JMIR Publications

ABSTRACT

Background:

Addressing loneliness is a public health priority, with a growth in technological solutions aiming to mitigate loneliness. However, engaging older people in technological development is limited.

Objective:

This paper describes the proof-of-concept pilot of a new wearable device, the Conversation as Therapy (CaT) Pin, that aimed to establish whether a relationship exists between loneliness and time spent in conversation for older adults.

Methods:

In Phase 1, a one-hour discussion with a Community Advisory Group provided input on study processes and procedures. Subsequently, a subset of older participants tested processes and prototype CaTPin device for one week, with acceptability, feasibility, validity and reliability assessed through interviews. In Phase 2, participants aged ≥65 years living alone, experiencing loneliness or not, trialed the device for two weeks. Participants documented feelings of loneliness, device wear, activity engagement, and conversations in activity logs, in six-hourly intervals. Time spent in conversation was captured by the CaTPin, with thematic analysis of post-trial interviews.

Results:

Phase 1 discussion (n=6) and prototype test (n=3) identified key device design issues and shaped data collection content, resulting in adjustments. Phase 2 involved 23 participants (15 female, mean age 72 ±6.8 years), 7 lonely (according to the UCLA-3). Too few participants concurrently wore the device and collected activity data (n=8, 35%), preventing ascertainment of a relationship between conversation time (CaTPin capture), and experiencing loneliness (activity log capture). Device functionality and design hampered participants integrating the device into their lifestyle during the pilot, despite initial modifications. Although participants considered the concept of timely identification of loneliness using a device positively for others, it was not perceived as useful for themselves; mainly due to a perceived lack of need (either not being lonely or having sufficient existing support) or desire (related to the appeal or functionality of device).

Conclusions:

Use of novel technology can likely enhance the lives of older people: however, the concept of technology cannot be separated from device usability. Capturing data for hypothesis testing needs considerable planning and education, including all stakeholders (biomedical engineers, clinical researchers and participants), to ensure device data captured aligns with validated measures or other forms of data (here, in our case the activity logs). Further, an appealing prototype that functions effectively is essential. Loneliness is a multifaceted concept, occurring due to factors at individual, interpersonal, community and societal levels. Further investigation is needed around the complexity of loneliness and how older community members understand the concept; as well as the role of stigma. Once understanding improves, effective methods for real-time identification and interventions to contribute to mitigating and reducing loneliness can be developed, that consider the array of factors that play a role in its development, with technology being one component.