Older Adult Preferences of Mobile Application Functionality Supporting Medication Self-Management

Needs and Experiences of Older Adults With Multiple Morbidities Using Health Technologies for Self-Management: A Systematic Review and Meta-Synthesis

BACKGROUND

The global population is aging, and it is becoming increasingly common for older people to suffer from multiple diseases. The development of digital health technologies has assisted the self-management of multimorbid older patients. Currently, there is a lack of qualitative review that synthesizes the needs and experiences of multimorbid older patients using digital health technologies for self-management.

AIMS

To synthesize the needs and experiences of multimorbid older adults using digital health technologies for self-management.

METHODS

The following six electronic databases were searched: PubMed, Embase, Web of Science, Scopus, Cochrane Library, and CINAHL. The search timeframe was from construction to November 4, 2024. Thematic synthesis by Thomas and Harden was used for meta-synthesis. Study selection and data extraction were conducted independently by two researchers, and quality was evaluated using the 10-item Critical Appraisal Skills Programme tool.

RESULTS

Ten studies were included. Three themes and seven subthemes were synthesized: (1) different impressions and perceptions, (2) challenges of use, and (3) conveniences and benefits. Older adults with multiple medical conditions have positive or negative impressions and perceptions of digital health technologies and experience multiple challenges in their use (lack of expertise, technical and equipment barriers, need support), while at the same time, digital health technologies offer huge benefits for their self-management (improved communication with healthcare professionals, enhanced self-management skills).

LINKING EVIDENCE TO ACTION

This review provides support for healthcare professionals to understand the experiences of multimorbid older adults using digital health technologies for self-management. Healthcare professionals and technology developers should establish collaborative relationships to design comprehensive, usable, and less burdensome digital health technologies for older adults with multiple morbidities. Additionally, comprehensive technical support services should be provided to ensure the effective utilization of these technologies by older adults.

TRIAL REGISTRATION

PROSPERO number: CRD42024599433.

Development of content for a mobile application aimed to increase medication adherence among older adults

BACKGROUND

An increase in the use of health-related mobile applications is expected in the future. It is believed that mobile applications are valuable tools for patients, caregivers, and healthcare professionals. The use of mobile applications to improve medication adherence in older adults is effective, but it must be developed based on the special needs of older adults for high quality and long-term use. The aim of this Delphi survey study is to develop the content of a mobile application aimed to improve medication adherence among older adults by obtaining views from a panel including healthcare professionals, patients and patient care givers.

METHODS

An online Delphi method was implemented by using a questionnaire platform to obtain consensus on key content for a mobile application. Pharmacists, physicians, nurses, patients and patient caregivers were invited to participate in the consensus.

RESULTS

A total of 107 health care professionals, patients and care givers were invited to the study to develop consensus for the content of the mobile application. The response rates to three surveys were 56%, 90%, and 96%, respectively. Content including reminders for the patient on when to take the medicine, instructions for medications such as taking medication on an empty or full stomach or every morning or evening, feedback for getting new prescriptions when the medications are about to run out, information on what to do if the patient forgets to take the medication, and confirmation after the patient takes the medication, visual and written instructions for specific medications, information about medication doses specific to the patient's prescription, reminders to take medication one hour before or after based on the requirement of empty or full stomach administration and reminder when is the appropriate time for physician appointment were selected as critical.

CONCLUSIONS

The content was created for the potential development of a mobile application to improve medication adherence. These findings could serve as a foundation for designing a mobile application tailored specifically for older adults in the future.

CLINICAL TRIAL NUMBER

Not applicable.

Pharmacist roles in the Medication Use Process: Qualitative analysis of stakeholder perceptions

BACKGROUND

Pharmacist roles in the Medication Use Process (MUP) have advanced along with new healthcare delivery models and interprofessional collaborative practice. It is unclear whether stakeholder perceptions of pharmacist roles have evolved simultaneously.

OBJECTIVES

Examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP.

METHODS

This institutional review board-approved study used a cross-sectional design with Qualtrics panels of patients, pharmacists, and physicians. Role Theory was used as a framework to develop 12-item surveys to study pharmacist role perceptions in the MUP: prescribing, transcribing, dispensing, administration, and monitoring. Content analysis was performed on the responses to open-ended questions.

RESULTS

From 1004 patients, a total of 7217 comments were obtained on 9 questions (740-1004 comments), resulting in an average of 802 comments per question or 0.8 comments per question per respondent (CQR). Similarly, 1620 comments from 205 pharmacists on 11 questions (121-205 comments) averaged 0.72 CQR; and 1561 comments from 200 physicians on 11 questions (136-200 comments) equated to 0.74 CQR. Content analysis revealed recurring themes across the stakeholders: "pharmacists," "physicians," "insurance," "technology," "collaboration," "time," "communication," and "patient's responsibility." Some role congruence was seen regarding pharmacist roles by all 3 stakeholders; noting pharmacist roles in improving all steps of the MUP, except transcribing. Pharmacists highlighted professional challenges such as staffing issues, burnout, and competing demands; which were not acknowledged by patients and physicians indicating the need to increase awareness.

CONCLUSION

This study showed increased visibility and awareness of pharmacist roles in the MUP by all stakeholders, compared to previous research showing pharmacist roles limited to dispensing. Known barriers to pharmacy practice such as lack of provider status and reimbursement were not reported by any of the stakeholders in this study. There is a need to continuously inform stakeholders about pharmacists' expanding roles in the MUP through advocacy and marketing.

Tools to measure barriers to medication management capacity in older adults: a scoping review

BACKGROUND

Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications.

PURPOSE

1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers.

METHODS

The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus.

RESULTS AND DISCUSSION

In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA).

CONCLUSION

This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.

Mobile health application (WeFit) among community-dwelling older adults: Development, validation, acceptance, and usability study

Background

Technology advancement along with the increase in the older adults' population leads to the creation of health applications. The combination of exercise, nutrition, and cognition should be studied carefully in improving older adults' health.

Objective

The purpose of this study is to develop a health application, WeFit contains these three components and to determine its content validity, acceptability, and usability.

Methodology

This study is a design and development study involving three phases. The first phase is the need analysis involving a review on 16 mobile applications available in Google play and iTunes App store as well as a review of six articles for identifying the perception of older adults in using mobile applications. Second phase is mobile application development and content validity. The content validity was determined using the Content Validity Index for Individual Items (I-CVI). Phase 3 evaluated the acceptance of the WeFit mobile application among older adults and health practitioners.

Results

Phase 1 indicated that half of the applications reviewed (50.0%) had physical activity component and the other half (50.0%) had a cognitive component, and none on nutrition. No application is reported to have all three components. In Phase 2, WeFit health application containing the three components was developed where users can view exercise and food recommendations and play cognitive games. WeFit had an I-CVI value of 0.98. With respect to acceptability, majority of the study participants (93.3%) understood the WeFit's content and the graphics used were appropriate. The usability study found that the majority of the older adults were satisfied with the interface and content. All health practitioners (100%) agreed WeFit is easy to use and agreed that it can guide them in giving medical advices.

Conclusion

WeFit mobile app has been successfully developed, validated, and tested for acceptance among the older adults and health practitioners.

Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e-Cardiology

Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance across the world. This Consensus document discusses the potential implementation of digital health technology in older adults, suggesting a practical approach to general cardiologists working in an ambulatory outpatient clinic, highlighting the potential benefit and challenges of digital health in older patients with, or at risk of, cardiovascular disease. Advancing age may lead to a progressive loss of independence, to frailty, and to increasing degrees of disability. In geriatric cardiology, digital health technology may serve as an additional tool both in cardiovascular prevention and treatment that may help by (i) supporting self-caring patients with cardiovascular disease to maintain their independence and improve the management of their cardiovascular disease and (ii) improving the prevention, detection, and management of frailty and supporting collaboration with caregivers. Digital health technology has the potential to be useful for every field of cardiology, but notably in an office-based setting with frequent contact with ambulatory older adults who may be pre-frail or frail but who are still able to live at home. Cardiologists and other healthcare professionals should increase their digital health skills and learn how best to apply and integrate new technologies into daily practice and how to engage older people and their caregivers in a tailored programme of care.

Willingness, perceived barriers and motivators in adopting mobile applications for health-related interventions among older adults: a scoping review

OBJECTIVES

This scoping review aims to identify the level of willingness, the existing barriers, and motivators among older adults in using mobile applications to monitor and manage their health conditions. The secondary aim of this paper is to categorise these willingness, barriers and motivators using the Theoretical Domains Framework (TDF).

DESIGN

Scoping review.

DATA SOURCE

PubMed, Embase, CINAHL, Cochrane Library, Google Scholar and Science Direct (January 2009-December 2020).

STUDY SELECTION

Studies that describe older adults' perspectives with regard to their willingness, barriers or motivators towards the use of mobile applications in monitoring and managing their health condition were included.

DATA EXTRACTION

Titles and abstracts were initially screened by two reviewers. Articles agreed by both reviewers were proceeded to full-text screening. One reviewer extracted the data, which were verified by a second reviewer. Findings were further classified according to the 14 TDF domains by two researchers.

RESULTS

Six studies were included in the final scoping review. Barriers to adopting mobile applications for health-related interventions among older adults were the most common topic identified in the included studies. Barriers included being unaware of the existence of mobile health applications, lack of technological skills, lack of perceived ability and time, absence of professional involvements, and violation of trust and privacy. With regard to willingness, older adults are willing to use mobile applications if the apps incorporated features from a trusted source and have valid credentials. Motivators included continuous improvements of mobile applications' design interface and personalised features tailored to older adults' needs.

CONCLUSIONS

With the constant research for more diversified technology, the development of mobile applications to help older adults to manage and monitor health is seen as feasible, but barriers have to be addressed. The most prominent barriers linked to TDF domains were: (1) technological skills, (2) belief about consequences, and (3) memory, attention and decision process. Future interventions should use behaviour change techniques that target these three TDF domains in order to improve the ability to engage older adults with mobile technology.

Using a Mobile Application for Health Communication to Facilitate a Sense of Coherence: Experiences of Older Persons with Cognitive Impairment

The increasing use of technology by older persons and their preferences for living at home and being independent have created an avenue for self-care and care delivery using mobile technologies and health communication. This study aimed to explain how older persons with cognitive impairment experienced technology-based health communication through the use of a mobile application to facilitate a sense of coherence. Individual, semi-structured interviews with 16 participants in the SMART4MD project were conducted. The interviews were transcribed then coded deductively and thematically, creating themes that corresponded to the central components of the sense of coherence model: comprehensibility, manageability, and meaningfulness. The findings produced an overall theme: a challenging technology that can provide support, based on the three identified themes: making sense of mobile technologies, mastering mobile technologies, and the potential added value to use mobile technologies. The participants’ experiences were influenced by their previous use and expectations for the application. Personal support, cognitive and physical ability, and different sources for information impacted use. The participants experienced that using the application created an ambiguity to be challenging and have possible benefits. The study suggests that the sense of coherence model may be used as a method to understand the use of technology by older populations.

Personalized and Self-Management: Systematic Search and Evaluation Quality Factors and User Preference of Drug Reference Apps in Taiwan

Background: Drug reference apps promote self-management and improve the efficiency and quality of work for physicians, nurses, pharmacists, and patients. This study aimed to describe a systematic and stepwise process to identify drug reference apps in Taiwan, assess the quality of these apps, and analyze the influential factors for user ratings. Methods: A two-step algorithm (KESS) consisting of keyword growing and systematic search was proposed. Seven independent reviewers were trained to evaluate these apps using Mobile App Rating Scale (MARS). A logistic regression model was fitted and average marginal effects (AME) were calculated to identify the effects of factors for higher user ratings. Results: A total of 23 drug reference apps in Taiwan were identified and analyzed. Generally, these drug reference apps were evaluated as acceptable quality with an average MARS score of 3.23. Higher user engagement, more functionality, better aesthetics, and more information associated with higher user ratings. Navigation is the most influential factor on higher user ratings (AME: 13.15%) followed by performance (AME: 11.03%), visual appeal (AME: 10.87%), credibility (AME: 10.67%), and quantity of information (AME: 10.42%). Conclusions: User experience and information clearly affect user ratings of drug reference apps. Five key factors should be considered when designing drug reference apps.

What Kind Of A Mobile Health App Do Patients Truly Want? A Pilot Study Among Ambulatory Surgery Patients

BACKGROUND

An increasing number of surgeries are performed as ambulatory surgeries, and mobile health applications (m-health apps) have therefore been designed to help provide patients with more convenient health-care services and improve the working efficiency of health-care professionals (HCPs). To find an effective approach to design such m-health apps, a study to evaluate ambulatory surgery patients' preferences is necessary.

METHODS

A structured questionnaire was distributed to 360 patients undergoing ambulatory surgery to understand their demographic characteristics, preferences regarding the features and functions of m-health apps and willingness to engage with m-health apps.

RESULTS

In total, 84.16% of ambulatory surgery patients stated that they would be willing to engage with an m-health app during the perioperative period. In addition, their top 10 necessary features and functions of m-health apps were related mainly to ambulatory surgery and communication with HCPs. Furthermore, younger age (χ ²=10.42, p<0.01), employment (χ ²=9.04, p<0.01), higher education (χ ²=13.67, p<0.01), longer daily use of phones (χ ²=11.84, p<0.01) and more frequent usage of m-health apps (χ ²=23.23, p<0.01) were associated with patients' willingness to engage with m-health apps, but only more frequent usage of m-health apps (OR=2.97, 95% CI=1.54-5.71, p<0.01) was found to be a predictor.

CONCLUSION

This study presents an initial evaluation of ambulatory surgery patients' preferences regarding m-health apps. Gaining these insights will be useful to help us design an evidence-based, highly functional m-health app that best meets the needs of patients undergoing ambulatory surgery.