Feature ArticleEvaluating the older adult experience of a web-based, tablet-delivered heart failure self-care program using gerontechnology principles
Introduction
Geriatric nurses are increasingly confronted with both patient use of mHealth technology such as web portals and hand held devices as well as patient feedback on difficulties experienced with this technology. While the National Health and Aging Trends Study found that 40% of Medicare beneficiaries used e-mail or text messaging and almost 43% used the internet, many patients experience difficulties related to ease of use or familiarity with certain types of technology.1 Gerontechnology brings together two separate fields of study – demography and technology – with the stated goal of developing technology that facilitates goal attainment and improves life satisfaction for older adults.2 Using gerontechnology principles to develop new mHealth technology should result in fewer difficulties for older adults using new technology.
Over 5 million people in the United States have heart failure (HF), the majority of which are older adults.3 Advances in mechanical circulatory support devices and treatment regimens continue to increase the likelihood that individuals who are hospitalized with HF will recover sufficiently to be discharged home.4 However, more than 25% of these individuals will be re-hospitalized within 30 days5 and 50% will be readmitted within the first six months after discharge.4, 6 Many of these unplanned readmissions are related to failures in self-care regimens at home.6, 7 mHealth technology offers new approaches to improve individuals' self-care through self-tracking and increasing patient empowerment in cost effective ways.8 Our team is engaged in developing technology to improve self-care which hopefully will allow older adults with HF to be safely managed in the community.
Current HF technology studies have identified significant problems with effectiveness and broad implementation9, 10 suggesting the need for older adults to participate with technology designers earlier in the testing phase. However, to date, there has been relatively little report of participant feedback, on the technology itself, early in HF mHealth technology trials. When interviews have been conducted, participants have been asked about satisfaction with the technology or care delivery,11, 12 rather than being more broadly assessed to provide meaningful and specific feedback early in the development phase on their experience of the technology as currently designed and what changes they would like to see in the technology before future use. The purpose of this paper was to fill this gap by presenting the qualitative analysis of participant post-intervention interviews with older adults from the tablet-delivered Penn State Heart Assistant (PSHA) mHealth intervention using a gerontechnology interpretive lens. A gerontechnology interpretive lens involves the examination of the text for statements related to goal attainment or life satisfaction.
Section snippets
Design
A proof of concept trial involving the PSHA was conducted with 12 older adults to assess participants' experience and response to the technology, as well as elicit suggestions for improvement. The quantitative data is reported elsewhere.13 All participants were interviewed at the end of a 30 day trial with the PSHA.
Participants
Participants were recruited from a large, academic medical center in the mid-Atlantic region of the United States after Institutional Review Board approval of the protocol. Inclusion
Results
The average participant was a 65 year old married, college educated male (Table 1). Six of the nine participants who provided information about their technical ability stated that they were familiar with the tablet or technically literate.
Analysis of the narratives resulted in two themes arising: theme 1: Benefits from current use which included the sub-themes – information sharing with others, usability and learnability, use of help resources; and theme 2: Suggestions for future use included
Acknowledgements
The team acknowledges the instrument help provided by Eric Balaban, BS, John Chan, BS, Penn State medical students, as research assistants and interventionists on this project.
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Conflict of Interest: none.
Funding: Department of Public Health Sciences and Department of Medicine, Penn State College of Medicine, Hershey, PA.
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