JMIR Publications

ABSTRACT

Background:

Background Digital health technologies and the aging population Worldwide, digital health technologies are expected to support older persons in daily life and preserve autonomy and quality of life [1]. However, their potential to address population aging remains partly unrealized, due to design processes that fail to meet end-user needs and persistent stereotypes of older persons as vulnerable and unskilled. Further evaluation is also needed to ensure that such technologies effectively support health [2]. In Sweden, the welfare system emphasizes mutual rights and social equality, and digital technologies are seen as a means to uphold them. Welfare technology is defined as digital solutions intended to maintain or enhance safety, activity, participation, or independence among persons with or at risk of disability [3]. More broadly, eHealth - defined by the World Health Organization as the cost-effective and secure use of information and communications technologies in health-related fields – has expanded healthcare provision globally and improved system responsiveness and efficiency [4]. A wide range of technologies aims to meet the physical, cognitive, and social needs of older persons. Although further research is needed, their integration into care settings has the potential to enhance autonomy, safety, and quality of life through tailored solutions [5]. Use of digital technologies may also reduce loneliness – an important risk factor for mental ill-health and social isolation. In Sweden, digital device use is widespread, including among older age groups, with reported benefits such as increased social interaction, support, empowerment, and security [6]. Learning to use new technologies in later life may further support social engagement and mitigate risks of cognitive decline [7]. As with long-term relationships, commitment and emotional attachment are important in interactions with technological systems [8]. While digital health technologies are increasingly integrated into care for older persons, challenges remain in translating designs into real-world contexts. Therefore, older persons should be recognized as co-creators, users, and recipients of technological innovations [9]. Digital life stories for person-centered dementia care Tablets and other digital technologies have increasingly been used in dementia care to support communication, social interaction, and engagement. Applications that include music, videos, and digital life stories have been shown to facilitate interactions among persons living with dementia, Healthcare Professionals (HPs), and family members [10]. Digital technologies can support social connectedness through activities such as communication, reminiscence, and information sharing. There are legal considerations to take into account, including respect for a person’s rights to autonomy and integrity, as well as the opportunity to participate in and influence one's own life. Digital participation can be a challenge due to rapid technological development, access to technology, and digital skills, where persons living with dementia risk being excluded. The person's wishes should guide decision-making, regardless of health status or decision-making ability. Persons with cognitive impairment may experience communication difficulties, but they can still demonstrate their understanding of a specific action through their reactions [6], [11], [12], [13]. However, barriers to adoption remain, including limited digital literacy, accessibility challenges, and concerns regarding privacy and security [13]. Person-centered care is widely recognized as a cornerstone of quality dementia care. It emphasizes understanding the person beyond the disease and building partnerships between HPs, persons living with dementia, and their families. The goal is to support participation, autonomy, and well-being in everyday life. One important component of person-centered care is understanding the person’s life history, preferences, values, and meaningful relationships [14], [15], [16]. Life stories are commonly used in dementia care to support this process. They document personal experiences, preferences, and important events, thereby facilitating communication and personalized care [15], [16]. Access to a person’s life story can strengthen a sense of identity and belonging, while HPs better understand the person and tailor care to their personal needs [17]. However, life stories should be dynamic and continuously updated to reflect the person’s current life situation and preferences [18]. Digital life story tools enable the storage, updating, and sharing of life story information in an accessible format. This makes personal information readily available and easily accessible to HPs, persons living with dementia, and family members. Evidence shows that such tools may support communication, reminiscence, and the delivery of person-centered care [18]. Despite the growing interest in digital life story tools, less is known about how they are used in routine care settings and how HPs perceive their usefulness in supporting person-centered dementia care [14]. Digital life story tools can be delivered in various formats, including web-based applications, desktop computers, smartphones, tablets, interactive displays, and video. They may incorporate multimedia content such as pictures, videos, music, and text to support communication and reminiscence [10]. The tools can be assisted by various software programs and applications that offer diverse sources of collected content, including both personal and generic material [19]. Some digital solutions utilize personal profiles as a starting point for conversations and reminiscence, while also supporting communication between generations and serving as a communication platform for persons living with dementia, HPs, and relatives of the person [17]. Digital life story tools have been developed to support communication and person-centered dementia care. One example is Min Memoria (MM), a web-based platform that enables persons living with dementia, relatives, and HPs to create, update, and share life story information within a shared digital environment [20]. Previous studies have explored the use of digital life stories to support reminiscence, communication, and engagement among persons living with dementia [14], [17], [19]. However, less is known about how HPs use these tools in routine care and whether they perceive them as supporting person-centered care. Therefore, this study aimed to explore HPs’ perceptions of the usability of a digital life story tool and their self-reported use patterns in Swedish care settings.

Objective:

Objectives This study aimed to explore healthcare professionals’ perceptions of the usability of a digital life story tool and their self-reported use patterns in Swedish care settings.

Methods:

Methods Study design This cross-sectional study employed an exploratory design using questionnaire data collected via web-based and paper formats from Healthcare Professionals (HPs) at five care facilities in Sweden. This study was designed to describe patterns of use and perceptions of the digital life story tool Min Memoria (MM). The study is part of a project evaluating digital life stories to support person-centered care for persons living with dementia. Throughout this paper, persons living with dementia are referred to as care recipients. This paper adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies [21]. Setting The study was conducted in care facilities in Sweden (three daycare centers, one dementia care facility, and one residential care facility). At the time of data collection, five care facilities agreed to participate, accounting for 36 HPs who were MM users at the included care facilities, out of approximately 60 HPs using it in Sweden. These eligible HPs were invited to participate. In Sweden, daycare centers are aid-assessed facilities, where a person living with dementia can participate in personalized activities throughout the day. Daycare activities for persons living with dementia are designed using a person-centered approach, enabling them to remain in their own homes while offering temporary relief to family members. The activities can also enable social interaction, structure, and content during the day, through participation in purposeful activities with HPs’ support [22], [23]. Residential care facilities are person-assisted accommodations for persons aged > 65 years or older. They provide extensive care around the clock when it is no longer possible to remain in ordinary housing, with HPs’ assistance of various support measures tailored to the person’s situation. These facilities offer opportunities for diverse forms of physical activity, social interaction, and flexibility in routines. This applies, for example, to specific measures such as modified mealtime and opportunities to spend time outdoors. To be eligible for a place in a dementia care facility, you must have this diagnosis, unlike in a residential care facility, where this is not necessary [24]. The participating care facilities also differed in the duration of their experience with MM. The dementia care facility had been using MM since 2021, one daycare center since 2022, and the other three care facilities for less than a year. At facilities newly adopting MM, a manufacturer consultant provided introductory sessions to support the tool's initial use. Ongoing support was offered through monthly digital meetings involving the research team and the consultant. Participants HPs working in participating care facilities who had experience using MM to care for persons living with dementia were eligible for inclusion. A purposive sampling approach was used, and eligible participants were invited through their facility managers. Participant recruitment and inclusion are summarized in Figure 1. Figure 1. Recruitment and inclusion of participants Data collection The questionnaire was piloted with eight HPs, colleagues of the authors, who volunteered to test it and were experienced in nursing technology, to assess the items' clarity and relevance. As no substantial changes were required, the questionnaire was subsequently distributed to the study sample. Data were collected via paper or web-based questionnaires, according to participant preference, from February to October 2025. The managers at the care settings were asked to distribute the questionnaire to those who use or have previously used MM. Reminder e-mails were sent to the care facilities included in the sample. Digital tool Min Memoria MM is a web-based digital life story tool that enables care recipients, relatives, and HPs to create, update, and share life story information. Users can upload text, pictures, videos, and other multimedia content to document personal experiences, preferences, and important life events. The tool includes functions in the theme areas: Family, life story, memories, album, and guest book. The care recipient decided who had access to MM, when necessary, with support from HPs. The theme area family can include information regarding family members that the care recipient wants to share. In the life story theme, the care recipient’s interests, previous occupations, and life highlights can be evident. It is a place to document what is and has been important for the care recipient. Memories can include a variety of content, such as valuable pictures, music, videos, and text, that can support reminiscing. In the theme album, pictures can be selected, uploaded, and viewed. The guest book serves as a communication platform for the care recipient, their family members, and HPs. The care facility can upload material, and family members with access to MM can do the same. Questionnaire The questionnaire contained 31 items to explore HPs’ perceptions of the usability of a digital life story tool in Swedish care settings and their self-reported use patterns. The questions concerned sociodemographic factors and MM’s usability, including ease of use, functionality, and attitudes, and aimed to gather users' experiences with MM. Items 1–13 were self-designed. The full questionnaire is provided in Appendix 1. The questionnaire also incorporated items from the Theoretical Extension of the Technology Acceptance Model (TAM2) and Technophilia (TechPH) instruments. These items were taken from TAM2 and TechPH and translated into Swedish for the survey. TAM2 was used to guide items related to perceived usefulness, perceived ease of use, and attitudes towards technology use [25]. TechPH-informed items were utilized to address enthusiasm for and anxiety towards technology [26]. These instruments were used to support the interpretation of HPs' perceptions of MM. Sociodemographic characteristics The sociodemographic variables (Items 1-4) included participants' age, gender, education level, and professional role in the care facility. Min Memoria characteristics Items 5-13 in the questionnaire explored how long participants had used MM and how they rated their experience with it. The questions concerned who initiated MM use, which theme areas were most commonly used, when during the day MM was used, and the positive (i.e. improved communication between HPs, the care recipient, and the relatives of the care recipient; use of personal material; getting to know the care recipient; planning activities; onverse about memories; managing anxiety and behavioral symptoms; and feasibility) and negative factors (i.e. time consuming to learn and use the technique; time consuming to update the content; difficulty to integrate MM into work and use it securely) regarding its use. The questionnaire also explored whether the care recipient interacted with the use and whether MM promoted person-centered care. The theoretical extension of the technology acceptance model Items 14–25 assessed technology acceptance using constructs derived from the TAM2. These were assessed using a 7-point Likert scale without modification. The responses were rated on a Likert scale from 1 (strongly disagree) to 7 (strongly agree) [27]. The items were adapted following the measurement scales utilized when TAM2 was developed: intention to use, perceived usefulness, perceived ease of use, subjective norm, voluntariness, image, job relevance, output quality, and result demonstrability [25].The items and Likert scale options were translated into Swedish. Technophilia instrument Items 26-31, which addressed attitudes towards technology (TechPH), were assessed using a 5-point Likert scale without any modifications, as suggested by [26], [27]. The items were adapted following the instrument items used to develop TechPH. The items and Likert scale options were translated into Swedish. The level of enthusiasm or anxiety to try new technology was rated on a scale from 1 (strongly disagree) to 5 (strongly agree). Statistical analysis Descriptive statistics, including frequencies, means, and standard deviations, were used to summarize the data. Missing data were reported in the tables and the results text. The survey data were imported into and analyzed with Jamovi 2.7.12. No formal psychometric evaluation (e.g., Cronbach's alpha) of the translated scales was undertaken because the study was exploratory and the sample size was insufficient to support robust reliability or validity analyses (n = 17). Ethical considerations Before data collection, the study's objective and procedures were presented to the participants in writing and verbally, upon request. No additional consent was obtained for the survey, as completion was voluntary and equivalent to consent. All data were collected anonymously, and no personal identifiable information was recorded. The study was approved by the Swedish Ethical Review Authority (Dnr 2025-02787-02). This study was part of a larger project registered with ClinicalTrials.gov. ID (NCT06337201).

Results:

Results Sociodemographic characteristics In total, 17 Healthcare Professionals (HPs) responded to the questionnaire (see Flow Chart in Figure 1). The response rate was 47.2%. Partial item nonresponse refers to HPs who did not respond to all the questions. Nine of the variables used in the analyses contained missing values, which are reported in text and tables. The descriptive statistics regarding the demographic characteristics are shown in Table 1. The entire sample consisted of women, with a mean age of 40.9 years (SD = 11.3 years), indicating high age variability. About half of the respondents were between 46 and 55 years old (52.9%). The majority had completed secondary school (10/17, 58.8%), and the remaining had received higher education. Assistant nurse was the dominant professional role among respondents, accounting for 64.7% (11/17) of the sample. Table 1. Frequency for the demographic characteristics. All participants (N=17), n (%) Age (years) All participants (N=17), n (%) 18-25 2 (11.8) 26-35 1 (5.9) 36-45 3 (17.7) 46-55 9 (52.9) 56-65 2 (11.8) Gender Women 17 (100.0) Education level Secondary school 10 (58.8) Higher education 7 (41.2) Professional role Assistant nurse 11 (64.7) Nursing assistant/Care assistant 2 (11.8) Other 4 (23.5) Self-reported usage patterns Most respondents reported using Min Memoria (MM) for 7-9 months (6/17, 35.2%) or for over a year (5/17, 29.4%). A majority of respondents (14/15, 93.3%), (two partial item nonresponses) reported that HPs initiated MM use, while only one respondent reported that relatives initiated it. When rating ease of use, 58.8% (10/17) reported that MM was easy to use. The most commonly used themes in MM were the guest book (10/17, 58.8%), the life story (8/17, 47.1%), and memories and albums, each used by 35.3% (6/17) of the respondents. Three of sixteen respondents (18.8%) used MM to talk about family members (one non-respondent). Of the respondents, 87.5% (14/16) reported using MM in the afternoon (one non-respondent). One respondent (6.3%) reported using MM in the morning and one (6,3%) in the evening. Six of sixteen (37.5%) used MM in pre-noon. The reported four favourable positive factors about the utilization of MM at the top tier (one non-respondent) were the option to converse about memories (15/16, 93.8%), getting to know the care recipient (13/16, 81.3%), improved communication between the HPs and the relatives of the care recipient (12/16, 75.0%), and improved communication between the HPs and the care recipient (11/16, 68.8%). 56.3% (9/16) reported ease of using and updating personal material in MM (7/16, 43.8%), and 56.3% (9/16) experienced the ability to plan activities when using MM. Among the respondents, 43.8% (7/16) used MM to manage anxiety and behavioral symptoms. A majority of respondents (one non-respondent) reported that the care recipient interacted when using MM (12/16, 75.0%); the remaining respondents were unsure. 82.4% (14/17) experienced that MM use enabled good care aligned with the care recipient’s wishes and needs. Two respondents were unsure, and only one reported that MM did not provide good care for the care recipient. The descriptive statistics for the distribution of responses on MM usage patterns are shown in Table 2. Table 2. Distribution of responses regarding the use of Min Memoria. All participants (N=17), n (%) How long have you been using Min Memoria? 1-3 months 3 (17.7) 4-6 months 2 (11.8) 7-9 months 6 (35.3) 10-12 months 1 (5.9) >12 months 5 (29.4) How do you rate the use of Min Memoria? 1: difficult 1 (5.9) 3 1 (5.9) 4 5 (29.4) 5: easy 10 (58.8) Who takes the initiative to use Min Memoria? a Healthcare professionals 14 (93.3) Relatives 1 (6.7) Select the areas you use most in Min Memoria. Select a maximum of three. b Family 3 (17.7) Life story 8 (47.1) Memories 6 (35.3) Album 6 (35.3) Guest book 10 (58.8) When do you typically use Min Memoria during the day? Multiple answers are possible. c Morning 1 (6.3) Pre-noon 6 (37.5) Afternoon 14 (87.5) Evening 1 (6.3) Describe positive factors regarding the use of Min Memoria. Multiple answers are possible. d Improved communication between you and the care recipient 11 (68.8) Improved communication between you and the relatives of the care recipient 12 (75.0) Use personal material 9 (56.2) Get to know the care recipient 13 (81.3) Plan activities 9 (56.3) Conversations about memories 15 (93.8) Manage anxiety and behavioral symptoms. 7 (43.8) Easy to use 9 (56.3) Easy to update 7 (43.8) Describe negative factors regarding the use of Min Memoria. Multiple answers are possible. e Takes time to learn the technique 2 (25.0) Takes time to use the technique 4 (50.0) Takes time to update the content 1 (12.5) Difficult to integrate Min Memoria into work 1 (12.5) Difficult to use Min Memoria in a secure way 3 (37.5) Does the care recipient interact when using Min Memoria? f Yes 12 (75.0) I do not know 4 (25.0) Does Min Memoria provide good care (a calm, safe environment; comfort; daily needs met; participation; and self-determination) in line with the care recipient's wishes and needs? Yes 14 (82.4) No 1 (5.9) I do not know 2 (11.8) a: n=15 responding to this item b: Three answers were possible c: Multiple answers were possible. n=16 responding to this item d: Multiple answers were possible. n=16 responding to this item e: Multiple answers were possible. n=8 responding to this item f: n=16 responding to this item Acceptance of and attitudes towards technology Responses to the technology acceptance items are presented in Table 3. Overall, respondents reported a high level of acceptance of MM. Most participants agreed that they would use MM if they had access to it (15/17, 88.2%), found it useful in their work (15/16, 93.8%), and considered it easy to use (13/17, 76.5%). Most also reported that MM improved their work performance (12/17, 70.6%), was important in their work (14/17, 82.4%), and represented a high-quality digital tool (14/17, 82.4%). Furthermore, 82.4% (14/17) reported that they could communicate the consequences of using MM to others. Most respondents (13/17, 76.5%) indicated that their use of MM was voluntary, while opinions regarding social influence were more mixed. More than half of the respondents (8/14, 57.1%) neither agreed nor disagreed that people who influenced their behavior thought they should use MM. Similarly, most respondents disagreed with the statements that MM was merely helpful rather than essential in their work (10/17, 58.8%) or that having MM was a status symbol within their organization (10/17, 58.8%). Table 3. Distribution of responses regarding technology acceptance. All participants (N=17), n (%) If I have access to Min Memoria, I will use it. Somewhat agree 2 (11.8) Agree 4 (23.5) Strongly agree 11 (64.7) Using Min Memoria improves my work performance. Disagree 1 (5.9) Neither agree nor disagree 3 (17.6) Somewhat agree 1 (5.9) Agree 3 (17.6) Strongly agree 9 (52.9) I find Min Memoria useful in my work. a Neither agree nor disagree 1 (6.3) Agree 6 (37.5) Strongly agree 9 (56.3) I find it easy to use Min Memoria. Neither agree nor disagree 2 (11.8) Somewhat agree 2 (11.8) Agree 5 (29.4) Strongly agree 8 (47.1) People who influence my behavior think I should use Min Memoria. b Strongly disagree 1 (7.1) Disagree 1 (7.1) Somewhat disagree 1 (7.1) Neither agree nor disagree 8 (57.1) Somewhat agree 1 (7.1) Agree 1 (7.1) Strongly agree 1 (7.1) My use of Min Memoria is voluntary. Strongly disagree 1 (5.9) Disagree 2 (11.8) Neither agree nor disagree 1 (5.9) Somewhat agree 4 (23.5) Agree 2 (11.8) Strongly agree 7 (41.1) My manager requires me to use Min Memoria. Strongly disagree 5 (29.4) Disagree 2 (11.8) Somewhat disagree 1 (5.9) Neither agree nor disagree 4 (23.5) Agree 3 (17.6) Strongly agree 2 (11.8) Although it may be helpful, Min Memoria is not essential in my work. Strongly disagree 6 (35.3) Disagree 4 (23.5) Somewhat disagree 1 (5.9) Neither agree nor disagree 3 (17.6) Somewhat agree 1 (5.9) Agree 2 (11.8) In my organization, having Min Memoria is a status symbol. Strongly disagree 7 (41.1) Disagree 2 (11.8) Somewhat disagree 1 (5.9) Neither agree nor disagree 4 (23.5) Agree 3 (17.6) In my work, the use of Min Memoria is significant. Disagree 1 (5.9) Somewhat agree 2 (11.8) Agree 3 (17.6) Strongly agree 11 (64.7) It is a high-quality digital tool, Min Memoria. Neither agree nor disagree 2 (11.8) Somewhat agree 1 (5.9) Agree 4 (23.5) Strongly agree 10 (58.8) I feel that I can tell others about the consequences of using Min Memoria. Somewhat agree 3 (17.6) Agree 3 (17.6) Strongly agree 11 (64.7) a: n=16 responding to this item b: n=14 responding to this item Responses related to attitudes towards technology are presented in Table 4. Overall, participants reported positive attitudes towards technology. Most respondents considered technical gadgets enjoyable (13/17, 76.5%) and agreed that technology made their lives easier (12/16, 75.0%). More than half (10/17, 58.8%) disagreed that technological developments occur so rapidly that they are difficult to keep up with. Interest in acquiring the latest technological models or updates was more variable: 35.3% (6/17) expressed interest, and 47.1% (8/17) remained neutral. Despite these generally positive attitudes, some respondents expressed concerns about their ability to use new technologies and indicated a need for additional support in adopting technological innovations. Table 4. Distribution of responses regarding attitudes towards technology. All participants (N=17), n (%) I think technical gadgets are fun. Strongly disagree 2 (11.8) Disagree 1 (5.9) Neither agree nor disagree 1 (5.9) Agree 5 (29.4) Strongly agree 8 (47.1) I sometimes fear I will not be able to use new technological devices. Strongly disagree 7 (41.2) Disagree 1 (5.9) Neither agree nor disagree 2 (11.8) Agree 6 (35.3) Strongly agree 1 (5.9) Using technology makes my life easier .a Disagree 1 (6.3) Neither agree nor disagree 3 (18.8) Agree 8 (50.0) Strongly agree 4 (25.0) Today, technological developments are happening so fast that I find it difficult to keep up. Strongly disagree 5 (29.4) Disagree 5 (29.4) Neither agree nor disagree 3 (17.6) Agree 2 (11.8) Strongly agree 2 (11.8) I am keen to acquire the latest models or updates. Strongly disagree 1 (5.9) Disagree 2 (11.8) Neither agree nor disagree 8 (47.0) Agree 4 (23.5) Strongly agree 2 (11.8) I would have been more willing to try new technological gadgets if I had had more support than I do today. Strongly disagree 2 (11.8) Disagree 3 (17.6) Neither agree nor disagree 5 (29.4) Agree 3 (17.6) Strongly agree 4 (23.5) a: n=16 responding to this item Barriers to usage Regarding negative factors related to MM use (nine non-respondents), 2/8 (25.0%) reported that it took time to learn and use the technique, 4/8 (50.0%) reported difficulties with the secure use of MM, and 3/8 (37.5%) reported difficulties with its secure use. Only 1 of 8 respondents (12.5%) reported that updating the content took time. One respondent (12.5%) reported that integrating MM into the workflow was difficult (see Table 2). 17.6% (3/17) reported that using MM was not voluntary for them, and 29.4% (5/17) agreed or strongly agreed that their manager required them to use MM (see Table 3). Of the respondents, 41.2% (7/17) sometimes feared they would not be able to use new technological devices, yet 47.1% (8/17) disagreed on this statement. 41.2% (7/17) of respondents would have been more willing to try new technological gadgets if they had more support than they do today (see Table 4).

Conclusions:

Conclusions Given the limited sample size and the low response rate to the questionnaire, conclusions should be drawn with caution. Nevertheless, Healthcare Professionals (HPs) reported that Min Memoria (MM) is a digital tool that can support person-centered communication and care. MM was experienced in supporting engagement and workflow, and as a communication platform among HPs, care recipients, and their relatives. MM was reported to support reminiscence with the care recipients and serve as a source of information about them. The findings can guide practice, research, and education by indicating the ease of use and accessibility of utilizing digital life stories as communication tools and for person-centered care. When HPs utilize digital life stories in daily care, it may lead to structured workflows and a better understanding of their tasks. Digital tools can simplify documentation and reporting, reducing the time spent manually keeping relatives up to date and freeing up resources for direct care. Communication and interaction can be enhanced, making it easier to coordinate efforts and share information among colleagues. Visualizing the needs and preferences of persons living with dementia can be enhanced through digital life stories. Feedback from relatives and the care recipient can create a meaningful working environment and enhance job satisfaction. Further large scale studies are warranted to validate and expand upon these results. Clinical Trial: URL: https://clinicaltrials.gov/study/NCT06337201