Self-Management via Health Kiosk by Community-Residing Older Adults

Wearable devices, mobile apps, and patient portals allow users to monitor and manage their health. Despite their benefit, older adults have barriers to using these technologies, including a lack of access, being disabled, living in areas without robust cell phone or internet service, and low technology literacy. In addition, the lack of accessible, user-friendly delivery platforms, compounded by resources not being designed for this demographic, has resulted in poor adoption by older adults.

This research refined and deployed multi-user health kiosks into community venues that serve older adults and observed whether and how they were used. The health kiosks allowed users to obtain and record physical measures, answer questionnaires, and interact with health intervention modules, including ones focused on self-management of health, sleep, bladder control, emotional health, and lifestyle behaviors. Kiosks were deployed in 13 venues, including senior centers, senior housing communities, continuing care retirement communities, and a library, with a focus on accessibility.

The specific aims of the research were as follows:

• Describe the self-management needs, motivations, design preferences, and patterns of health kiosk use among diverse community-residing older adults in congregate settings.
• Determine factors that influence intensity of kiosk use among older adults with a range of needs for a healthier lifestyle and improved self-management of chronic disease.
• Explore primary care visits, emergency room visits, and hospitalization during kiosk access.

The health kiosks were designed to be of maximal benefit to older adults by being easy and intuitive to use, responsive to sensory deficits due to impaired hearing or vision, and respectful of privacy concerns. The kiosk desk was paired with an adjustable height chair and digital seated scale. A desk drawer contained an RFID reader, flip phone for contacting the research team as needed, a wrist blood pressure cuff, and a hand dynamometer. Digital devices were integrated into the computer.

The analysis was done via a prospective observational study with embedded cognitive-behavioral interventions designed for self-administration at the kiosk. Assessments were conducted at baseline, 6, 12, and 18 months, and health resource utilization was tracked monthly, with 242 participants. After the first three assessments, health intervention modules were recommended that promoted strategies for self-monitoring and managing health in general and specifically in relation to sleep, bladder control, mood, diet, weight, and physical activity. Individuals who screened positive or expressed a desire to improve in a particular area were offered a recommendation to complete the corresponding health intervention module. All others could opt for a health promotion version of the module.

The research was interrupted during the grant period due to the COVID-19 pandemic, when the kiosks had to be closed to the public. While at baseline there was high intention and willingness to use the kiosks by the participants, the study suffered from considerable attrition impacting the ability to assess the data. Reasons for attrition included participants moving away or withdrawing from the study to take care of a family member; participants living elsewhere for periods during the study; some lost interest or lacked the time to engage with all sessions of a health intervention module; others ran out of things to do at the kiosk; and others became ill or died. At the time of completion of the grant period the data was still being collected and analyzed, to be completed and published in the future.