JMIR Publications

ABSTRACT

Background:

Timely detection of stress in people with dementia and people with intellectual disabilities (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care residents with dementia and residents with ID have communication impairments, limiting their abilities to express themselves. Wearables can help detect stress but are not always accepted by users and uncomfortable to wear for longer time periods. Integrating sensors into clothing may be a more acceptable approach for users in long-term care (LTC). To develop a sensor system for early stress detection that is accepted by long-term care residents with dementia and residents with ID, understanding their perceptions and requirements is essential.

Objective:

This study aims to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users towards the sensor system, and (3) investigate the implementation requirements in LTC settings.

Methods:

A qualitative design with 18 focus groups and 29 interviews was employed. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, persons with ID, family caregivers, healthcare professionals). Focus groups were conducted at three time points within a 6-month period, where each new focus group build on the findings of previous rounds. The data from each round was used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data.

Results:

The study included 44 participants who expressed a positive attitude towards the idea of a garment-integrated sensor system but could also identify some potential concerns. Besides early stress detection, participants recognized other potential purposes or benefits for the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as wash-ability and safety and user requirements such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the costs of the sensor system, added value to resident and healthcare professionals, and education for all users.

Conclusions:

The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for healthcare professionals and residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice.