JMIR Publications

ABSTRACT

Background:

Smart home health technology is a popular research area with vast amounts of investigative literature. While there are myriads of reviews on home health technology for specific diseases, there is a need to summarize the effectiveness of monitoring across health domains. In addition, the available frameworks for maximizing acceptability of health monitoring technologies are important to summarize for long-term monitoring studies.

Objective:

This scoping review of systematic reviews aims to summarize the clinical evidence on home-based health monitoring. The paper outlines ethical and user concerns and discusses the challenges of the current user-oriented conceptual frameworks in the literature.

Methods:

This review included two searches. First, a scoping search of systematic reviews was conducted in Scopus, MEDLINE, EMBASE and CINAHL. Reviews that examined the effectiveness of home-based health monitoring for older adults were included. Studies that focused on mobile phones, telephone or video interventions, virtual reality and robots were excluded because our focus was on automated sensing technologies with clinician intervention. Health monitoring themes were generated, and the evidence was summarized as positive, inconclusive, or negative. A second search including both systematic reviews and original articles was conducted to find ethical concerns and user-centred frameworks for smart home technology with the search halted after saturation in the basic themes being presented.

Results:

The first section of this scoping review on clinical effectiveness of home health monitoring found 822 systematic reviews with 96 being extracted. Monitoring was effective for reducing health utilization in acute exacerbations of disease (16/23 reviews), reducing exacerbations or mortality (17/24 studies), managing diabetes via reduction in HbA1c (6/10 reviews), and increasing physical activity in older adults (10/11 reviews). The effectiveness of long-term monitoring of older adults remains unknown. The second section on ethical and user-centred frameworks found 19 papers focused on ethical concerns, with privacy (n=12), autonomy (n=12) and control (n=10) being most common and the idea of trade-offs considered a potential solution. An additional seven user-centred frameworks were studied, which help identify the needs and concerns that stakeholders have with the technology and guide the development of technology that is readily acceptable.

Conclusions:

There is positive evidence that smart home health monitoring can improve health outcomes in heart failure, COPD, diabetes and increase physical activity. However, long-term monitoring of older adults needs more clinical evidence for its usage. The concept of trade-offs between technology providing outcomes and user acceptability is critical to consider in long-term monitoring Older adults have a hierarchy of concerns and may be willing to “trade-off” one concern if another is maintained. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness from clinicians, policy makers, and end users.