Effects of mHealth on Promoting Self-care Health Management Among Older Adults in the Community

Study Overview
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Brief Summary
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Many of the existing mobile health (mHealth) apps designed in a reactive care approach, in which people do not receive individualized care until they consulted health care professionals through the apps. This proposal endeavors to develop a proactive mHealth application on promoting self-care ability and health among older adults to examine the differential benefits of adding nurse interaction supported by an integrated health-social partnership model in the use of mHealth.

Detailed Description
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Objectives: Many of the existing mobile health (mHealth) apps designed in a reactive care approach, in which people do not receive individualized care until they consulted health care professionals through the apps. This proposal endeavors to develop a proactive mHealth application on promoting self-care ability and health among older adults to examine the differential benefits of adding nurse interaction supported by an integrated health-social partnership model in the use of mHealth. Hypothesis to be tested: There is no difference in self-management outcomes, individual and societal benefits between the subjects receiving mHealth+Interactivity, mHealth, and usual care. Design and subjects: This is a single-blinded, three-armed randomized controlled trial. The subjects are people who are aged 60 or above with chief complaints of either pain, hypertension, or diabetes mellitus. Instruments: mHealth application designed by the research team with the information technological support by Smartone. Interventions: mHealth with interactivity group receives both mHealth app and nurse case management supported by a social service team in community. mHealth group will have access to health content on mHealth platform only. Usual care group receives usual community services. Main outcome measures: Self-management outcomes (self-efficacy, pain score, blood pressure, capillary blood glucose), individual (quality of life, depression) and societal benefits (institutionalization and health service utilization). Data analysis: Generalized Estimating Equation (GEE) is used to determine the between-group effects, within-group effects, and the interaction effects. Expected results: Older adults would benefit from supported self-care equipping them with sufficient knowledge, skills and confidence to lead to relatively independent life at home.

Official Title
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Effects of mHealth on Promoting Self-care Health Management Among Older Adults in the Community: A 3-arm Randomized Controlled Trial

Conditions
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Telemedicine

Intervention / Treatment
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* Other: mHealth application with interactivity
* Other: mHealth application


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: people who are aged 60 or above with chief complaints of either pain, hypertension, or diabetes mellitus living within the service areas and (4) using smartphone Exclusion Criteria: already engaged in other mHealth programs diagnosed with psychiatric problems bed-bound living in area with no internet coverage

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: mHealth+I<br>This group of participants will receive a proactive mHealth with interactivity program which includes two main elements: 1) mHealth application designed by the research team with the information technological support by Smartone and 2) nurse case management supported by a social service team | Other: mHealth application with interactivity<br>* a mHealth device with interactivity with nurse case manager<br>|
| Active Comparator: mHealth<br>The mHealth group will have access to the health content on the mHealth platform. This group 2018 HMRF Open Call Proposal Section 13: Proposed Research Project 5 will enjoy the same content and client-initiated help if needed. Same as the above group, the client is invited to use the mHealth application. A reminder message will pop up on the screen of smartphone when participants have not used it for more than one week. The participants are encouraged to read the self-care information that is featured in the app. There is a button for the client-imitated call if they would like to consult a nurse. | Other: mHealth application<br>* a mHealth device<br>|
| No Intervention: Control<br>All groups will receive usual community services. The study district provides community-based health talks and basic health checks such as measuring blood pressure and blood glucose that are accessible to all residents, and their participation is voluntary. Both health and social services are available in the community for those who need help, including referral for further help if appropriate. These services are however episodic with design for continuity of care. No mHealth application will be provided to the participants in this group but the individuals are free to do their own surfing for e-health information. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of life (general well-being of individual) | Quality of life will be measured by SF-12v2 (physical and psychological component) version which has been translated, validated and proven reliable for use among the Hong Kong Chinese population.This questionnaire is a generic measure, as opposed to one that targets a specific age and disease. It has shown useful in Chinese elderly patients. The scale ranged from 0 to 100, with 50 indicating the standardized norm scale | 3-month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| depression | Depression will be measured by the Chinese version of the Geriatric Depression Scale. Good validity and reliability were reported in this scale, with criterion-related validity 0.95 and test-retest reliability 0.85 among the elderly Chinese population. The questionnaire consists of 15 questions which are used to explore the feelings of participants with the dichotomous answers. The scale has ranged from 0 to 15, higher scores indicated higher depressive severity. | 3-month | 
| self-efficacy | Self-efficacy will be measured by General Self-Efficacy Scale. This scale is used to determine how people judge their ability to handle difficult situations or solve their own problems, and thus can be a way to assess the effectiveness of empowerment programs. All 10-item in the Chinese version are rated on a 4-point Likert scale ranging from 1= not at all true to 4= exactly true. Scores on the scale are summated and higher scores indicate greater self-efficacy.Measuring general self-efficacy can provide a way to evaluate the effectiveness of empowerment interventions. | 3-month | 
| pain score | Pain score is measured by Visual Analog Scale that installed in the app. Pain score is ranging from 0 (no pain) to 10 (severe pain). | 3-month | 
| blood pressure | Blood pressure measurement will be performed after 10 minutes of sitting rest. A standard electronic sphygmomanometer will be used to measure supine blood pressure on the right arm of each candidate (unless contraindicated). | 3-month | 
| capillary blood glucose | Capillary blood glucose level will be measured by a standard capillary glucose meter. | 3-month | 
| health service utilization | Health service utilization will be measured by the number of attendance to government out-patient clinics (GOPC), and number of unscheduled visits to the emergency department and hospital admission. | 3-month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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mHealth, app