Design and Development of a Mobile Exercise Application for Home Care Aides and Older Adult Medicaid Home and Community-Based Clients

Insights Results

Overview of article

• This article describes the engagement of home care aides (HCAs), older adult HCBS clients, and physical therapists in the design, development, and pilot testing of a mobile exercise app
• While a number of mobile app exercise programs exist, none have targeted frail older adults receiving Medicaid Home and Community-Based Services (HCBS), nor engaged these important stakeholders in the development process. Given the low rates of exercise participation among older adults, this study hypothesized that engaging these stakeholders in exercise program development would result in a program that integrated the preferences of Medicaid HCBS clients, along with best-practice recommendations from physical therapists to improve exercise participation rates and adherence

Methods of article

• In the development phase of the Functional Resistance Activities to Impact Frailty (FRAIL) study, a participatory action research design was employed to co-develop the exercise intervention and mobile app through focus groups and semi-structured interviews with stakeholders
• Researchers evaluated the acceptability and usability of the mobile intervention following a 2-week pilot test. Intervention development occurred in three stages: 1) a qualitative stage focused on developing exercise program content; 2) a qualitative stage focused on developing the mobile app; 3) a 2-week pilot usability test of the app prototype with evaluation through client semi-structured interviews and HCA completion of the IBM Post-Study System Usability Questionnaire
• All client interviews were conducted between the first and second HCA focus group. Client interviews explored exercise preferences, and barriers and facilitators to exercise

Results

• Results can be categorized into 3 steps:
  Stage 1 – Exercise Content Preference
• Researchers identified four themes regarding HCAs’ preferences for intervention content: 1) Exercise and motivation training needs, 2) Exercise simplicity with individualization capability, 3) Short intervention duration, and 4) Variety while maintaining routine. The focus groups revealed that some HCAs exercised regularly, while others were sedentary and requested more exercise instruction training before implementing the exercise intervention with their clients. The HCAs anticipated clients may defer exercise some days because of pain, being “unmotivated”, or depressed and wanted to learn motivational techniques to encourage participation
• Learning to modify exercises was identified as an essential training element
• Client exercise preferences focused on 3 themes: 1) The need to address activities of daily living (ADLs); 2) Short duration; and 3) Concerns over the impact on the HCA-client relationship. Clients identified a range of ADLs with which they had difficulty (e.g., sit to stand, getting out of bed, going up stairs) and would like to improve upon. They did not want interventions that would be greater than 30 minutes. To encourage participation, clients suggested not describing the intervention as ‘exercise’, ‘fitness’, or ‘health’ as those terms sounded “too comprehensive and medical” and “something hard that I don’t want to do”
  Stage 2 – Mobile Application Preferences
• Clients overwhelmingly did not want to complete exercises in time with the video, but rather wanted videos to demonstrate a few repetitions of the exercise so that each person could “go at your own speed.” Further, clients desired methods to individualize app content including selecting whether to complete exercises in sitting or standing, turning music on or off, and receiving motivational prompts that rewarded intervention success. Both clients and HCAs thought having a new tablet would be an incentive to participate, but were also concerned that the device could potentially be stolen
  Stage 3 – Pilot Test Results
• After incorporating the mobile application and exercise content preferences into the mobile exercise app, researchers conduced a pilot study to assess the usability of the app
• Overall, HCAs were highly satisfied with the app formatting, usability, and noted high levels of confidence to use the exercise app with minimal outside assistance. Qualitative feedback from HCAs were that videos should be lighter and easier to view for clients, the videos would be “better if the HCA and client interacted throughout”, response anchors should be added to the Likert scale, and “featuring of clients doing things together – group exercise.” Clients overwhelmingly liked the mobile technology and found it easy to use

Key takeaways/implications

• This exercise program may serve as a model for other agencies within the Medicaid HCBS system to integrate exercise programming within usual care services to bring needed physical activity into the homes of community-limited older adults