JMIR Publications

ABSTRACT

Background:

In the United States, nearly 80% of dementia family caregivers have at least one chronic condition. Dementia caregivers experience high stress and burden, which trigger poor health outcomes and adversely impact their self-management. mHealth applications (apps) can improve outcomes and self-management among dementia caregivers with chronic conditions. However, caregivers’ adoption of mHealth apps is low and the reasons why are not well understood.

Objective:

To explore factors associated with caregivers’ intention to adopt mHealth apps for their chronic disease self-management.

Methods:

We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers using online and community-based methods. We created the survey using validated instruments and collected data with a combination of computer-assisted telephone interviews and online surveys. Before the COVID19 pandemic, we mainly recruited caregivers through community-based strategies, including attending community events and receiving referrals from local memory clinics. Following nationwide closures due to the pandemic, the team focused on online recruitment. Multiple logistic regression was used to test relationships between independent and dependent variables.

Results:

A total of 117 caregivers completed the survey. Our sample had an average age of 53 years (standard deviation [SD]: 17.4), education of 16 years (SD: 3.3), and multimorbidity of 4 chronic conditions (SD: 2.5). Caregivers were predominantly female (79%) and minorities (54%); experienced somewhat to extreme difficulties managing income (55%); and were the child/child-in-law (45%), spouse (19%), or grandchild (19%) of the person with dementia. In the final multiple logistic regression model, perceived usefulness was the strongest predictor (odds ratio [OR]: 23, 95% confidence interval [CI]: 5.6–97) and explained the most variance (52%) of caregivers’ intention to adopt mHealth apps for their self-management. The interaction effect of caregivers’ education and burden of chronic disease and treatment on their intention to adopt mHealth apps was also significant (OR: 31, 95% CI: 2.2–430). Perceived ease of use (OR: 2.4, 95% CI: 0.67–8.7) and social influence (OR: 1.8, 95% CI: 0.58–5.7) were not significantly associated with caregivers’ intention to adopt mHealth apps.

Conclusions:

When designing mHealth app interventions for dementia caregivers with chronic conditions, it is important to consider caregivers’ perceptions about how well an mHealth app will help them self-manage chronic conditions and which mHealth app features are most useful for their self-management. Caregiving factors (e.g., burden and time spent caregiving weekly) do not appear to be relevant to caregivers’ intention to adopt mHealth apps. This is a promising finding, as mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate mechanisms for why caregivers with low education and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management than caregivers with high education and high burden of chronic disease and treatment.