A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial

Augmenting K-Means Clustering With Qualitative Data to Discover the Engagement Patterns of Older Adults With Multimorbidity When Using Digital Health Technologies: Proof-of-Concept Trial

BACKGROUND

Multiple chronic conditions (multimorbidity) are becoming more prevalent among aging populations. Digital health technologies have the potential to assist in the self-management of multimorbidity, improving the awareness and monitoring of health and well-being, supporting a better understanding of the disease, and encouraging behavior change.

OBJECTIVE

The aim of this study was to analyze how 60 older adults (mean age 74, SD 6.4; range 65-92 years) with multimorbidity engaged with digital symptom and well-being monitoring when using a digital health platform over a period of approximately 12 months.

METHODS

Principal component analysis and clustering analysis were used to group participants based on their levels of engagement, and the data analysis focused on characteristics (eg, age, sex, and chronic health conditions), engagement outcomes, and symptom outcomes of the different clusters that were discovered.

RESULTS

Three clusters were identified: the typical user group, the least engaged user group, and the highly engaged user group. Our findings show that age, sex, and the types of chronic health conditions do not influence engagement. The 3 primary factors influencing engagement were whether the same device was used to submit different health and well-being parameters, the number of manual operations required to take a reading, and the daily routine of the participants. The findings also indicate that higher levels of engagement may improve the participants' outcomes (eg, reduce symptom exacerbation and increase physical activity).

CONCLUSIONS

The findings indicate potential factors that influence older adult engagement with digital health technologies for home-based multimorbidity self-management. The least engaged user groups showed decreased health and well-being outcomes related to multimorbidity self-management. Addressing the factors highlighted in this study in the design and implementation of home-based digital health technologies may improve symptom management and physical activity outcomes for older adults self-managing multimorbidity.

Autonomous Tool for Monitoring Multi-Morbidity Health Conditions in UAE and India

Multi-morbidity is the presence of two or more long-term health conditions, including defined physical or mental health conditions, such as diabetes or schizophrenia. One of the regular and critical health cases is an elderly person with a multi-morbid health condition and special complications who lives alone. These patients are typically not familiar with advanced Information and Communications Technology (ICT), but they are comfortable using smart devices such as wearable watches and mobile phones. The use of ICT improves medical quality, promotes patient security and data security, lowers operational and administrative costs, and gives the people in charge to make informed decisions. Additionally, the use of ICT in healthcare practices greatly reduces human errors, enhances clinical outcomes, ramps up care coordination, boosts practice efficiencies, and helps in collecting data over time. The proposed research concept provides a natural technique to implement preventive health care innovative solutions since several health sensors are embedded in devices that autonomously monitor the patients' health conditions in real-time. This enhances the elder's limited ability to predict and respond to critical health situations. Autonomous monitoring can alert doctors and patients themselves of unexpected health conditions. Real-time monitoring, modeling, and predicting health conditions can trigger swift responses by doctors and health officials in case of emergencies. This study will use data science to stimulate discoveries and breakthroughs in the United Arab Emirates (UAE) and India, which will then be reproduced in other world areas to create major gains in health for people, communities, and populations.

The role of phone-based triage nurses in supporting older adults with multimorbidity to digitally self-manage - Findings from the ProACT proof-of-concept study

Background

Achieving patient-centred care necessitates supporting individuals to have more involvement in the self-management of their care. Digital health technologies are widely recognised as a solution to empower more effective self-management. However, given the complexity of multiple chronic condition (multimorbidity) management, coupled with changes that occur as part of the normal ageing process, human support alongside digital self-management is often necessary for older people with multimorbidity (PwM) to sustain successful self-management.

Methods

The aim of the study was to explore the role played by a clinical, nurse-led telephone triage service in responding to alerts generated by older adults using a digital health platform, ProACT, to self-manage multiple chronic conditions over a period of 1 year. Semi-structured interviews with participants with multimorbidity were carried out across four time points during the trial, while interviews and focus groups were conducted with triage nurses at the end of the trial. Thematic analysis was conducted on the resulting transcripts.

Results

Themes found in the data include the work of triage nurses; the benefits of triage support; tensions such as anxiety due to patient monitoring; and the relationship between triage nurses and participants.

Discussion

This work contributes to an understanding of how older adults with multimorbidity and triage nurses collaborate in multiple chronic disease self-management. Findings are discussed within the context of Hudon et al.'s patient-centred care framework and indicate that patient-centred care was achieved, with both PwM and triage participants reporting positive experiences, relationships and several benefits of the triage support alongside digital self-management.

Home-based digital health technologies for older adults to self-manage multiple chronic conditions: A data-informed analysis of user engagement from a longitudinal trial

Background

Ageing populations are resulting in higher prevalence of people with multiple chronic conditions (multimorbidity). Digital health platforms have great potential to support self-management of multimorbidity, increasing a person's awareness of their health and well-being, supporting a better understanding of diseases and encouraging behaviour change. However, little research has explored the long-term engagement of older adults with such digital interventions.

Methods

The aim of this study is to analyse how 60 older adults with multimorbidity engaged with digital symptom and well-being monitoring through a digital health platform over a period of approximately 12 months. Data analysis focused on user retention, frequency of monitoring, intervals in monitoring and patterns of daily engagement.

Results

Our findings show that the overall engagement with the digital health platform was high, with more than 80% of participants using the technology devices for over 200 days. The submission frequency for symptom parameters (e.g. blood glucose (BG), blood pressure (BP), etc.) was between three and four times per week which was higher than that of self-report (2.24) and weight (2.84). Submissions of exercise (6.12) and sleep (5.67) were more frequent. The majority of interactions happened in the morning time. The most common time of submission for symptom parameters was 10 am, whereas 8 am was the most common time for weight measurements.

Conclusions

The findings indicate the patterns of engagement of older adults with complex chronic diseases with digital home-based self-management systems.