JMIR Publications

ABSTRACT

Background:

Remote healthcare delivery, including the use of digital health interventions, has emerged as an effective tool for managing health outcomes, but its design and implementation often overlook the needs and preferences of end-users.

Objective:

The primary aim of this modified Delphi process was to develop consumer consensus on preferences for remote assessment and management of physical function in older adults.

Methods:

Research and consumer experts of the RAMP Working Group co-developed the Round 1 Delphi survey which was advertised to consumers (adults aged ≥60 years) via international clinical and research networks, and social media, between August and November 2023. The online survey presented 23 Delphi statements for which respondents reported their level of agreement using an 11-point Likert scale (0-10; scores ≥7 indicated agreement). Statements were classified as having “strong agreement” and achieving consensus if ≥80% of participants indicated agreement. Statements classified as having “moderate” (70-80% of participants indicated agreement) or “low” (<70% of participants responded indicated agreement) agreement were revised or rejected. Revised statements were presented to participants in Round 2 (January to February 2024) and the final consensus statements were consolidated into recommendations.

Results:

A total of 654 consumers (75.7% female) with a mean (SD) age 69.0 (6.0) years from 15 countries (five continents) were included in analyses in Round 1. Of 23 statements, 13 achieved consensus, with the strongest agreement observed for statements relating to the importance of physical function for quality of life and performing activities of daily living (6 statements; agreement 97.6-99.5%). Two statements regarding privacy and security concerns when using technology (agreement 20.8%) and inability to perform physical function assessments or exercise in the home (agreement 15.5%) were rejected with low agreement. The remaining eight statements (agreement 49.5-79.5%) were modified into seven new statements for the Round 2 survey, which was completed by 526 (80.4%) of respondents from Round 1. Five of seven Round 2 statements were accepted with strong agreement (agreement 80.0-82.7%), including the importance of addressing personal preferences for self- versus clinician-led remote interventions, group versus individual exercise, and availability of necessary resources (e.g. technology and exercise equipment).

Conclusions:

Eighteen statements achieved consensus and were translated into seven recommendations highlighting that older adults recognise physical function as a health priority, would value more information about it, and are willing to participate in remote assessment and management interventions (including via digital health) to maintain or improve it. These recommendations also reinforce that interventions should be easily accessible and meet individual preferences of consumers.