JMIR Publications

ABSTRACT

Background:

The Canadian government and its provincial counterparts consider home care a top priority, and home care services are looking for ways of optimizing their limited human and financial resources to offer the right services, at the right time. Telemonitoring of activities of daily living (ADL) holds great promise for better understanding the home care needs of older adults with cognitive decline, especially those who live alone. Therefore, it could support the delivery of better-targeted services for this population.

Objective:

This article presents the research protocol of the SAPA project, designed to document the potential of ADL telemonitoring as a support tool for home care clinicians working with older adults within the Canadian public healthcare system. The project’s three main objectives were to: (1) Co-develop an ADL telemonitoring system that meets the requirements of key stakeholders; (2) Implement the system and identify specific use cases; (3) Identify factors that could promote its long-term use in a real-world setting.

Methods:

An action design research (ADR) project was conducted. It consisted of a four-stage research process including 1) problem formulation; 2) building, intervention, and evaluation in the real context of home care services; 3) reflection and learning; and 4) formalization of learning. This project consisted of two cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system of ADL. Stakeholders were included in each co-development cycle, among them healthcare managers, clinicians, older adults and their family. Qualitative and quantitative data were collected throughout the project.

Results:

A first iterative cycle, the alpha cycle, took place from early-2016 to mid-2018. A first prototype of an ADL telemonitoring system was deployed in the homes of four care recipients receiving home care services through one public health institution. The prototype was used to collect data about the care recipients’ ADL routine. The data were used by clinicians to support their home care intervention plan and results are presented here. The prototype was successfully implemented and perceived as useful, although obstacles were encountered. Likewise, a second co-development cycle (beta cycle) took place in three public health institutions from late-2018 to late-2022. The telemonitoring system was installed in 31 care recipients’ homes and detailed results will be presented in future papers.

Conclusions:

To the best of our knowledge, this is the first reported ADR project in ADL telemonitoring research including two iterative cycles of co-development and implementation embedded in real-world clinical settings of a public health system. The SAPA project will provide extensive documentation of use cases and factors that either facilitate or restrict the implementation of an ADL telemonitoring system.