Using Digital Health Technology to Optimise Older People’s Pain Self-Management Capabilities: A Mixed Methods Study (The DigiTech Pain Project)

Background Arthritic pain is a major cause of illness and disability among older people. As the use of smartphones and apps increases in the lives of older people, there is an opportunity to explore the role of these apps in helping older people better manage their arthritic pain. Aim To explore the feasibility and acceptability of older people using an arthritic pain selfmanagement app to improve their pain symptoms. Methods A parallel convergent, mixed methods design underpinned by Bandura’s Self-Efficacy Theory and the Technology Acceptance Model 2; comprising of the following five studies: (i) Study 1a: an integrative review; (ii) Study 1b: a systematic review; (iii) Study 2a: a phase I feasibility study of pre–post-test design; (iv) Study 2b: a qualitative sub-study involving participants of study; and (v) Study 3: a qualitative interview study with primary care and allied health clinicians. The data from these studies was integrated to answer the project’s research questions. Results Study 1a revealed paucity of evidence on use of apps for older people’s pain selfmanagement. Study 1b indicated that few publicly available pain self-management apps are based on robust evidence. Eighteen older people were recruited into Study 2a, 80% via snowballing. Over 59% of participants were provided face-to-face app download and use training, none had used a pain self-management app in the past. Telephone-based survey and interview data collection was found to be acceptable to older people. Almost 90% of study 2a participants (n=16) took part in study 2b sharing their experiences of using the intervention app. Following four themes emerged: (i) Apps are valuable selfmanagement tool, but they do have the potential for harm; (ii) pain self-management apps need to be strictly relevant to the user; (iii) Clinicians’ involvement is crucial; and (iv) pain self-management apps must be designed with the end user in mind. Study 3 recruited seventeen (n=17) primary care and allied health clinicians who shared their perceptions and attitudes regarding app use by their older patients for pain self-management. Four themes emerged: (i) self-management apps are a potentially useful tool but require careful consideration; (ii) clinicians’ involvement is crucial yet potentially onerous; (iii) no single app is right for every older person; and (iv) patient data access is beneficial but caution is needed for real-time data access. Meta-inference of the data from all five studies indicated that an app intervention involving older people was both feasible and acceptable, with the following caveats: snowballing recruitment may be required; and access to app download and use training is an important element to implement into the study design. Older people and primary care clinicians were keen to engage with pain self-management apps; however, they wanted these apps to offer high level usefulness, adaptability and information sharing features. Future pain self-management apps need to be underpinned by robust evidence, while providing appropriate support and resources to clinicians. Conclusion While older people and their clinicians welcomed the opportunity to use pain self-management apps, their engagement ought to be supported by systems level policies, and high-quality apps. Collaboration among clinicians, older people, researchers and app developers ought to be considered when developing, researching and integrating pain self-management apps

Telepsychiatry

Mental illness affects 18% of American adults and 8.0% of American children. Untreated mental illness can increase mortality, influence treatment of other conditions, and impose unnecessary burdens on individuals, families, and communities. Despite the prevalence and burdens of untreated mental illness, there are still numerous financial, social, and organizational barriers to the availability, utilization and quality of mental health services. In the last two decades, many efforts have been made to improve healthcare access through legal and regulatory overhauls, health insurance reform, electronic health system infrastructure expansion, and development of new models of care. These efforts are perhaps most easily observed through the implementation of telehealth and telemedicine. Telehealth is an umbrella term indicating the use of technology for the provision of healthcare, health administration, and health education while telemedicine is a more specific term referring to the use of technology for the delivery of healthcare across distances. While telemedicine is used in almost all subspecialties, implementation and research are more developed in some specialties than in others. Research on telepsychiatry shows that 1) telepsychiatry can be used to effectively diagnose and treat a variety of mental illnesses in a number of populations in many locations; 2) telepsychiatry has the potential to be a cost effective alternative to treatment as usual for patients, providers, and communities; 3) telemental health can function successfully within the legal and regulatory landscape in United States; 4) the technology for telemental health is already available and continually improving; 5) There are resources available to facilitate the use of telemental health by patients, providers and healthcare organizations. Telepsychiatry has the potential to improve access to mental health services by connecting patients with the right providers, reducing the costs of receiving and providing mental healthcare, lowering social barriers that prevent individuals from seeking and providers from offering care, and facilitating organizational practices and goals. This paper summarizes published data concerning the clinical, financial, legal and regulatory, and technological aspects of telepsychiatry and explores how telepsychiatry might be used to improve the availability, utilization, and quality of mental health services in the United States

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Design and Architecture of an Ontology-driven Dialogue System for HPV Vaccine Counseling

Speech and conversational technologies are increasingly being used by consumers, with the inevitability that one day they will be integrated in health care. Where this technology could be of service is in patient-provider communication, specifically for communicating the risks and benefits of vaccines. Human papillomavirus (HPV) vaccine, in particular, is a vaccine that inoculates individuals from certain HPV viruses responsible for adulthood cancers - cervical, head and neck cancers, etc. My research focuses on the architecture and development of speech-enabled conversational agent that relies on series of consumer-centric health ontologies and the technology that utilizes these ontologies. Ontologies are computable artifacts that encode and structure domain knowledge that can be utilized by machines to provide high level capabilities, such as reasoning and sharing information. I will focus the agent’s impact on the HPV vaccine domain to observe if users would respond favorably towards conversational agents and the possible impact of the agent on their beliefs of the HPV vaccine. The approach of this study involves a multi-tier structure. The first tier is the domain knowledge base, the second is the application interaction design tier, and the third is the feasibility assessment of the participants. The research in this study proposes the following questions: Can ontologies support the system architecture for a spoken conversational agent for HPV vaccine counseling? How would prospective users’ perception towards an agent and towards the HPV vaccine be impacted after using conversational agent for HPV vaccine education? The outcome of this study is a comprehensive assessment of a system architecture of a conversational agent for patient-centric HPV vaccine counseling. Each layer of the agent architecture is regulated through domain and application ontologies, and supported by the various ontology-driven software components that I developed to compose the agent architecture. Also discussed in this work, I present preliminary evidence of high usability of the agent and improvement of the users’ health beliefs toward the HPV vaccine. All in all, I introduce a comprehensive and feasible model for the design and development of an open-sourced, ontology-driven conversational agent for any health consumer domain, and corroborate the viability of a conversational agent as a health intervention tool

Tablet-based Self-management Intervention for Diabetes Mellitus Type II Patients: Usability and Efficacy of The ASSISTwell Tool

Background: The usefulness of technology and the powerful capabilities of technological applications have led to a significantly increased interest in finding novel approaches to support older adults’ self-management. Self-management technological applications have been used in various contexts, and usability is key in sustainability and adoption of such technologies. Objective: The purpose of this research is to assess the usability of the ASSISTwell application in an older adult population with Diabetes Type II (DMII) and explore whether the application can effectively enhance DMII patients’ self-management. Design: Qualitative interviews, Observation, and Quasi-experimental design. Methods: Semi-structured interviews, observation, documentation, and quantitative standardized measures were used in this study. A purposive sample of 24 elderly patients with DMII was recruited for the study. Descriptive and inferential analysis were used to analyze the quantitative data. Simple content analysis was used to organize the emerging usability themes. Results: User feedback from the four-week user intervention demonstrated good usability of the ASSISTwell application. After using the ASSISTwell for 30 days, there was significant improvement in the perceived diabetes self-management skills of the intervention group (difference in mean PDSMS (F (1, 20) =5.11, p=0.035). Furthermore, those who used ASSISTwell (mean= 30.22, SD= 6.34) had higher PDSMS scores than those who received usual care without ASSISTwell (mean= 23.95, SD= 7.12). There was no significant difference in mean blood glucose levels (F (1, 20) =0.37, p=0.54) between the two groups. Those who used ASSISTwell (M=178, SD=40) had lower blood glucose levels than those who received usual care without ASSISTwell (M=185, SD=49), but the difference is not statistically significant. Conclusions: The novel ASSISTwell application presented in this paper helped participants improve their diabetes self-management skills. A well-designed application with new features has the ability to provide more promising results regarding improving perceived diabetes self-management skills. Also, examining usability is an essential step in application development to ensure that the application\u27s features match users\u27 expectations and needs and minimize the likelihood of user errors and difficulties using the system

Wearables at work:preferences from an employee’s perspective

This exploratory study aims to obtain a first impression of the wishes and needs of employees on the use of wearables at work for health promotion. 76 employ-ees with a mean age of 40 years old (SD ±11.7) filled in a survey after trying out a wearable. Most employees see the potential of using wearable devices for workplace health promotion. However, according to employees, some negative aspects should be overcome before wearables can effectively contribute to health promotion. The most mentioned negative aspects were poor visualization and un-pleasantness of wearing. Specifically for the workplace, employees were con-cerned about the privacy of data collection