Using Technology to Improve Function for Older Latinos With Disabilities in Underserved Areas
- Conditions
- AgingDisability Physical
- Interventions
- Other: Attention callsBehavioral: Viviendo las Ventajas de la Asistencia Tecnológica
- Registration Number
- NCT06425510
- Lead Sponsor
- University of Puerto Rico
- Brief Summary
This project aims to test a culturally appropriate assistive technology (AT) intervention called VIVE-AT to help older Latinos with disabilities improve their function and quality of life. The researchers will first refine the VIVE-AT program based on feedback from a Community Advisory Board and focus groups with older Latinos with disabilities. Then, 76 older Latinos with disabilities will be recruited from a primary care clinic serving low-income communities in Puerto Rico. They will be randomly assigned to either receive the VIVE-AT intervention in the primary care clinic or be placed on a waitlist with regular phone calls. All participants will continue to receive standard care at the clinic.
- Detailed Description
Functional disabilities (FDs), defined as difficulties in performing daily activities, constitute a significant public health problem associated with increased dependency, poor health outcomes, diminished quality of life, institutionalization, and premature death. Older Latinos residing in Puerto Rico (PR) are disproportionately affected by FDs, with one of the highest rates of FDs (58%) in the US and its territories. Research has demonstrated positive outcomes from employing assistive technology (AT) devices, such as jar openers, sock aids, and canes, among older adults with FDs, thereby enhancing their functioning, participation, and capacity to remain at home or in the community for a longer period. However, Latinos are among the least likely to utilize AT. Given the dearth of culturally competent assistive technology interventions for Latinos, along with the scarcity of rehabilitation professionals and assistive technology services in primary healthcare facilities, this project leverages preliminary data from a prior study that assessed the feasibility of the Viviendo las Ventajas de la Asistencia Tecnológica; (VIVE-AT for short; Living the Advantages of Assistive Technologies) intervention. The specific aims of this project are to:
1. refine the protocol of the VIVE-AT to align with the unique needs of the primary health care clinic;
2. assess the efficacy of the VIVE-AT in comparison to a waitlist control arm, in decreasing FDs and improving the quality of life among Latinos aged ≥65 years post-intervention and at six months;
3. evaluate whether proposed mechanisms of change in FDs, specifically knowledge of AT, motivation for using AT, self-efficacy for using AT, and use of AT, account for the reduction in FDs post-intervention.
To achieve these aims, the interdisciplinary team of this project will first refine the intervention based on recommendations from participants in the feasibility study, as well as input from the Community Advisory Board and older Latinos with FDs through iterative focus groups (Aim 1). Subsequently, 76 older Latinos with physical FDs recruited from a primary health care facility serving low-income communities in PR will be randomly assigned to either the VIVE-AT intervention group (n=38) or a waitlist + attention calls controlled condition group (n=38) to assess its efficacy and mechanisms of change (Aims 2 and; 3). All participants will receive standard usual care at the primary health care center. Participants in the intervention group will attend a weekly, two-hour group session for 6 weeks, facilitated by trained healthcare workers, focusing on self-management of FDs through the use of AT. Additionally, participants will receive up to five AT devices tailored to their specific FI needs, along with training on their usage. All participants will be assessed at baseline, post-intervention, and six months after intervention. The goals of the VIVE-AT are to encourage participants to use AT devices to self-manage their FDs and improve their quality of life. Our approach will contribute to scientific knowledge and inform a subsequent scalable multisite Hybrid Type I RCT, designed to evaluate its effectiveness in reducing physical FDs among older Latinos in primary healthcare settings in the U.S. and P.R.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 76
- Spanish speaking Latino adults ≥65 years
- With a physical function impairment (PROMIS-HAQ T-Score ≤45)
- Living independently in the community (not requiring supervision to perform their daily living activities)
- Self-reported ability to participate in a 6 weeks of group intervention
- Having no plans to move for the next 12 months
- Currently residing in a nursing or group home
- Receiving home healthcare services
- Having a significant cognitive impairment as evidenced by a score ≤23 in the Mini Mental State Examination (MMSE)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Waitlist Control Attention calls Participants in the waitlist control group will receive weekly attention calls providing general health advice during the 6-week intervention period. They will also receive usual care for the initial 6 months post-randomization, followed by crossover to the VIVE-AT intervention. Viviendo las ventajas de la Asistencia Tecnológica (VIVE-AT) Viviendo las Ventajas de la Asistencia Tecnológica The VIVE-AT program consists of a six-week, once-a-week, 2-hour group educational intervention guided by the social cognitive model. It is facilitated by primary care and community health workers in a primary healthcare clinic. The intervention aims to teach older Latinos self-management strategies to increase the adoption and use of assistive technology devices that enhance their function in daily activities. VIVE-AT is designed to support behavioral change by providing up to five assistive technology devices to participants, along with information, instruction, demonstration, action planning, and guided practice in using the devices.
- Primary Outcome Measures
Name Time Method Quality of Life as Assessed by PROMIS Scale v1.2 - Global Health Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention This is a 10 items health-related quality of life measure with five domains: physical health, pain, fatigue, mental health, and social health, along with an overall health assessment. It also includes two subscales: Global Mental Health (GMH) and Global Physical Health (GPH).
Physical Function as Assessed by the PROMIS Short Form v2.0 - Physical Function 24a (PROMIS-HAQ) Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention This is a patient-reported outcome measure design to assess physical FDs in adults across the categories of dressing and grooming, arising, eating, walking, hygiene, reaching, gripping, errands, and chores. It comprises 20 items on a 5-point Likert-type scale, ranging from 5 "without difficulty" to 1 "unable to do".
- Secondary Outcome Measures
Name Time Method Intention to Use Assistive Technology as Assessed by Intention to Use Assistive Device Scale Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention This measure consists of three items presenting increasing levels of intention (motivation) to use assistive technology devices. It employs a 5-point Likert scale, ranging from 1 (I do not have the intention to do this at all) to 5 (I certainly have the intention to do this). The total score ranges from 3 to 15; higher scores indicating a strong intention to use asssitive technology devices.
Assistive Technology Knowledge as Assessed by Assistive Technology Use and Awareness Scale (ATUAS) Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention The ATUAS assess participants knowledge of 44 assistive technology devices. Participants are presented with photographs and names of the devices and asked if they possess each item. If the answer is 'No,' further questions will determine whether they use it (code 2) or not (code 1), are aware of its existence (code 3), or neither (code 4). Assistive technology knowledge is assessed by recoding the answer for each assistive technology into two categories: aware (codes 1, 2, 3) versus not aware (code 4).
Motivation to Use Assistive Technology as Assessed by Attitudes Towards Assistive Device Scale (AADS) Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention The AADS consists of 12 items designed to measure older adults' attitudes (motivation) including the substitution of care, the financial aspect of care, and the effect on privacy. It utilizes a Likert scale with 5 points, ranging from 5 (totally agree) to 1 (totally disagree), with interval scores ranging from 12 to 60. A high score indicates a positive attitude.
Self-efficacy as Assessed by Self-efficacy Regarding Assistive Device Use Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention This measure measures assesses self-efficacy for using assistive technology devices with three items, each representing increasing barriers. The interval scale ranges from 3 to 15; higher score indicates higher self-efficacy.
Use of Assistive Technology Devices as Assessed by Assistive Technology Awareness Scale (ATUAS) Baseline, at the end of the intervention (6 weeks), and at 6 months post-intervention The ATUAS assess participants knowledge of 44 assistive technology devices. Participants are presented with photographs and names of the devices and asked if they possess each item. If the answer is 'No,' further questions will determine whether they use it (code 2) or not (code 1), are aware of its existence (code 3), or neither (code 4). Responses will be recoded into two categories: used (code 2) and not used (codes 1, 3, and 4) to calculate ATD usage.
Trial Locations
- Locations (1)
University of Puerto Rico Medical Sciences Campus
🇵🇷San Juan, Puerto Rico