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Co-design, feasibility and acceptability testing of a digital falls prevention programme (KOKU) for older adults: a mixed methods study
ABSTRACT
Background:
Falls in older adults are common, costly and can lead to serious consequences such as head injuries, hip fractures or death. Progressive strength and balance exercises can reduce falls but may be unavailable, or inaccessible, to older adults. Digital technologies offer the potential to increase access and engagement with falls prevention programmes. Keep-On-Keep-Up (KOKU) is a gamified, self-manageable, falls prevention digital programme with progressive strength and balance exercises. In addition, it includes health literacy games to educate users about modifiable risk factors for falls.
Objective:
The two objectives were to i) develop a person-centred, personalised falls prevention digital programme incorporating gamification (as a behaviour change technique) suitable for independent use by older adults and ii) to conduct a mixed methods feasibility and acceptability study to investigate use of KOKU by older adults in assisted living facilities.
Methods:
Ten focus groups were conducted to co-design KOKU. Older adults (>55 years) were then invited to use KOKU unsupervised, three times a week for six weeks. Data collection included: observations, pre-post assessments, 6-week questionnaires and end of study interviews (study procedures, usability, acceptability, training, support needs). A post-study focus group was also conducted with falls prevention therapists to explore usability of the programme. Statistical tests were applied to quantitative data, and qualitative data was analysed using the Framework approach.
Results:
The co-design focus groups (n=59 older adults, n=10 falls prevention therapists) informed the development of the KOKU prototype. Thirty older adults (mean age = 75 + 9) were recruited from four Assisted Living Facilities within Greater Manchester and one from Nottinghamshire to test the prototype alongside 6 therapists who took part in a post-intervention focus group. The mean System Usability Scale score was 71 (SD + 14). The three main themes reflected Technology Acceptance Model constructs: ease of use (system usability; iPad physical properties; exercise presentation), usefulness (perceived benefits; falls education) and attitude towards and intention to use KOKU (technological barriers; group exercise versus KOKU). No adverse events were reported during the study.
Conclusions:
This study demonstrates that KOKU is a feasible, acceptable and an easy to use falls prevention intervention. It facilitates community dwelling older adults’ ability to access strength and balance exercises at a time and location, that suits them. Further development of the digital programme would help ensure that a range of physical abilities are catered for in future studies, and to sustain long-term interest in the exercise programme.
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