Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 13, 2019
Open Peer Review Period: May 16, 2019 - Jul 11, 2019
Date Accepted: Sep 28, 2019
(closed for review but you can still tweet)
A tablet app supporting self-management of people with dementia: Analysis of adoption and use patterns
ABSTRACT
Background:
Assistive technology (AT) is fast emerging within dementia care and support. One area of application is AT to support people with dementia in compensating for cognitive symptoms and thereby promote their self-management. There is, however, generally little evidence for the applicability, usability and effectiveness of AT for people with dementia and a need to identify factors that can promote adoption.
Objective:
The aims of this study were (1) to evaluate the applicability and usability of an app, tailormade for people with dementia, (2) to explore factors affecting adoption, (3) to explore the possible influence of caregiver involvement and (4) contribute to process evaluation of the intervention.
Methods:
The ReACT app had been designed as a holistic solution to support memory and structure in daily living. The person with dementia had access to a personal user-account and family caregivers were given a parallel login. Written and online materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use-patterns, including background and disease-related data, qualitative data from a survey and log data. Adoption was defined as use of the app over a period of 90 or more days.
Results:
Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595 P=0.046, r=.19) and caregiver having activated the app (p=.02; FET) had a significant impact on participant adoption status. Logistic regression analysis showed that if caregivers had activated the app the participant was 5 times more likely to become an adoptor (OR 5.1; 95% CI 1.29-19.99; P=.02). The overall predictive power was however low and there was quite wide variation in background and disease-related characteristics among adoptors. Level of experience and skills in tablet-use were not significantly different between adoptors and non-adoptors. Adoptors generally rated the app high on usefulness, satisfaction, and ease of using (rated on the USEdem questionnaire). Their scores were significantly higher compared to non-adoptors (U=5.5 P=0.02, r=.64). Analysis of use-patterns showed that all functionalities of the app were used among adoptors.
Conclusions:
For those participants who became adopters the ReACT app and the methods for self-applied implementation were applicable. Results were, however, also in accordance with the well-known challenges of non-adoption and non-adherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.