Active Life Engagement in Relation to Health-related Outcomes Among Community-dwelling Chinese Older Adults
Condition: Aging
Study type: Observational

Summary: 
      This study aims to examine within-person variations of different contexts (time, physical,
      psychosocial and affective) of active life engagement, and how these variations predict a set
      of physiological indicators and health-related outcomes among community-dwelling older
      people. Specifically, this study has the following objectives.

      Objective 1: To investigate within-person variations in different contexts (i.e., time,
      physical, psychosocial, and affective) of active life engagement and interactions of these
      contexts.

      Objective 2: To examine how within-person variations in different contexts (i.e., time,
      physical, psychosocial, and affective) of active life engagement and interactions of these
      contexts may associate with a set of cardiovascular indicators measured on daily basis.

      Objective 3: To examine how within-person variations in different contexts (i.e., time,
      physical, psychosocial, and affective) of active life engagement and interactions of these
      contexts may associate with a set of health-related outcomes (e.g., physical functioning,
      depression, health-related quality of life).
    

Detailed description: 
      1. Participants

      This study will recruit 70 participants from the community with the help from staffs from
      community service center. Investigators recruited participants who aged 60 or older and lived
      in the community independently, and screened participants for eligibility based on the
      following exclusionary criteria: (1) unable to complete brief survey presented in mobile
      devices (e.g., have severe visual deficits or other self-report difficulty reading the
      screen), (2) diagnosed with a cognition disorder, (4) diagnosed with a mental disorder.

      Study protocol

      I. Self-administered questionnaire survey

      All the participants will be asked to complete the baseline self-administrated survey on line
      (in some cases, participants could be organized to complete the survey under the guide of the
      research staff).

      II. Training sessions/orientation

      All the eligible participants will be invited to attend the training session/orientation. The
      research staff will assign each participant a Android phone installed with a
      researcher-developed application and a mobile-electrocardiogram (ECG) recording device. The
      participants will be briefed on its basic functions and how to use the application and device
      to provide data. The whole session will take steps proactively to increase participants'
      confidence and comfort with using the electronic band and the real-time assessment
      application through in-person training and mutual support between participants. Detailed
      take-home handbook (hardcopy or electronic version) that cover the use guidelines of the
      electronic bans and the real-time assessment application, and troubleshooting help, will be
      distributed to participants. Then, two warm-up days prior to the main study will be conducted
      and on-call help will be provided.

      III. Real-time assessment survey of daily experiences

      The real-time assessment application will allow each user to register a personal account, and
      to define their person-specific time-frame for the procedure, in specific, the start and the
      end time in a typical day they accept the signaling. The time frame will basically cover the
      user's waking hours (approximately 7 ± 3 hours). Within the defined time frame, the mobile
      device with the application will randomly prompt the user to complete a report for 6 times.
      The minimum and the maximum time between two consecutive signals will be 30 and 150 minutes
      respectively. The device will correctly record each response time once sending the signal. If
      the device receives no response for over 20 minutes, substitute prompts will be automatically
      sent every 5 minutes for 2 times. If still no response, a missing will be recorded. This
      procedure will be repeated on 7 consecutive days, with different random patterns for each
      day. For answering one signaling report, it will take approximately 3 to 5 minutes for most
      users (a total of less than 30 min per day). The content of report will be the same each
      time, which will comprise questions on engagement in daily activities, individual
      distractions, mood, and social systems.

      IV. Physiological data provision

      Physiological data will be collected concurrently during the 7 consecutive days for real-time
      data collection. All participants will be required to carry the mobile-ECG device assigned to
      them during the whole process of data collection. They will use the smartphone-based
      application and the mobile-ECG device to provide a 30-second ECG recording for six times each
      day.

      V. In-person follow-up survey

      All participants will be asked to complete the open-ended questions focusing on the
      feasibility/acceptability of the method.

      No drug usage and medical treatment will be involved in the study. Intensive assessment do
      not impose any physical or medical risk to participants. The only possible problem is that
      the intensive assessment may interfere with the participants' normal daily routines.
      Participants can voluntarily drop out the study at any time, without giving any reason.

      Data analyses:

      Intra-individual variability in the activity engagement will be analyzed by calculating the
      standard-deviation for each participant's timing of each domains of engagement resulting in
      an intra-individual standard deviation (iSD). In order to model within-person change and
      between-person factors simultaneously, two alternative statistical methods, namely, time
      series analysis and random coefficient multilevel modelling will be used. Multiple
      hierarchical regression analyses will be conducted with activity indicators predicting health
      and well-being outcomes.
    

Intervention name(s): real-time assessment of biopsychosocial functioning
Intervention type(s): Other
Intervention description(s): the participants were asked to provide biopsychosocial data using the mobile device
Observational model: Ecologic or Community
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Healthy aging population living in the urban areas of a site city, Changsha in the central
        part of China.
      
Keywords: mobile technology; real-time assessment; active life engagement