Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study

Socially sustainable housing and built environments to support the health and social inclusion of older adults: protocol for a scoping review and stakeholder consultation

INTRODUCTION

Housing and the ageing population are issues that pose challenges for social, health and economic policies. Therefore, there is a need for more knowledge on how to design housing and public infrastructure to improve the social engagement and well-being of older adults who age in place. This project aims to provide an overview of the existing literature on design features that support socially sustainable living environments for older adults.

METHODS AND ANALYSIS

A systematic scoping methodology was used to identify and summarise the findings. Four databases were searched (CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Medline and Embase) to identify the articles. Articles were included if published in English in the last 15 years (eg, from January 2008 to June 2023) without restricting the study location or country. Articles were included if they were based on empirical qualitative, quantitative and mixed-method data. The results of the review will be discussed with a panel of 15 stakeholders (n=15) from Canada, Sweden and the Netherlands (five per country). The interdisciplinary stakeholders will have expertise in housing, architecture, engineering and social and health services. The consultations will provide content expertise to the literature findings and an opportunity to build evidence-based solutions that support the design of socially sustainable living environments for older persons.

ETHICS AND DISSEMINATION

Ethical clearance for this project has been granted by the Swedish Ethical Review Authority for Dalarna University (dnr 2023-01543-01) and the Natural Sciences and Engineering Sciences (NES) Ethics Committee at the University of Twente in the Netherlands (dnr 230407) has approved this project. Stakeholders will be asked to provide signed consent to participate in the study. The results of this project will be disseminated through web seminars, community advisory groups, peer-reviewed journals and policy documents to support the development of housing and public health policy.

TRIAL REGISTRATION NUMBER

OSF, https://doi.org/10.17605/OSF.IO/PR2NC.

Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study

BACKGROUND

A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors.

OBJECTIVE

The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability.

METHODS

The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data.

RESULTS

As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025.

CONCLUSIONS

We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52489.

Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study

BACKGROUND

 The internet of things (IoT) is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. This study aims to identify the facilitators and barriers associated with implementing IoT solutions in health care within a Scandinavian context. It addresses the pressing need to adapt health care systems to the demographic changes occurring in Scandinavia. The vision of "Vision eHealth 2025," a long-term strategic direction for digitalization in Sweden, serves as the background for this project. The implementation of IoT solutions is a crucial aspect of achieving the vision's goal of making Sweden a global leader in using digitalization and eHealth opportunities by 2025. IoT is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. Previous research has shown that there is a gap in our understanding of social and organizational challenges related to IoT and that the implementation and introduction of new technology in health care is often problematic.

OBJECTIVE

 In this study, we will identify facilitating and hindering factors for the implementation of IoT solutions in social and health care.

METHODS

 We will use an explorative design with a case study approach. The data collection will comprise questionnaires and qualitative interviews. Also, a literature review will be conducted at the start of the project. Thus, quantitative and qualitative data will be collected concurrently and integrated into a convergent mixed methods approach.

RESULTS

 As of June 2023, data for the review and 22 interviews with the stakeholders have been performed. The co-design with stakeholders will be performed in the fall of 2023.

CONCLUSIONS

 This study represents a unique and innovative opportunity to gain new knowledge relevant and useful for future implementation of new technology at health care organizations so they can continue to offer high-quality, person-centered care. The outcomes of this research will contribute to a better understanding of the conditions necessary to implement and fully use the potential of IoT solutions. By developing cocreated implementation strategies, the study seeks to bridge the gap between theory and practice. Ultimately, this project aims to facilitate the adoption of IoT solutions in health care for promoting improved patient care and using technology to meet the evolving needs of health care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44562.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

BACKGROUND

Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision.

OBJECTIVE

We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention.

METHODS

We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA.

RESULTS

Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001).

CONCLUSIONS

Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

The Role of Information and Communication Technology (ICT) for Older Adults' Decision-Making Related to Health, and Health and Social Care Services in Daily Life-A Scoping Review

Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults' decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults' decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults' use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives.