Browsing by Author "Werner, Nicole"

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    Co-Design of a Mobile App For Care Partners Who Manage Medications For People Living With Dementia
    (Oxford University Press, 2024-12-31) Werner, Nicole; Ganci, Aaron; Patel, Himalaya; Thuemling, Teresa; Holden, Richard; Herron School of Art and Design
    For unpaid care partners of community-dwelling people living with Alzheimer’s disease and related dementias (ADRD), medication management is effortful and time-consuming work that often continues over several years. Although this work may be eased by mobile application software (apps), current consumer apps underserve care partners’ needs. Through co-design workshops, our objective was to identify the user requirements for a mobile app supporting at-home medication management for people with ADRD. We conducted five 1-hour virtual co-design workshops with current and recent ADRD care partners. Care partners described their difficulties with medication management, then proposed ideal end-states by hand-drawing storyboards. We co-reflected on care partners’ descriptions and proposals, chose the app’s necessary functions, and digitally sketched corresponding user-facing features. After reviewing the sketches, care partners self-reported attitudes toward the proposed features. We ranked features by desirability, then created a digital user interface prototype. Care partners reviewed the prototype and self-reported adoption intent on a scale from 1 to 5. Seven care partners participated, ages 56-75 (Mdn=63), with 3-14 years’ care-partner experience (Mdn=5.5). Elicited requirements included tracking medication administration, recording behavioral changes, instructing other care partners, and briefing healthcare professionals. The user interface prototype included a medication checklist, observation journal, and contacts management. Care partners self-reported moderately high adoption intent (M=4.2, SD=0.9). By supporting both short- and long-term information needs, the proposed mobile app promotes shared awareness among ADRD care partners and healthcare professionals. This work is foundational to developing the app and assessing usability and utility in situ.
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    Technology caregiver intervention for Alzheimer’s disease (I-CARE): Feasibility and preliminary efficacy of Brain CareNotes
    (Wiley, 2023) Rodriguez, Miriam Jocelyn; Martinez Kercher, Vanessa; Jordan, Evan J.; Savoy, April; Hill, Jordan R.; Werner, Nicole; Owora, Arthur; Castelluccio, Pete; Boustani, Malaz A.; Holden, Richard J.; Medicine, School of Medicine
    Background: The primary aim of the current pilot study was to examine enrollment rate, data completion, usability, acceptance and use of a mobile telehealth application, Brain CareNotes. A secondary aim was to estimate the application's effect in reducing caregiver burden and behavioral and psychological symptoms related to dementia (BPSD). Methods: Patient-caregiver dyads (n = 53) were recruited and randomized to intervention and control groups. Assessment of usability, acceptance, BPSD symptoms, and caregiver burden were collected at baseline, 3- and 6-month follow-up. Results: The enrollment rate was acceptable despite pandemic related challenges (53/60 target recruitment sample). Among randomized individuals, there was a retention rate of 85% and data completion was attained for 81.5% of those allocated to usual care and 88.5% of those allocated to Brain CareNotes. Mean caregiver-reported app usability at 6 months was 72.5 (IQR 70.0-90.0) on the System Usability Scale-considered "Good to Excellent"-and user acceptance was reasonable as indicated by 85%-90% of caregivers reporting they would intend to use the app to some degree in the next 6 months, if able. Regarding intervention effect, although differences in outcome measures between the groups were not statistically significant, compared to baseline, we found a reduction of caregiver burden (NPI-Caregiver Distress) of 1.0 at 3 months and 0.7 at 6 months for those in the intervention group. BPSD (NPI Total Score) was also reduced from baseline by 4.0 at 3 months and by 0.5 at 6 months. Conclusions: Brain CareNotes is a highly scalable, usable and acceptable mobile caregiver intervention. Future studies should focus on testing Brain CareNotes on a larger sample size to examine efficacy of reducing caregiver burden and BPSD.
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    User Personas to Guide Technology Intervention Design to Support Caregiver-Assisted Medication Management
    (Oxford, 2022-11) Linden, Anna; Loganathar, Priya; Holden, Richard; Boustani, Malaz; Campbell, Noll; Ganci, Aaron; Werner, Nicole; Herron School of Art
    Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medications for people with ADRD to guide future design decisions for technology interventions. Data were collected through virtual contextual inquiry in which caregivers (Nf24) sent daily multimedia text messages depicting medication management activities for seven days each, followed by an interview that used the messages as prompts to understand medication management needs. We applied the persona development method to the data to identify distinct caregiver personas, i.e., evidence-derived groups of prospective users of a future intervention. We used team-based affinity diagramming to organize information about participants based on intragroup (dis)similarities, to create meaningful clusters representing intervention-relevant attributes. We then used group consensus discussion to create personas based on attribute clusters. The six identified attributes differentiating personas were: 1. medication acquisition, 2. medication organization, 3. medication administration, 4. monitoring symptoms, 5. care network, 6. technology preferences. Three personas were identified based on differences on those attributes: Regimented Ruth (independent, proactive, tech savvy, controls all medications), Intuitive Ian (collaborative, uses own judgment, some technology, provides some medication autonomy), Passive Pamela (reactive, easy going, technology novice, provides full medication autonomy). These personas can be used to guide technology intervention design by evaluating how well intervention designs support each of them.