TY - JOUR AU - Arader, Lindsay AU - Miller, Danielle AU - Perrin, Alexandra AU - Vicari, Frank AU - Friel, P. Ciaran AU - Vrany, A. Elizabeth AU - Goodwin, M. Ashley AU - Butler, Mark PY - 2025/4/16 TI - Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults JO - J Med Internet Res SP - e54629 VL - 27 KW - older adults KW - personalized KW - digital KW - clinical trial KW - remote KW - physical activity KW - back pain KW - pain KW - COVID-19 KW - clinical trials KW - pandemic KW - chronic health KW - digital intervention KW - Fitbits KW - Fitbit KW - wearable KW - wearables KW - exercise KW - gerontology KW - geriatric KW - geriatrics KW - old KW - older KW - older people KW - aging KW - aged KW - mobile phone N2 - Background: The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults? increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population. Objective: This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial). Methods: We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes. Results: Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials? digital systems including SMS text message interventions and surveys (?62% satisfied) and the use of wearable devices such as Fitbits (?81% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults. Conclusions: Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics. UR - https://www.jmir.org/2025/1/e54629 UR - http://dx.doi.org/10.2196/54629 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54629 ER - TY - JOUR AU - Parsons, Marie E. AU - Figueroa, G. Zoë AU - Hiserodt, Michele AU - Cornelius, Talea AU - Otto, W. Michael PY - 2025/2/13 TI - Relative Preference for In-Person, Telehealth, Digital, and Pharmacologic Mental Health Care After the COVID-19 Pandemic: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e54608 VL - 27 KW - stigma KW - digital CBT KW - age KW - generalized anxiety disorder KW - insomnia KW - adult KW - telehealth KW - digital health N2 - Background: Most adults and children in the United States fail to receive timely care for mental health symptoms, with even worse rates of care access for individuals who belong to racial and ethnic minority groups. Digital (ie, app-based) care has proven to be an efficacious and empirically supported treatment option with the potential to address low rates of care and reduce care disparities, yet little is known about the relative preference for such treatment. Furthermore, the rapid adoption of telehealth care during the COVID-19 pandemic may have shifted care preferences. Objective: This study aimed to examine relative treatment preferences for 4 different types of mental health care: in-person psychological care, telehealth psychological care, digital treatment, or pharmacologic care. Care preferences were also examined relative to potential predictors of care use (ie, gender, race, age, stigma, discrimination, and level of shame). Methods: In this cross-sectional online survey study of adults (N=237, mean age 35 years, range 19-68 years), we ranked 4 mental health care modalities based on care preference: (1) in-person care, (2) telehealth care, (3) digital care, and (4) pharmacologic care. Preference for treatment modality was assessed based on vignette presentation for generalized anxiety disorder and insomnia. In addition, participants completed self-report questionnaires for demographics, symptom severity, and psychological and stigma-related variables. Results: We found no difference in overall preference for in-person versus both telehealth and digital care. For both generalized anxiety disorder and insomnia, participants preferred in-person care to telehealth care, although this finding was attenuated amongst older participants for insomnia treatment. Participants? depressed mood was associated with a greater relative preference for pharmacologic care. There was no evidence of differential preference for digital care according to demographics, symptom severity, or psychological and stigma-related variables. Conclusions: These results indicate that digital care now competes well in terms of treatment preference with in-person, telehealth, and pharmacologic treatment options. UR - https://www.jmir.org/2025/1/e54608 UR - http://dx.doi.org/10.2196/54608 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54608 ER - TY - JOUR AU - Kitsiou, Spyros AU - Gerber, S. Ben AU - Buchholz, W. Susan AU - Kansal, M. Mayank AU - Sun, Jiehuan AU - Pressler, J. Susan PY - 2025/1/15 TI - Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial JO - J Med Internet Res SP - e55586 VL - 27 KW - mHealth KW - app KW - digital health KW - telehealth KW - text messaging KW - smartphone KW - wearable electronic devices KW - heart failure KW - self-care KW - self-management KW - randomized controlled trial KW - cardiology KW - SMS N2 - Background: Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. Objective: The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. Methods: We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ?40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). Results: A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48%) or usual care (n=14, 52%). Of these 27 patients, 11 (41%) in the intervention group (iCardia4HF) and 14 (52%) in the usual care group started their assigned care and were included in the full analysis. Patients? mean age was 56 (SD 8.3) years, 44% (11/25) were female, 92% (23/25) self-reported race as Black, 76% (19/25) had NYHA class II or III HF, and 60% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high (>80%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95% CI ?0.65 to 1.02), symptom perception (Cohen d=0.33, 95% CI ?0.51 to 1.17), and self-care management (Cohen d=0.25, 95% CI ?0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. Conclusions: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. Trial Registration: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275 UR - https://www.jmir.org/2025/1/e55586 UR - http://dx.doi.org/10.2196/55586 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55586 ER - TY - JOUR AU - Khatib, Sewar AU - Palgi, Yuval AU - Ashar, K. Yoni AU - Polyvyannaya, Natalya AU - Goldstein, Pavel PY - 2025/1/14 TI - The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e55042 VL - 27 KW - Snoezelen room KW - mental health KW - sensory stimulation environment KW - social support KW - nursing homes KW - older adults N2 - Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults? chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults? physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=?0.35, P=.003) and TS alone (B=?0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=?4.29, P<.0001) compared with SS (B=?2.38, P=.0042) and TS alone (B=?1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 UR - https://www.jmir.org/2025/1/e55042 UR - http://dx.doi.org/10.2196/55042 UR - http://www.ncbi.nlm.nih.gov/pubmed/39808474 ID - info:doi/10.2196/55042 ER - TY - JOUR AU - Ong, Anthony AU - Wilcox, Kenneth AU - Reid, Carrington M. AU - Wethington, Elaine AU - Cintron, Dakota AU - Addington, Elizabeth AU - Goktas, Selin AU - Moskowitz, Judith PY - 2024/12/10 TI - Targeting Daily Positive Events to Improve Emotional and Functional Well-Being in Adults With Fibromyalgia: Insights From the LARKSPUR Randomized Controlled Trial JO - J Med Internet Res SP - e54678 VL - 26 KW - positive affect KW - chronic pain KW - chronic condition KW - long-term pain KW - positive psychology KW - positive events KW - fibromyalgia KW - mHealth KW - app KW - digital technology KW - digital interventions KW - gerontology KW - geriatrics KW - older adult KW - aging KW - well-being N2 - Background: Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties, affecting individuals across all age groups. Positive affect (PA) interventions have shown promise in enhancing emotional well-being and pain management in patients with diverse chronic pain conditions. However, the efficacy of internet-delivered PA interventions for individuals with fibromyalgia remains understudied. Objective: This randomized controlled trial investigated the efficacy of a web-based PA regulation intervention?Lessons in Affect Regulation to Keep Stress and Pain Under Control (LARKSPUR)?in enhancing emotional and functional well-being among adults with fibromyalgia syndrome. Methods: A total of 95 participants with fibromyalgia syndrome aged 50 years and older (89/95, 94% female) were randomized to one of two fully automated conditions: (1) LARKSPUR (n=49) or (2) emotion reporting/attention control (n=46). At the postintervention and 1-month follow-up time points, participants completed 7 consecutive, end-of-day, web-based reports capturing positive events (PE), pain, fatigue, PA, and negative affect. Results: Compared to control, LARKSPUR resulted in greater improvements in daily affective responsivity to PE at the postintervention time point, including greater reductions in negative affect (bL?bC=?0.06, 95% highest posterior density interval [HPD] ?0.10 to ?0.02) and increases in PA (bL?bC=0.10, 95% HPD 0.02-0.19). Furthermore, across the postintervention and 1-month follow-up time points, LARKSPUR led to greater reductions in pain (bL?bC=?0.20, 95% HPD ?0.36 to ?0.04) and fatigue (bL?bC=?0.24, 95% HPD ?0.41 to ?0.06) following PE. Conclusions: This randomized controlled trial provides initial evidence that a web-based PA skills intervention can enhance emotional well-being and reduce pain and fatigue in aging adults with fibromyalgia. Trial Registration: ClinicalTrials.gov NCT04869345; https://clinicaltrials.gov/study/NCT04869345 UR - https://www.jmir.org/2024/1/e54678 UR - http://dx.doi.org/10.2196/54678 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54678 ER - TY - JOUR AU - Kannan, Lakshmi AU - Sahu, Upasana AU - Subramaniam, Savitha AU - Mehta, Neha AU - Kaur, Tanjeev AU - Hughes, Susan AU - Bhatt, Tanvi PY - 2024/11/27 TI - Gaming-Based Tele-Exercise Program to Improve Physical Function in Frail Older Adults: Feasibility Randomized Controlled Trial JO - J Med Internet Res SP - e56810 VL - 26 KW - exergame training KW - Matter of Balance KW - MOB KW - pre-frail KW - tele-exergame KW - tele-rehabilitation KW - gaming-based KW - tele-exercise KW - physical function KW - frailty KW - older adults KW - aging KW - physical activity KW - dementia KW - CogXergaming KW - telehealth KW - dynamic balance N2 - Background: Frailty leads to reduced physical activity can cause increased fall risk. This contributes to accelerated aging processes, leading to adverse health outcomes and reduced quality of life. We have developed and piloted the design, usability, safety, and feasibility of a gaming-based cognitive-motor (CogXergaming) tele-exercise protocol in prefrail older adults. Objective: This pilot randomized control trial tested preliminary feasibility and effectiveness of the CogXergaming telehealth protocol for improving physical function. Methods: Community-dwelling, prefrail older adults were randomly assigned to CogXergaming (n=13) or a control group (n=14). The CogXergaming group received supervised tele-exercises in a gaming format for 6 weeks (3 sessions per week) comprising 18 sessions lasting 90 minutes each. Control group participants participated in a Matter of Balance (MOB), an 8-week, once-a-week structured 90-minute tele-session that has been shown to reduce the fear of falling and increase physical activity. Feasibility of training was obtained by computing the median duration of training sessions for the CogXergaming group. Effectiveness was assessed using dynamic balance control (Four Square Step Test), subjective self-efficacy (Activities-Specific Balance Confidence scale), gait function (Tinetti Performance Oriented Mobility Assessment), muscle strength (30-second chair stand test), and endurance (2-minute step in-place test). Results: Of the 45 participants enrolled in the study, 4 participants from CogXergaming group and 5 from MOB group lost contact after signing the consent form and did not receive their respective intervention. Eighteen participants were randomized to each group. In the CogXergaming group, 15 (83%) completed the intervention, with 3 (16%) dropping out in the first week. In the MOB group, 16 (88%) completed the program, with 2 (11%) withdrawing during the first week. In addition, there was a significant time group interaction for Four Square Step Test (F1,21=5.55, P=.03), Tinetti Performance Oriented Mobility Assessment (F1,25=4.16, P=.05), and 30-second chair stand test (F1,21=5.06, P=.03), with a significant improvement in these measures for the CogXergaming group post training, compared with no change observed in the MOB group. Conclusions: These pilot findings indicate that CogXergaming is feasible and applicable in prefrail older adults. Such game-based protocols can be beneficial in improving physical function among community-dwelling, prefrail older adults, however, the efficacy of such training requires further investigation. Trial Registration: ClinicalTrials.gov NCT04534686; https://clinicaltrials.gov/study/NCT04534686 UR - https://www.jmir.org/2024/1/e56810 UR - http://dx.doi.org/10.2196/56810 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56810 ER - TY - JOUR AU - Duran, T. Andrea AU - Cumella, M. Robin AU - Mendieta, Miguel AU - Keener-Denoia, Adrianna AU - López Veneros, David AU - Farris, G. Samantha AU - Moise, Nathalie AU - Kronish, M. Ian PY - 2024/11/12 TI - Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study JO - JMIR Form Res SP - e55137 VL - 8 KW - behavioral intervention development KW - implementation science KW - acute coronary syndrome KW - exercise sensitivity KW - interoceptive exposure KW - digital health KW - mobile phone N2 - Background: To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. Objective: This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. Methods: We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ?4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Results: Of 31 patients approached during recruitment, 3 (10%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67% male; 1/3, 33% Black; and 1/3, 33% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. Conclusions: The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline. UR - https://formative.jmir.org/2024/1/e55137 UR - http://dx.doi.org/10.2196/55137 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55137 ER - TY - JOUR AU - Miller, M. Lyndsey AU - Kaye, Jeffrey AU - Lindauer, Allison AU - Au-Yeung, M. Wan-Tai AU - Rodrigues, K. Nathaniel AU - Czaja, J. Sara PY - 2024/10/18 TI - Remote Passive Sensing of Older Adults? Activities and Function: User-Centered Design Considerations for Behavioral Interventions Conducted in the Home Setting JO - J Med Internet Res SP - e54709 VL - 26 KW - user-centered design KW - remote passive sensing KW - remote monitoring KW - behavioral interventions KW - caregiving KW - dementia KW - Alzheimer KW - monitoring KW - gerontology KW - geriatrics KW - older adult KW - aging KW - usability KW - acceptability KW - trust KW - behavioral UR - https://www.jmir.org/2024/1/e54709 UR - http://dx.doi.org/10.2196/54709 UR - http://www.ncbi.nlm.nih.gov/pubmed/39423003 ID - info:doi/10.2196/54709 ER - TY - JOUR AU - Bronas, G. Ulf AU - Marquez, X. David AU - Fritschi, Cynthia AU - Petrarca, Katherine AU - Kitsiou, Spyros AU - Ajilore, Olu AU - Tintle, Nathan PY - 2024/9/5 TI - Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e55079 VL - 26 KW - sedentary time KW - physical activity KW - cognition KW - older adults KW - Latinos KW - mobile phone N2 - Background: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. Objective: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. Methods: This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. Results: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean ?35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. Conclusions: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. Trial Registration: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5 UR - https://www.jmir.org/2024/1/e55079 UR - http://dx.doi.org/10.2196/55079 UR - http://www.ncbi.nlm.nih.gov/pubmed/39235836 ID - info:doi/10.2196/55079 ER - TY - JOUR AU - Quinn, Kelly AU - Leiser Ransom, Sarah AU - O'Connell, Carrie AU - Muramatsu, Naoko AU - Marquez, X. David AU - Chin, Jessie PY - 2024/8/30 TI - Assessing the Feasibility and Acceptability of Smart Speakers in Behavioral Intervention Research With Older Adults: Mixed Methods Study JO - J Med Internet Res SP - e54800 VL - 26 KW - smart speakers KW - physical activity KW - older adults KW - behavioral health KW - intervention KW - smart device KW - smart devices KW - conversational agent KW - physical activities KW - behavioral intervention KW - intervention research N2 - Background: Smart speakers, such as Amazon?s Echo and Google?s Nest Home, combine natural language processing with a conversational interface to carry out everyday tasks, like playing music and finding information. Easy to use, they are embraced by older adults, including those with limited physical function, vision, or computer literacy. While smart speakers are increasingly used for research purposes (eg, implementing interventions and automatically recording selected research data), information on the advantages and disadvantages of using these devices for studies related to health promotion programs is limited. Objective: This study evaluates the feasibility and acceptability of using smart speakers to deliver a physical activity (PA) program designed to help older adults enhance their physical well-being. Methods: Community-dwelling older adults (n=18) were asked to use a custom smart speaker app to participate in an evidence-based, low-impact PA program for 10 weeks. Collected data, including measures of technology acceptance, interviews, field notes, and device logs, were analyzed using a concurrent mixed analysis approach. Technology acceptance measures were evaluated using time series ANOVAs to examine acceptability, appropriateness, feasibility, and intention to adopt smart speaker technology. Device logs provided evidence of interaction with and adoption of the device and the intervention. Interviews and field notes were thematically coded to triangulate the quantitative measures and further expand on factors relating to intervention fidelity. Results: Smart speakers were found to be acceptable for administering a PA program, as participants reported that the devices were highly usable (mean 5.02, SE 0.38) and had strong intentions to continue their use (mean 5.90, SE 0.39). Factors such as the voice-user interface and engagement with the device on everyday tasks were identified as meaningful to acceptability. The feasibility of the devices for research activity, however, was mixed. Despite the participants rating the smart speakers as easy to use (mean 5.55, SE 1.16), functional and technical factors, such as Wi-Fi connectivity and appropriate command phrasing, required the provision of additional support resources to participants and potentially impaired intervention fidelity. Conclusions: Smart speakers present an acceptable and appropriate behavioral intervention technology for PA programs directed at older adults but entail additional requirements for resource planning, technical support, and troubleshooting to ensure their feasibility for the research context and for fidelity of the intervention. UR - https://www.jmir.org/2024/1/e54800 UR - http://dx.doi.org/10.2196/54800 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54800 ER - TY - JOUR AU - Sweeting, Anna AU - Warncken, A. Katie AU - Patel, Martyn PY - 2024/7/30 TI - The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future JO - J Med Internet Res SP - e58846 VL - 26 KW - assistive technology KW - older adults KW - users KW - aging KW - aging in place KW - UK KW - cocreation KW - research trial KW - independent living KW - North Norfolk KW - disability KW - injury KW - tool KW - use KW - design KW - barrier UR - https://www.jmir.org/2024/1/e58846 UR - http://dx.doi.org/10.2196/58846 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58846 ER - TY - JOUR AU - Miura, Watanabe Kumi AU - Kudo, Takashi AU - Otake-Matsuura, Mihoko PY - 2024/7/11 TI - Web-Based Group Conversational Intervention on Cognitive Function and Comprehensive Functional Status Among Japanese Older Adults: Protocol for a 6-Month Randomized Controlled Trial JO - JMIR Res Protoc SP - e56608 VL - 13 KW - randomized controlled trial KW - web-based intervention KW - communication technology KW - cognitive health KW - neural blood markers KW - social isolation KW - well-being N2 - Background: Social communication is a key factor in maintaining cognitive function and contributes to well-being in later life. Objective: This study will examine the effects of ?Photo-Integrated Conversation Moderated by Application version 2? (PICMOA-2), which is a web-based conversational intervention, on cognitive performance, frailty, and social and psychological indicators among community-dwelling older adults. Methods: This study is a randomized controlled trial with an open-label, 2-parallel group trial and 1:1 allocation design. Community dwellers aged 65 years and older were enrolled in the trial and divided into the intervention and control groups. The intervention group receives the PICMOA-2 program, a web-based group conversation, once every 2 weeks for 6 months. The primary outcome is verbal fluency, including phonemic and semantic fluency. The secondary outcomes are other neuropsychiatric batteries, including the Mini-Mental State Examination, Logical Memory (immediate and delay), verbal paired associates, and comprehensive functional status evaluated by questionnaires, including frailty, social status, and well-being. The effect of the intervention will be examined using a mixed linear model. As a secondary aim, we will test whether the intervention effects vary with the covariates at baseline to examine the effective target attributes. Results: Recruitment was completed in July 2023. A total of 66 participants were randomly allocated to intervention or control groups. As of January 1, 2024, the intervention is ongoing. Participants are expected to complete the intervention at the end of February 2024, and the postintervention evaluation will be conducted in March 2024. Conclusions: This protocol outlines the randomized controlled trial study design evaluating the effect of a 6-month intervention with PICMOA-2. This study will provide evidence on the effectiveness of social interventions on cognitive function and identify effective target images for remote social intervention. Trial Registration: UMIN Clinical Trials UMIN000050877; https://tinyurl.com/5eahsy66 International Registered Report Identifier (IRRID): DERR1-10.2196/56608 UR - https://www.researchprotocols.org/2024/1/e56608 UR - http://dx.doi.org/10.2196/56608 UR - http://www.ncbi.nlm.nih.gov/pubmed/38990615 ID - info:doi/10.2196/56608 ER -