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The Old Man (or Woman) and the App: Crossing the digital divide and bringing an adherence app to elderly patients who have no prior experience with tablets or smartphones

Talya Miron-Shatz, Phd1*
  • 1 Ono Academic College, Founding Director, Israel

The rational for this study is the increasing prevalence of digital health, alongside the realization that, for some populations, it is not readily accessible. We have set out to examine: A. Whether older people use digital health, B. Whether there is a way for such patients, even with no prior smartphone or tablet experience, to benefit from a digital health interventions, and C. Whether said patients would prefer a more traditional, pen and paper journal, adherence intervention. METHODS Study 1: Between 2010-2012, the mobile application “Medication Plan” could be downloaded free of charge from the Apple-App-Store. It was aimed at supporting the regular and correct intake of medication. Demographic and health-related data were collected via an online questionnaire. This study analyzed captured data. We analyzed results from 1799 users (74% male, median age 45) for whom data was captured. For this observational study, the DV was frequency and length of using the app. Study 2: Coronary heart disease patients (N= 24, 50% male, mean age 73.8) with no prior experience with smartphones or tablets, received a tablet with the 'medication adherence' app, and an introductory tutorial session. They used the app for a month, and (in randomized order) also used a pen and paper adherence journal. The patients were recruited from local clinics via cardiac-rehab sports groups (we approached 100 patients), in 2015. RESULTS Study 1: Variance analysis showed a significant effect of the users´ age regarding duration of usage (p = 0.025). On average, users under 21 used it for 23.3 days. Usage increased with age, up to users age60 and above (103.9 days). “Daily usage intensity” increased with number of prescribed medications, from an average of 1.87 uses per day and 1 drug per day, to 3.71 uses per day for users taking over 7 different drugs daily (p<0.001). The results clearly indicate that, with age, as well as with drug regimen complexity, the loyalty to a medication adherence app increases. This has encouraged us in carrying out Study 2, which deals with older, and smartphone/tablet naïve patients. Study 2: Baseline mean subjectively assessed adherence was 50.0 (SD=3.44), and increased after the digital intervention (54.0; SD=2.01), more than after the paper system (52.6; SD=2.49) (for all pairs, P<0.001). Logging data showed significantly stronger adherence for the app than the paper system for both blood pressure recordings (P<0.001) and medication intake (P=0.033). Almost all participants wanted to integrate the medication app in their daily lives and required no further assistance with it. CONCLUSION Study 1: Patients age 60 and over engage in prolonged use of an adherence to medication app. Across ages, usage increases with complexity of medication regimen. This suggests that digital health solutions are required, and adopted, including by patients who are slightly older, albeit self-select to download an app. Study 2: The results show that, despite being digitally naïve, elderly patients were capable to use an adherence app, which increased their adherence to medication and to blood pressure measurements. Granted, the patients received a home-visit during each phase of the study, and the tablet applications were hugely simplified for them. However, following this initial training session, the patients used the app, benefited from it. and preferred it to a pen and paper system. Thus, bridging the digital age gap is possible, and can lead to health improvements. That said, an offline component might need to be added, alongside modifications in the mode of delivering the intervention, to truly accommodate patients' needs. The results show the great promise of digital health in a scalable manner, as well as the modifications that need to be carried out for it to reach its full potential, including among the older and the less tech-savvy.

Acknowledgements

Roche gave financial support to one of the authors for his part in the study (recruitment and home visits). The company did not interfere with the study design, nor with the analysis or outcomes.

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Keywords: Digital Health, Aging, Hypertension, Adherence to medication, Digital Rectal Examination

Conference: 3rd UCL Centre for Behaviour Change Digital Health Conference 2017: Harnessing digital technology for behaviour change, London, United Kingdom, 22 Feb - 23 Feb, 2017.

Presentation Type: Research abstract

Topic: Digital Health

Citation: Miron-Shatz, Phd T (2017). The Old Man (or Woman) and the App: Crossing the digital divide and bringing an adherence app to elderly patients who have no prior experience with tablets or smartphones. Front. Public Health. Conference Abstract: 3rd UCL Centre for Behaviour Change Digital Health Conference 2017: Harnessing digital technology for behaviour change. doi: 10.3389/conf.FPUBH.2017.03.00024

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Received: 22 Feb 2017; Published Online: 22 Feb 2017.

* Correspondence: Prof. Talya Miron-Shatz, Phd, Ono Academic College, Founding Director, Kiryat Ono, Israel, talya@curemyway.com