Digital prompting technology to support people
Description: Digital prompting technology to support people with early dementia Hazel Boyd ( User Interface Engineer, Designability) Nina Evans ( Research Occupational Therapist, Designability) Jess Ridgers (Product Designer, Designability) Nigel Harris
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slide1. Digital prompting technology to support people with early dementia Hazel Boyd ( User Interface Engineer, Designability)
Nina Evans ( Research Occupational Therapist, Designability)
Jess Ridgers (Product Designer, Designability)
Nigel Harris (Chief Executive, Designability)
Richard Cheston (Professor of Mental Health Research, UWE )
Krist Noonan (Research and Development Operations Manager, AWP)
Aron Jarvis (Research Psychologist, RICE)
Tom Ingram ( Assistant Clinical Studies Officer, NIHR CRN)
This research has been funded by the Dunhill Medical Trust<br>
slide2. Symptoms of dementia Short term memory loss
Impaired communication
Difficulty thinking and problem solving
In a survey of 1,000 carers most (96%) reported problems with the management of activities of daily living (Georges et al 2008)
Multi-step tasks become increasingly problematic ( Wherton and Monk 2010)<br>
slide3. Why prompt? A strategy routinely used by professionals and carers is to deconstruct tasks into steps which can be supported by prompts ( Small et al 2003, Wilson et al 2013)<br>
slide4. Paper or digital prompts? ELECTRONIC
Shows text in bitesize steps
Can combine audio and text
Easy to illustrate with personalised photographs
Timed
Add alarms PAPER
Familiar aide memoir
Full instruction list on page
Inexpensive<br>
slide5. Digital Prompter<br>
slide6. Research questions Can the training materials enable carers to choose and breakdown tasks into suitable steps and successfully load this task information onto a tablet computer?
Can individuals with dementia understand and use the prompting technology to carry out tasks or activities in the home<br>
slide7. Mixed methods design (observational and experimental) Phase 1: supported home testing Training session
Tablet and instruction manual
4 week home trial
Goal setting
Weekly telephone calls
Semi structured recorded interviews pre and post intervention Phase 2: independent home testing “ Out of the box” experience
Tablet and instruction manual
4 week home trial
Goal setting
Weekly telephone calls
Semi structured recorded interviews pre and post intervention<br>
slide8. Sample Person diagnosed with mild Alzheimer's disease / vascular dementia/mixed dementia and primary carer
26 dyads (26 pre and 23 post intervention interviews)
Majority spouses
Majority living in same home
14 male / 12 female participants
Majority of carers were female (6:20)
Age range 67 to 94 (Average 80)<br>
slide9. Psychometric testing Addenbrooke’s Cognitive Examination-III(ACE III) (>50)
Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test
California Verbal Learning Test-II(CVLT-II)
Bristol Activities of Daily Living Scale (BADLS)(>5)<br>
slide10. Participants and carer’s use of technology (Phase 2 only) 2 out of 14 couples did not have a computer, laptop, tablet or smart phone
10 participants were not using a computer, laptop, tablet or smart phone<br>
slide11. Participants and carer’s confidence with technology (Phase 2 only)<br>
slide12. Tasks tried with tablet<br>
slide13. Goals<br>
slide14. Checklist (Phase 2 only)<br>
slide15. Case study 1:Wife participant / Husband carer<br>
slide16. Case study 1:<br>
slide17. Case study 2: Goal 1 Husband participant / wife carer<br>
slide18. Case study 2: Goal 2<br>
slide19. Thematic analysis of interview data (49 pre and post intervention interviews) Listened to audio data and created transcripts
Codes generated and reviewed into themes
Themes developed and refined by researchers not connected to the data collection
A recursive process then added refinement to the final naming of themes<br>
slide20. Thematic Map<br>
slide21. Attitude to technology “I am not technical” 1. Level of interest, support networks, familiarity and perception of skill required to use technology determined the level of engagement with the prompter
1.1 The greater the familiarity with technology, the more confidence there was to utilise the prompter; lack of interest or engagement with technology was a barrier for some participants and carers
(I use a computer a lot I have an iPad so I am used to a touchscreen-C) ( This modern age I am not in it for a start this puts a barrier for me, high tech systems-PPT)
1.2 Carers assumed setting up and using technology would need high level skills (I am not a computer genius-C)
1.3 Carers consulted family and friends using them as a network of help and support for using technology (If I come across a problem I have a grandson who sorts everything out-C)<br>
slide22. Judgement about utility “chances of success are fifty-fifty” 2. Judgement about the utility of prompting technology was determined by participants and carers according to whether it worked for them and fitted into their routines and lifestyle
2.1 Benefit was more likely if the prompter was recognised as a necessary source of help, or means of practise and fitted existing routines and the home environment ( If he hadn’t been using the tablet he wouldn’t have made it ( the coffee) full stop-C) ( I can learn on the camera by this machine that is what I want to do –C)
2.2 Some participants and carers were challenged to find time and purpose to use the prompting technology ; a lack of conviction in the intervention was expressed (That’s what we need something we could use it for-C) ( It requires a lot more work of mine to work out in what way it can be useful-C )<br>
slide23. EMOTIONAL IMPACT “loss of status” 3. Views of self and relationships influenced usage of the prompter
3.1 Sensitivity was expressed about the stigma and embarrassment associated with prompting or being prompted (Perhaps I was coming at it from a slightly different way I was the victim rather than the… yes..”-P)
3.1 Carers motivation and the affect using the prompter had on relationships were significant factors in whether the prompter was used ( It was just another task for me to get him to do these things I can’t honestly say it is going to save me any time at all -C ) ( Why am I doing this ( using the tablet) becomes a bit of a problem-C )<br>
slide24. Design changes Some small changes were made to the hardware and software in response to the participants’ experiences, including:
Longer cables for more convenient charging
A rigid tablet cover to protect the power button from being pressed inadvertently when holding up the prompter to take a photo
Allowing the screen content to rotate, for comfortable typing on a shallower slope when setting up a task
Showing a battery level on the screen for reassurance”<br>
slide25. Conclusions Can the training materials enable carers to choose and breakdown tasks into suitable steps and successfully load this task information onto a tablet computer?
Yes
Can individuals with dementia understand and use the prompting technology to carry out tasks or activities in the home?
Yes but…<br>
slide26. Future Explore initiation
Stakeholder interviews (Design changes needed before testing with other user groups)
Make available as a product<br>
slide27. Reference List Georges J, Jansen S, Jackson J, Meyrieux A, Sadowska A, Selmes M. Alzheimer’s disease in real life- the dementia survey. Int J Geriatr Psychiatry 2008;23(5):546-51
Wherton J, Monk A. Problems people with dementia have with kitchen tasks: The challenge for pervasive computing. Interacting with Computers 2010; 22(4):253-66
Small J, Gutman G, Makela S, Hillhouse B. Effectiveness of communication strategies used by caregivers of persons with Alzheimer’s disease during activities of daily living. J Speech Lang Hear Res 2003;46(2): 353-67
Wilson R, Rochon E, Mihailidis A, Leonard C. Quantitative analysis of forwmal caregivers’ use of communication strategies while assisting individuals with moderate and severe Alzheimer’s disease during oral care. J Commun Disord 2013:46(3):249-63<br>
Nina Evans ( Research Occupational Therapist, Designability)
Jess Ridgers (Product Designer, Designability)
Nigel Harris (Chief Executive, Designability)
Richard Cheston (Professor of Mental Health Research, UWE )
Krist Noonan (Research and Development Operations Manager, AWP)
Aron Jarvis (Research Psychologist, RICE)
Tom Ingram ( Assistant Clinical Studies Officer, NIHR CRN)
This research has been funded by the Dunhill Medical Trust<br>
slide2. Symptoms of dementia Short term memory loss
Impaired communication
Difficulty thinking and problem solving
In a survey of 1,000 carers most (96%) reported problems with the management of activities of daily living (Georges et al 2008)
Multi-step tasks become increasingly problematic ( Wherton and Monk 2010)<br>
slide3. Why prompt? A strategy routinely used by professionals and carers is to deconstruct tasks into steps which can be supported by prompts ( Small et al 2003, Wilson et al 2013)<br>
slide4. Paper or digital prompts? ELECTRONIC
Shows text in bitesize steps
Can combine audio and text
Easy to illustrate with personalised photographs
Timed
Add alarms PAPER
Familiar aide memoir
Full instruction list on page
Inexpensive<br>
slide5. Digital Prompter<br>
slide6. Research questions Can the training materials enable carers to choose and breakdown tasks into suitable steps and successfully load this task information onto a tablet computer?
Can individuals with dementia understand and use the prompting technology to carry out tasks or activities in the home<br>
slide7. Mixed methods design (observational and experimental) Phase 1: supported home testing Training session
Tablet and instruction manual
4 week home trial
Goal setting
Weekly telephone calls
Semi structured recorded interviews pre and post intervention Phase 2: independent home testing “ Out of the box” experience
Tablet and instruction manual
4 week home trial
Goal setting
Weekly telephone calls
Semi structured recorded interviews pre and post intervention<br>
slide8. Sample Person diagnosed with mild Alzheimer's disease / vascular dementia/mixed dementia and primary carer
26 dyads (26 pre and 23 post intervention interviews)
Majority spouses
Majority living in same home
14 male / 12 female participants
Majority of carers were female (6:20)
Age range 67 to 94 (Average 80)<br>
slide9. Psychometric testing Addenbrooke’s Cognitive Examination-III(ACE III) (>50)
Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test
California Verbal Learning Test-II(CVLT-II)
Bristol Activities of Daily Living Scale (BADLS)(>5)<br>
slide10. Participants and carer’s use of technology (Phase 2 only) 2 out of 14 couples did not have a computer, laptop, tablet or smart phone
10 participants were not using a computer, laptop, tablet or smart phone<br>
slide11. Participants and carer’s confidence with technology (Phase 2 only)<br>
slide12. Tasks tried with tablet<br>
slide13. Goals<br>
slide14. Checklist (Phase 2 only)<br>
slide15. Case study 1:Wife participant / Husband carer<br>
slide16. Case study 1:<br>
slide17. Case study 2: Goal 1 Husband participant / wife carer<br>
slide18. Case study 2: Goal 2<br>
slide19. Thematic analysis of interview data (49 pre and post intervention interviews) Listened to audio data and created transcripts
Codes generated and reviewed into themes
Themes developed and refined by researchers not connected to the data collection
A recursive process then added refinement to the final naming of themes<br>
slide20. Thematic Map<br>
slide21. Attitude to technology “I am not technical” 1. Level of interest, support networks, familiarity and perception of skill required to use technology determined the level of engagement with the prompter
1.1 The greater the familiarity with technology, the more confidence there was to utilise the prompter; lack of interest or engagement with technology was a barrier for some participants and carers
(I use a computer a lot I have an iPad so I am used to a touchscreen-C) ( This modern age I am not in it for a start this puts a barrier for me, high tech systems-PPT)
1.2 Carers assumed setting up and using technology would need high level skills (I am not a computer genius-C)
1.3 Carers consulted family and friends using them as a network of help and support for using technology (If I come across a problem I have a grandson who sorts everything out-C)<br>
slide22. Judgement about utility “chances of success are fifty-fifty” 2. Judgement about the utility of prompting technology was determined by participants and carers according to whether it worked for them and fitted into their routines and lifestyle
2.1 Benefit was more likely if the prompter was recognised as a necessary source of help, or means of practise and fitted existing routines and the home environment ( If he hadn’t been using the tablet he wouldn’t have made it ( the coffee) full stop-C) ( I can learn on the camera by this machine that is what I want to do –C)
2.2 Some participants and carers were challenged to find time and purpose to use the prompting technology ; a lack of conviction in the intervention was expressed (That’s what we need something we could use it for-C) ( It requires a lot more work of mine to work out in what way it can be useful-C )<br>
slide23. EMOTIONAL IMPACT “loss of status” 3. Views of self and relationships influenced usage of the prompter
3.1 Sensitivity was expressed about the stigma and embarrassment associated with prompting or being prompted (Perhaps I was coming at it from a slightly different way I was the victim rather than the… yes..”-P)
3.1 Carers motivation and the affect using the prompter had on relationships were significant factors in whether the prompter was used ( It was just another task for me to get him to do these things I can’t honestly say it is going to save me any time at all -C ) ( Why am I doing this ( using the tablet) becomes a bit of a problem-C )<br>
slide24. Design changes Some small changes were made to the hardware and software in response to the participants’ experiences, including:
Longer cables for more convenient charging
A rigid tablet cover to protect the power button from being pressed inadvertently when holding up the prompter to take a photo
Allowing the screen content to rotate, for comfortable typing on a shallower slope when setting up a task
Showing a battery level on the screen for reassurance”<br>
slide25. Conclusions Can the training materials enable carers to choose and breakdown tasks into suitable steps and successfully load this task information onto a tablet computer?
Yes
Can individuals with dementia understand and use the prompting technology to carry out tasks or activities in the home?
Yes but…<br>
slide26. Future Explore initiation
Stakeholder interviews (Design changes needed before testing with other user groups)
Make available as a product<br>
slide27. Reference List Georges J, Jansen S, Jackson J, Meyrieux A, Sadowska A, Selmes M. Alzheimer’s disease in real life- the dementia survey. Int J Geriatr Psychiatry 2008;23(5):546-51
Wherton J, Monk A. Problems people with dementia have with kitchen tasks: The challenge for pervasive computing. Interacting with Computers 2010; 22(4):253-66
Small J, Gutman G, Makela S, Hillhouse B. Effectiveness of communication strategies used by caregivers of persons with Alzheimer’s disease during activities of daily living. J Speech Lang Hear Res 2003;46(2): 353-67
Wilson R, Rochon E, Mihailidis A, Leonard C. Quantitative analysis of forwmal caregivers’ use of communication strategies while assisting individuals with moderate and severe Alzheimer’s disease during oral care. J Commun Disord 2013:46(3):249-63<br>