Digital support for self-management and meaningful activities of people with mild dementia:Development, implementation and feasibility of a person-centred touch-screen intervention

This thesis reports on the research that was conducted to develop and pilot test a person-centred touchscreen-based program (FindMyApps intervention) that supports people with mild dementia and their informal carers in how to use a tablet and apps for self-management and meaningful activities. The program consists of the FindMyApps training for informal carers in supporting people with mild dementia in using a tablet and the FindMyApps selection tool designed to help people with mild dementia find apps for self-management and meaningful activities that fit their needs, wishes and abilities. The program was developed following the Medical Research Council (MRC) Framework for the design and evaluation of complex interventions and in co-creation with end users. The chapters of this thesis describe the first three phases of this framework i.e.: the preclinical or theoretical phase (0); the modelling phase (I) and the exploratory trial (II). The execution of an RCT (III), and further implementation (IV) in case the intervention proves effective, are beyond the scope of this thesis. In the first phase user needs studies were performed to identify user requirements for desired self-management and meaningful activities and to identify user-requirements related to the use of apps. Eight focus groups were performed in which people with mild cognitive impairment (MCI) or mild dementia (n=13) and informal carers (n=15) participated. We also conducted a literature review to explore which training interventions are most effective for people with mild dementia in (re)learning how to use technologies, including handheld touchscreen devices. An electronic search was conducted in the following databases: PubMed, APA PsycInfo (EBSCO) and CINAHL (EBSCO). In total 16 studies met the inclusion criteria. Our review contributed to the growing amount of promising evidence on the potential impact of Errorless learning training interventions for people with mild to moderate dementia in (re)learning how to use technology. Based on these results we developed the FindMyApps training. In the second phase of the framework we developed a first concept of the FindMyApps selection tool based on identified user requirements. To ensure its usability, the web-based tool was developed using a ‘user-participatory design’ involving the close collaboration of potential users, a development team (researchers, developers and designers) and an expert team (experts in person-centred dementia care and ICT). In three short iterative rounds – so called ‘sprints’ – the users (people with dementia (n=8) and (in)formal carers (n=10)) were invited to test whether the prototypes were in line with their needs, wishes and abilities. This generated important insights into user-interface aspects relating to (i) useful content and (ii) a user-friendly tool design. In the third phase we pilot tested the FindMyApps intervention by means of individual semi-structured interviews and a pilot randomized controlled exploratory trial. Twenty people with mild dementia and informal carer dyads were randomly assigned to the FindMyApps group (n=10), receiving either the FindMyApps training and selection tool, or a control condition (n=10), receiving only a short tablet training. Pre- and post-test measurements at a three month follow-up, consisted of questionnaires and post-test semi-structured interviews. Based on the qualitative results and the effect sizes on the outcomes measured in this study, we consider that the FindMyApps intervention has the potential to positively influence the self-management and engagement in meaningful activities in people with dementia. Future studies with a larger sample should better indicate whether this expectation can be confirmed. The intervention will be further improved and tested in a larger pilot-RCT study and its effectiveness subsequently evaluated in a definite RCT

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

The appraisal of Facebook online community: An exposition of mobile commerce in social media reviews

Peer reviewe

The Potential of the Transformative Storytelling Technique for supporting informal caregiver wellbeing

In una società in cui i progressi e le innovazioni si verificano quotidianamente, lo sviluppo di strumenti digitali per la salute mentale continua a ritmi quasi incontrollabili. Seguendo le tendenze nell'utilizzo dello storytelling in tutti i campi e riflettendo sulla mancanza di modelli di lavoro e strutture per l'applicazione dello storytelling nel supporto della salute mentale, la Transformative Storytelling Technique è progettata e sviluppata come parte di questo lavoro. Questa tecnica rappresenta una nuova categoria per la creazione di contenuti ibridi per guidare l'esperienza del pubblico, a partire dal caso dei caregiver informali. Lo scopo di questa dissertazione è introdurre ed esplorare la fattibilità di una nuova tecnica - Transformative Storytelling (TST) - nel supportare la salute mentale e il benessere dei caregiver informali con storie audio progettate. La tesi è presentata in quattro capitoli in linea con gli obiettivi e strutturata secondo le fasi di ricerca e sviluppo applicate nello sviluppo di questa nuova tecnica. In questo lavoro viene utilizzato il disegno del metodo misto, inclusa la revisione qualitativa dell'ambito nel primo studio, l'indagine narrativa utilizzando interviste semi-strutturate progettate seguendo le categorie di esplorazione TST a priori nel secondo studio e lo studio quantitativo pre-post interventistico combinato con il facciale monitoraggio dell'espressione nello studio pilota. La Transformative Storytelling Technique è dimostrata come un approccio metodologico e narrativo digitale potenzialmente di successo per strutturare, sintetizzare tematicamente le esperienze dei gruppi target e consegnarle attraverso la narrazione digitale. Questo potenziale è stato osservato nella valutazione pilota pre-post, in cui la tecnica ha dimostrato una significativa riduzione del carico soggettivo e un significativo aumento della felicità durante l'esposizione della storia TST. Nello Studio 1, vengono esplorati gli strumenti di salute mentale digitale esistenti per i caregiver informali, seguiti dallo Studio 2 in cui è stata discussa e proposta una potenziale soluzione di supporto. In linea con ciò, il lavoro continua con lo Studio 3 in cui la Transformative Storytelling Technique viene adattata dal Transformative Video Design e viene eseguita la dimostrazione metodologica. Successivamente, la valutazione pilota della tecnica menzionata nello Studio 4 è inclusa per testare la fattibilità dell'utilizzo della tecnica di narrazione per supportare i caregiver informali con narrazioni digitali TST. Infine, i limiti e le implicazioni per la ricerca futura sono discussi nella sezione finale.In a society where advances and innovations occur daily, the development of digital mental health tools continues at almost uncontrollable rates. Following trends in utilization of storytelling across fields and reflecting on the lack of working models and frameworks for application of storytelling in mental health support, the Transformative Storytelling Technique is designed and developed as a part of this work. This technique represents a new category for creating hybrid content to guide the experience of audiences, starting with the case of informal caregivers. The aim of this dissertation is to introduce and explore the feasibility of a novel technique – Transformative Storytelling (TST) - in supporting informal caregivers’ mental health and wellbeing with designed audio stories. The dissertation is presented in four chapters in line with the objectives and structured according to the research and developmental phases applied in developing this novel technique. Mixed-method design is used in this work, including qualitative scoping review in first study, narrative inquiry using semi-structured interviews designed following a-priori TST categories of exploration in the second study, and quantitative pre-post interventional study combined with the facial expression tracking in the pilot study. Transformative Storytelling Technique is demonstrated as a potentially successful methodological and digital narrative approach for structuring, thematically synthesizing experiences of target groups, and delivering them via digital narration. This potential was observed in the pilot pre-post assessment, where the technique demonstrated significant reduction of the subjective burden and a significant increase in happiness during the TST story exposure. In Study 1, the existing digital mental health tools for informal caregivers are being explored, followed by the Study 2 where a potential support solution has been thoroughly discussed and proposed. In line with that, the work continues with Study 3 where the Transformative Storytelling Technique is adapted from the Transformative Video Design and methodological demonstration is being performed. Next, the pilot assessment of the mentioned technique in Study 4 is included to test the feasibility of using the storytelling technique for supporting informal caregivers with TST digital narratives. Finally, limitations and implications for future research are discussed in the final section