Toward the Integration of Technology-Based Interventions in the Care Pathway for People with Dementia: A Cross-National Study

Abstract

Background: The integration of technology-based interventions into health and care provision in our aging society is still a challenge especially in the care pathway for people with dementia. Objective: The study aims to: (1) identify which socio-demographic characteristics are independently associated with the use of the embodied conversational agent among subjects with dementia, (2) uncover patient cluster profiles based on these characteristics, and (3) discuss technology-based interventions challenges. Methods: A virtual agent was used for four weeks by 55 persons with dementia living in their home environment. Results: Participants evaluated the agent as easy-to-use and quickly learnable. They felt confident while using the system and expressed the willingness to use it frequently. Moreover, 21/55 of the patients perceived the virtual agent as a friend and assistant who they could feel close to and who would remind them of important things. Conclusions: Technology-based interventions require a significant effort, such as personalized features and patient-centered care pathways, to be effective. Therefore, this study enriches the open discussion on how such virtual agents must be evidence-based related and designed by multidisciplinary teams, following patient-centered care as well as user-centered design approaches.

Embodied Conversational Agents for Chronic Diseases: Scoping Review

“…Among the studies that reported a study design, mixed method studies (8/36, 22%) [ 10 , 28 , 39 - 44 ] and pilot studies (8/36, 22%) [ 31 , 34 , 38 , 45 - 48 ] were the most commonly used study designs, followed by qualitative studies (6/36, 17%) [ 11 , 26 , 35 , 49 - 51 ], randomized controlled trials (5/36, 14%) [ 32 , 37 , 52 - 54 ], ongoing trials (4/36, 11%) [ 33 , 55 - 57 ], quasiexperimental designs (2/36, 6%) [ 30 ], longitudinal study (1/36, 3%) [ 29 ], single-group nonrandomized trial (1/36, 3%) [ 36 ], and pre- and posttest design (1/36, 3%) [ 27 ]. Of the 36 studies, 30 (83%) were conducted on patients (15/36, 42%) [ 10 , 26 , 32 , 34 - 37 , 40 , 42 , 47 , 52 , 54 - 57 ] or healthy individuals (15/36, 42%) [ 11 , 27 , 29 - 31 , 44 - 46 , 48 - 51 , 53 ] and 6 (17%) [ 28 , 33 , 38 , 39 , 41 , 43 ] on stakeholders such as homecare providers or experts. The mean age of the target population across studies was >40 years, except for 19% (7/36) of the studies [ 30 , 33 , 35 , 47 , 53 , 57 ].…”

“…Of the 36 studies, 8 (22%) addressed atrial fibrillation [ 34 , 52 , 55 , 56 ] and type 2 diabetes [ 10 , 26 , 37 , 39 ]. Other conditions included dementia (2/36, 6%) [ 41 , 42 ], obesity (1/36, 3%) [ 32 ], Parkinson disease (1/36, 3%) [ 36 ], sleep apnea syndrome (1/36, 3%) [ 38 ], spinal cord injury (1/36, 3%) [ 35 ], and chronic pain (3/36, 8%) [ 47 , 54 , 57 ]. One study focused on 2 diseases [ 40 ].…”

“…The goals of the ECA-led interventions varied, with 31% (11/36) of the studies aiming to promote self-management [ 10 , 26 , 33 - 35 , 37 , 39 , 40 , 52 , 55 , 56 ], including activities such as daily walking, medication taking, healthy eating, monitoring symptoms, and interaction management. ECAs were also used for mental therapy (3/36, 8%) [ 47 , 54 , 57 ], genetic counseling (3/36, 8%) [ 30 , 53 ], assisted living (2/36, 6%) [ 41 , 42 ], diagnosis (1/36, 3%) [ 38 ], and education (1/36, 3%) [ 43 ]. Of the 36 studies, 2 (6%) [ 32 , 36 ] used ECAs to promote exercise.…”

“…Across 67% (24/36) of the studies, we found that ECAs were given 9 different names, including ALEX [ 31 , 45 , 46 , 48 , 51 ], Tanya [ 30 , 34 , 35 , 52 , 53 ], Danya [ 43 ], Anne [ 41 , 42 , 47 , 57 ], Sylvia [ 40 ], Laura [ 10 , 26 , 37 ], Vitoria [ 39 ], iHeartHelper [ 33 ], and Ellie [ 54 ]. Of 36 studies, 14 (39%) reported that ECAs assumed the role of virtual health coaches or counselors [ 10 , 26 , 30 , 32 , 34 - 37 , 43 , 47 , 52 , 53 , 57 ], whereas others described them as virtual health assistants (n=9, 25%) [ 11 , 31 , 33 , 39 , 44 , 48 - 50 ], virtual clinicians (n=3, 8%) [ 45 , 46 , 51 ], health providers (n=2, 6%) [ 27 , 29 ], a virtual human interviewer (n=1, 3%) [ 54 ], and a semiexpert (n=1, 3%) [ 40 ].…”

Impact of Actual Use Behavior of Healthcare Wearable Devices on Quality of Life: A Cross-Sectional Survey of People with Dementia and Their Caregivers in Ghana

“…Undertaking research in dementia and other neurological degenerative diseases is complex and poses several challenges [ 98 , 99 ]. To the best of our knowledge, no other study has empirically assessed the impact of actual use behavior of healthcare wearable devices on the quality of life of PWDs in the context of developing countries using extended UTAUT and SF-36 instruments, thus making the insights from this study very useful in guiding future research in this area.…”