Aplicaciones psicosociales de la tecnología para la capacitación en salud y bienestar de adultos mayores con demencia y deterioro cognitivo leve y sus cuidadores en zonas rurales

Tesis por compendio de publicaciones.[EN]Introduction: The transition to an ageing population has brought several challenges to societies and healthcare systems around the world. The need for new healthcare approaches and interventions to adjust to the new situation is one of the most relevant issues worldwide. This project particularly targets three of these challenges: the complexity of older adult care, the increase of people living with dementia and their caregivers, and the poor accessibility of rural populations to access healthcare services to face these challenges. Aims: To develop a proof of concept of a technological platform integrating several innovative digital tools for health and wellness coaching of older adults with dementia and cognitive impairment and their carers, and to study the effects of utilisation of the platform on physical health, mental and emotional wellbeing, activities of daily living, social and cognitive functioning and professional care use. To involve older adults with dementia and their carers in the design and development of the platform, assessing their satisfaction, the impact of the system in realistic settings, acceptability and usability, to enable them to manage the system autonomously in daily life. Methodologies: Two systematic reviews were conducted in July 2021 and April 2023 in PubMed, CINAHL, and Web of Science. A qualitative appraisal/risk of bias was performed for the studies included. Three qualitative studies were conducted, implementing online and face-to-face workshops, semi-structured interviews, focus groups, and co-design and co-production processes with Patient and Public Involvement (PPI). Thematic analysis was the chosen approach for the analysis of the results. A mixed-methods usability and user experience study and a pilot study of an online training and support programme for caregivers of people living with dementia are being carried out, implementing semi-structured interviews and questionnaires targeting usability, dementia knowledge and caregiver burden. Results: A series of steps necessary to create the foundations of a technological platform were identified: a) the interRAI LTFC and the interRAI HC were recommended as the CGAs to be used for the assessment and monitoring of potential users in long-term care facilities and home care, respectively; b) the barriers for the usability and implementation of DHTs to assist and to help to reach the full potential of CGAs are described, as well as a series of recommendations to improve its usability and implementation by healthcare professionals and clinical settings; c) a framework to study the pros and cons of developing digital patient and public involvement and suggestions to improve the implementation of e-PPI were developed and identified; d) the facilitators and barriers to implementing the socio-community intervention of the Meeting Centre Support Programme were identified and several recommendations were described to overcome the limitations for a successful implementation; and e) as an attempt to offer a support service alternative for caregivers of PLwD in remote rural areas, the cultural adaptation of the iSupport training and support programme for carers of PLwD was developed, and its usability and user-experience, and impact on dementia knowledge and caregiver burden are under study. Conclusions: This project described a series of steps necessary to create the foundations of a technological platform for health and wellness coaching of older adults with dementia and cognitive impairment and their carers. By embedding the findings in this project and including novel technologies such as AI, robotics, wearable technologies, and monitoring devices, the idea of the technological platform could be feasible. Further projects could implement these initiatives to generate an impact on facing the current challenges of the ageing population. [ES]Introducción: La transición hacia una población que envejece ha planteado varios retos a las sociedades y los sistemas sanitarios de todo el mundo. La necesidad de nuevos enfoques e intervenciones sanitarias para adaptarse a la nueva situación es una de las cuestiones más relevantes en todo el mundo. Este proyecto se centra especialmente en tres de estos retos: la complejidad de la atención a los adultos mayores, el aumento del número de personas que viven con demencia y de sus cuidadores, y la escasa accesibilidad de las poblaciones rurales a los servicios sanitarios para hacer frente a estos retos. Objetivos: Desarrollar una prueba de concepto de una plataforma tecnológica que integre varias herramientas digitales innovadoras para la capacitación en salud y bienestar de adultos mayores con demencia y deterioro cognitivo y sus cuidadores, y estudiar los efectos de la utilización de la plataforma en la salud física, el bienestar mental y emocional, las actividades de la vida diaria, el funcionamiento social y cognitivo y el uso para los cuidados profesionales. Involucrar a los adultos mayores con demencia y a sus cuidadores en el diseño y desarrollo de la plataforma, evaluando su satisfacción, el impacto del sistema en entornos realistas, su aceptabilidad y usabilidad, para permitirles manejar el sistema de forma autónoma en la vida diaria. Métodos: Se realizaron dos revisiones sistemáticas en julio de 2021 y abril de 2023 en PubMed, CINAHL y Web of Science. Se realizó una valoración cualitativa/riesgo de sesgo de los estudios incluidos. Se realizaron tres estudios cualitativos, implementando talleres online y presenciales, entrevistas semiestructuradas, grupos focales y procesos de codiseño y coproducción con Participación de Pacientes y Público (PPI). El análisis temático fue el enfoque elegido para el análisis de los resultados. Se está llevando a cabo un estudio de usabilidad y experiencia de usuario con métodos mixtos y un estudio piloto de un programa en línea para la capacitación y formación de cuidadores de personas que viven con demencia, en los que se aplicarán entrevistas semiestructuradas y cuestionarios sobre usabilidad, conocimiento de la demencia y sobrecarga de los cuidadores. Resultados: Se identificaron una serie de pasos necesarios para crear las bases de una plataforma tecnológica: a) se recomendaron el interRAI LTFC y el interRAI HC como las Evaluaciones Geriátricas Integrales (EGI) que se utilizarán para la evaluación y el seguimiento de los usuarios potenciales en los centros de larga estancia y en la atención domiciliaria, respectivamente; b) se describen las barreras para la usabilidad y la implementación de las Tecnologías de Salud Digital (TSD) para asistir y ayudar a alcanzar todo el potencial de las EGI, así como una serie de recomendaciones para mejorar su usabilidad e implementación por parte de los profesionales sanitarios y los entornos clínicos; c) se desarrolló e identificó un marco para estudiar los pros y los contras del desarrollo de la participación digital de pacientes y público (e-PPI, por sus siglas en inglés) y sugerencias para mejorar la implementación de e-PPI; d) se identificaron los factores que facilitan y dificultan la aplicación de la intervención sociocomunitaria del Programa de Atención de Centros de Encuentro (MCSP, por sus siglas en inglés) y se describieron varias recomendaciones para superar las limitaciones y lograr una aplicación satisfactoria; y e) como intento de ofrecer una alternativa de servicio de apoyo a los cuidadores de personas que viven con demencia en zonas rurales remotas, se desarrolló la adaptación cultural del programa de formación y apoyo iSupport para cuidadores de personas que viven con demencia, y se está estudiando su usabilidad y experiencia de usuario, así como su impacto en los conocimientos sobre la demencia y la sobrecarga en los cuidadores. Conclusión: Este proyecto describe una serie de pasos necesarios para crear los cimientos de una plataforma tecnológica para la capacitación en salud y bienestar de los adultos mayores con demencia y deterioro cognitivo y sus cuidadores. La idea de la plataforma tecnológica podría ser factible si se incorporan los resultados de este proyecto y se incluyen tecnologías novedosas como la inteligencia artificial, la robótica, las tecnologías ponibles y los dispositivos de monitorización. Otros proyectos podrían poner en práctica estas iniciativas para generar un impacto a la hora de afrontar los retos actuales del envejecimiento de la población

Insights on conducting digital patient and public involvement in dementia research during the COVID-19 pandemic: supporting the development of an “E-nabling digital co-production” framework

BackgroundThe rapid transition to digital working, accelerated due to the response to the COVID-19 pandemic, has impacted the involvement of patients and public in research. This paper presents experiences of engaging in digital Patient and Public Involvement (e-PPI) in dementia research since the lockdowns, offering recommendations regarding future digital and hybrid working. Furthermore, it introduces a co-produced framework for researchers, PPI coordinators and public contributors to identify and discuss challenges and opportunities provided by e-PPI.MethodsTwo online workshops and one individual interview were performed with a group of researchers and PPI coordinators with experience in PPI in dementia research, and with an existing dementia PPI group having some experience of working online during the pandemic. The project was constructed as a PPI activity, with the MindTech Involvement Team (PPI group) involved in the entire process, and a collaborative data analysis process was adopted.ResultsAfter refinement of the coding structure, the MindTech Involvement Team and Project Leaders identified four main themes, resulting in the ‘E-nabling Digital Co-production' Framework. During this framework development, different positions were expressed, associated with the transition to digital working. Two main themes were shared by the participating groups regarding e-PPI: wider potential reach without geographical constraints, and the perception of more business-like sessions with reduced opportunities for social interactions and communication. Specifically for dementia research, whilst e-PPI may allow public contributors to attend more meetings, potentially mutually supportive environments provided by face-to-face meetings could be diminished, with carers experiencing a possible reduction in informal respite opportunities.ConclusionsThrough involving public contributors, researchers, and PPI coordinators with a focus on digital PPI in dementia research, we were able to further refine and co-produce the ‘E-nabling Digital Co-production' Framework. Demonstrating potential for analysis of benefits and limitations within e-PPI, it was possible to identify both general insights and those specific to dementia research. However, the most significant contribution of the framework is the potential to support local journeys of co-production in ongoing digital and hybrid public involvement activities

Promoviendo el desarrollo conceptual en las aulas de preescolar: una sistematización de hallazgos de investigación / Promoting conceptual development in preschool classrooms: a systematic review of research findings

 Este artículo resume y discute hallazgos sobre la manera en que las docentes promueven el desarrollo conceptual en aulas costarricenses de preescolar. Para esto, se revisaron los Trabajos Finales de Graduación (TFG) de pregrado realizados entre el 2007 y el 2011 en las carreras de Psicología y Educación Preescolar que ofrecen las universidades públicas costarricenses. Del total de los 347 TFG realizados en ese período, se identificaron 36 trabajos que tratan el tema del desarrollo conceptual en la edad preescolar. Solamente uno de estos trabajos fue realizado en Psicología. De los TFG realizados en Educación Preescolar, se encontró que mayoritariamente utilizan metodologías cualitativas y que, en su formulación y ejecución, no recurren al uso de recursos provenientes de revistas indexadas. Los hallazgos referentes a la promoción del desarrollo conceptual en las aulas de preescolar que se desprenden de los TFG revisados, sugieren la presencia de algunas prácticas docentes que promueven el desarrollo conceptual, como el caso del juego y la experimentación. A la vez, los trabajos revisados enumeran distintas deficiencias en la promoción del desarrollo conceptual por parte de las docentes. Una cuarta parte de los TFG indican que las docentes 1) no incentivan la participación activa del estudiantado, 2) realizan escasas actividades que resultan significativas para los niños y, 3) no consideran las diferencias del desarrollo y las individuales existentes en el salón de clase en el planteamiento de sus lecciones. This article discusses findings concerning the way preschool teachers promote conceptual development in the classroom. We reviewed final graduation projects conducted by psychology and preschool education majors in Costa Rican public universities, between 2007 and 2011. Thirty-six of the 347 final projects produced during this period dealt with conceptual development in the preschool age. One project was conducted by a psychology major while the rest were executed by preschool education majors. We found that the majority of projects developed in preschool education programs used qualitative methodologies rarely based on empirical facts. Findings from these projects indicate the presence of some teacher practices that promote conceptual development in the classroom, such as games and experiments. The projects examined also pointed out a series of deficits in the teachers’ promotion of conceptual development. A quarter of the projects indicated that teachers 1) do not promote children’s active participation, 2) seldom develop activities that are engaging for the children, 3) and do not consider the developmental and individual differences within the class in their lesson planning

PROMOVIENDO EL DESARROLLO CONCEPTUAL EN LAS AULAS DE PREESCOLAR: UNA SISTEMATIZACIÓN DE HALLAZGOS DE INVESTIGACIÓN

E ste artículo resume y discute hallazgos sobre la manera en que las docentes promueven el desarrollo conceptual en aulas costarricenses de preescolar . Para esto, se revisar on los T rabajos F inales de G raduación (TFG) de pregrado realizados entre el 2007 y el 2011 en las carreras de Psicología y Educación Preescolar que ofrecen las universidades públicas costarricenses. Del total de los 347 TFG realizados en ese período, se identificaron 36 trabajos que tratan el tema del desarrollo conceptual en la edad preescolar. Solamente uno de estos trabajos fue realizado en Psicología. De los TFG realizados en Educación Preescolar, se encontró que mayoritariamente utilizan metodologías cualitativas y que, en su formulación y ejecución, no recurren al uso de recursos provenientes de revistas indexadas. Los hallazgos referentes a la promoción del desarrollo conceptual en las aulas de preescolar que se desprenden de los TFG revisados, sugieren la presencia de algunas prácticas docentes que promueven el desarrollo conceptual, como el caso del juego y la experimentación. A la vez, los trabajos revisados enumeran distintas deficienci as en la promoción del desarrollo conceptual por parte de las docentes. Una cuarta parte de los TFG indican que las docentes 1) no incentivan la participación activa del estudiantado, 2) realizan escasas actividades que resultan significativas para los niñ os y , 3) no consideran las diferencias del desarrollo y las individuales existentes en el salón de clase en el planteamiento de sus lecciones

Promoviendo el desarrollo conceptual en las aulas de preescolar: una sistematización de hallazgos de investigación / Promoting conceptual development in preschool classrooms: a systematic review of research findings

 Este artículo resume y discute hallazgos sobre la manera en que las docentes promueven el desarrollo conceptual en aulas costarricenses de preescolar. Para esto, se revisaron los Trabajos Finales de Graduación (TFG) de pregrado realizados entre el 2007 y el 2011 en las carreras de Psicología y Educación Preescolar que ofrecen las universidades públicas costarricenses. Del total de los 347 TFG realizados en ese período, se identificaron 36 trabajos que tratan el tema del desarrollo conceptual en la edad preescolar. Solamente uno de estos trabajos fue realizado en Psicología. De los TFG realizados en Educación Preescolar, se encontró que mayoritariamente utilizan metodologías cualitativas y que, en su formulación y ejecución, no recurren al uso de recursos provenientes de revistas indexadas. Los hallazgos referentes a la promoción del desarrollo conceptual en las aulas de preescolar que se desprenden de los TFG revisados, sugieren la presencia de algunas prácticas docentes que promueven el desarrollo conceptual, como el caso del juego y la experimentación. A la vez, los trabajos revisados enumeran distintas deficiencias en la promoción del desarrollo conceptual por parte de las docentes. Una cuarta parte de los TFG indican que las docentes 1) no incentivan la participación activa del estudiantado, 2) realizan escasas actividades que resultan significativas para los niños y, 3) no consideran las diferencias del desarrollo y las individuales existentes en el salón de clase en el planteamiento de sus lecciones.This article discusses findings concerning the way preschool teachers promote conceptual development in the classroom. We reviewed final graduation projects conducted by psychology and preschool education majors in Costa Rican public universities, between 2007 and 2011. Thirty-six of the 347 final projects produced during this period dealt with conceptual development in the preschool age. One project was conducted by a psychology major while the rest were executed by preschool education majors. We found that the majority of projects developed in preschool education programs used qualitative methodologies rarely based on empirical facts. Findings from these projects indicate the presence of some teacher practices that promote conceptual development in the classroom, such as games and experiments. The projects examined also pointed out a series of deficits in the teachers’ promotion of conceptual development. A quarter of the projects indicated that teachers 1) do not promote children’s active participation, 2) seldom develop activities that are engaging for the children, 3) and do not consider the developmental and individual differences within the class in their lesson planning

Methodologies Used to Study the Feasibility, Usability, Efficacy, and Effectiveness of Social Robots For Elderly Adults: Scoping Review

Background: New research fields to design social robots for older people are emerging. By providing support with communication and social interaction, these robots aim to increase quality of life. Because of the decline in functioning due to cognitive impairment in older people, social robots are regarded as promising, especially for people with dementia. Although study outcomes are hopeful, the quality of studies on the effectiveness of social robots for the elderly is still low due to many methodological limitations. Objective: We aimed to review the methodologies used thus far in studies evaluating the feasibility, usability, efficacy, and effectiveness of social robots in clinical and social settings for elderly people, including persons with dementia. Methods: Dedicated search strings were developed. Searches in MEDLINE (PubMed), Web of Science, PsycInfo, and CINAHL were performed on August 13, 2020. Results: In the 33 included papers, 23 different social robots were investigated for their feasibility, usability, efficacy, and effectiveness. A total of 8 (24.2%) studies included elderly persons in the community, 9 (27.3%) included long-term care facility residents, and 16 (48.5%) included people with dementia. Most of the studies had a single aim, of which 7 (21.2%) focused on efficacy and 7 (21.2%) focused on effectiveness. Moreover, forms of randomized controlled trials were the most applied designs. Feasibility and usability were often studied together in mixed methods or experimental designs and were most often studied in individual interventions. Feasibility was often assessed with the Unified Theory of the Acceptance and Use of Technology model. Efficacy and effectiveness studies used a range of psychosocial and cognitive outcome measures. However, the included studies failed to find significant improvements in quality of life, depression, and cognition. Conclusions: This study identified several shortcomings in methodologies used to evaluate social robots, resulting in ambivalent study findings. To improve the quality of these types of studies, efficacy/effectiveness studies will benefit from appropriate randomized controlled trial designs with large sample sizes and individual intervention sessions. Experimental designs might work best for feasibility and usability studies. For each of the 3 goals (efficacy/effectiveness, feasibility, and usability) we also recommend a mixed method of data collection. Multiple interaction sessions running for at least 1 month might aid researchers in drawing significant results and prove the real long-term impact of social robots

Psychometric characteristics of comprehensive geriatric assessments (CGAs) for long-term care facilities and community care: A systematic review

Background: Comprehensive Geriatric Assessments (CGAs) have been incorporated as an integrated care approach effective to face the challenges associated to uncoordinated care, risk of hospitalization, unmet needs, and care planning experienced in older adult care. As they assessed different dimensions, is important to inform about the content and psychometric properties to guide the decisions when selecting and implementing them in practice. This systematic review provides a comprehensive insight on the strengths and weaknesses of the CGAs used in long-term care settings and community care. Methods: A systematic search was conducted in PubMed, CINAHL, and Web of Science Core Collection. Studies published up to July 13, 2021, were considered. Quality appraisal was performed for the included studies. Results: A total of 10 different CGAs were identified from 71 studies included. Three instruments were reported for long-term care settings, and seven for community care. The content was not homogenous and differed in terms of the detail and clearness of the areas being evaluated. Evidence for good to excellent validity and reliability was reported for various instruments. Conclusions: Setting more specific and clear domains, associated to the special needs of the care setting, could improve informed decisions at the time of selecting and implementing a CGA. Considering the amount and quality of the evidence, the instrument development trajectory, the validation in different languages, and availability in different care settings, we recommend the interRAI LTCF and interRAI HC to be used for long-term facilities and community care

Cultural adaptation of the iSupport online training and support programme for caregivers of people with dementia in Castilla y León, Spain

Background: E-learning has shown to be an effective intervention in helping informal caregivers of people living with dementia. It has the potential to reach people living in remote areas, increasing service coverage. As a response to the demographic context in Spain associated with a higher percentage of ageing, depopulation, and the complexities of health service delivery in rural areas, this paper describes the cultural adaptation and co-design of the iSupport online training and support programme for Castilla y León, Spain, as a potential e-health intervention to mitigate these constraints. Methods: The translation and cultural adaptation were performed following the WHO guidelines, with some adaptation due to the cultural context of Spain. Three focus groups were conducted with informal caregivers, health professionals, and a group of experts on cognitive impairment and dementia. The co-design process was performed as a Patient and Public Involvement activity with three groups consisting of people living with dementia, informal caregivers, rural population and experts on technology and dementia. Results: A total of 435 suggestions were proposed for adaptation associated with erroneous terminology, rewording text/writing, grammatical or punctuation marks errors, and repeated information or need for additional content. Several recommendations were exposed during the co-design process: preference for interactive material such as videos or images, a forum to receive feedback from health care professionals and to leave satisfaction comments, availability in multiple platforms (e.g., tablet, laptop, mobile), slide format for information presentation, and availability to edit letter size and background colours. Conclusions: A culturally adapted version of the iSupport was developed for Castilla y León, Spain. The need for modification of words and expressions, information links to local resources websites, adjustments of characters’ names and caregivers’ scenarios, and additional content to some sections were recommended. Suggestions for the design should be taken into account for further adapted versions and platform developments

Experiencing the digital working transition in participant and public involvement in dementia research during the COVID‐19 pandemic

BackgroundInvolvement of patients and public in research have been disrupted by the consequences of the COVID-19 pandemic, forcing a rapid transition from face-to-face meetings to digital working as an alternative to engage experts by experience. This project presents a co-production experience of a Participant and Public Involvement (PPI) group implementing a framework in dementia research, during this transition period.MethodA PPI activity was developed with the participation of the MindTech Involvement Team (PPI group) through the entire process. A group of experienced researchers, facilitators, and contributors in PPI in dementia research, and an active PPI group during the pandemic were targeted. Three online workshops were performed, and thematic analysis was chosen for the data analysis.ResultConflicting positions were identified regarding the transition from face-to-face meetings to digital working by using a refine version of the ‘E-nabling Digital Co-production' Framework as the coding structure. Regarding e-PPI (digital PPI), the participating groups shared two perspectives associated to the non-geographical constraints and the more business-like sessions. For dementia research, e-PPI was identified to decrease the supportive and respite environment associated to face-to-face meetings, however, it was considered to allow the participants to attend more meetings.ConclusionThe project gives feedback on the digital working in PPI by identifying concerns and fortes of this transition, both for general PPI and in the field of dementia research. It contributes further co-production initiatives by introducing the ‘E-nabling Digital Co-production' Framework as a tool to reflect on future public involvement

Insights on conducting digital patient and public involvement in dementia research during the COVID-19 pandemic: supporting the development of an “E-nabling digital co-production” framework

Background: The rapid transition to digital working, accelerated due to the response to the COVID-19 pandemic, has impacted the involvement of patients and public in research. This paper presents experiences of engaging in digital Patient and Public Involvement (e-PPI) in dementia research since the lockdowns, offering recommendations regarding future digital and hybrid working. Furthermore, it introduces a co-produced framework for researchers, PPI coordinators and public contributors to identify and discuss challenges and opportunities provided by e-PPI. Methods: Two online workshops and one individual interview were performed with a group of researchers and PPI coordinators with experience in PPI in dementia research, and with an existing dementia PPI group having some experience of working online during the pandemic. The project was constructed as a PPI activity, with the MindTech Involvement Team (PPI group) involved in the entire process, and a collaborative data analysis process was adopted. Results: After refinement of the coding structure, the MindTech Involvement Team and Project Leaders identified four main themes, resulting in the ‘E-nabling Digital Co-production' Framework. During this framework development, different positions were expressed, associated with the transition to digital working. Two main themes were shared by the participating groups regarding e-PPI: wider potential reach without geographical constraints, and the perception of more business-like sessions with reduced opportunities for social interactions and communication. Specifically for dementia research, whilst e-PPI may allow public contributors to attend more meetings, potentially mutually supportive environments provided by face-to-face meetings could be diminished, with carers experiencing a possible reduction in informal respite opportunities. Conclusions: Through involving public contributors, researchers, and PPI coordinators with a focus on digital PPI in dementia research, we were able to further refine and co-produce the ‘E-nabling Digital Co-production' Framework. Demonstrating potential for analysis of benefits and limitations within e-PPI, it was possible to identify both general insights and those specific to dementia research. However, the most significant contribution of the framework is the potential to support local journeys of co-production in ongoing digital and hybrid public involvement activities