Designing Self-Management Health Systems to Support Ageing in Place

Given the ageing population worldwide, researchers are looking for alternatives to support older adults to age in place, i.e., live at home for as long as possible. One solution to empower older adults in maintaining a healthy lifestyle is through Self-Management Health Systems (SMHS). In this manuscript, SMHS are defined as integrated systems that combine data logging via multiple sensors and/or self-reports with data visualisation and possibly risk assessment and decision support. On the one hand, SMHS may include commercial off-the-shelf monitoring devices such as activity trackers that measure and motivate to reach daily step goals, active minutes, or sleep goals. On the other hand, SMHS may include medical-grade applications that monitor vital physiological parameters, e.g., blood pressure or oxygen saturation, and that share this health information with healthcare professionals and relatives. Notwithstanding that SMHS are heralded as essential in a digital health care revolution that empowers older adults and mitigates the challenges of a greying population; several research studies show a limited adoption of health-related ICT among older adults and question its feasibility and desirability. Hence, the aim of this manuscript is to study how to design SMHS for older adults, including the oldest old (>80 years) so that they are ready to accept and use them, and are motivated to maintain a healthy lifestyle. To address this objective, the following research questions will be answered. RQ1. What are older adults' requirements for using a self-management health system? RQ2. What are the main drivers for older adults to adopt a self-management healthsystem to support ageing in place? RQ3. Can motivational design techniques help older adults to engage in using a self-management health system? RQ4. How to perform a human-centred design process with older adults? Within this research study, a Human-Centred Design (HCD) process was conducted.This HCD process is an iterative process, cycling through the subsequent phases of inspiration, ideation, implementation, and evaluation. During this process, essential stakeholders, here older adults, were involved from start to finish. During the entire HCD process, spanning four years, 81 older adults with ages ranging from 65 to 97 (median=83) participated in one or more different phases. In the first phase, i.e., the inspiration phase, the context of use and corresponding requirements for older adults to use an SMHS were investigated by means of focusgroup discussions. In the next phase, i.e., the ideation phase, designs and prototypes were generated and then again evaluated. Next, the implementation phase followed, in which the SMHS application was developed. Three different sensors, i.e., an activity monitor, blood pressure monitor, and sleep monitor, were integrated into the SMHS. Data from these sensors were gathered in collaboration with the company BeWell Innovations. Additionally, self-reports were integrated via three validated questionnaires that measure quality of life, cognitive and physical functioning. Data was captured and visualised to the older adult via a tablet application. After finalising the development of the SMHS, an adoption study was performed to better understand older adults' uses and attitudes, guided by the Unified Theory of Use and Acceptanceof Technology (UTAUT). While results showed positive scores for perceived ease-of-use, perceived usefulness, social support and adequate infrastructure, nevertheless, the behavioural intention of participants to adopt the SMHS was low. In the next iteration, the preference for motivational design techniques was investigated through semi-structured interviews. These findings showed, again, that motivational design techniques are no panacea and are preferred the most by those already motivated to follow a healthy lifestyle. Finally, performing research studies with older adults was not always straightforward. Both during the recruitment and the actual research activities, methodological challenges were encountered. Based on the experiences of conducting user research with 81 older adults over four years, we end with lessons learned for future researchers who want to conduct HCD processes with older adults, including the oldest old. It is our aim to help future designers of SMHS for healthy ageing; this doctoral study contributes to the field of Human-Computer Interaction (HCI) by defining requirements for older adults to welcome SMHS, by evaluating whether they are ready to adopt these systems, by investigating preferences towards Motivational Design Techniques(MDT) and finally, by summarising this into guidelines. In addition, lessons learned on performing an HCD process with this older population are shared and also summarised in several guidelines. Although the findings in this manuscript paint a nuanced picture ofolder adults' readiness to embrace SMHS, there is no doubt that self-care technologies will play an important role in the future. Ultimately, this manuscript aspires to generate insights to guide designers of future SMHS that will be embraced by and truly empower older adults.

Publication year:2021

Accessibility:Open