Graduate Program in Speech-Language Pathology, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Republic of Korea.
JMIR Mhealth Uhealth. 2020 Jul 27;8(7):e19585. doi: 10.2196/19585.
Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits.
The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults' self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties.
A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews).
The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=-2.023, P=.04). Additionally, the usability scores in the low-potential group were within the "marginal acceptability" range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience.
To the best of the authors' knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.
吞咽困难（即吞咽障碍）在老年人中很常见，患病率为 13%至 54%。充分干预老年人的吞咽功能可降低发病率并提高健康相关生活质量。移动健康（mHealth）应用程序可以通过提供最大限度地提高训练强度和频率的方案来帮助减轻吞咽障碍症状，而无需高成本或定期就诊。
本试点研究旨在通过定量和定性评估老年人的自我报告数据来评估吞咽训练应用程序的可用性，同时考虑他们的教育水平和移动技术的使用情况。我们在参与者使用我们开发的吞咽干预应用程序时进行了调查和简短访谈。随后，我们确定并解决了特定于个人的可用性问题，以改善未来针对吞咽困难老年人实施应用程序方案的情况。
共有来自两个区办老年福利中心的 11 名参与者（10 名女性，91%；平均年龄 75.7 岁，SD 3.93）参加了这项研究。根据他们的受教育年限和智能设备使用情况，参与者被分为高潜力组和低潜力组。为了两次评估应用程序的可用性（即在干预的第二周和干预后阶段），我们使用了混合方法，包括定量方法，即系统可用性量表（SUS）和修改后的计算机自我效能量表（mCSES）调查，以及定性方法（即访谈）。
SUS 和 mCSES 调查的定量结果表明，高潜力组比低潜力组更倾向于采用和学习新技术。具体来说，在高潜力组中，Wilcoxon 符号秩检验表明，干预后 mCSES 评分（中位数 65.50）明显高于干预第二周的评分（中位数 54.00；z=-2.023，P=.04）。此外，即使完成了 8 周的干预计划，低潜力组的可用性评分仍处于“边缘可接受性”范围内。通过半结构化访谈进行的定性分析得出了关于应用程序可接受性、培训计划利用率、情绪反应和学习经验的有希望的结果。
据作者所知，这是一项关于为改善老年人吞咽功能而设计的吞咽训练应用程序的可用性和可行性研究的首次报告。未来的研究应考虑用户特征、预培训教育以及干预计划的强度和固有特征等问题。
