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Traumatic brain injury (TBI) can result in chronic sensorimotor, cognitive, psychosocial, and communication challenges that can limit social participation. Social media can be a useful outlet for social participation for individuals with TBI, but there are barriers to access. While research has drawn attention to the nature of access barriers, few studies have investigated technological solutions to address these barriers, particularly considering the perspectives of individuals with TBI. To address this gap in knowledge, we used a participatory approach to engage 10 adults with TBI in conceptualizing tools to address their challenges accessing Facebook. Participants described multifaceted challenges in using social media, including interface overload, social comparisons, and anxiety over self-presentation and communication after injury. They discussed their needs and preferences and generated ideas for design solutions. Our work contributes to designing assistive and accessibility technology to facilitate an equal access to the benefits of social media for individuals with TBI.CCS CONCEPTS • Human-centered computing → • Accessibility → • Accessibility design and evaluation methods

BACKGROUND Voice-controlled smart speakers and displays have unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale, rigorous trials. Older adults with multiple chronic health conditions (eg, diabetes, arthritis)—who need tools to help with daily management of their conditions—may be especially good candidates for interventions on voice-controlled devices, because these patients often have physical limitations such as tremors or vision problems that make use of laptops and smartphones challenging. OBJECTIVE Assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison to participants using ElderTree on a laptop and control participants given no device or access to ElderTree. METHODS 291 adults age 60 and older with chronic pain plus at least 3 additional chronic conditions (eg, diabetes, arthritis) will be recruited from primary care clinics and community venues and randomized 1:1:1 to: (1) access to ElderTree on a smart display along with their usual care, (2) access to ElderTree on a touchscreen laptop along with usual care, or (3) usual care alone. All patients will be followed for 8 months. Primary outcomes are differences between groups on measures of pain interference and psychosocial quality of life. Secondary outcomes are between-groups differences on system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of effects of ElderTree on both platforms. At 0, 4, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations; ElderTree use data will be collected continuously in system logs. We will use linear mixed effect models to evaluate outcomes over time, with treatment condition and time as between-subjects factors. Separate analyses will be conducted for each outcome. RESULTS Recruitment began August 2021 and will run through April 2023; the intervention period will end December 2023. CONCLUSIONS To our knowledge, this is the first study to examine with a large sample and long timeframe whether a smart device can perform as well as or better than a laptop in implementing a health intervention. The goal of ElderTree, regardless of delivery platform, is to improve patient self-management, and as a result relieve some of the burden on the healthcare system. Because patients with multiple chronic conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. CLINICALTRIAL ClinicalTrials.gov NCT04798196

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