A Novel Instrument for Measuring Older People's Attitudes Toward Technology (TechPH): Development and Validation

Patient-Related Barriers to Digital Technology Adoption in Alzheimer Disease: Systematic Review

Background

Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics.

Objective

In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology.

Methods

Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen κ statistics. The risk of bias assessment was also recorded.

Results

Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution.

Conclusions

Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics.

Unlocking Self-Esteem in Older Adults: A Conceptual Exploration of Technological Proficiency and Its Effects

With the current rapid increase in digital technology adoption, understanding the relationship between technological proficiency and self-esteem is crucial to older adults. This study explores the mechanisms through which technological proficiency influences self-esteem, particularly considering its associations with technological engagement, self-efficacy, social participation, and autonomy. By using a narrative review approach, this study synthesizes recent findings from gerontology and psychology to examine these relationships. The analysis shows that higher technological proficiency enhances self-esteem by boosting self-efficacy, fostering social participation, and promoting greater autonomy. Older adults who are skilled in using digital tools exhibit greater confidence in managing daily activities and maintaining their social networks, contributing to their psychological resilience. Conversely, lower technological proficiency is linked to frustration, social exclusion, and diminished self-esteem, exacerbated by the digital divide. However, despite these insights, much remains unexplored; for example, no longitudinal study has been conducted to capture the dynamic relations between technological proficiency and self-esteem. These findings suggest that further research is needed to learn more about how technological proficiency influences self-esteem and recommend clinical ways of supporting older adults in their current stage.

Influence of social support on technophobia in older adults in urban communities: the mediating role of self-efficacy and e-health literacy, a cross-sectional study

OBJECTIVES

To explore the chained mediating role of self-efficacy and e-health literacy in the association between social support and technophobia in older adults in urban communities.

DESIGN

A cross-sectional study conducted from June 2023 to April 2024.

SETTING

This study was conducted in three districts of Taiyuan City, Shanxi Province, China.

PARTICIPANTS

The study enrolled 1658 older adults (> 60 years old) in urban communities in Taiyuan.

METHODS

The analyses included assessments using the technophobia, e-health, self-efficacy and social support scales, and the mediating effects of these indices were investigated using Model 6 in SPSS V.26.

RESULTS

The level of technophobia in older adults was found to be moderately high. Technophobia was negatively correlated with social support, self-efficacy and e-health literacy. Stepwise regression analysis showed that age, residential situation, health and the frequency of electronic device use were risk factors for technophobia (p<0.05). Social support could influence technophobia directly (β=-0.266). In addition, self-efficacy (β=-0.080) and e-health literacy (β=-0.098) significantly mediated the relationship between social support and technophobia.

CONCLUSION

Social support was found to affect technophobia in older adults via the independent or chained mediating effects of self-efficacy and e-health literacy.

The Development of the Smartphone Proficiency Questionnaire for Chinese Older Adults (SPQ-COA)

While mobile technology is rapidly evolving, it remains a challenge for some older adults to use smartphones worldwide. To address this issue through tailored skill training and product design, this study developed a questionnaire to assess the smartphone proficiency of older adults. The Smartphone Proficiency Questionnaire for Chinese Older Adults (SPQ-COA) assessed proficiency based on 30 up-to-date tasks (e.g., mobile payment), that covered common operations in daily life of Chinese older adults. The questionnaire was distributed to 452 older adults (age ≥60), as well as 100 young adults (age: 18-30) as a control group. The questionnaire performed well in terms of reliability, difficulty, and discrimination. Among older adults, higher scores were associated with lower age, longer daily use duration, more years of use, higher monthly income, and higher education level, further validating the questionnaire. Overall, the SPQ-COA is a valid tool for evaluating Chinese older adults' smartphone usage skills.

Validity and reliability of the TechPH scale in assessing Iranian older adults' attitudes toward technology

BACKGROUND AND AIM

Given the rapid technological advancements and increased usage of digital tools, understanding older people's attitudes toward technology is vital. Assessing their views can help identify barriers and facilitators to adoption. This understanding is essential for developing effective educational strategies and user-friendly technologies that enhance seniors' quality of life. Therefore, the present study aimed to psychometrically evaluate the scale for measuring attitudes-both willingness and anxiety-toward technology (TechPH) in Iranian older adults.

METHODS

This methodological study was conducted on 420 older individuals (aged 60 and above) in Tehran in 2024 to perform a psychometric test of the attitudes toward technology scale (TechPH). Validation was carried out using translation validity methods, including translation-back translation with bilingual experts (n = 2), face validity with a sample of the older population (n = 10), content validity with a panel of 11 experts, and construct validity through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) (n = 420). Instrument reliability was determined through test-retest and internal consistency (Cronbach's alpha) methods with a sample of older individuals (n = 30). Data analysis was performed using SPSS version 16 and EQS 6.4 software.

RESULTS

A comparison of Persian and English translations revealed acceptable translation validity and cultural adaptability for the scale. Each item's Content Validity Index (CVI) and Content Validity Ratio (CVR) were determined, with a total average CVI of 0.95. The results of EFA indicated that the sample size was adequate, as shown by the KMO value of 0.754. Additionally, Bartlett's sphericity test demonstrated a significant correlation between the items (χ2 = 221.819, df = 15, P < 0.0001). EFA revealed that two extracted factors explained 41.002% and 18.111% of the total variance. Furthermore, CFA yielded suitable estimates based on the general fit indices of the model (RMSEA = 0.061, IFI = 0.979, GFI = 0.983, CFI = 0.978, CMIN/DF = 1.769, MFI = 0.989, AGFI = 0.942). In evaluating test-retest stability and internal consistency, the values of the Intra-class Correlation Coefficient (ICC) and Cronbach's α were 0.85 and 0.77, respectively, indicating appropriate reliability for the scale.

CONCLUSION

P.TechPH, the first Persian version of the scale for measuring technophilia and technophobia among Iranian older people, has favorable psychometric properties. It can serve as a standard tool for assessing older people's attitudes toward technology in various studies.

Evaluating the impact of a peer-education digital literacy course on older adults' digital skills and wellbeing: a mixed-methods study protocol

The digital transition poses relevant challenges and opportunities for older adults in aging European societies. To unleash the potential of the digital transition in old age and avoid the risk of exclusion, digital education for older adults seems to be a valuable solution. One of the most suitable approaches to digital education for older adults appears to be the peer-to-peer approach. However, not much literature is available on this topic. Within the ACTIVE-IT project, we aimed to design, implement, and evaluate a digital peer education course for older adults, focusing specifically on the use of smartphones and daily utility apps, such as mailing, e-Gov, and e-commerce. The purpose of this contribution is to document the protocol adopted to evaluate the course. The course involved 32 participants aged 65 or older, who, between March 2024 and June 2024, divided into three groups, attended a 10-lesson weekly course taught by a peer. We aim to measure the effect of the course on participants' digital skills and their perceived wellbeing. To do so, we will adopt a mixed methods approach, employing: digital methods by collecting and analyzing data on participants' smartphone use (i.e., log data on smartphone use before/during/after the intervention); a quasi-experiment, collecting information on course participants' wellbeing before/after the course attendance using a questionnaire survey; ethnographic observation conducted during the course, observing interactions between subjects during the course. The study has been approved by the Ethic Committee of the University of Milano Bicocca (prot.nr. 167541/2024).

Nursing Students' Attitudes Toward Technology: Multicenter Cross-Sectional Study

BACKGROUND

The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students' attitudes toward technology could be investigated to assess their needs regarding this proficiency.

OBJECTIVE

This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes.

METHODS

Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences.

RESULTS

In total, 646 students answered the questionnaire-342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students' technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=-0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=-0.196; ρSwedish=-0.262; ρPolish=-0.133) and with the perceived skill in using computer devices (P<.001; ρall=-0.209; ρSwedish=-0.347; ρPolish=-0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=-0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively).

CONCLUSIONS

This study highlights nursing students' techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care's increasing reliance on technology, integrating health technology-related topics into education is crucial for future professionals to address health care challenges effectively.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14643.

Navigating the crossroads of aging, caregiving and technology: Insights from a southern Spain about video-based technology in the care context

Objective

As the world faces an aging population, the complexities of care management become increasingly pronounced. While technological solutions hold promise in addressing the dynamic demands of care, many nuances are to be considered in the design and implementation of active and assisted living technologies (AAL) for older adult care. This qualitative study, set in southern Spain, is positioned at the crossroads of healthcare challenges, as seen by the different actors involved in the care process and the technological solutions developed in response to these challenges. By investigating the complex landscape of caregiving and by examining the experiences and challenges faced by caregivers, healthcare professionals, and older adults, we aim to guide the development of vision-based AAL technologies that are responsive to the genuine needs of older adults and those requiring care.

Methods

A qualitative research methodology was used in the study. In total15 in-depth interviews and five focus groups were conducted with a diverse group of stakeholders involved in the process of care provision and reception.

Results

While the results demonstrate that there is a readiness for technological solutions, concerns over privacy and trust highlight the need for a carefully integrated, human-centric approach to technology in caregiving.

Conclusion

This research serves as a compass, guiding future discussions on the intersection of aging, technology, and care, with the ultimate goal of transforming caregiving into a collaborative and enriching journey for all stakeholders involved.

Association Between Clinician-Level Factors and Patient Outcomes in Virtual and In-Person Outpatient Treatment for Substance Use Disorders: Multilevel Analysis

BACKGROUND

The use of virtual treatment services increased dramatically during the COVID-19 pandemic. Unfortunately, large-scale research on virtual treatment for substance use disorder (SUD), including factors that may influence outcomes, has not advanced with the rapidly changing landscape.

OBJECTIVE

This study aims to evaluate the link between clinician-level factors and patient outcomes in populations receiving virtual and in-person intensive outpatient services.

METHODS

Data came from patients (n=1410) treated in a virtual intensive outpatient program (VIOP) and an in-person intensive outpatient program (IOP), who were discharged between January 2020 and March 2021 from a national treatment organization. Patient data were nested by treatment providers (n=58) examining associations with no-shows and discharge with staff approval. Empathy, comfort with technology, perceived stress, resistance to change, and demographic covariates were examined at the clinician level.

RESULTS

The VIOP (β=-5.71; P=.03) and the personal distress subscale measure (β=-6.31; P=.003) were negatively associated with the percentage of no-shows. The VIOP was positively associated with discharges with staff approval (odds ratio [OR] 2.38, 95% CI 1.50-3.76). Clinician scores on perspective taking (β=-9.22; P=.02), personal distress (β=-9.44; P=.02), and male clinician gender (β=-6.43; P=.04) were negatively associated with in-person no-shows. Patient load was positively associated with discharge with staff approval (OR 1.04, 95% CI 1.02-1.06).

CONCLUSIONS

Overall, patients in the VIOP had fewer no-shows and a higher rate of successful discharge. Few clinician-level characteristics were significantly associated with patient outcomes. Further research is necessary to understand the relationships among factors such as clinician gender, patient load, personal distress, and patient retention.

Screen or No Screen? Lessons Learnt from a Real-World Deployment Study of Using Voice Assistants With and Without Touchscreen for Older Adults

While voice user interfaces offer increased accessibility due to hands-free and eyes-free interactions, older adults often have challenges such as constructing structured requests and perceiving how such devices operate. Voice-first user interfaces have the potential to address these challenges by enabling multimodal interactions. Standalone voice + touchscreen Voice Assistants (VAs), such as Echo Show, are specific types of devices that adopt such interfaces and are gaining popularity. However, the affordances of the additional touchscreen for older adults are unknown. Through a 40-day real-world deployment with older adults living independently, we present a within-subjects study (N = 16; age M = 82.5, SD = 7.77, min. = 70, max. = 97) to understand how a built-in touchscreen might benefit older adults during device setup, conducting self-report diary survey, and general uses. We found that while participants appreciated the visual outputs, they still preferred to respond via speech instead of touch. We identified six design implications that can inform future innovations of senior-friendly VAs for managing healthcare and improving quality of life.

Understanding Barriers and Facilitators to Online and App Activities for People Living With Dementia and Their Supporters

BACKGROUND

Stigma often surrounds people with dementia when it comes to use of computer technology, although evidence does not always support this. More understanding is needed to investigate attitudes and experience in relation to computer technology use among those living with dementia and their readiness to use it to support self-management.

METHODS

An online self-report questionnaire was completed by adults living with a dementia diagnosis and those living with them. Questions explored how long the participants had been using computer technology; how regularly they used it; the popularity of common communication apps; and whether they were interested in using an app to support their independence.

RESULTS

47 participants with dementia and 62 supporters responded to the questionnaire. There were no obvious differences between those with dementia and supporters when it came to regular technology usage and both groups showed positive attitudes to the use of it for independence in dementia.

CONCLUSIONS

There was active use of computer technology among this population. Benefits were shown to include communication, increasing individuals' understanding of dementia diagnoses, and enabling independent activities for both those with dementia and supporters.

ITV-Pal programme: protocol of evaluation of the implementation of tech-volunteer programme in palliative care services

INTRODUCTION

Volunteer support for patients and families at the end of life provides many benefits for the beneficiaries. New technologies could be a necessary resource in the accompaniment although, if there is little literature on palliative care volunteering in general, specifically on volunteering and new technologies, we find little information on the subject.Therefore, the aim of this study is to implement and evaluate a training program for palliative care volunteers using new technologies in order to begin accompanying patients and families in hospital or at home.

METHODS AND ANALYSIS

A mixed-method study design will be conducted. We will recruit 20 volunteers and 70 patients in two years.

INTERVENTION

training of volunteers in new technologies and volunteer accompaniment of patients/relatives using technologies. The control group will accompany patients as usual.

ETHICS AND DISSEMINATION

Ethics approval for the ITV-Pal Programme project was granted by the Malaga Regional Research Ethics Committee. As new knowledge is gained from this project, findings will be disseminated through publications, presentations and feedback to clinicians who are participating in this study.

TRIAL REGISTRATION NUMBER

NCT04900103.

Needs and expectations for artificial intelligence in emergency medicine according to Canadian physicians

BACKGROUND

Artificial Intelligence (AI) is recognized by emergency physicians (EPs) as an important technology that will affect clinical practice. Several AI-tools have already been developed to aid care delivery in emergency medicine (EM). However, many EM tools appear to have been developed without a cross-disciplinary needs assessment, making it difficult to understand their broader importance to general-practice. Clinician surveys about AI tools have been conducted within other medical specialties to help guide future design. This study aims to understand the needs of Canadian EPs for the apt use of AI-based tools.

METHODS

A national cross-sectional, two-stage, mixed-method electronic survey of Canadian EPs was conducted from January-May 2022. The survey includes demographic and physician practice-pattern data, clinicians' current use and perceptions of AI, and individual rankings of which EM work-activities most benefit from AI.

RESULTS

The primary outcome is a ranked list of high-priority AI-tools for EM that physicians want translated into general use within the next 10 years. When ranking specific AI examples, 'automated charting/report generation', 'clinical prediction rules' and 'monitoring vitals with early-warning detection' were the top items. When ranking by physician work-activities, 'AI-tools for documentation', 'AI-tools for computer use' and 'AI-tools for triaging patients' were the top items. For secondary outcomes, EPs indicated AI was 'likely' (43.1%) or 'extremely likely' (43.7%) to be able to complete the task of 'documentation' and indicated either 'a-great-deal' (32.8%) or 'quite-a-bit' (39.7%) of potential for AI in EM. Further, EPs were either 'strongly' (48.5%) or 'somewhat' (39.8%) interested in AI for EM.

CONCLUSIONS

Physician input on the design of AI is essential to ensure the uptake of this technology. Translation of AI-tools to facilitate documentation is considered a high-priority, and respondents had high confidence that AI could facilitate this task. This study will guide future directions regarding the use of AI for EM and help direct efforts to address prevailing technology-translation barriers such as access to high-quality application-specific data and developing reporting guidelines for specific AI-applications. With a prioritized list of high-need AI applications, decision-makers can develop focused strategies to address these larger obstacles.

How do Older Adults Set Up Voice Assistants? Lessons Learned from a Deployment Experience for Older Adults to Set Up Standalone Voice Assistants

While standalone Voice Assistants (VAs) are promising to support older adults' daily routine and wellbeing management, onboarding and setting up these devices can be challenging. Although some older adults choose to seek assistance from technicians and adult children, easy set up processes that facilitate independent use are still critical, especially for those who do not have access to external resources. We aim to understand the older adults' experience while setting up commercially available voice-only and voice-first screen-based VAs. Rooted in participants observations and semi-structured interviews, we designed a within-subject study with 10 older adults using Amazon Echo Dot and Echo Show. We identified the values of the built-in touchscreen and the instruction documents, as well as the impact of form factors, and outline important directions to support older adult independence with VAs.

Gaining resolution when creating imagery of aging

In seeking to support healthy aging, designers have struggled to reduce their assumptions and biases toward older adults, been seen to interpret the worlds of later life through unfiltered imagery, as well as engage with stigmas, ultimately diminishing the technologies they construct. This article seeks to critically analyse this state-of-the-art from a design research perspective while engaging with the growing interdisciplinary study of aging and technologies. Toward this, we proposition "resolution" as a concept indicative of the level of detail that seeks to characterize the fidelity that representations of later life have. This concept is explored through a cultural probe study that investigated the sentiments of several older Australians regarding the inequities and social isolation brought on by the COVID-19 pandemic. Providing a diary alongside photovoice and mapping tasks, the study captured perceptions of social technology, practices, networks, and wellbeing, offering a diverse and complex picture of aging and technology. Through reflexive thematic analyses of some of these materials, this case study offers designers pathways to understanding and including older adults in their work. In determining the resolution of these images of aging, we discuss how transparency about the limitations and qualities of such participatory methods through incorporating reflexivity can influence the degree of detail such imagery gains. Ultimately this concept builds on the notion of participation configuration, supporting designers to realize better images of aging and representations of later life.

Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study

BACKGROUND

Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients' readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users' expectations.

OBJECTIVE

This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases.

METHODS

We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants.

RESULTS

Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication.

CONCLUSIONS

During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions.

Psychological Health and Digital Social Participation of the Older Adults during the COVID-19 Pandemic in Blekinge, Sweden-An Exploratory Study

COVID-19 has affected the psychological health of older adults directly and indirectly through recommendations of social distancing and isolation. Using the internet or digital tools to participate in society, one might mitigate the effects of COVID-19 on psychological health. This study explores the social participation of older adults through internet use as a social platform during COVID-19 and its relationship with various psychological health aspects. In this study, we used the survey as a research method, and we collected data through telephonic interviews; and online and paper-based questionnaires. The results showed an association of digital social participation with age and feeling lack of company. Furthermore, in addition, to the increase in internet use in older adults in Sweden during COVID-19, we conclude that digital social participation is essential to maintain psychological health in older adults.

CoGNIT Automated Tablet Computer Cognitive Testing in Patients With Mild Cognitive Impairment: Feasibility Study

Background

Early diagnosis of cognitive disorders is becoming increasingly important. Limited resources for specialist assessment and an increasing demographical challenge warrants the need for efficient methods of evaluation. In response, CoGNIT, a tablet app for automatic, standardized, and efficient assessment of cognitive function, was developed. Included tests span the cognitive domains regarded as important for assessment in a general memory clinic (memory, language, psychomotor speed, executive function, attention, visuospatial ability, manual dexterity, and symptoms of depression).

Objective

The aim of this study was to assess the feasibility of automatic cognitive testing with CoGNIT in older patients with symptoms of mild cognitive impairment (MCI).

Methods

Patients older than 55 years with symptoms of MCI (n=36) were recruited at the research clinic at the Blekinge Institute of Technology (BTH), Karlskrona, Sweden. A research nurse administered the Mini-Mental State Exam (MMSE) and the CoGNIT app on a tablet computer. Technical and testing issues were documented.

Results

The test battery was completed by all 36 patients. One test, the four-finger–tapping test, was performed incorrectly by 42% of the patients. Issues regarding clarity of instructions were found in 2 tests (block design test and the one finger-tapping test). Minor software bugs were identified.

Conclusions

The overall feasibility of automatic cognitive testing with the CoGNIT app in patients with symptoms of MCI was good. The study highlighted tests that did not function optimally. The four-finger–tapping test will be discarded, and minor improvements to the software will be added before further studies and deployment in the clinic.

Chinese Version of the mHealth App Usability Questionnaire: Cross-Cultural Adaptation and Validation

Background

Mobile health (mHealth) apps have shown the advantages of improving medication compliance, saving time required for diagnosis and treatment, reducing medical expenses, etc. The World Health Organization (WHO) has recommended that mHealth apps should be evaluated prior to their implementation to ensure their accuracy in data analysis.

Objective

This study aimed to translate the patient version of the interactive mHealth app usability questionnaire (MAUQ) into Chinese, and to conduct cross-cultural adaptation and reliability and validity tests.

Methods

The Brislin’s translation model was used in this study. The cross-cultural adaptation was performed according to experts’ comments and the results of prediction test. The convenience sampling method was utilized to investigate 346 patients who used the “Good Doctor” (“Good Doctor” is the most popular mHealth app in China), and the reliability and validity of the questionnaire were evaluated as well.

Results

After translation and cross-cultural adaptation, there were a total of 21 items and 3 dimensions: usability and satisfaction (8 items), system information arrangement (6 items), and efficiency (7 items). The content validity index was determined to be 0.952, indicating that the 21 items used to evaluate the usability of the Chinese version of the MAUQ were well correlated. The Cronbach’s α coefficient of the total questionnaire was 0.912, which revealed that the questionnaire had a high internal consistency. The values of test-retest reliability and split-half reliability of the Chinese version of the MAUQ were 0.869 and 0.701, respectively, representing that the questionnaire had a good stability.

Conclusion

The translated questionnaire has good reliability and validity in the context of Chinese culture, and it could be used as a usability testing tool for the patient version of interactive mHealth apps.

The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study

Background

COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people.

Objective

This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak.

Methods

This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout.

Results

The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization.

Conclusions

Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions.

Trial Registration

ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797

International Registered Report Identifier (IRRID)

RR2-10.2196/26431

The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial

Background

Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise.

Objective

This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment.

Methods

Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session.

Results

In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology.

Conclusions

The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments.

Trial Registration

German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759

The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe

Background

Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation.

Objective

This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ≥50 years, for which other surveys present contradictory results.

Methods

We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6.

Results

The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4% of individuals in the nonuser group experienced high social isolation, only 12.9% of individuals who used the internet experienced this condition.

Conclusions

Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older.

Adoption Intention and Factors Influencing the Use of Gerontechnology in Chinese Community-Dwelling Older Adults: A Mixed-Methods Study

Objective: To explore the Chinese community-dwelling intention of older adults to adopt gerontechnology and its influencing factors.

Design: A mixed-methods sequential explanatory design with an inductive approach was employed. In phase 1, a self-made questionnaire was administered from August 2018 to December 2019. Multifactor logistic regression was used to analyze the adoption intention and factors influencing the use of gerontechnology. In phase 2, participants completed a semistructured interview to explore the adoption intention of a specific form of gerontechnology, Smart Aged Care Platform, from May to July 2020.

Setting: Twelve communities in three districts of Chongqing, China.

Participants: Community-dwelling older adults were included.

Results: A total of 1,180 older adults completed the quantitative study; two-thirds of them (68.7%) showed adoption intention toward gerontechnology. Nineteen participants (10 users and nine nonusers) completed the qualitative study and four themes were explored. Through a summarized understanding of the qualitative and quantitative data, a conceptual model of influencing factors, namely, predictive, enabling, and need factors, was constructed.

Conclusions: This study reveals that most Chinese community-dwelling older adults welcome the emergence of new technologies. However, there was a significant difference in the adoption intention of gerontechnology in Chinese community-dwelling older adults based on their sociodemographic and psychographic characteristics. Our findings extend previous technology acceptance models and theories and contribute to the existing resource base.

Forecasting care seekers satisfaction with telemedicine using machine learning and structural equation modeling

Many individuals visit rural telemedicine centres to obtain safe and effective health remedies for their physical and emotional illnesses. This study investigates the antecedents of patients’ satisfaction relating to telemedicine adoption in rural public hospitals settings in Bangladesh through the adaptation of Expectation Disconfirmation Theory extended by Social Cognitive Theory. This research advances a theoretically sustained prediction model forecasting patients’ satisfaction with telemedicine to enable informed decision making. A research model explores four potential antecedents: expectations, performance, disconfirmation, and enjoyment; that significantly contribute to predicting patients’ satisfaction concerning telemedicine adoption in Bangladesh. This model is validated using two-staged structural equation modeling and artificial neural network approaches. The findings demonstrate the determinants of patients’ satisfaction with telemedicine. The presented model will assist medical practitioners, academics, and information systems practitioners to develop high-quality decisions in the future application of telemedicine. Pertinent implications, limitations and future research directions are endorsed securing long-term telemedicine sustainability.

Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study

BACKGROUND

The COVID-19 pandemic has led to worldwide implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine, and home confinement measures. Such restrictions on activities of daily life and separation from loved ones may lead to social isolation and loneliness with health-related consequences among community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, inadequate access to health care and social support services may aggravate chronic conditions. Home-based technological interventions have emerged for combating social isolation and loneliness, while simultaneously preventing the risk of virus exposure.

OBJECTIVE

The aim of this cohort study is to explore, analyze, and determine the impact of social isolation on (1) cognition, quality of life, mood, technophilia, and perceived stress among community-dwelling older adults with mild cognitive impairment or mild dementia and on the caregiver burden; (2) access to and utilization of health and social care services; and (3) cognitive, social, and entertainment-related uses of information and communication technologies.

METHODS

This study will be conducted in Málaga (Andalucía, Spain). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia and his/her informal caregiver, will be contacted by telephone. Potential respondents will be participants of the following clinical trials: support, monitoring, and reminder technology for mild dementia (n=100) and television-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (n=100).

RESULTS

As of May 2021, a total of 153 participants have been enrolled and assessed during COVID-19 confinement, of whom 67 have been assessed at 6 months of enrollment. Changes in the mean values of the variables will be analyzed relative to baseline findings of previous studies with those during and after confinement, using repeated-measures analysis of variance or the nonparametric Friedman test, as appropriate. The performance of multivariate analysis of covariance (ANCOVA) to introduce potential covariates will also be considered. Values of 95% CI will be used.

CONCLUSIONS

If our hypothesis is accepted, these findings will demonstrate the negative impact of social isolation owing to COVID-19 confinement on cognition, quality of life, mood, and perceived stress among community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, the access to and utilization of health and social care services, and the cognitive, social, and entertainment-related use of information and communication technologies during and after COVID-19 confinement.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/26431.

An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study

Background

Older people’s use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people’s internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time.

Objective

The aim of this study was to create an instrument to measure an older person’s perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness.

Methods

A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193).

Results

A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach α coefficient was .92. The 1-factor solution explained 55% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model (χ²₆=13.985; χ²/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025).

Conclusions

The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected.

Determination of the effects of innovativeness levels of the elderly on their psychological resilience

PURPOSE

This study was conducted to determine the rate at which the individual levels of innovativeness of the elderly explain their psychological resilience.

DESIGN AND METHODS

This study was conducted with 313 elderly people. The data of the study were collected using the Individual Innovativeness Scale and Psychological Resilience Scale for Adults.

FINDINGS

In this study, a significant relationship was found between individual innovativeness and psychological resilience in the elderly. Demographic variables were related to psychological resilience.

PRACTICE IMPLICATIONS

Within the scope of these results, increasing the individual innovativeness levels of older adults will enable them to be psychologically more resilient.

Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study

Background

Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied.

Objective

The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM.

Methods

A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma.

Results

The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV.

Conclusions

PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.

A concept analysis of health communication in a home environment: Perspectives of older persons and their informal caregivers

BACKGROUND

Health communication (HC) is a vast research field focusing on changing health behaviours, and rapidly evolving technology is creating different ways and possibilities to reach target groups and audiences. In the context of home care, a deeper understanding of HC is lacking, specifically for older persons with care needs and their informal caregivers. The aim of this concept analysis is to identify and construct the meaning of HC from the perspective of older persons in need of care in the home environment and their informal caregivers.

MATERIALS AND METHODS

This study utilised Rogers' (2000) Evolutionary Concept Analysis Method (EMCA) to create and construct a meaning of the concept of HC. The EMCA was based on a systematic literature review of scientific articles, using CINAHL, Pubmed and Inspec (2000-2017). A total of 29 articles were retrieved and analysed.

RESULTS

The identified attributes of the concept were as follows: resources of the recipient, influence on decisions and advantages of tailored information. HC was described as both contributing to knowledge as well as being overwhelming where habits and resources influenced the use of information. The attributes led to the following descriptive definition of HC: 'Tailored HC, based on needs and resources of the recipient influence care decisions'. The home environment influenced HC by habits and interactions between older persons and their informal caregivers.

CONCLUSIONS

The home environment influenced HC in terms of social aspects of interactions and habits and between the older person and the informal caregiver. Tailored information with the use of technology contributed to knowledge in care of older persons and their informal caregivers. HC was shown to contribute to improve care for older people in their home environment.

Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study

Background

Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies.

Objective

The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in people with dementia/mild cognitive impairment and their caregivers.

Methods

Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis.

Results

A total of 1086 dyads were included (N=2172). Overall, 299 (27.53%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26%) used smartphones and tablets almost every day, and 181 (16.67%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P<.001), but not in technology anxiety (B=–0.042, P=.37). Technophilia was associated with lower age (B=–0.009, P=.004), male gender (B=–0.160, P<.001), higher education level (P=.01), living arrangement (living with children vs single; B=–2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P<.001), lower depression (B=–0.046, P<.001), and better health status (B=0.004, P<.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=–0.005, P=.04) and better quality of life (B=0.348, P<.001).

Conclusions

Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies.

Trial Registration

ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699

GoPerio - impact of a personalized video and an automated two-way text-messaging system in oral hygiene motivation: study protocol for a randomized controlled trial

Background

Oral hygiene is of paramount importance for the preservation of oral health, and for patients affected by periodontal disease establishing an effective oral hygiene routine is the first step of therapy. Several clinical frameworks have been developed to foster behavior change, such as motivational interviewing. However, two obstacles can be identified. First, patients tend to forget the advice they were given during the consultation. Second, it is hard to maintain motivation in the long term, thus leading to relapse. An innovative eHealth solution was designed with the aim to tackle both obstacles and supplement the current clinical standard of care. The primary objective is to compare the full mouth plaque scores of study groups (eHealth plus standard of care versus standard of care only) at 8 weeks of follow up. The main secondary objective is to compare the full mouth bleeding score at 8 weeks of follow up.

Methods/design

The “GoPerio” study is a multicenter, randomized, controlled trial assessing the impact of a novel eHealth concept for oral hygiene motivation (personalized video of oral hygiene routine available for the patient via a cloud server plus interactive text messages) in addition to the current standard of care (motivational interviewing plus tooth scaling and polishing). The minimum sample size required is 86 patients. Participants will be randomized (allocation ratio 1:1): test group (eHealth plus standard of care) versus control group (standard of care only). The primary outcome is oral hygiene as measured by the full mouth (six sites per tooth) plaque control record (PCR) index. The main secondary outcome is gingival inflammation as measured by the full mouth (six sites per tooth) bleeding on probing (BOP) index. Both the primary and the main secondary outcomes are evaluated by blinded and calibrated examiners at 8 weeks of follow up. The other secondary outcomes are patient satisfaction and patient behavior change and motivation.

Discussion

The study will investigate the value of an innovative eHealth approach to strengthen patient motivation for oral hygiene. If proven effective, such an approach would supplement the current clinical standard of care, resulting in improved clinical outcomes with negligible impact on productivity in a dental practice.

Trial registration

ClinicalTrials.gov, NCT03109808. Registered on 12 April 2017.

Sponsor: Hospices Civils de Lyon. BP 2251, 3 quai des Célestins, 69,229 Lyon cedex 02.

Protocol version: 1.0 as of 21 September 2016.

Analyzing Nursing Students' Relation to Electronic Health and Technology as Individuals and Students and in Their Future Career (the eNursEd Study): Protocol for a Longitudinal Study

Background

The nursing profession has undergone several changes in the past decades, and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, and primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective, it is of great importance that students are prepared for the new demands and needs of the patients. From a societal point of view, the society, health care included, is facing several challenges related to technological developments and digitization. Preparation for the next decade of nursing education and practice must be done, without the advantage of certainty. A training for not-yet-existing technologies where educators should not be limited by present practice paradigms is desirable. This study presents the design, method, and protocol for a study that investigates undergraduate nursing students’ internet use, knowledge about electronic health (eHealth), and attitudes to technology and how experiences of eHealth are handled during the education in a multicenter study.

Objective

The primary aim of this research project is to describe the design of a longitudinal study and a qualitative substudy consisting of the following aspects that explore students’ knowledge about and relation to technology and eHealth: (1) what pre-existing knowledge and interest of this area the nursing students have and (2) how (and if) is it present in their education, (3) how do the students perceive this knowledge in their future career role, and (4) to what extent is the education capable of managing this knowledge?

Methods

The study consists of two parts: a longitudinal study and a qualitative substudy. Students from the BSc in Nursing program from the Blekinge Institute of Technology, Karlskrona, Sweden, and from the Swedish Red Cross University College, Stockholm/Huddinge, Sweden, were included in this study.

Results

The study is ongoing. Data analysis is currently underway, and the first results are expected to be published in 2019.

Conclusions

This study presents the design of a longitudinal study and a qualitative substudy. The eHealth in Nursing Education eNursEd study will answer several important questions about nursing students’ attitudes toward and use of information and communications technology in their private life, their education, and their emerging profession. Knowledge from this study will be used to compare different nursing programs and students’ knowledge about and relation to technology and eHealth. Results will also be communicated back to nursing educators to improve the teaching of eHealth, health informatics, and technology.

International Registered Report Identifier (IRRID)

DERR1-10.2196/14643

The Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments.

OBJECTIVE

A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination.

METHODS

A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads-split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information.

RESULTS

Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit.

CONCLUSIONS

This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13711.