Digital health screening tool for identification of elder mistreatment.
Digital health screening tool for identification of elder mistreatment.
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DOI：
10.4017/gt.2020.19.s.70138
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发表时间：
2020-10-03
期刊：
影响因子：
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通讯作者：
Gill T
中科院分区：
文献类型：
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作者：
Abujarad F;Edwards C;Choo E;Pantalon M;Jubanyik K;Dziura J;D'Onofrio G;Gill T
据估计，全球60岁及以上的老年人中有15.7%受到某种形式的虐待。在美国，多达1/24的EM病例未被专业人员识别，没有得到帮助的老年人的死亡风险增加了300%。目前的筛查方法往往会错过不太明显的EM迹象，并可能阻止老年人披露EM，因为缺乏对虐待构成的理解或害怕犯罪者的报复。我们的方法通过自动化的基于平板电脑的工具将EM识别的重点转移到老年人身上。虚拟辅导在作出知情的选择对老年人虐待自我披露（声音）工具包括各种多媒体组件，如视频，音频和动画，旨在教育和加强筛选。筛选为阳性的患者通过简短的协商访谈（BNI）进行指导，利用动机访谈来帮助自我识别（认识到他们正在经历老年人虐待）或自我披露（告知他人他们的老年人虐待经历）。在工具开发过程中，我们进行了一项定性研究，以评估采用基于平板电脑的方法来促进ED中EM的筛查和自我披露的感知价值和可能性。我们与利益相关者举行了3个焦点小组，包括24名60岁或以上的成年人，2名社会工作者，2名护理人员和2名艾德临床医生。我们使用焦点小组的研究结果和以用户为中心的设计方法（UCD）来开发基于平板电脑的筛选工具。一旦工具准备好了，我们就用14名老年人测试了它的可用性和可接受性。焦点小组参与者支持使用基于平板电脑的工具来筛查EM，这表明数字筛查受益于隐私和匿名的感觉。在从“1=非常舒适”到“7=非常不舒适”的7分制Likert量表上，老年人在使用平板设备筛查EM是否感到舒适方面的平均得分为2.8。老年人提出的突出建议包括使用女性声音作为工具叙述者，更大的字体大小，更多的多媒体，耳机隐私;以及在需要时在筛选期间提供帮助。参与者表示，经历EM的老年人很难寻求帮助，任何类型的虐待筛查都会有所帮助。他们还强调，一旦EM被披露，需要解释老年人可用的社区资源，特别是为照顾者提供帮助的资源。可用性评估的参与者在系统可用性量表（SUS）上对该工具的平均评分为86.6（中位数= 88.8，iQR =18.1），远高于68的基准SUS评分，这表明该系统是“良好”或“可接受”的。将重点从提供者转移到老年人，可以通过解决传统筛查过程的主要障碍来鼓励EM的自我披露。总之，本研究支持使用自我管理的自动化基于片剂的EM筛查。与会者普遍认为，在艾德环境中，使用数字健康工具来促进筛查过程将是有益的。
It is estimated that 15.7% of people aged 60 years and older were subjected to some form of Elder Mistreatment (EM) globally. In the USA, as many as 1 in 24 EM cases are left unidentified by professionals, with a 300% increased mortality risk for older adults who do not receive help. Current methods of screening tend to miss less obvious signs of EM and may discourage older adults from disclosing EM, due to either a lack of understanding of what constitutes mistreatment or fear of retaliation from the perpetrator. Our approach shifts the focus of EM identification to the older adults themselves through an automated tablet-based tool. The Virtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure (VOICES) tool includes various multimedia components such as videos, audio, and animations designed to educate and enhance screening. Patients screened as positive are guided through a Brief Negotiated Interview (BNI) utilizing motivational interviewing to assist in self-identification (recognize that they are experiencing elder mistreatment) or self-disclosure (inform others about their elder mistreatment experiences). During tool development, we conducted a qualitative study to evaluate the perceived value and likelihood of adopting a tablet-based approach to facilitate screening and self-disclosure of EM in the ED. We held 3 focus groups with stakeholders, including 24 adults 60 years or over, 2 social workers, 2 caregivers, and 2 ED clinicians. We used the findings from the focus groups and User-Centered Design approach (UCD) to develop the tablet-based screening tool. Once the tool was ready, we tested its usability and acceptability with 14 older adults. Focus group participants supported use of a tablet-based tool to screen for EM, indicating that digital screening benefits from feelings of privacy and anonymity. On a 7-point Likert scale ranging from “1=Very Comfortable” to “7=Very Uncomfortable”, older adults scored 2.8 on average for whether they would feel comfortable using a tablet device to screen for EM. Prominent suggestions made by older adults included using a female voice for the tool narrator, larger font size, more multimedia, headphones for privacy; and having someone available during screening for assistance if needed. Participants indicated that it is difficult for older adults experiencing EM to ask for help and that any type of mistreatment screening would be helpful. They also highlighted the need to explain community resources available to older adults once EM is disclosed, especially resources offering help to the caregiver. Participants of the usability evaluation rated the tool a mean score of 86.6 (median= 88.8, iQR =18.1) on the System Usability Scale (SUS), far above the benchmark SUS score of 68, which indicates that the system is “good” or “acceptable”. Shifting the focus from the provider to the older adult may encourage self-disclosure of EM by addressing major barriers to traditional screening processes. In summary, this study supported the use of self-administered automated tablet-based screening for EM. Participants generally believed that the use of digital health tools to facilitate the screening process would be beneficial in the ED setting.