The Perceived Efficiency and Acceptability of Remote Real-time Health Monitoring System in Elderly Residential Setting and Community Isolation Facility
Conditions: Technology
Sponsor: The University of Hong Kong

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The perceived efficiency and acceptability of remote real-time health monitoring 
system in elderly residential setting and community isolation facility 
 
 
 
Registration No.: NCT05302440 
Document Date: 30 March 2022 
  
 
 

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STUDY PROTOCOL 
1. 
Project title 
The perceived efficiency and acceptability of remote real-time health monitoring system in 
elderly residential setting and community isolation facility   
2. 
Investigators 
Principal Investigator 
Dr. Derek Yee Tak CHEUNG, Assistant Professor, School of Nursing, The University of 
Hong Kong 
 
3. 
Study sites 
Woo Ping Care and Attention Home, Haven of Hope Christian Service 
Haven of Hope Nursing Home, Haven of Hope Christian Service 
Haven of Hope Sister Annie Skau Holistic Care Centre, Haven of Hope Christian Service 
Kai Tak Holding Centre Zone D (operated by Haven of Hope Christian Service) 
4. 
Aims of the project 
The study is a single-group 4-week trial of exploring the perceived efficiency and 
acceptability of remote real-time health monitoring system. The qualitative sub-study 
aims to explore the experience in setting up the remote health monitoring system, and the 
perceived benefits and acceptability of the care staff towards the system. The study 
deliverable will be a local testing protocol for future adaptation of remote health 
monitoring systems in elderly residential settings. 
5. Outcomes 
The primary outcomes include the efficiency of the system perceived by the care staff and 
staff perceptions on the whether the adoption of the system facilitates early detection of 
abnormal vital signs, facilitates early delivery of medical support, and reduces staff stress.  

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Ancillary outcomes include number of hospital admissions and any medical assistance due 
to the adoption of the system, and perceived benefits and acceptability of the care staff 
towards the system. The barriers and difficulties in the set-up of the system, and the 
concerns in choosing wireless or cable connection for the system are also explored.  
6. 
Estimated duration and commencement data 
Project start date: March 2022 
Testing period: March 2022 – April 2022 
Proposed study completion date: April 2022 
Expected final report date: June 2022 
7. 
Scientific/historical background 
The vital signs of physically weak residents need to be continuously monitored so as to 
facilitate timely medical intervention. The procedures involved are labour intensive and 
time consuming. Moreover, during pandemic, a proportion of residents are infected with 
infectious disease, imposing threat to the staff who monitor their vital signs in close 
contacts. The application of remote monitoring system enables autonomous and continuous 
monitoring of vital signs without close contact between the residents and the staff. It is 
expected to reduce the time in monitoring the vital signs, however the efficiency is yet to 
be investigated. Apart from the potential time saving, the perceived benefits and 
acceptability of the stakeholders towards the system would also influence the future 
adoption of the system. Their perceived benefits and acceptability need to be explored.   
Gerontechnology is playing a role in assisting the elderly in living independently, 
supporting their social interactions, improving their quality of life, and preventing 
emergencies. Conceptually, gerontechnology can be divided into four categories according 
to its use: first, gathering continuous data (e.g., heart rate and motion) to monitor the 
performance of older adults or detect falls through wearable sensors; second, assisting older 
people cognitively and socially using, for instance, interactive robotic pets; third, providing 
care or monitoring of health from a distance, with the help of telecare or telemedicine; and 
finally, compensating for possible technology deficits in the home environment, which 
mainly refers to a smart home. In this study, gerontechnology is used as an umbrella term 
for all the aforementioned technologies. Gerontechnology helps older adults maintain their 

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health and wellbeing in their homes, which is considered to be of positive significance to 
aging in place. Using telecommunications, gerontechnology can now provide health 
professionals and caregivers with remote access to older patients. In addition, 
gerontechnology has shown great potential in reducing escalating medical costs by 
eliminating the need for expensive and limited medical facilities. In the context of the 
accelerated aging process, gerontechnology already has a broad market prospect, and 
delivering healthcare services based on gerontechnology has been one of the trends of 
providing care for older adults in Hong Kong. 
Compared to developed countries, the smart health technology of China is still in its 
infancy. It was only in 2020 that the Social Innovation and Entrepreneurship Development 
Fund and other NGOs first introduced the Gerontechnology Platform specifically work on 
projects on improving access and evaluating technology-based applications and 
innovations for consumer (elderly use at home) and healthcare settings (e.g., elderly home 
and geriatric hospital ward setting). Thus, although several international studies have 
explored the perspectives of the care staff in residential homes and healthcare settings on 
emerging technologies across the world, the data on Hong Kong are still insufficient. Thus, 
this study aims to determine:  
1. The intention of the care staff in residential homes and community isolation facility in 
Hong Kong to adopt gerontechnology. 
2. The factors influencing the adoption intention and use of gerontechnology.   
Gerontechnology, based on the elderly users’ needs, is playing a role in improving the daily 
functions of the elderly. Piau et al. (2014) mentioned that gerontechnology can help the elderly 
in living independently and support their social interactions. They classified gerontechnology 
applications by the elderly users’ needs: social isolation (e.g., mobile phone technologies and 
social media apps), functional decline (e.g., robotic vacuums and electric wheelchairs), and 
cognitive disorders and Behavioral and Psychological Symptoms of Dementia (BPSD) (e.g., 
telemonitoring and location tracking technologies). Carmeli (2009) indicated that 
gerontechnology such as “smart or future homes” allows the elderly to control their 
environments, and therefore they improve their overall quality of life, increase independence, 

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and prevent emergencies. This study refers to the abovementioned gerontechnology application 
contexts and then explains the products and services of gerontechnology for the participants by 
giving some examples, such as “mobile phones for the elderly, social media apps, robotic 
vacuums, electric wheelchairs, wearable healthcare monitoring systems, location tracking 
technologies, and smart homes”. The study will be conducted in compliance with the protocol, 
GCP and the applicable regulatory requirement(s). 
8. 
Research Questions 
The study has 3 primary research questions and 6 secondary research questions targeting care 
staff in the setting of residential homes for the elderly and community isolation facilities. The 
3 primary research questions are:  
(1) Will care staff perceive the remote real-time health monitoring system as efficient?  
(2) Will the system facilitate any early detection of abnormal vital signs?  
(3) Will the system facilitate early delivery of medical support? 
The 6 secondary research questions are: 
(4) What are the numbers of hospital admissions and further medical assistance due to the 
adoption of the system?  
(5) Will the system reduce the stress level of the care staff?  
(6) What are the perceived benefits and acceptability of the care staff towards the system?  
(7) What should be considered when developing the evaluation framework for the 
adaption of the system in elderly residential setting?   
(8) Are there any barriers and difficulties in the set-up of the system?  
(9) What are the concerns in choosing wireless or cable connection for the monitoring 
device? 
9. 
Study design 

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This is a single-group 4-week trial of using the remote health monitoring system. All care 
staff who manage the system will complete a very brief survey (1-minute) after each work 
shift for 2 weeks. Detection of abnormal vital signs will be recorded by the system. Hospital 
admission and further medical assistance due to the adoption of the system will be counted 
by the care team. The care staff will be interviewed about the set-up of the system, their 
perceived benefits and acceptability of the system. 
10. 
Subjects 
Care staff in study sites who are responsible to set up and operate real-time remote health 
monitoring system will be recruited. They also need to be able to read and understand 
Chinese.  
11. 
Procedures 
11.1 Implementation 
The remote monitoring system will constantly record the temperature, pulse and SpO2 of 
the residents wearing the equipment. When the staff find abnormal vital signs, they will 
provide further medical assistance. After every shift during the trial period for 2 weeks, 
they will fill in a 1-minute survey.  
11.2 Data collection 
The remote monitoring system will remotely and real-time record the temperature, pulse 
and SpO2 of the residents wearing the sensor. When the staff are notified of any abnormal 
vital signs by the system via screen display and notification sound, they will deliver 
further medical assistance. Hospital admission and further medical assistance due to the 
adoption of the system will be counted by the care team under pre-existing practice. After 
every shift during the trial period for 2 weeks, the staff will fill in a 1-minute survey about 
their operation and perceived efficiency of the system, such as facilitating more frequent 
monitoring of particular residents’ vital signs, the provision of further medical assistance, 
perceived time saving in monitoring vital signs, and acceptability of the system. They could 
record their experience of using the system in written format or in a mobile phone 
messaging app (such as Whatsapp) in audio format. If they fill in the survey for fewer than 
8 times during the 2 weeks, they would be invited to continue to fill in the survey after 
work shift for an extra week until they fill in it for at least 8 times. Meanwhile, as a staff 

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may complete more than 1 shift per day, they would not be invited to fill in the survey after 
having completed it for 12 times. At the end of the trial, HOHCS staff will provide the 
number of abnormal vital signs recorded by the system, number of hospital admissions and 
further medical assistance without any personal identifiers to HKU research team. All data 
collected that is related to residents is not identifiable. 
There are two parts of the qualitative sub-study. When the system is set up, the unit IC and 
care staff responsible to set up the system from each participating unit will be interviewed 
by HKU research assistant(s). Themes of qualitative questions include: (1) barriers and 
difficulties in the set-up of the system; and (2) the concerns in choosing wireless or cable 
connection for the monitoring device. Meanwhile, when the main trial ends, a total of 9-15 
care staff from all participating units responsible to operate the system will be interviewed 
about their perceived benefits and acceptability of the system. Themes of qualitative 
questions include: (1) Acceptance of using the remote health monitoring system (including 
ease of operation, care staff’s confidence and convenience in using the system); (2) Benefits 
of using the remote health monitoring system (including usefulness of the innovation, 
impacts on quality of care); (3) Concerns in using the remote health monitoring system 
(including if any residents stop using the sensor and the reason behind); and (4) Overall 
perception of using the remote health monitoring system. For both parts of the qualitative 
sub-study, an interview guide with open-ended and iterative questions will be used to probe 
for more experiences from the interviewees. Each interview will be conducted by a trained 
research assistant and will last about 15 - 30 minutes.  
12. 
Blinding 
Blinding is not applicable in this single group study. 
13. 
Sample size determination 
The sample size is estimated by the number and availability of the staff in the participating 
units. It is estimated that a total of 12-20 staff will be recruited.   
14. 
Data analyses 
The proportion of all the responses in the staff survey will be calculated. The numbers of 
abnormal vital signs, hospital admission and further medical assistance due to the adoption 
of the system will be counted. 

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The qualitative interview content will be transcribed verbatim in Chinese for further 
analysis. The qualitative interview transcripts will be analyzed using framework analysis 
to construct a coherent and logical structure from the classification of many opinions and 
perceptions of the system. The results will then be discussed and consolidated in the panel 
meetings with the co-authors. 
15. 
Risk Control & Contingency Planning 
Outbreak of infectious disease in the society/service unit that might limit the access of the 
research staff to carry out qualitative study. As a contingency plan, the qualitative interview 
can be done via virtual platform (e.g. WhatsApp or Zoom).  
For damage and repair of any components during the testing period, the product supplier 
will provide sufficient number of devices as back-up with a 3-month warranty for the new 
device and maintenance.  
As a voluntary participation, the participants have the right to withdraw from the study and 
intervention any time without consequences.  
In case of inclination of product developers to produce positive test results, the research 
investigators will maintain research independence by excluding the product developer in 
data analysis and evaluation report writing.  
16. 
Time-line: (HOLD*3 study) 
HKU to prepare research instruments (staff survey etc.) 
March 2022 
Perform trial and monitoring for the main trial 
March 2022 –  
April 2022 
Carry out qualitative study 
Perform data cleaning and analysis 
Prepare datasets for data entry  
April 2022 – 
June 2022 
Data entry  
Transcription 
Summarization of transcripts by Nvivo 
Data analysis and tabulation 
17. Describe any unusual or discomforting procedures to be used: Nil. 
18. Are there any hazards associated with the investigation? No.  
19. Direct access to source data/documents 

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The raw data will be stored in the CD-ROM and locked in a cupboard with keys kept by 
the Principal Investigator. Only the Investigators and Research Assistant of the project will 
be permitted to access to raw data and/or study record. The data will be kept for 10 years 
or longer after the study completed.  
20. Dissemination of study result 
Study results will be made available for the funder, Gerontechnology Platform (GTP), and 
Haven of Hope Christian Service (HOHCS). Upon the agreement of the funder and 
product supplier, study results shall be made available presented in international 
conferences such as International Conference on Gerontechnology and published in 
internationally ranked journals, such as Gerontechnology Journal and International 
Journal of Nursing Studies.  
21. Consent 
Care staff responsible for the operation or installation of the remote health monitoring 
system will be invited to participate in the study by obtaining written consent. The HKU 
researcher or the investigator not responsible for the home will explain to the relevant 
details of the study before seeking consent. As a voluntary participation, the participants 
have the right to withdraw from the study any time without consequences to their rights 
or their work appraisals.   
22. Conflict of interest: None 
23. Financing and insurance 
This research will be funded by the Social Innovation and Entrepreneurship Development 
Fund. 
 
24. Reference 
Carmeli, E. (2009). Aspects of assistive gerontechnology. International Journal on Disability 
and Human Development, 8(3), 215-218.  
Piau, A., Campo, E., Rumeau, P., Vellas, B., & Nourhashemi, F. (2014). Aging society and 
gerontechnology: a solution for an independent living? The journal of nutrition, health & aging, 
18(1), 97–112. https://doi.org/10.1007/s12603-013-0356-5.