A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns (Preprint)
Authors: Øksnebjerg Laila , Woods Bob , Ruth Kathrine , Lauridsen Annette , Kristiansen Susanne , Holst Helle Dalsgaard , Waldemar Gunhild 
Published: May 2019

BACKGROUND

Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption.

OBJECTIVE

This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention.

METHODS

The ReACT (<italic>Rehabilitation in Alzheimer's disease using Cognitive support Technology</italic>) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days.

RESULTS

Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; <italic>P</italic>=.046; <italic>r</italic>=0.19) and caregiver activating the app (<italic>P</italic>=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; <italic>P</italic>=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; <italic>P</italic>=.02; <italic>r</italic>=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters.

CONCLUSIONS

For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.