Ecological Momentary Assessment Within a Digital Health Intervention for Reminiscence in Persons With Dementia and Caregivers: User Engagement Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>User-interaction event logs provide rich and large data sets that can provide valuable insights into how people engage with technology. Approaches such as ecological momentary assessment (EMA) can be used to gather accurate real-time data in an individual’s natural environment by asking questions at any given instant.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The purpose of this study was to evaluate user engagement and responses to EMA questions using InspireD, an app used for reminiscence by persons with dementia and their caregivers. Research findings can be used to inform EMA use within digital health interventions.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A feasibility trial was conducted in which participants (n=56) used the InspireD app over a 12-week period. Participants were a mean age of 73 (SD 13) and were either persons with dementia (n=28) or their caregivers (n=28). Questions, which they could either answer or choose to dismiss, were presented to participants at various instants after reminiscence with personal or generic photos, videos, and music. Presentation and dismissal rates for questions were compared by hour of the day and by trial week to investigate user engagement.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Overall engagement was high, with 69.1% of questions answered when presented. Questions that were presented in the evening had the lowest dismissal rate; the dismissal rate for questions presented at 9 PM was significantly lower than the dismissal rate for questions presented at 11 AM (9 PM: 10%; 11 AM: 50%; χ21=21.4, P&lt;.001). Questions asked following reminiscence with personal media, especially those asked after personal photos, were less likely to be answered compared to those asked after other media. In contrast, questions asked after the user had listened to generic media, in particular those asked after generic music, were much more likely to be answered.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The main limitation of our study was the lack of generalizability of results to a larger population given the quasi-experimental design and older demographic where half of participants were persons with dementia; however, this study shows that older people are willing to participate and engage in EMA. Based on this study, we propose a series of recommendations for app design to increase user engagement with EMA. These include presenting questions no more than once per day, after 8 PM in the evening, and only if the user is not trying to complete a task within the app.</jats:p> </jats:sec>

A Mobile App–Based Intervention Program for Nonprofessional Caregivers to Promote Positive Mental Health: Randomized Controlled Trial

“…On the other hand, the program allowed the self-management of time when planning the daily operation of the program. In this way, adherence was facilitated and the risk of dropouts was also reduced, as was also shown in another study [ 56 ].…”

Home-based digital health technologies for older adults to self-manage multiple chronic conditions: A data-informed analysis of user engagement from a longitudinal trial

“…Analysing the time of submissions can reveal what time of day participants prefer to interact with digital health interventions. Potts et al 35 found that the most popular time for people with dementia to answer ecological momentary assessment (EMA) questions is between 21:00 and 22:00. They also found that dismissal rates are relatively low at postprandial times such as 09:00 and 18:00.…”

“…They also found that dismissal rates are relatively low at postprandial times such as 09:00 and 18:00. 35 In the ProACT study, participants were not given any instruction as to how often or at what time of day they should monitor symptom or well-being parameters. The majority of participants interacted with the various devices to monitor symptoms in the morning, with peaks of usage also found in the evening time.…”

Copyright as a Barrier to Music Therapy Telehealth Interventions: Qualitative Interview Study

“…Emerging research confirms that technology-based music therapy holds tantalizing promise [54]. In the mental health field, the widespread adoption of telehealth has made it the "new normal" [18].…”