BACKGROUND For older adults (≥70 years), maintaining newly acquired nutrition and physical activity behaviors after rehabilitation to minimize the risk for negative health consequences is often challenging. To support this vulnerable target group, an e-coach could be helpful. Aligning the program with an established concept such as the Transtheoretical Model of Behavior Change (TTM) and professional guidance should optimize behavior change. OBJECTIVE The usability and feasibility of a nutrition and mobility e-health intervention, accompanied by corresponding healthcare professionals, during and after rehabilitation for a period of 9 weeks was evaluated. In addition, the change in the TTM phase of the participants was assessed as an indicator of the participants' readiness to change or changes implemented. METHODS Rehabilitation patients (≥70 years) with nutrition and or physical activity deficits were recruited. Their phases of behavior change in TTM were determined by comparison with age-specific nutrition and physical activity recommendations and a tablet with the correspondingly configured e-coach was provided. Participants used the e-coach during and after rehabilitation and received regular support from the experts. The TTM phases were assessed at four time points (t0-t4) and the available e-coach content was adjusted accordingly. At the end of the study, usability was assessed using the System Usability Scale (SUS). To assess practicability, timestamps in the e-coach were used to evaluate on how many days the participants used the program, classified into three categories: high (e-coach used on <67% of the days), medium (e-coach used on 66-33% of the days), and low (e-coach used on <33% of the days). The acceptance of the e-coach was assessed by using a self-developed questionnaire on the relevance of the content, use of the e-coach in everyday life and ease of use of the e-coach. RESULTS In total, data from 21 participants (38% female, mean age 79.0 ± 6.0 years) were included in the data analysis. The SUS was 78.6 points and 11 participants (42%) were classified as high users, 6 (39%) as medium users and 4 (19%) as low users. In the subjective evaluation, the usefulness of the information in daily life (76%, n=16), the handling (76%, n=16) and the general satisfaction with the app (81%, n=17) were evaluated especially positive. Need for optimization was identified in finding specific content. After nine weeks, 15 participants (71%) achieved the physical activity recommendations (t0: 33%, n=7) and 14 (66%) achieved the nutrition recommendations (t0: 24%, n=5), thus reaching the highest TTM phases in each area. CONCLUSIONS The e-coach seems to be usable and feasible for the target group. With our study we could also identify some optimization potentials for our application, which can also be transferred to the development of comparable e-health interventions with the group of vulnerable older adults. CLINICALTRIAL DRKS00024481

Background Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one’s nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. Objective This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting. Methods Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). Results In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%). Conclusions The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change.

BACKGROUND Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one’s nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged &lt;70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. OBJECTIVE This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting. METHODS Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). RESULTS In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%). CONCLUSIONS The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change.