Validation of a novel mHealth app to support foreign domestic workers in domiciliary eldercare

Many families in Singapore rely on Foreign Domestic Workers (FDWs) for domiciliary eldercare. However, FDWs often lack confidence and competence in providing basic healthcare to older adults, potentially compromising their health outcomes. This pilot randomized controlled trial (RCT) determined the feasibility, usability and effectiveness of E-CHEER, a prototype multilingual mobile-health application to upskill their domiciliary caregiving competency to senior care-recipients.

Sixty FDW-employer dyads from two local public primary care clinics were recruited and randomized to intervention (n = 30; E-CHEER access) or control (n = 30; no app). Study feasibility outcomes included recruitment, retention, and adherence rate metrics. The System Usability Scale (SUS) determined the E-CHEER usability in the intervention group. FDWs' scores in caregiving knowledge (CK), video recordings of their blood pressure measurement (BPM), and ambulation supervision ability (AS) were remotely evaluated by independent clinician-assessor for effectiveness at baseline and follow-up at up to 12 weeks. Statistical analyses were conducted to evaluate intra- and intergroup outcomes.

Recruitment rate was 50.4% (60 dyads recruited from 119 approached). Among the 49 dyads who completed the study (retention 81.6%), almost all of them completed their assigned tasks. The intervention group showed significant intra-group improvements in BPM (P = 0.003), AS (P = 0.02), and CK (P = 0.002), and significant AS improvement (P = 0.03) compared to the control group. The mean SUS score was 62.6 (95% CI 58.9-66.3).

Implementation of E-CHEER app was feasible based on the response and retention rates and was effective in improving FDWs' supervision of their care-recipients during ambulation, but its usability needs enhancement.