Supporting Physical Activity for Informal Caregivers during and beyond COVID-19: Exploring the Feasibility, Usability and Acceptability of a Digital Health Smartphone Application, ‘CareFit’
Abstract
:1. Introduction
2. Materials and Methods
- -
- Educational components: including the following “stages”: (1) Welcome and Introduction (2) Physical activity: Beginners Guide” (3) “Relationships and” Physical Activity”, (4) “Managing time”, (5) “Goals and Rewards”, (6) “Physical activity and consequences” (7) “The Mind and body” and; (8) “Knowledge Quiz”.
- -
- Physical activity components: (a weekly planner that allows planning for two weeks ahead and viewing of the week previous). The planner and physical activity options supports three different components of physical activity (cardiovascular activity, strength and balance, sedentary behaviour with a bespoke icon and individual screen for each). Videos for each component for caregivers were developed by colleagues at the University of Strathclyde who have previously worked with caregivers.
- -
- Communication elements and an online user guide.
- (i)
- Online Questionnaires: We collected baseline information through questionnaires (using Qualtrics software, Seattle, WA, USA) that were provided to users in app. Questions covered basic demographic information (e.g., age, gender, number of years caring, number of hours caring per day, the council district of residence), details around health and wellbeing (e.g., medical conditions of the carer, current levels of physical activity), education level, work status alongside, motivators and barriers to physical activity (including decisional balance, self-efficacy, stage of change in the TTM). Our definitions of physical activity were based on UK government guidance where; (i) “meeting guidelines” equated to “at least 150 min/week of moderate physical activity, 75 min/week vigorous physical activity, or an equivalent combination of these”, (ii) “some activity” equated to “60–149 min/week of moderate physical activity, 30–74 min/week vigorous physical activity, or an equivalent combination of these”, (iii) “low activity” equated to “30–59 min/week of moderate physical activity, 15–29 min/week vigorous physical activity or an equivalent combination of these” and (iv) “very low activity” equated to “less than 30 min/week of moderate physical activity, less than 15 min/week vigorous physical activity, or an equivalent combination of these”. Optional interim feedback was possible also through a short free text response delivered mid-way through the 3-week test study. The follow up survey involved a ‘push’ of surveys in a similar manner. Users could provide feedback on free-text opinions of the app. We used the second Unified Theory of Acceptance and Use of Technology (UTAUT2) [23] to add clarity to the key strengths/weaknesses of the app and to help with future directions. The UTAUT2 is a well-established scale that hypothesises that expectancy, effort expectancy, social influence, and facilitating conditions are the determinants of behavioural intention or use behaviour [24].
- (ii)
- Telephone interviews: We aimed to interview 6 to 10 participants, selected at random (using random function within excel). We used a semi-structured interview to explore themes as described in the study protocol. Interviews took no longer than 20 min and were recorded using an encrypted Dictaphone before being fully transcribed.
- (iii)
- In app data: As each participant was assigned a unique identifier- we explored access and use of the educational and physical activity content within the app. This included data relating to the initiation and completion of the educational ‘stage’ (stored with a time stamp for each user). Physical activity elements included the type of activity planned and completed (across the three core elements of ‘cardiovascular’, ‘muscle and balance’ and ‘sedentary breaker’ activities). For physical activities we additionally stored information on which specific activity was undertaken (e.g., ‘muscle and balance exercise 1’, ‘cardiovascular exercise 2’, etc.). We did not record information on the weekly plans made by each user or record social/media communication elements from users within the app stored data.
3. Results
3.1. Feasibility of the ‘CareFit’ App
“I can now fit my exercise around my caring duties with my son” Carefit Participant.
3.2. Overall Acceptability and Usability of the ‘CareFit’ App
“Overall I enjoyed using the app and found it easy to use” Carefit Participant.
3.3. Barriers and Facilitators for Use of ‘Careft’
“The app was gently telling me to look after myself. I loved the instructor she just cared.” Carefit Participant.
“The family were very helpful and enjoyed doing some of the exercises together. This is something we haven’t done a lot together recently.” Carefit Participant.
3.4. Future Perspective
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Need/Requirement | Example Quote 1 | Example Quote 2 |
---|---|---|
Feasibility | Assess whether the digital health system works as intended in a given context | |
Inclusive of many caregivers | The app has also encouraged me to get out for longer walks which has been difficult due to COVID and caring. | I can now fit my exercise around my caring duties with my son. |
Phone accessible | It was great having these on my phone as I could take this with me anywhere in the house. | It is really tough for carers just now not being able to get out, but this app showed me the things I can do in my own house. |
Time flexible | I would do the cardio in the morning and some strength ones in the afternoon which fitted into my routine. | So, the sedentary ones were great you could be sitting there with the person you are caring for and do the exercise without having to go away somewhere else to do the exercise. |
Monitoring physical activity progress | The fact that the exercises were gentle, and you could build up made them more engaging. | They motivated me to be more active and defiantly kept me going |
Goal setting and planning ahead. | I would have preferred to just click a button, do the exercise and it was recorded onto the planner rather than the other way around. I don’t know if that would work for everyone, but I am retired and have a set routine and would just like to record my activity as I did it rather than have to pre-plan it. | I would have liked the planner to be able to add more than 3 options if I decided to do more activities. I couldn’t record all the various activities I was doing if they were more than 3 a day. |
Delivery of education materials on physical activity | This can be very useful at this time as most health care is out of reach for a lot of people just now because of COVID with most clinics cancelled. Carers like me with underlying health conditions feel isolated just now and your educational section was very useful. | I think the education part of it is very important for people that haven’t started that process and don’t understand that there is a definite link between the amount of exercise that you need to do and general fitness and overall health. |
Functions to motivate behavioural change (e.g., planner, videos, text materials) | The app was gently telling me to look after myself. I loved the instructor she just cared. | The app has also encouraged me to get out for longer walks which has been difficult due to COVID and caring. |
Facilitate connections to human supports (e.g., friends/family/other carers) | No not really I am quite a private person. I did though send an email to my son saying what I had done, and this brought us closer together. | I do not do social media so wasn’t sure who I should share my stuff with. |
Acceptability and usability | Would caregivers be willing to use it-and is the digital health system used as intended? | |
Overall | Overall I enjoyed using the app and found it easy to use. | This app has encouraged me to be more active. |
Presentation of educational materials | It was well written though and I kept going back over it. I liked the graphics which helped break-up the writing. | I found the reading of the education section really good. All the background and reasons for doing things was very helpful. |
Reminders | I was trying to set a reminder for the following day, but it would only come up the day before. | It only appeared to work on the day I set it but not in the future. |
Planner | I used the planner to measure what I had done and found this good to track my activities. | This app has encouraged me to be more active. |
Physical activities and videos | The videos were good but I think having the ability to make them bigger would have helped. | Then in the second week I went in I must admit that I don’t think I pressed the start button properly when I was doing exercise as often as I was doing or even at all. |
Share functionalities | I didn’t really understand who I was to share the information with friends, relatives etc. |
Performance Expectancy | Mean | SD |
---|---|---|
I find CareFit useful in my daily life | 4.92 | 1.80 |
Using CareFit increases my chances of achieving things that are important to me | 4.85 | 1.72 |
Using CareFit helps me accomplish things more quickly | 4.23 | 1.69 |
Using CareFit increases my productivity | 4.23 | 1.54 |
Effort expectancy | ||
Learning how to use CareFit is easy for me | 5.54 | 1.45 |
My interaction with CareFit is clear and understandable | 5.25 | 1.29 |
I find CareFit easy to use | 5.69 | 1.25 |
It is easy for me to become skilful at using CareFit | 5.69 | 0.95 |
Social Influence | ||
People who are important to me think that I should use CareFit | 3.38 | 1.85 |
People who influence my behaviour think that I should use CareFit | 2.69 | 2.06 |
Social Influence—People whose opinions that I value prefer that I use CareFit | 2.85 | 2.38 |
Facilitating conditions | ||
I have the resources necessary to use CareFit | 5.69 | 1.44 |
I have the knowledge necessary to use CareFit | 5.85 | 0.80 |
CareFit is compatible with other technologies I use | 4.46 | 1.81 |
I can get help from others when I have difficulties using CareFit | 5.23 | 1.64 |
Hedonic Motivation | ||
Using CareFit is fun | 4.69 | 1.70 |
Using CareFit is enjoyable | 4.85 | 1.86 |
Using CareFit is very entertaining | 4.31 | 1.75 |
Habit | ||
The use of CareFit has become a habit for me | 4.69 | 2.18 |
I am addicted to using CareFit | 2.15 | 1.63 |
I must use CareFit | 2.46 | 1.51 |
Using CareFit has become natural to me | 3.69 | 1.65 |
Behavioural Intention | ||
I intend to continue using CareFit in the future | 4.77 | 2.09 |
I will always try to use CareFit in my daily life | 4.31 | 2.21 |
I plan to continue to use CareFit frequently | 4.62 | 1.98 |
Barriers and Enablers | Facilitator/Enabler Example | Barrier Example |
---|---|---|
Current | ||
Instructions and guidance | At the beginning I found the educational section very confusing and a lot of information. It was only when I finished it that I had a better understanding. It was great though being able to go back and look over the educational material again. | I had completed the educational section early and wasn’t sure if I should start the activities. You clarified that I could start using the planner at that stage which wasn’t clear in the instructions. |
Personalization and flexibility | I also loved the flexibility and length of the exercise videos. Five mins was ideal and if you ran out of time you could just stop and still feel you had done something. If the videos had been any longer I would have struggled to do the exercises but the times on the app were perfect and really motivated me to be more active. | I would have preferred to just click a button, do the exercise and it was recorded onto the planner rather than the other way around. I don’t know if that would work for everyone, but I am retired and have a set routine and would just like to record my activity as I did it rather than have to pre-plan it. |
Planning ahead, measuring progress and changing needs | To Learn and I have—my own routines at last. Been to Gym with variety of staff taking class not so good. This was consistent and I was able to Learn the routines and the options, but I MISS THE APP now the trial ended. It was helpful. | Easily forgot about it as reminders didn’t work and as I never saved it to my home screen it was out of sight. The videos were too much for me to compute, some went through several versions of exercise and I got lost in what the first one was |
Technology experience of carer | I actually found it ok and did it myself which for me was a surprise as I am not good with these things. | I think it was just from my point of view that I felt had it been something I was more used to an integrated app. I use Fitbit quite a lot for example and you have got Fitbit on and you start going for a walk it recognises that you are going for a walk and starts measuring distance, stride, steps and so on. |
Social connections | The family were very helpful and enjoyed doing some of the exercises together. This is something we haven’t done a lot together recently. | This is just for me and I don’t feel the need for support from others. Others might find this useful, but I don’t feel the need to share my personal activities with Joe Blogs in Largs. |
Wider behavioural change | Fitness level and energy level plus confidence to look after myself for a change its a shift in outlook. The education part lifted me to feeling I needed this and deserved this. Love the Schedule and the programming. | When you are out exercising you are worried about meeting people. |
Individual carer circumstance | It was great having these on my phone as I could take this with me anywhere in the house. | This can be very useful at this time as most health care is out of reach for a lot of people just now because of COVID with most clinics cancelled. Carers like me with underlying health conditions feel isolated just now and your educational section was very useful. |
Self-awareness of physical and mental health | I have been trying to lose weight and this app has got me thinking about not only exercise but my diet. | You get wrapped up in other things and sometimes forget about yourself. |
Technology/phone delivery approach | I loved having it on my phone so I could do the exercises when and where I wanted. | Reading so much information on the phone screen was also difficult. |
Future scoping/sustainability | ||
Extend the recognition of further carer physical activities | I don’t know if there are any that don’t use the phone metrics to gauge what it is that you are actually doing. So whether if you are going for a walk or whether its anything that you are doing physical activity that you might be doing like lifting weights or doing housework or whatever it is that you are using to get your exercise or burn calories then. | “Felt extremely supported. The Healthcare professional visiting said a lot of carers she supports would like to know about CareFit’. |
Integration with other technologies | Linking it into the phone metrics would help. GPS or steps. Most smartphones have these facilities and would be a great addition to the app. | I tried to link my phone with my TV, but it didn’t work. Having that facility to link with my TV would have been great. I found this difficult when doing some of the exercises such as against the wall or on the floor. I had to carry my phone and found it difficult to see the screen. |
Pricing | If it was a modest fee then yes. I also use myfitnesspal and happy to pay for the additional services. If it was about £1 a week then I think that is reasonable. | It would depend if it was a one off or a monthly payment. I did pay recently for a type of house organising app. I think it was about £4.99 as a one-off payment. I found this useful so didn’t mind paying for it. I would be happy to get access of this app through either a GP or care support group. The human interaction is really important for carers as it can be very lonely on occasions. |
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Gender (n = 27) | n | % | Location (n = 27) | n | % |
Male | 4 | 14.8 | Edinburgh city | 3 | 11.1 |
Female | 23 | 85.2 | North Lanarkshire | 3 | 11.1 |
Ethnicity (n = 27) | Inverclyde | 3 | 11.1 | ||
White | 27 | 100 | Glasgow city | 2 | 7.4 |
Mixed/multiple ethnic groups | 0 | 0 | Perth and Kinross | 2 | 7.4 |
Asian/Asian British | 0 | 0 | Angus | 2 | 7.4 |
Black/African/Caribbean/Black British | 0 | 0 | South Ayrshire | 2 | 7.4 |
Other ethnic group | 0 | 0 | East Lothian | 2 | 7.4 |
Education level (n = 27) | Fife | 1 | 3.7 | ||
Degree or equivalent | 15 | 55.6 | South Lanarkshire | 1 | 3.7 |
Higher education | 4 | 14.8 | Highland | 1 | 3.7 |
SVQ | 3 | 11.1 | Falkirk | 1 | 3.7 |
School qualifications | 3 | 11.1 | Dundee City | 1 | 3.7 |
Other qualifications | 2 | 7.4 | North Ayrshire | 1 | 3.7 |
Age group (n = 27) | Moray | 1 | 3.7 | ||
18 to 24 | 1 | 3.7 | East Renfrewshire | 1 | 3.7 |
25 to 34 | 2 | 7.4 | Setting (n = 27) | ||
35 to 44 | 4 | 14.8 | Urban | 19 | 70.4 |
45 to 54 | 12 | 44.4 | Rural | 6 | 22.2 |
55 to 64 | 7 | 25.9 | Not sure | 2 | 7.4 |
65 to 74 | 1 | 3.7 | |||
Years caregiving (n = 27) | |||||
1 year or less | 2 | 7.4 | |||
Up to 2 years | 0 | 0 | |||
Up to 3 years | 3 | 11.1 | |||
Up to 10 years | 8 | 29.6 | |||
10 year or more | 14 | 51.9 | |||
Hours caregiving per day (n = 27) | |||||
Up to 4 h | 3 | 11.1 | |||
Up to 6 h | 4 | 14.8 | |||
Up to 8 h | 3 | 11.1 | |||
8 h and more | 17 | 63.0 | |||
Work status (n = 27) | n | % | |||
Caregiving has not affected my working/studying hours | 7 | 25.9 | |||
Yes, caregiving has caused me to reduce my working/studying hours | 5 | 18.5 | |||
Caregiving has caused me to give up work/study | 8 | 29.6 | |||
I do not currently work/study and did not have to give up work/study due to my caregiving role | 7 | 25.9 |
Familiarity with physical activity guidelines (n = 26) | n | % | Awareness of the benefits of physical activity (n = 26) | n | % |
Not heard of these | 15 | 57.7 | I am not aware of these | 1 | 3.9 |
Heard of it, but very unfamiliar | 6 | 23.1 | Aware of these, but very unfamiliar | 5 | 19.2 |
Heard of it, but mainly unfamiliar | 3 | 11.5 | Aware of these, but mainly unfamiliar | 7 | 26.9 |
Broadly familiar | 1 | 3.9 | Broadly Aware | 5 | 19.2 |
Very Familiar | 1 | 3.9 | Very aware | 8 | 30.8 |
Motivation for undertaking physical activity (n = 26) | Barriers to activity (n = 26) | ||||
To improve my physical health | 23 | 88.5 | Motivation (lack of) | 19 | 73.1 |
To keep fit | 18 | 69.2 | Caring duties | 16 | 61.5 |
To lose weight | 18 | 69.2 | Lack of time | 12 | 46.2 |
To improve my mental wellbeing | 18 | 69.2 | COVID-19 restrictions | 9 | 34.6 |
Reduce stress | 15 | 57.7 | Finances | 8 | 30.8 |
To reduce my sedentary time | 15 | 57.7 | Weather | 6 | 23.1 |
To help undertake my caring role | 14 | 53.8 | Lack of equipment | 6 | 23.1 |
Improve my mobility | 14 | 53.8 | Confidence | 5 | 19.2 |
To prevent illness | 12 | 46.2 | Physical space/environment | 5 | 19.2 |
Improve posture | 8 | 30.8 | Others | 3 | 11.5 |
Improve balance | 7 | 26.9 | |||
Other | 1 | 3.85 | |||
Support (n = 26) | Confidence (n = 26) | ||||
Highly supported | 1 | 3.85 | Not confident/No confidence | 8 | 30.8 |
Moderately supported | 5 | 19.2 | Slight confidence | 6 | 23.1 |
Slightly supported | 4 | 15.4 | Moderate confidence | 9 | 34.6 |
Not supported | 16 | 61.5 | High confidence | 3 | 11.5 |
Physical activity levels (n = 27) | Sedentary behaviours (n = 26) | ||||
Meets Guidelines | 3 | 11.1 | Average proportion of day spent sedentary | 5.43 | |
Some activity | 2 | 7.4 | SD of this value | 2.18 | |
Low activity | 9 | 33.3 | |||
Very low activity | 13 | 48.2 |
Familiarity with activity guidelines (n = 13) | n | % | Awareness of the benefits of physical activity (n = 13) | n | % |
Not heard of these | 3 | 23.1 | I am not aware of these | 0 | 0 |
Heard of it, but very unfamiliar | 6 | 46.2 | Aware of these, but very unfamiliar | 1 | 7.69 |
Heard of it, but mainly unfamiliar | 1 | 7.7 | Aware of these, but mainly unfamiliar | 1 | 7.69 |
Broadly familiar | 3 | 23.1 | Broadly Aware | 7 | 53.9 |
Very Familiar | 0 | 0 | Very aware | 4 | 30.8 |
Motivation for undertaking physical activity (n = 13) | Barriers to activity (n = 13) | ||||
To improve my physical health | 11 | 84.6 | Motivation | 9 | 69.2 |
To keep fit | 9 | 69.2 | Caring duties | 9 | 69.2 |
To help me undertake my caring role | 8 | 61.5 | Lack of time | 7 | 53.9 |
To prevent illness | 8 | 61.5 | Weather | 5 | 38.5 |
To improve my mental wellbeing | 7 | 53.9 | COVID-19 restrictions | 5 | 38.5 |
Reduce stress | 7 | 53.9 | Confidence | 4 | 30.8 |
To lose weight | 6 | 46.2 | Others | 3 | 23.1 |
Improve my mobility | 6 | 46.2 | Finances | 2 | 15.4 |
To reduce my sedentary time | 6 | 46.2 | Physical space/environment | 2 | 15.4 |
Improve balance | 4 | 30.8 | Lack of equipment | 2 | 15.4 |
Improve posture | 4 | 30.8 | |||
Other | 2 | 15.4 | |||
Support (n = 13) | Confidence (n = 13) | ||||
Highly supported | 4 | 30.8 | Not confident/No confidence | 0 | 0 |
Moderately supported | 1 | 7.7 | Slight confidence | 3 | 23.1 |
Slightly supported | 3 | 23.1 | Moderate confidence | 3 | 23.1 |
Not supported | 5 | 38.5 | High confidence | 7 | 53.9 |
Current physical activity levels (n = 13) | Sedentary behaviours (n = 13) | ||||
Meets Guidelines | 4 | 30.8 | Average proportion of day spent sedentary | 4.89 | |
Some activity | 1 | 7.7 | SD of this value | 2.00 | |
Low activity | 3 | 23.1 | |||
Very low activity | 5 | 38.5 |
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Egan, K.J.; Hodgson, W.; Imperatore, G.; Dunlop, M.D.; Maguire, R.; Kirk, A. Supporting Physical Activity for Informal Caregivers during and beyond COVID-19: Exploring the Feasibility, Usability and Acceptability of a Digital Health Smartphone Application, ‘CareFit’. Int. J. Environ. Res. Public Health 2022, 19, 12506. https://doi.org/10.3390/ijerph191912506
Egan KJ, Hodgson W, Imperatore G, Dunlop MD, Maguire R, Kirk A. Supporting Physical Activity for Informal Caregivers during and beyond COVID-19: Exploring the Feasibility, Usability and Acceptability of a Digital Health Smartphone Application, ‘CareFit’. International Journal of Environmental Research and Public Health. 2022; 19(19):12506. https://doi.org/10.3390/ijerph191912506
Chicago/Turabian StyleEgan, Kieren J., William Hodgson, Gennaro Imperatore, Mark D. Dunlop, Roma Maguire, and Alison Kirk. 2022. "Supporting Physical Activity for Informal Caregivers during and beyond COVID-19: Exploring the Feasibility, Usability and Acceptability of a Digital Health Smartphone Application, ‘CareFit’" International Journal of Environmental Research and Public Health 19, no. 19: 12506. https://doi.org/10.3390/ijerph191912506