An Agile Development Cycle of an Online Memory Program for Healthy Older Adults

Examining Challenges to Co-Design Digital Health Interventions With End Users: Systematic Review

BACKGROUND

Digital health interventions (DHIs) are changing the dynamic of health care by providing personalized, private, and instantaneous solutions to end users. However, the explosion of digital health has been fraught with challenges. The approach to co-design with end users varies across a diverse domain of stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital stakeholders (ie, user experience and retention) and health stakeholders (ie, safety and efficacy). Several methodologies and frameworks are being implemented to address this challenge to varying degrees of success.

OBJECTIVE

We aimed to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken to identify the key problem areas at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users.

METHODS

We conducted a systematic search of key databases for co-design studies involving end users in DHIs. Searches were divided into 3 relevant streams: health behavior, user experience, and digital methodologies and frameworks. The eligibility criteria were guided by the PerSPEcTiF framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In line with this framework, studies were included in this review that (1) address research on DHIs; (2) focus on interaction and co-design with end users; (3) explain results such that uptake, effectiveness, satisfaction, and health outcomes are discernible, positively or negatively; and (4) describe actionable procedures for better DHI design. The search was conducted in a diverse group of 6 bibliographical databases from January 2015 to May 2024: PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Institute of Electrical and Electronics Engineers Xplore, and Scopus. From the 13,961 studies initially screened for titles and abstracts, 489 (3.6%) were eligible for a full-text screening, of which 171 (1.2%) studies matched the inclusion criteria and were included in a qualitative synthesis.

RESULTS

Of the 171 studies analyzed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies. These studies identified several core themes when co-designing with end users: advancements, which included participatory co-design; challenges, which included participatory co-design, environment and context, testing, and cost and scale; and gaps, which included a pragmatic hybridized framework and industry implementability.

CONCLUSIONS

This research supports a pragmatic shift toward using mixed methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of digital health co-designers with the pragmatism of Agile design methodology and the rigor of health care metrics.

TRIAL REGISTRATION

PROSPERO CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238164.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/28083.

Preventive Pathways for Healthy Ageing: A Systematic Literature Review

Background: The world's population is not only growing but also ageing, and healthcare systems should adapt to the needs of an ageing population. Until now, there has been no clear definition of a preventive pathway with the aim of improving lifestyles and promoting healthy and active ageing. The present systematic review aims to provide evidence to support the development of effective ways of delivering preventive pathways for healthy ageing. Methods: Several databases were searched, i.e., MEDLINE, COCHRANE, CINAHL, and PsycINFO, by using specific inclusion criteria, such as elderly population (i.e., subjects aged 65 years and older), preventive interventions for healthy ageing, studies with or without control groups, and effectiveness and methodological structure of the prevention pathway. The risk of bias was assessed by using the Joanna Briggs Institute and mixed methods appraisal tools. Results: A total of 9998 studies were identified after the removal of duplicates, and after screening title, abstracts, and full text, 14 studies were finally included. All the prevention pathways described are based on physical activity (PA) programmes, dietary interventions, and cognitive and mental health. The professional figures involved in the pathways were experts in prevention and health promotion, like family and community nurses, kinesiologists, and experts in stress management. The majority of the preventive pathways were implemented in primary care and community settings. Conclusions: Our systematic review provides evidence for developing an effective preventive healthy ageing pathway through tailored PA, diet, and cognitive health interventions. This co-designed approach should involve a multidisciplinary expert team and be implemented in primary care and community settings to improve psycho-physical health and longevity.

A self-guided e-learning program improves metamemory outcomes in healthy older adults: a randomized controlled trial

OBJECTIVES

Aging brings memory changes that can be concerning for some older adults. Whereas in-person memory interventions can positively impact knowledge, mental health, and behavioural outcomes, self-guided e-learning programs may offer scalable and accessible alternatives to in-person programming. The current study aimed to evaluate efficacy of an e-learning program compared to no treatment.

METHOD

The trial was registered at ClinicalTrials.gov (NCT03602768). As part of a larger, multi-arm, controlled trial, healthy older adults (ages 60-84, 71% female) were randomized into an intervention or a delayed-start control condition. Data collection personnel were masked to participant grouping. Outcome measures were completed through telephone interviews and online questionnaires at baseline, immediate post-intervention, and 6- to 8-week follow-up.

RESULTS

Among 115 analyzed participants, there were larger improvements over time in memory knowledge, memory strategy acquisition and daily use, and self-reported memory satisfaction and ability in the group that completed the intervention than in the control group. There was no interaction effect for health-promoting behaviors. Intention-to-treat analyses showed attenuated but largely similar findings.

CONCLUSION

This self-guided e-learning memory program demonstrated similar clinical outcomes provided by in-person, facilitator-led programs. It may serve as an effective first-line treatment for older adults presenting with memory concerns in clinical settings.

Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) Program for Older Adults: Results from a Single-Arm Pre-Post Trial (Preprint)

BACKGROUND

Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers.

OBJECTIVE

We report on OPTIMiSE's feasibility, acceptability, and efficacy.

METHODS

Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE.

RESULTS

OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=-0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives.

CONCLUSIONS

This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3233/ADR-200251.