Materials: Paper dairies - Pen and paper checklist of daily self-care behaviors. HealthCare Manager (HCM) – Touch screen software developed by AbleLink Technologies used to deliver self-care reminders and questionnaires electronically in participants home. Routines for morning, afternoon, evening served as both a prompt to engage in a self-care behavior and a reminder to record the action in an electronic diary; the HCM’s design required participants to record actions to continue to the next prompt. • Self-care behaviors included: • On-demand videos featuring guided relaxation, humorous pets and laughing babies were available for participants to use. Method and Procedure Frail seniors receiving home health care may benefit from prompting to help complete daily health care tasks when home health aides are not present in the home. Technology-based prompting may be one answer to providing personalized prompts to complete and track home health care tasks. The present study compared a paper-based tracking system with a novel technology-based prompting system using an ABAB design. Equivalent ratings across all conditions suggest that the technology system was viewed as equivalently easy to use as the paper tacking system (Ms above 4.5). Ratings of usefulness were somewhat lower (Ms ranged from 3.6 to 4) but equivalent for technology and paper systems. A non-significant 2 (time) x2 (paper, technology) ANOVA validates the statistical equivalence across conditions. Ratings of usefulness for both paper-based and technology-based prompting were highly variable (range: 1-5) orienting future research to discover which types of home health patients find technology- based prompting useful and how it can inform clinicians’ treatment and support for seniors living alone. • Pen and paper diaries are burdensome, requiring a person to actively remember to record behaviors (Bloger, Davis, Rafael, 2003), which results in high rates of retrospective reporting (Stone, Shiffman, Schwartz, Broderickm, & Hufford, 2002) which can often be inaccurate. • Electronic diaries and computerized programs, such as the HCM, offer simple tailoring for individuals, increasing engagement (Vires & Brug, 1999) while also increasing in-the-moment reporting and reducing burden via visual and auditory reminders (Bolger, Davis, & Rafael, 2003). • Computerized systems to prompt behavior are now being developed and used but relatively little is known about their impact on the desired behavior or their acceptability/usability by frail older adults. Abstract • Sleep • Exercise • Relaxation • Meals • Outdoor activity • Distress Tolerance • Medication Compliance • Mood • Positive Thinking • Hydration • Mindful Awareness • Custom behaviors Acceptance of Mobile Wellness Technology in a Frail Senior Home Health Population J. D. Gentry 1 , C.E. Sutton 1 , M. A. Doffing 1 , S. H. Qualls 1 , D. K. Davies 2 , & S. Stock 2 1 University of Colorado Colorado Springs, Gerontology Center 2 AbleLink Technologies *Developed using language from Developed from language suggested by Lorig, K., Stewart, A., Ritter, P., González, V., Laurent, D., & Lynch, J. (1996) This research is funded by National Institute of Health grant #2R44AG034726-02 Selected References Stone A.A., Shiffman S., Schwartz J.E., Broderick J.E., & Hufford M.R. (2002). Patient non-compliance with paper diaries. BMJ, 324, 1193-1194. http://dx.doi.org/10.1136/bmj.324.7347.1193 Bolger N., Davis A., & Rafaeli E (2003). Diary methods: Capturing life as it is Lived. Annual Review of Psychology, 54, 579–616 doi: 10.1146/ annurev.psych.54.101601.145030 de Vries H., & Brug J (1999). Computer-tailored interventions motivating people to adopt health promoting behaviours: Introduction to a new approach. Patient Education and Counseling, 36, 99–105 Lorig, K., Stewart, A., Ritter, P., González, V., Laurent, D., & Lynch, J. (1996). Outcome measures for health education and other health care interventions. Thousand Oaks, CA: SAGE Publications, Inc. doi: http://dx.doi.org/10.4135/9781452232966 • Cognitive ability and HCM use. • Rate of compliance with and without the HCM. • Clinical value of the HCM. • Measures of mood when using the HCM. • Larger sample trends and differences. Discussion Do seniors accept mobile computer methods in the home to prompt and report their health and self-care? Yes The highly rated ease of use, usefulness, and desire to continue using for both systems indicates the older adults find technology just as usable as paper when used to track self-care activities. Touch screen mobile technology and tailored questionnaires with both visual and auditory prompting is a method that older adults find usable and acceptable. Knowing this, technology creators and health care workers should develop and research effective and relevant information to collect from older adults. Knowing this, development and research should also focus on how this technology can be used for tailored interactive health promotion. This type of technology has the capacity for both assessment and intervention. Using this type of technology to track home health care activity in the absence of a caregiver could support clinician's understanding of a client and inform planning for the types of support and frequency of support an older adult might need. As an intervention, this technology could be used to support older adults with cognitive impairment or a poor history of self care by prompting and tracking their self-care activity to support caregiver and family supervision. Future directions should/will examine: Table 1. Acceptability and Usability of Prompting by Phase Perception Ratings Baseline (0) n = 20 Paper I (A1) n = 19 Technology I (B1) n = 19 Paper 2 (A2) n = 18 Technology 2 (B2) n = 17 M SD M SD M SD M SD M SD Ease of Use 4.61 .50 4.68 .58 4.72 .58 4.65 .79 Usefulness 3.89 1.41 3.89 1.33 3.61 1.58 3.53 1.55 Desire to Continue Using 3.74 1.15 3.63 1.34 3.39 1.42 3.59 1.23 Results Ease of Use, Usefulness, and Desire to Continue using were rated highly across all phases. See Figure 1. Equivalent ratings across all conditions suggest that the technology system was viewed as equivalently easy to use as the paper system (Ms > 4.5). Ratings of usefulness were somewhat lower but equivalent for technology and paper systems. A non-significant 2 (time) x2 (paper, technology) ANOVA validates the statistical equivalence across conditions, F (4, 200) = .83, p = . 67. See table 1 for details of acceptability and usability variables across phases. Recruitment: Twenty participants were recruited from two local home health agencies that serve older adults. Participants were nominated by agency clinicians for their need for prompting and cueing for completion of self-care behaviors. Eighteen (90%) participants completed all phases of the trial. Measures: Participant questionnaires were completed through structured interviews. Questions addressed health, confidence in health management, and acceptability/usability with both data collection systems (paper and HCM); Measures (except demographics) were all likert-type self-reported ratings with 3 response options or 5 response options. Procedure: The paper and technology systems were implemented using an ABAB design. Data was collected at participant's homes at baseline and the completion of each phase. Each phase lasted seven to fourteen days. Participants were compensated with a $5 gift card after the completion of each phase and a $10 gift card at the completion of the study. The figure below represents the data collection and intervention process. Data Collec*on Data Collec*on Data Collec*on Data Collec*on Data Collec*on HCM HCM Withdrawal Method and Procedure (cont’d) 4.61 3.89 3.74 4.68 3.89 3.63 4.72 3.61 3.39 4.65 3.53 3.59 1 2 3 4 5 Ease of Use Usefulness Desire to Con*nue Using Figure 1. Usability of technology diary compared to paper diary Paper I (A1) Technology I (B1) Paper 2 (A2) Technology 2 (B2)