Involving users in the evaluation of apps for specific health conditions

With rapid growth of Internet accessibility over recent years, the way in which we engage with healthcare services and make decisions about our own healthcare has changed. One form of engagement with the Internet is through the use of mobile applications (apps) via mobile devices such as smartphones and tablets. As a result of this, many apps have been developed to target people with varying long term conditions. These apps may aim to help educate individuals about their condition or help them to manage it. Assessing the quality of these apps is crucial especially when considering the risks associated with providing misleading information or unsubstantiated claims. This has led to a growing body of research assessing the quality of apps aimed at people living with varying long term conditions. These attempts have not involved service users to address the suitability of apps for their intended target audiences. This paper presents two examples of how service users and associated healthcare professionals can be involved in the suitability assessment of mobile apps for children and young people with Attention Deficit Hyperactivity Disorder and those living with dementia

People with dementia playing casual games on a tablet

Objective: Preserving clients’ quality of life (QoL) has become increasingly important in dementia care. Engagement in pleasant and meaningful activities may influence this QoL. We studied people with dementia’s experiences and views of independent tablet games in a practice-based study, conducted at two day-care centres and five small-scale living facilities for people with dementia in the city of Rotterdam. Method: The participants were 54 clients (24 men, 30 women; mean age 83 years) who participated in a total of 177 game-playing sessions. Ten existing iPad games and three new game prototypes were evaluated. Written informed consent was obtained from the clients or the clients’ representatives prior to the study. Data collection included epidemiological and game playing characteristics. Observers took note of the specific game(s) offered, the clients’ mood and engagement, and the duration of game playing. Immediately after each participant finished playing,a short 4-question interview was conducted to discover their opinion on the game. The participants’ answers were recorded verbatim. Qualitative content analysis was used to explore their experiences and views of the games. Results: This study revealed positive experiences related to people’s need for achievement, self-esteem, sense of connection and belonging, identity, having something to do, and admiration for the game. Negative experiences included failure (low self-esteem), annoyance and a sense of insecurity. Conclusions: This study shows there is potential for people with dementia to play casual games on a tablet as a pleasant and meaningful activity. It is important, however that there is a match between the game, the touchscreen skills of the person with dementia, and their ambitions or interests. It is challenging to find the right game for the right person. An interactive tool to support the choice of the game that is most suitable and a database of dementia-friendly tablet games may support the use of these games by people with dementia, in health care organisations as well as at home

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

Technology and dementia: the future is now

Background: Technology has multiple potential applications to dementia from diagnosis and assessment to care delivery and supporting ageing in place. Objectives: To summarise key areas of technology development in dementia and identify future directions and implications. Method: Members of the US Alzheimer’s Association Technology Professional Interest Area involved in delivering the annual pre-conference summarised existing knowledge on current and future technology developments in dementia. Results: The main domains of technology development are as follows: (i) diagnosis, assessment and monitoring, (ii) maintenance of functioning, (iii) leisure and activity, (iv) caregiving and management. Conclusions: The pace of technology development requires urgent policy, funding and practice change, away from a narrow medical approach, to a holistic model that facilitates future risk reduction and pre- vention strategies, enables earlier detection and supports implementation at scale for a meaningful and fulfilling life with dementia

The use of motion-based technology for people living with dementia or mild cognitive impairment: a literature review

Background: The number of people living with dementia and mild cognitive impairment (MCI) is increasing substantially. Although there are many research efforts directed toward the prevention and treatment of dementia and MCI, it is also important to learn more about supporting people to live well with dementia or MCI through cognitive, physical, and leisure means. While past research suggests that technology can be used to support positive aging for people with dementia or MCI, the use of motion-based technology has not been thoroughly explored with this population. Objective: The aim of this study was to identify and synthesize the current literature involving the use of motion-based technology for people living with dementia or MCI by identifying themes while noting areas requiring further research. Methods: A systematic review of studies involving the use of motion-based technology for human participants living with dementia or MCI was conducted. Results: A total of 31 articles met the inclusion criteria. Five questions are addressed concerning (1) context of use; (2) population included (ie, dementia, MCI, or both); (3) hardware and software selection; (4) use of motion-based technology in a group or individual setting; and (5) details about the introduction, teaching, and support methods applied when using the motion-based technology with people living with dementia or MCI. Conclusions: The findings of this review confirm the potential of motion-based technology to improve the lives of people living with dementia or MCI. The use of this technology also spans across several contexts including cognitive, physical, and leisure; all of which support multidimensional well-being. The literature provides evidence that people living with dementia or MCI can learn how to use this technology and that they enjoy doing so. However, there is a lack of information provided in the literature regarding the introduction, training, and support methods applied when using this form of technology with this population. Future research should address the appropriate introduction, teaching, and support required for people living with dementia or MCI to use the motion-based technology. In addition, it is recommended that the diverse needs of these specific end-users be considered in the design and development of this technology

Applying Mobile Application Development to Help Dementia and Alzheimer Patients

Caregiver anecdotes attest that music and photographs play an important role for family members diagnosed with Alzheimer’s disease (AD), even those with severe AD. Tablets and iPads, which are prevalent, can be utilized with dementia patients in portraying favorite music and family photographs via apps developed in close partnership with geriatric facilities. This study addresses cognitive functioning and quality of life for people diagnosed with dementia via technology. Research has shown that technology instruments such as iPods, help stimulate those with dementia. This study focuses on innovative devices such as iPads and tablets, which are mainstream and easy to use, cannot only help determine stage of dementia, but also provide stimulation to improve cognitive functioning. It is hoped that this research will analyze that specially created apps and existing assistive software can be used to decrease the symptoms and improve cognition of older adults suffering from AD or other dementia related diseases. Via service-learning courses, students developed an easy-to-use application for tablets to help older adults with disabilities more readily use the technology. This research will discuss student developed mobile applications in the scope of helping improve the quality of life of patients with AD or dementia

Feasibility-Usability Study of a Tablet App Adapted Specifically for Persons with Cognitive Impairment—SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia)

Population ageing within Europe has major social and economic consequences. One of the most devastating conditions that predominantly affects older people is dementia. The SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia) project aims to develop and test a health application specifically designed for people with mild dementia. The aim of this feasibility study was to evaluate the design of the SMART4MD protocol, including recruitment, screening, baseline examination and data management, and to test the SMART4MD application for functionality and usability before utilization in a full-scale study. The feasibility study tested the protocol and the app in Spain and Sweden. A total of nineteen persons with cognitive impairment, and their informal caregivers, individually performed a task-based usability test of the SMART4MD app model in a clinical environment, followed by four-week testing of the app in the home environment. By employing a user-centered design approach, the SMART4MD application proved to be an adequate and feasible interface for an eHealth intervention. In the final usability test, a score of 81% satisfied users was obtained. The possibility to test the application in all the procedures included in the study generated important information on how to present the technology to the users and how to improve these procedures

Touchscreen interventions for people with dementia

This project builds on the existing evidence that suggests that art-based interventions can be beneficial for the wellbeing of people with dementia and their carers, and explores whether such interventions can be delivered via a touchscreen tablet device using an application that allows them to view art images. Twelve pairs of volunteers with dementia and their informal carers were recruited through Alzheimer’s Society Dementia Cafés. A quasi-experimental mixed-methods within-subjects study evaluated the impact of art-viewing on wellbeing using visual analogue scales as well as exploring the experiences of participants qualitatively with thematic analysis. Quantitative results showed a significant effect for change in composite wellbeing from viewing session one to session five. Wellbeing subdomain scores showed an impact on wellbeing which tended to increase with the number of sessions. Qualitative findings were reported in relation to shifts in cognition, changes in behaviour, mood and relationships between people with dementia and their carers. These changes tended to be viewed as positive by interviewees. The results suggest that touchscreen based art interventions have the potential to provide an activity people with dementia can engage in with their carers which can benefit their wellbeing. A larger-scale controlled study would help to further determine whether wider dementia care practice implications can be drawn for clinical psychologists and other healthcare providers