Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Nov 02, 2022)
Date Submitted: Oct 21, 2022
Open Peer Review Period: Oct 21, 2022 - Nov 2, 2022
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Usability and Feasibility of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Prospective Pilot study
ABSTRACT
Background:
For older adults (≥70 years), maintaining newly acquired nutrition and physical activity behaviors after rehabilitation to minimize the risk for negative health consequences is often challenging. To support this vulnerable target group, an e-coach could be helpful. Aligning the program with an established concept such as the Transtheoretical Model of Behavior Change (TTM) and professional guidance should optimize behavior change.
Objective:
The usability and feasibility of a nutrition and mobility e-health intervention, accompanied by corresponding healthcare professionals, during and after rehabilitation for a period of 9 weeks was evaluated. In addition, the change in the TTM phase of the participants was assessed as an indicator of the participants' readiness to change or changes implemented.
Methods:
Rehabilitation patients (≥70 years) with nutrition and or physical activity deficits were recruited. Their phases of behavior change in TTM were determined by comparison with age-specific nutrition and physical activity recommendations and a tablet with the correspondingly configured e-coach was provided. Participants used the e-coach during and after rehabilitation and received regular support from the experts. The TTM phases were assessed at four time points (t0-t4) and the available e-coach content was adjusted accordingly. At the end of the study, usability was assessed using the System Usability Scale (SUS). To assess practicability, timestamps in the e-coach were used to evaluate on how many days the participants used the program, classified into three categories: high (e-coach used on <67% of the days), medium (e-coach used on 66-33% of the days), and low (e-coach used on <33% of the days). The acceptance of the e-coach was assessed by using a self-developed questionnaire on the relevance of the content, use of the e-coach in everyday life and ease of use of the e-coach.
Results:
In total, data from 21 participants (38% female, mean age 79.0 ± 6.0 years) were included in the data analysis. The SUS was 78.6 points and 11 participants (42%) were classified as high users, 6 (39%) as medium users and 4 (19%) as low users. In the subjective evaluation, the usefulness of the information in daily life (76%, n=16), the handling (76%, n=16) and the general satisfaction with the app (81%, n=17) were evaluated especially positive. Need for optimization was identified in finding specific content. After nine weeks, 15 participants (71%) achieved the physical activity recommendations (t0: 33%, n=7) and 14 (66%) achieved the nutrition recommendations (t0: 24%, n=5), thus reaching the highest TTM phases in each area.
Conclusions:
The e-coach seems to be usable and feasible for the target group. With our study we could also identify some optimization potentials for our application, which can also be transferred to the development of comparable e-health interventions with the group of vulnerable older adults. Clinical Trial: DRKS00024481
Citation
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