation (TR) systems, which have been designed to take rehabilitation beyond hospitals and care centers. In this article, we propose which features should be addressed in the development of TR systems, that is, they should consider adaptive, multisensorial, physiological and social aspects. For this aim, the research project Vi-SMARt is being conducted for evaluating whether and how different technologies, such as virtual reality (VR), multi-sensorial feedback, or telemonitoring, may be exploited for the development of the next generation of TR systems. Beyond traditional aural and visual feedback, the exploitation of haptic sense by using devices such as haptic gloves or wristbands, can provide patients with additional guidance in the rehabilitation process. For telemonitoring, Electroencephalography (EEG) devices show signs of being a promising approach, not only to monitor patients’ emotions, but also to obtain neuro-feedback useful for controlling his/her interaction with the system and thus to provide a better rehabilitation experience.

An integrative review of information and communication technology based support interventions for carers of home dwelling older people

BACKGROUND

A growing number of studies of informal carers of older people reveal positive results concerning support via Information and Communication Technologies (ICT). Systematic examination of factors that have a potential impact on carer outcomes are needed to inform future research.

OBJECTIVE

To explore studies concerning ICT support of adult carers of older people and to identify study characteristics that have a potential impact on carer outcomes.

METHODS

This integrative review includes 123 studies published since 2005. Fundamental questions for designing sensitive support interventions; 'who, what, and how' were applied to a synthesis of the results.

RESULTS

Identified characteristics from the studies responding to the who question included variables of the carers, such as their relationship with the care recipient or their ethnicity. Characteristics related to the what question related to the types of interventions, and the how question concerned the different services or programs offered, the idiosyncratic needs of the carers, and the types of technologies used.

CONCLUSION

Results are discussed according to micro, meso and macro levels of analysis. This extensive review can inform future studies and highlight the evidence in the area for decision makers, practitioners and/or NGOs working with innovative forms of support for carers of older people.

Use of Tablet Devices in the Management of Agitation Among Inpatients with Dementia: An Open-Label Study

OBJECTIVE

To investigate the feasibility, safety, and utility of tablet devices as novel nonpharmacologic tools in managing older psychiatric inpatients with agitation and dementia.

METHODS

Thirty-six patients at a geriatric psychiatry inpatient unit were provided with tablets when agitated and used various apps on the tablet related to communication, games, music, web browser, and photography during their stay. Study staff documented the frequency, duration, and app usage history and rated the extent to which agitation improved after tablet use.

RESULTS

All participants, regardless of dementia severity, were able to use apps and were rated by staff to have clinical benefit. Dementia severity was negatively associated with app complexity. Age was negatively associated with frequency and duration of tablet use.

CONCLUSION

Tablet use as a nonpharmacologic intervention for agitation in older adults, including those with severe dementia, appears to be feasible, safe, and of potential utility.

Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review

BACKGROUND

The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations.

OBJECTIVES

The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults.

METHODS

A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data.

RESULTS

We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies.

CONCLUSIONS

There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.