JMIR Publications

ABSTRACT

Background:

Preventing age-related diseases, such as cardiovascular disease and dementia, is a public health priority. Digital health interventions could be useful in this context, but little is known about how older adults engage with such interventions, especially in the long-term. Furthermore, it is unclear if engagement with digital health interventions is associated with changes in clinical, behavioral or biological outcomes in this age group, as it is in younger adults. Finally, there may be disparities in engagement with digital health interventions amongst older people, which could be associated with health inequalities.

Objective:

To describe the engagement of older adults with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, body mass index (BMI), physical activity, diet, and composite cardiovascular/dementia risk scores).

Methods:

Secondary analysis of the 18-month randomized controlled HATICE trial of an interactive tailored eHealth intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged 65 and older in the Netherlands, Finland and France. Engagement was assessed via login frequency, number of lifestyle goals set/measurements entered/messages sent to coaches, and percentage of education materials read.

Results:

Higher engagement with the eHealth intervention was associated with significantly more improvement in biological and behavioral risk factors, compared to the control group, with evidence of a dose-response effect. For example, compared to the control group, the adjusted mean difference [95% confidence interval (CI)] in 18-month change in the trial’s primary outcome, a composite z-score comprising blood pressure, BMI and cholesterol, was -0.08 [-0.12, -0.03] in the high engagement group, -0.04 [-0.08, 0.00] in the moderate engagement group, and 0.00 [-0.08, 0.08] in the low engagement group. Low engagers showed no improvement in any outcome measures, compared to the control group. Participants who did not report regular computer use before the study (reference group) were much less likely to engage with the intervention than those using a computer up to 7 (adjusted odds ratio (aOR) 5.39 [2.66, 10.95]) or ≥7 hours per week (6.58 [3.21, 13.49)). Those already working on (aOR 2.02 [1.23, 3.25]) or with short-term (aOR 2.25 [1.33, 3.80]) plans for lifestyle improvement at baseline, and with better cognition (aOR 1.67 [1.26, 2.21]), engaged more.

Conclusions:

Greater engagement with an eHealth lifestyle intervention was associated with more improvement in risk factors in older adults. However, those with limited computer experience, who tended to be lower educated, or poorer cognition were less likely to engage. Additional support and/or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. Clinical Trial: ISRCTN48151589