Kim Heejung, Park Eunhee, Lee Sangeun, Kim Mijung, Park Eun Jeong, Hong Soyun
College of Nursing, Yonsei University, Seoul, Republic Of Korea.
Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic Of Korea.
JMIR Mhealth Uhealth. 2018 Jun 29;6(6):e147. doi: 10.2196/mhealth.9988.
Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes.
This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol.
The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol.
Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence.
A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting.
韩国目前大多数慢性病自我管理培训项目主要在医疗保健场所进行面对面互动。因此，居住在社区的韩国老年人继续寻求其他慢性病管理培训机会。这促使了新的培训方法的发展，如移动健康（mHealth）护理，它在社区中心和家庭中很有价值。
本可行性研究（1）制定了一项移动健康培训方案，以使社区居住的老年人能够管理自己的慢性病；（2）研究通过移动平板电脑和应用程序（app）向老年人提供该移动健康培训方案的可行性；（3）讨论与该方案制定相关的背景和方法学挑战。
移动健康培训方案基于电子健康强化慢性病护理模型制定，包括四个阶段。第一阶段包括使用指南、示范和指导练习进行标准化技术（移动平板电脑）培训。第二阶段包括提供从政府和专业医疗保健组织获取的关于疾病管理的标准化信息。第三阶段包括提供关于使用根据个体诊断选择的高质量移动健康应用程序的培训。第四阶段包括鼓励患者根据个人需求使用自选的移动健康应用程序进行练习。使用定量描述性统计和用户评价的定性内容分析来评估该方案的可行性和用户接受度。
本研究纳入的27名老年人中，25人完成了为期4周的移动健康培训。损耗率为7%（2/27），原因包括时间冲突、情绪困扰和/或家人劝阻。男性在第一阶段几乎不需要或不需要培训，与男性相比，女性在第三阶段似乎更依赖移动健康培训师。性别、教育程度和以前使用智能手机的经验与学习速度、信心水平和总体能力相关。
为老年人制定移动健康培训方案需要采用量身定制和个性化的方法。通过移动健康培训进行慢性病自我管理需要仔细考虑人类行为、情绪反应和家庭影响的复杂性。因此，将理论、临床和技术方法相结合对于在社区环境中成功开发和实施针对患有慢性病的老年人的移动健康培训项目是必要的。
