Read and accepted? Scoping the cognitive accessibility of privacy policies of health apps and websites in three European countries.

Objective: Trust and accessibility are vital to adoption of health and wellness apps. This research scoped three elements of cognitive accessibility of health app privacy policies: availability, ease of navigation, and readability. Methods: For this cross-sectional study, quantitative data collected in the Netherlands, Sweden, and the United Kingdom included: whether privacy information was in a country's official language (availability); number of distracting visual elements (ease of navigation); word count and Common European Framework of Reference (CEFR) reading level (readability). Health app privacy policies were compared to policies from a purposively selected sample of websites, and to benchmarks, including CEFR reading level B1. Results: Health app privacy policies were less often available in countries' official languages compared to sampled websites (Chi-Square [1, 180] = 57.470, p < 0.001) but contained fewer distracting visual elements. More UK privacy policies were in the country's official language, whereas Swedish privacy policies contained fewest words and fewest potentially distracting design elements. Only one privacy policy met the CEFR reading level benchmark. Conclusions: Lack of privacy information in non-Anglophone app-users' native languages and high reading levels may be major barriers to cognitive accessibility. Web and app developers should consider recommendations arising from this study, to stimulate trust in and adoption of health and wellness apps.

Implementing Accessibility Settings in Touchscreen Apps for People Living with Dementia.

BACKGROUND: Accessibility options within apps can enable customisation and improve usability. The consideration of accessibility for people living with dementia has not been explored but is necessary to prevent a "digital divide" in our society. This study set out to examine whether the introduction of accessibility settings for people with dementia in two mainstream gaming apps (Solitaire and Bubble Explode) could improve the user experience. OBJECTIVES: To evaluate the effectiveness of tailored accessibility settings for people living with dementia by comparing the gameplay experience with and without the settings and measure the impact on their ability to initiate gameplay, play independently and experience enjoyment. METHODS: Thirty participants were recruited to test one of the two apps that had been adapted to include accessibility features. These features were derived from an analysis of gameplay in a previous study, from which the design of the present study was replicated. The results were compared with those from the earlier study (i.e., pre-adapted apps). RESULTS: The accessibility features significantly improved usability in Solitaire, which had been the more problematic of the two apps when evaluated in its pre-adapted form. Bubble Explode retained the high level of usability without further improvements. Initiation of gameplay was significantly improved in the adapted version of Solitaire, with no significant differences to progression or enjoyment for either app. CONCLUSIONS: This study represents the first implementation of accessibility settings for dementia in mainstream apps, whilst demonstrating the feasibility and positive impact of the approach. The findings reveal core principles of touchscreen interaction and design for dementia that can inform future app development.

Comparing Recent Reviews About Touchscreens for Dementia with Lessons Learnt from the Field.

Conclusions were synthesised from recent reviews on (touchscreen)technologies and people with dementia and lessons learnt, using these devices in projects in the UK, the Netherlands and Canada. The combined findings provide a strong basis for defining new strategies for exploiting touchscreen technology for people with dementia.

Involving Users in the Evaluation of Apps for Specific Health Conditions.

With rapid growth of Internet accessibility over recent years, the way in which we engage with healthcare services and make decisions about our own healthcare has changed. One form of engagement with the Internet is through the use of mobile applications (apps) via mobile devices such as smartphones and tablets. As a result of this, many apps have been developed to target people with varying long term conditions. These apps may aim to help educate individuals about their condition or help them to manage it. Assessing the quality of these apps is crucial especially when considering the risks associated with providing misleading information or unsubstantiated claims. This has led to a growing body of research assessing the quality of apps aimed at people living with varying long term conditions. These attempts have not involved service users to address the suitability of apps for their intended target audiences. This paper presents two examples of how service users and associated healthcare professionals can be involved in the suitability assessment of mobile apps for children and young people with Attention Deficit Hyperactivity Disorder and those living with dementia.

Does familiarity affect the enjoyment of touchscreen games for people with dementia?

INTRODUCTION: Previous research has indicated that people living with dementia are able to use touchscreen technology, which presents an opportunity to deliver meaningful and engaging activities for people to pass the time independently. The challenge is to identify suitable applications from the thousands that are currently available, and familiarity, where an app is a digital version of an existing real world game, may be one solution. OBJECTIVES: To evaluate the concept of familiarity in gameplay with people living with dementia by comparing a known game with a novel game and measuring whether users are able to play these games independently and whether they enjoy doing so. METHODS: Thirty older adults living with dementia were recruited from local care services. Each participant was assigned to one of two groups. Group 1 played a familiar game (Solitaire) and Group 2 played a novel game (Bubble Xplode). Each participant played the same game on three separate occasions within one week. Number of gameplay attempts, whether a checkpoint was reached and how much time to reach the checkpoint were measured. A brief post-session interview was conducted to assess the participants' enjoyment. RESULTS: Ninety percent of participants attempted gameplay independently with 17% of participants in the familiar group reaching the checkpoint compared with 93% playing the novel game. Regardless of which game was played or whether the checkpoint was reached, 88% of all participants reported enjoyment of the gaming sessions. DISCUSSION: People living with dementia can play touchscreen games independently, but familiarity does not ensure successful gameplay. Enjoyment appears to be independent of progression through a game. The potential of novel and unfamiliar games as meaningful activities that people with dementia can engage with independently should be further explored.

Studies Involving People With Dementia and Touchscreen Technology: A Literature Review.

BACKGROUND: Devices using touchscreen interfaces such as tablets and smartphones have been highlighted as potentially suitable for people with dementia due to their intuitive and simple control method. This population experience a lack of meaningful, engaging activities, yet the potential use of the touchscreen format to address this issue has not been fully realized. OBJECTIVE: To identify and synthesize the existing body of literature involving the use of touchscreen technology and people with dementia in order to guide future research in this area. METHODS: A systematized review of studies in the English language was conducted, where a touchscreen interface was used with human participants with dementia. RESULTS: A total of 45 articles met the inclusion criteria. Four questions were addressed concerning (1) the context of use, (2) reasons behind the selection of the technology, (3) details of the hardware and software, and (4) whether independent use by people with dementia was evidenced. CONCLUSIONS: This review presents an emerging body of evidence demonstrating that people with dementia are able to independently use touchscreen technology. The intuitive control method and adaptability of modern devices has driven the selection of this technology in studies. However, its primary use to date has been as a method to deliver assessments and screening tests or to provide an assistive function or cognitive rehabilitation. Building on the finding that people with dementia are able to use touchscreen technology and which design features facilitate this, more use could be made to deliver independent activities for meaningful occupation, entertainment, and fun.

Applying guidelines for evaluating digital technologies for people living with dementia: A case study.

Affordable solutions are needed to offer the growing population of people diagnosed with dementia support to maintain independence. Assistive technology has the potential to address this issue but devices should be tailored to the needs of this population. Previous work has focused on the design of such technologies and in new work evaluation (trial) guidelines are proposed to offer consistency amongst researchers looking to test completed products with intended users. The guidelines are implemented as trial protocol guidance and are applied to an existing protocol as a case example of how the guidelines could be used. Differences between the protocol and the guidelines are highlighted and provide evidence as to the potential usefulness of the document in informing an evaluation. The need for further development of the guidelines is also discussed and the authors state their intention to collaborate internationally in order to evolve the framework to the stage where it can be published as an accessible resource.