Expert appraisal and prioritization of barriers to mHealth use for older adults living with Alzheimer's disease and related Dementias: A Delphi study.

INTRODUCTION: Older adults living with Alzheimer's disease and related dementias (ADRD) can benefit from mHealth innovations in (daily) care. However, successful implementation and adoption of such innovations can be hindered by a lack of inclusive design. Inclusive design can be challenging, due to the variety of ADRD- and aging-related symptoms that can pose barriers to using mHealth. Previously, a literature-based model with 53 barriers to mHealth use for this population has been developed ("MHealth for OLder adults living with DEMentia - USability" or MOLDEM-US). In this study, we aim to prioritize these through a Delphi study with ADRD experts (case managers, informal caregivers, hospital healthcare professionals, district nurses, and researchers). METHODS: In the first round, participant characteristics and potentially new insights into barriers to mHealth use for older adults living with ADRD were gathered. The consensus questionnaire was submitted in the second round, containing barriers to mHealth use for this population (from MOLDEM-US) with questions inquiring its impact and frequency. In the third round, participants rejudged those barriers for which no consensus (<51 %) or minor consensus (51 % - 60 %) was reached. RESULTS: Thirty-seven participants completed the three rounds of the study. Consensus was reached for eleven barriers after the second round, all having major impact and frequency: integration of functions during daily activities, perceived complexity, efficiency in seeing benefits, trust in own ability, restlessness and agitation, computer literacy, self confidence in using wearables, learnability, working memory, and visual acuity. CONCLUSION: After round three, consensus was achieved for all 53 barriers. Twenty-six barriers are considered to majorly affect mHealth use, most of which relate to cognition and frame of mind. This study contributes to the development of mHealth design guidelines that take into account the progressive and diverse ADRD- and aging-related symptoms negatively affecting mHealth implementation and adoption.

Dementia-Related Barriers to mHealth Use: Validation by Expert Opinion.

mHealth use for people with dementia is fraught with factors influencing its implementation in care and daily life. A better understanding of these factors may provide guidelines to inclusive design. This study aimed to assess whether factors gathered in a literature-based model could be validated by opinions of experts. On basis of a questionnaire as part of a larger study, experts identified barriers that they considered to be related to aging and dementia influencing mHealth use. Nineteen barriers that were mentioned by the dementia experts were covered in our literature-based model. No adaptions to the model were required. The dementia experts acclaimed three barriers to mHealth use that could not be mapped onto the framework: the unavailability of (informal) caregivers to support the mHealth use, the stage and type of dementia of an mHealth user, and the fear of the unknown. These should be considered as prerequisites in the implementation phase of mHealth and explored more in future research.

Current mHealth Use in Dutch Dementia Care: A Guide to Action!

OBJECTIVE: To report underlying factors that hinder or advance mHealth implementation and use in Dutch dementia care. METHODS: 44 dementia experts (healthcare professionals, informal caregivers, dementia case managers, and researchers) completed a questionnaire as part of a wider Delphi study to share their experiences with, thoughts on, and proposals for mHealth use in Dutch dementia care. A SWOT-framework is used to categorize the experiences, thoughts and proposals. RESULTS: Four strengths, twelve weaknesses, thirteen opportunities and six threats for the current use of mHealth in Dutch dementia care were identified. CONCLUSION: Identified weaknesses highlight the importance for a guide for action for everyone involved in design and implementing mHealth for older adults with dementia. It is critical to raise awareness of mHealth's availability, improve its design, and continue to address the needs of older adults with dementia.