To Örebro University

The proportion of older persons worldwide is growing. With older age, complex health problems may occur and the need for home care increases. To support older persons to maintain health and self-care, innovative ways need to be developed. The aim of the project was to develop and evaluate an interactive app among older persons receiving home care. The project had several phases: i) to define and understand the problem ii) develop the intervention iii) develop and optimise evaluation. Qualitative and quantitative methods were employed. Data were collected through a scoping review, interviews with healthcare experts, older persons and nursing assistants (study I); interviews with older persons (studies II, III); focus groups with homecare nurses (study II). Questionnaires at baseline, end of intervention and 6-month follow-up; with instruments to assess aspects of health, health literacy, self-care, and a study specific question regarding sense of security were used (studies III-IV). Logged data from reported health concerns, alerts, and notes were collected (study IV). Data were analysed using qualitative content analysis (study I), thematic analysis (study II), qualitative content analysis with directed approach (study III) and descriptive and inferential statistics (studies III, IV). Results: Important aspects for health and self-care from the older persons’ perspectives were described as: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care (I). These results were included in the app as questions with self-care advice, graphs and alerts to homecare nurses. The app use was described as an enabler for learning (II). The older persons showed improved communicative and critical health literacy at the 6- month follow-up (IV). They described an increased sense of security (II and III), which decreased at the 6-month follow-up (III). They expressed increased self-confidence (II) and support in self-care, but reported a decrease in self-care ability at the 6-month follow-up (III). App usage was high, with the health concern pain triggering the most alerts (IV). Their aspects of health were unchanged at the three assessments points (IV). In this context using an app may increase older persons’ participation in their care. The results show that for some older persons, an app can be implemented as a tool for support in conventional home care.

AIMS AND OBJECTIVES: To explore the experiences of using an app among older people with home-based health care and their nurses.

BACKGROUND: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed.

DESIGN: Explorative qualitative design.

METHODS: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis.

RESULTS: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement.

CONCLUSIONS: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future.

IMPLICATIONS FOR PRACTICE: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.

AIM AND OBJECTIVES: To acquire knowledge regarding the contents to be implemented in an interactive ICT-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves.

BACKGROUND: The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform (ICT-platform) could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals.

DESIGN: Descriptive qualitative design.

METHODS: This study was based on three samplings: a scoping review of the literature (n=20 articles), interviews with healthcare professionals (n=5), and a secondary analysis of interviews with older persons (n=8) and nursing assistants (n=7). The data were analysed using qualitative content analysis.

RESULTS: Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons.

CONCLUSIONS: The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive ICT-platform for use in regular daily care assessments. Descriptions of self-care was limited indicating a possible gap in knowledge that requires further research.

RELEVANCE TO CLINICAL PRACTICE: Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.

Background: The increasing ageing population puts demands on society and particularly on health care system to promote a health related quality of life. Thus, it is necessary to develop strategies that promote self-care among older adults that enable them to live in their own homes as long as possible and to make them feel safe and involved in their care. In order to encourage their participation in their care, new innovative solutions are needed. The market of information-and communication technology (ICT)-based platforms directed to the health care arena has exploded during recent years. Despite the large range of products few are developed with interactive components. In collaboration within a multicenter research group and a Swedish health care company (Health Navigator) an ICT-platform is developed for use in a mobile phone or tablet that includes an interactive mobile application for reporting problems and concerns. This platform is unique through the real-time communication enabling rapid management of earlydetected problems.

Aim: The aim with the project is to evaluate an ICT-platform by older adults living in own homes with assistance from home care nurses in a community in Sweden.

Method: The study is prospective and has a mixed methods approach advocated for the evaluation of new technologies within healthcare. This includes a quantitative approach to evaluate effects, qualitative methods such as interviews and focus group discussions to evaluate how patients and health care professionals perceive the intervention. The design is underpinned by the Medical Research Council’s complex intervention evaluation framework. Thirty older adults >65 years or above, living in their own homes, with assistance from home care nurses have through an application in a tablet reported health status twice a week and when needed during three months. They have continuous access to evidence based self-care advice directly related to their reported problems and concerns. The risk assessment model sends alarms to involved nurses via text messaging (SMS). This initiates an interaction between the nurse and the older adult who is contacted by telephone to discuss the reported problems. Furthermore, the nurses in charge can also log into a web-interface and view the reports of the participants. Individually interviews with the older adults and focus groups interviews with nurses are conducted after the study period. Questionnaires are given to the older adults before intervention, after the study´s completed and after six months with primarily main outcomes as self-care, health literacy and well-being. A control group with older adults 65 years and above is used as a comparison.

Results: Preliminary results will be presented with focus on feasibility, acceptability and benefit of the ICT-platform from the perspective of older adults and home care nurses. Additional logged data on the frequency of symptom reports, alerts, and page views will also be presented.

Summary: An interactive ICT-platform is developed and used by older adults to report problems and concerns which enabling rapid management of early-detected problems. This study aims to evaluate the ICT-platform by thirty older adults living in own home with assistance from home care nurses.