Date Presented 03/26/20
The objective of this study was to develop and test the acceptability and usability of a mobile application directory of OTs who provide home modifications in the United States. Preliminary results show the mobile application demonstrates good preliminary acceptability and usability to OTs. The mobile application shows promise as a new tool to help increase access to home modification interventions provided by OTs.
Primary Author and Speaker: An Nguyen
Contributing Authors: Emily Somerville, Sandra Martina Esp ín-Tello, Marian Keglovits, Susan Stark
PURPOSE: Difficulties performing activities of daily living (ADLs), such as bathing, dressing, or toileting, place older adults at increased risk for adverse outcomes, including poorer health and frailty, premature institutionalization, and mortality (Feng et al., 2017). Home modifications delivered by occupational therapists are an effective intervention to improve older adults’ safety and independence when performing ADLs (Stark et al., 2017). However, the prevalence of home modification is low (Pynoos, 2018). One reason is due to lack of information on occupational therapists who provide home modifications. Existing directories of home modification resources lack comprehensive referral information for occupational therapists who deliver home modifications as part of their databases of resources. Therefore, there is a need to develop a centralized, publicly accessible database of occupational therapists who provide home modifications to help increase intervention access, improve care coordination, and reduce care delivery delays. The objective of this study was to develop and test the usability of a mobile application (app) directory of occupational therapists who provide home modifications in the United States. We hypothesized the mobile app would be acceptable and usable for occupational therapists and community-dwelling older adults.
METHODS: This study was carried out in two phases. In Phase 1, a prototype was developed by identifying occupational therapists who provide home modifications through keyword web searches and snowball sampling. Referral information was confirmed by phone or email. In Phase 2, community-dwelling older adults over the age of 65 and occupational therapists currently working in the U.S. were purposefully recruited to participate in a single usability test of the mobile app, titled the Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semi-structured interview questions (Bangor, Kortum & Miller, 2008). Interview data were coded and themes derived using a grounded theory approach.
RESULTS: In Phase 1, referral information for 101 occupational therapists across 49 states were confirmed. In Phase 2, six occupational therapists (mean clinical experience ± SD: 4.3 ± 1.6 years) and six older adults (mean age ± SD: 72.8 ± 5.0 years) participated in usability testing. The mean SUS score for occupational therapists was 91.7 ± 8.0 (out of 100), indicating good usability. The mean SUS score for older adults was 71.7 ± 27.1, indicating considerable variability in usability. Additionally, the SUS scores indicated the app is acceptable to occupational therapists and may be acceptable to some older adults. For occupational therapists, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information (e.g., on a computer with a keyboard and mouse, as opposed to a touch screen device).
CONCLUSIONS: Home Maddirs demonstrates good preliminary acceptability and usability to occupational therapists. Older adults’ perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make iterative improvements to the mobile app prior to public release. Home Maddirs demonstrates promise as a new tool to help increase older adults’ access to home modifications provided by occupational therapists.
References
Bangor, A., Kortum, P. T., & Miller, J. T. (2008). An empirical evaluation of the system usability scale. International Journal of Human Computer Interaction, 24(6), 574-594. doi:10.1080/10447310802205776
Feng, Z., Lugtenberg, M., Franse, C., Fang, X., Hu, S., Jin, C., & Raat, H. (2017). Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies. PLoS One, 12(6), e0178383. doi:10.1371/journal.pone.0178383
Pynoos, J. (2018). The future of housing for the elderly: Four strategies that can make a difference. Public Policy & Aging Report, 28(1), 35-38. doi:10.1093/ppar/pry006
Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. American Journal of Occupational Therapy, 71(2), 7102290010p7102290011-7102290010p7102290011. doi:10.5014/ajot.2017.018887
