Dementia Care Research and Psychosocial Factors

Persons living with dementia or cognitive impairment (PLWD/CI) often experience barriers to out-of-home participation (i.e., places outside home or in public) due to cognitive inaccessibility, risks or anxieties related to wandering, and care partners' safety concerns - which can impede health and quality of life. Technology offers the potential to support PLWD/CI in sustaining out-of-home participation, but real-world evaluations within complex, dynamic care ecosystems are necessary to ensure safety and effectiveness. The "Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research" (FASTER) was created to support the development and evaluation of interventions from conception to real-world use. The aim is to illustrate how FASTER was applied to a novel intervention encompassing a smart shoe insole technology designed to support out-of-home participation for PLWD/CI by enabling tracking, safety alerts, and care collaboration with care partners.

The FASTER approach includes the following phases: (1) Development, (2) Progressive Usability and Feasibility Evaluation, and (3) Phased Evaluation and Implementation. FASTER was applied to developing and evaluating the smart insole technology for PLWD/CI in real-world use contexts.

Phase 1 collaborated with the commercial partner to conceptualize the intervention design vis à vis technology design features and use cases, and model theoretically- and evidence-driven processes and outcomes. Six researchers conducted mixed-method pilot usability testing by completing structured use cases in real-world settings. Technical and design issues were identified and evaluation methods were refined to optimize usability, reliability, and mitigate safety risks, for subsequent evaluation with PLWD/CI and care partners. Phase 2 employed a small-scale, mixed-method multiple case study design to evaluate technology usability and feasibility, and primary outcomes (i.e., PLWD/CI's out-of-home participation, dyadic care collaboration) with 3 care ecosystems. Future research will adapt and scale the evaluation methodology for Phase 3, involving implementation and evaluation in a larger cross-Canadian study in Quebec, Ontario, and British Columbia.

FASTER is a systematic, iterative, and participatory approach to developing, evaluating, refining, and integrating technology-based interventions. This presentation highlights the application of FASTER using a real-world example, showcasing its value for both technological and health/social outcomes, including out-of-home participation and collaborative caring for PLWD/CI.