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/lp/jmir-publications/a-web-based-platform-carevirtue-to-support-caregivers-of-people-living-y79j2aCIEf
- Publisher
- JMIR Publications
- Copyright
- Copyright © The Author(s). Licensed under Creative Commons Attribution cc-by 4.0
- ISSN
- 2561-7605
- DOI
- 10.2196/36975
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- See Article on Publisher Site
Abstract
Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue’s feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75%), White (44/51, 86%), married (37/51, 73%), college educated (36/51, 71%), and were, on average, 60.3 (SD 9.8) years of age, with 18% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating “good” usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US $100K and mean 55.4 for those reporting <US $100K), relationship to care recipient (mean 18.7 posts for child and mean 56.4 for partners/spouses), and living situation (mean 44.7 for those who live with the care recipient and mean 13.1 for those who do not). Older care recipients were associated with fewer posts (r=–0.33, 95% CI –0.55 to –0.06). https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 1 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Conclusions: This study establishes the acceptability and feasibility of CareVirtue among ADRD care networks and highlights the importance of designing flexible, multicomponent interventions that allow care networks to tailor their engagement according to their needs. The results will be used to improve CareVirtue feasibility and acceptability in preparation for a subsequent randomized trial to test CareVirtue’s effectiveness in improving caregiver outcomes. (JMIR Aging 2022;5(3):e36975) doi: 10.2196/36975 KEYWORDS Alzheimer disease and related dementias; mHealth; caregivers; dementia caregiving; eHealth; telehealth living with ADRD receive care from more than 1 caregiver—a Introduction care network—with varying degrees of involvement [20-24]. Currently, caregivers face significant unmet needs regarding Background support for communicating and coordinating across the care More than 6 million individuals in the United States are living network including sharing information, maintaining situation with Alzheimer disease and related dementias (ADRD) and it awareness, distributing responsibilities, scheduling, and is attributed as the cause of death for 1 in 3 individuals over the managing caregiver hand offs [20-24]. age of 65 [1]. In the past 2 years, deaths attributed to ADRD Although some mobile apps exist that allow caregivers to share have increased by 16% and research has projected that the information, they are limited in their functionality, quality, and number of people living in the United States with ADRD will potential to meet the specific needs of ADRD caregivers [25]. triple by 2060 [1]. A recent review of mobile apps for caregivers of people living Individuals living with ADRD require prolonged and complex with ADRD available on the US market identified 2 mobile care that is primarily managed by informal caregivers. Informal apps that support shared communication and coordination [25]. caregivers are unpaid, nonprofessionals that provide care and According to study findings, one of those apps did not function typically include family and friends. There are an estimated 11 consistently and received a quality rating of inadequate as million caregivers providing care for people living with ADRD indicated by the Mobile Application Rating Scale (MARS). The in the United States and they provide approximately 15.3 billion second app received an overall quality rating of minimally hours of unpaid care valued at nearly US $257 billion [2]. acceptable quality according to the MARS but scored lower Caregivers report being undertrained, under-supported, and than average on subjective quality. A similar study conducted under-resourced to perform their caregiving role. Although in 2018 by Wozney et al [26] identified 3 mobile apps that caregivers can experience positive outcomes related to connect a primary caregiver to other members of the care caregiving, the imbalance of caregiving demands and supports network. One of the apps identified is no longer available on is often associated with mental, physical, and economic the US market. The other 2 apps identified are not specifically challenges that can lead to significant consequences for designed to meet the needs of caregivers for people living with caregivers and the individual living with ADRD, such as ADRD and are limited in their function (eg, only provide a caregiver stress, burden, depression, and morbidity [3-5]. shared calendar). To address these suboptimal caregiver outcomes, the US To address the current gaps in existing interventions, we National Institute on Aging and other national advisory panels developed CareVirtue, a progressive web application developed have highlighted the development and testing of in React to support and connect ADRD care networks that can technology-based interventions for caregivers of people living be accessed via a web browser on any device with a data with ADRD as a key priority [6-8]. For example, the 2015 connection. CareVirtue seeks to address the current gaps in Alzheimer’s Research Summit highlighted the need to “test the existing ADRD caregiver support technologies through a use of technology to overcome the workforce limitations in the high-quality, user-centered, ADRD caregiver–specific care of older adults with dementia as well as providing caregiver multicomponent technology to support communication, support and education.” [7]. In response, researchers have coordination, and connection among care networks. CareVirtue developed numerous information technology interventions such was initially inspired by an online support group for people as mobile apps and websites to support ADRD caregivers across newly diagnosed with ADRD and their caregivers in which a range of domains including caregiver education, self-care support group members expressed an unmet need for tools to support, support for managing behavioral symptoms of support communication and coordination among the care dementia, and virtual peer support groups [9-11]. Several network. The need for CareVirtue was further supported by systematic reviews and recent meta-analyses report that these several findings from foundational research on care networks. technology interventions can improve outcomes for caregivers, First, findings from Block et al [27] suggested that primary such as increased self-efficacy and reduced ADRD caregiver caregivers require technologies to communicate and coordinate burden, stress, and depression [3,12-19]. These reviews also among the care network, that they try to adapt existing suggest that effective interventions offer multiple components, technologies (eg, email, messaging) to meet their needs, and tailored options, and social support [9-11]. that adaptation requires additional time and effort. Further, Ponnala et al [20] found that for primary caregivers, the However, a significant gap in existing interventions is that most currently under-supported communication and coordination focus only on the primary caregiver, even though most people https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 2 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al among the care network increases their caregiving demands. by (1) treating people living with ADRD as individuals with Moreover, Tang et al [24] highlighted the consequences unique needs; (2) seeing the world from their perspective; and caregivers experience with under-supported care network (3) creating a positive social environment in which the person communication and coordination, including maintaining living with ADRD and caregiver can experience relative situation awareness among caregivers, missing care information well-being and quality of life. CareVirtue was designed and leading to potential patient harm (eg, missing a medication developed through consistent, iterative user input across multiple dose), and miscommunication leading to care network tensions stages of usability testing coupled with expert evaluation. or conflict. CareVirtue was specifically designed to encapsulate the foundational principles of person-centered care through the Collectively, this prior research provides the foundation for following features. Multimedia Appendix 1 provides a detailed CareVirtue. CareVirtue’s design honors the person-centered walkthrough of CareVirtue features, which are given in brief care model for people living with ADRD and their caregivers in Textbox 1. Textbox 1. CareVirtue features. CareVirtue Dashboard Acts as a centralized hub to document and share important information with the care team. The dashboard includes a view presenting upcoming care appointments and events, linked to the care calendar; a list of current and pending care team members; and a journal where care network members can document, communicate, and coordinate about daily care events (Figure 1). Journal Reports Search and filter options to explore trends and gain insights into care recipient needs. The care journal or portions of the care journal can be exported to PDF to share as necessary. Care Guide Template Includes a table of abilities related to specific activities of daily living and instrumental activities of daily living, and sections for needs and preferences, with a focus on quality-of-life details to help any caregiver understand the care recipient as a whole person (Figure 2). See Multimedia Appendix 2 for a detailed version of the care guide template. Care Team Management The ability to invite care network members to use the account with the primary caregiver with security permissions assigned at each invitation (Figure 3). Shared Calendar Supports scheduling and sharing recurring care events, reminders, and appointments (Figure 3). Geolocated Resources List For the current study, resources were limited to the Alzheimer’s Association 24×7 helpline, contact details for CareVirtue support, and contact details for the research team. The subsequent version of CareVirtue will include caregiver and person living with ADRD resources specific to their specific location such as the local area agency on aging (Figure 4). https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 3 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Figure 1. The CareVirtue Dashboard, a centralized hub to document and share important information with the care team. Figure 2. The CareVirtue Care Guide. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 4 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Figure 3. The CareVirtue Care Team management feature and form to create a new calendar event. Figure 4. Example of the CareVirtue resources list for a caregiver living in San Diego, California. Objectives Methods In this study, we used a mixed methods approach to evaluate Design CareVirtue’s feasibility across the following research questions: We conducted a feasibility study over a period of 8 weeks with Who used CareVirtue? the purpose of demonstrating CareVirtue’s acceptability and How did caregivers use CareVirtue? feasibility among care networks of people living with ADRD. How did caregivers perceive the acceptability of This study reports one aim of a larger project, which has 2 CareVirtue? specific aims. The first aim is the focus of this study. The second What factors were associated with CareVirtue use? aim is to leverage the CareVirtue data generated by this feasibility study to develop an intelligent caregiver assistant (R41AG069607). The larger sample size and longer study https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 5 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al duration than is typical for feasibility studies is due to CareVirtue Use adjustments made to achieve the second goal [28]. We collected data on 8 CareVirtue platform usage metrics across the study period: number of log-ins, journal posts, journal post Setting and Sample replies, calendar events, secondary caregiver invites sent, Participants were recruited between February and June 2021 secondary caregiver invites accepted, care guide sections through multiple community sites in Wisconsin and Southern created, and resources accessed. The log-in data are not fully California as well as through the Wisconsin Alzheimer’s Disease representative of actual use because users could remain logged Research Center. Advertisements for study participation were in to CareVirtue depending on their preference to log out. distributed via email, social media, and newsletter posts. Interested individuals contacted the study team via email or Acceptability Measures phone and were subsequently phone screened for the following Quantitative Acceptability Measures eligibility criteria: self-identified primary caregiver of a person To assess acceptability, we measured primary caregiver living with ADRD, at least 18 years of age, English speaking, perceptions of usability and usefulness. We measured usability daily internet access, and shares caregiving using a weekly confidence survey with a single question: “rate information/responsibility with other caregivers. your confidence in using CareVirtue on a scale from 1 (not at Procedures all confident) to 10 (very confident)” and using the System Eligible participants were scheduled for a 1-hour enrollment Usability Scale (SUS), which includes 10 statements (eg, visit via videoconferencing software. During the enrollment “Learning to use CareVirtue was quick for me”) and a 5-point visit, a study team member obtained informed consent from the response scale (1=strongly disagree to 5=strongly agree) [29]. primary caregiver and from the associated person living with We measured usefulness with 3 surveys. First, we used the ADRD (ie, the care recipient). If the person living with ADRD National Aeronautics and Space Administration-Task Load did not have decisional capacity to consent, the primary Index (NASA-TLX) to assess caregiver workload on a 6-item caregiver could consent on his/her behalf if he/she was the subscale with a 100-point range (1=very low to 5=very high). legally authorized representative. Next, the study team member The purpose of this measure was to understand the relationship administered a pretrial demographic survey, helped create the between caregiver workload and CareVirtue use. Second, we CareVirtue account, and provided a walk-through of used the Behavioral Intention Scale, which included 4 statements CareVirtue’s functionality. Primary caregivers selected and (eg, “If it were up to you, to what extent would you want to use invited secondary caregivers (to form a care network) at their CareVirtue?”) and 5-point response scale from 1 (not at all) to own discretion. Once secondary caregivers were invited, they 5 (a great deal) [30,31]. Third, we used the perceived usefulness were separately contacted via email to electronically obtain survey, which includes 4 statements (eg, “Using CareVirtue informed consent. would make it easier to perform my caregiving role”) and a 5-point response scale (1=strongly disagree to 5=strongly agree) Following enrollment, participants used CareVirtue for 8 weeks. [32]. Quantitative acceptability measures were collected from During the use period, we administered a weekly survey starting all primary caregiver participants. Secondary caregivers could 1 week after enrollment to assess caregiver workload and opt in to complete these assessments by contacting the study confidence using CareVirtue. If the survey was not completed, team. a follow-up reminder was sent the following day. At the completion of 8 weeks of use, we conducted a posttrial visit Qualitative Interviews with the primary caregiver participant via Zoom where we To provide context to the quantitative measures of acceptability, administered posttrial surveys and conducted a semistructured we conducted semistructured interviews with the primary interview as described in the following section. Primary caregivers, which focused on caregivers’ experiences with caregivers were provided with a US $150 e-gift card at the end CareVirtue during the study period. The interview guide was of the study period. Secondary caregivers contacted the study developed with input from the full research team (Multimedia team if they were interested in participating in the postuse survey Appendix 3). and interview. Secondary caregivers received US $15 for Analysis Plan completion of the postuse survey and US $25 for completion of the 30-minute postuse interview. Overview Data Sources We used Python 3.8 (Python Software Foundation) to compute descriptive statistics and conduct statistical analyses for all Demographic Data quantitative data. Qualitative data were coded using Microsoft We collected primary caregiver characteristics including age, Excel. Analyses related to research questions are described in gender, race and ethnicity, income, education, marital status, detail below. location, and employment. We also collected demographics for Who Used CareVirtue? the care receiver including age, gender, ethnicity, living situation, and relationship to the primary caregiver (Table 1). To determine participant characteristics, we computed Demographic data were not collected from the secondary descriptive statistics from demographic survey responses. caregivers. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 6 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al variables from the demographic survey: the NASA-TLX score How Did Caregivers Use CareVirtue? from each week, the confidence score from each week, the SUS To assess usage heterogeneity, we computed descriptive score, the average behavioral intention score, and the average statistics for each of the 8 usage characteristics. We then used perceived usefulness score. For continuous variables, we k-means clustering to cluster care networks into “user types,” computed Pearson correlation coefficient and the corresponding where each care network is represented by an 8-dimensional 95% CI to assess if the correlation was statistically significant usage vector. The number of clusters, k, was varied from 1 to (P=.05). For discrete variables, we first converted them into 20 and the elbow method was used to select the final k value: binary variables (if not already) by merging classes to ensure 8. See Multimedia Appendix 4 for more details. suitable sample sizes. Then, we used an unpaired t test to assess How Did Caregivers Perceive CareVirtue Acceptability? whether the difference between the average from each class was statistically significant. We were unable to perform multivariate To assess perceptions of usability and usefulness, we computed analyses due to our limited sample size. descriptive statistics for the SUS, Behavioral Intention Scale, and Perceived Usefulness Scale. We also computed Pearson Ethics Approval correlation coefficient for the weekly NASA-TLX to assess the Research ethics approval was granted by the Institutional change in overall caregiver workload over the study period and Review Board at the University of Wisconsin-Madison (Protocol for the confidence survey to assess if confidence changed over #2020-1035). the study period. To further explore perceptions of usability and usefulness, we Results conducted a general content analysis of the interview Who Used CareVirtue? transcripts. Three members of the research team (PL, SN, and AL) with training in human factors engineering reviewed all We enrolled 51 primary caregivers of people living with ADRD transcripts and identified initial categories related to CareVirtue (Table 1) and 61 secondary caregivers to use CareVirtue during usability and usefulness, with 2 team members coding each the study period. Care networks ranged from 1 to 8 members. transcript. Coders met weekly to discuss codes and resolve Primary caregivers were predominantly female (38/51, 75%), discrepancies, which were also discussed in a biweekly meeting White (44/51, 86%), married (37/51, 73%), college educated with a senior research team member (NEW) with expertise in (36/51, 71%), and were, on average, 60.3 (SD 9.8) years of age. qualitative research and human factors engineering. The Care recipients were also primary female (34/51, 67%) and codebook was refined iteratively across the team-based White (45/51, 88%), with an average age of 79.2 (SD 10.6). discussions and the final codebook was applied across all Care networks were located in both Wisconsin (29/51, 57%) transcripts using a team-based consensus process [33]. and California (19/51, 37%), with 18% (9/51) living in a rural area. During the study period, 4 primary caregivers dropped out What Factors Were Associated With CareVirtue Use? because of care recipient death (n=2) and personal situations To explore the factors associated with CareVirtue use, we (n=2). We were unable to reach 6 primary caregiver participants conducted a series of univariate analyses to assess the correlation for the posttrial visit. A total of 12 secondary caregiver between each of the 8 usage characteristics and each of the 14 participants completed the postuse survey. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 7 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Table 1. Summary of primary caregiver and care recipient characteristics. Characteristic Primary caregivers (n=51) Care recipients (n=51) Female gender, n (%) 38 (75) 34 (67) Age (years), mean (SD) 60.3 (9.8) 79.2 (10.6) Race/ethnicity, n (%) Asian 2 (4) 2 (4) Black or African American 1 (2) 1 (2) Hispanic or Latinx 2 (4) 2 (4) Native American or American Indian 1 (2) 0 (0) Not reported 1 (2) 1 (2) White 44 (86) 45 (88) Marital status, n (%) N/A Married or domestic partnership 37 (73) Divorced 11 (22) Single, never married 2 (4) Widowed 1 (2) Education, n (%) N/A Postcollege 19 (37) 4-year college 17 (33) Technical school, vocational training, communi- 10 (20) ty college High school diploma or equivalent 5 (10) Employment, n (%) N/A Full-time 21 (41) Retired 19 (37) Part-time 7 (14) Not working 4 (8) Income, n (%) N/A ≤US $19,000 1 (2) US $20,000-39,000 2 (4) US $40,000-59,000 8 (16) US $60,000-79,000 4 (8) US $80,000-99,000 6 (12) ≥US $100,000 18 (35) Do not wish to answer 8 (16) Location, n (%) N/A Wisconsin 29 (57) California 19 (37) Illinois 2 (4) Virginia 1 (2) Location type, n (%) N/A Urban 42 (82) Rural 9 (18) Relationship to caregiver, n (%) N/A https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 8 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Characteristic Primary caregivers (n=51) Care recipients (n=51) Parent 28 (55) Spouse/Partner 20 (39) Other relative 3 (6) Distance to caregiver, n (%) N/A In household 34 (67) <20 minutes 12 (24) 20-60 minutes 2 (4) >2 hours 3 (6) Living situation, n (%) N/A In a house 40 (78) In a nursing home, retirement community, or 9 (18) other assisted living facility N/A: not applicable. Table 2 presents the centroid (the mean values across all care How Did Caregivers Use CareVirtue? networks in that cluster), cluster size, and a cluster label for Figure 5 displays boxplots (across care networks) for each of each of the 8 clusters. The 8 clusters could be further reduced the 8 usage characteristics. The average (SD) was 18.3 (22.4) into 3 primary groups according to the degree of engagement log-ins, 32.5 (46.5) journal posts, 5.3 (13.2) journal post replies, with the platform. There was heterogeneity in how the most 10.6 (28.5) calendar events, 2.2 (2.1) secondary caregiver invites engaged care networks interacted with the platform; for example, sent, 2.2 (2.1) secondary caregiver invites accepted, 6.1 (0.4) 2 care networks made heavy use of the calendar feature (average care guide sections created, and 0.6 (1.9) resources accessed. of 141 events) with few posts (average of 41), while another The log-in data are not fully representative of actual use because care network made heavy use of the journal (257 posts) with users could remain logged in to CareVirtue depending on their only 1 calendar event. preference to log out. Figure 5. Box plots for each of the eight usage characteristics. They are separated into two plots due to differences in scale. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 9 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Table 2. Cluster centroids for the 8 usage clusters identified by k-means. Each centroid component (eg, invites sent) represents the average across all care networks within that cluster. Cluster descrip- Cluster size Cluster centroid tion Log-ins Posts Replies Invites sent Invites ac- Calendar Care guide Resources cepted events sections accessed Low engagement group 23 10 13 1 1 1 3 6 0 Moderate engagement group Small care net- 12 13 25 2 3 2 6 6 0 works Large care net- 7 19 40 11 6 6 3 6 0 works High engagement group Log-in heavy 3 88 56 9 3 3 18 6 0 Balanced usage 2 30 53 14 4 4 18 6 9 Calendar fo- 2 33 41 0 2 2 141 6 0 cused Posts and 1 15 162 84 3 3 16 8 2 replies Posts only 1 12 257 1 2 2 1 6 0 the remaining 29 primary caregivers (17 were excluded due to How Did Caregivers Perceive CareVirtue missingness). Acceptability? We used a confidence scale to assess CareVirtue usability. We used the NASA TLX score to assess usability and usefulness Figure 6B displays boxplots of the total confidence score for in terms of caregivers’ perceptions of their caregiver workload. each week of the study. The average confidence score increased Figure 6A displays boxplots of the total NASA TLX score for significantly over the duration of the study from a low of 7.8 each week from week 0 (before the study began) to 7 (the final in week 2 to a high of 8.9 in week 7 (P=.004; r=0.91, 95% CI week of the study). The average NASA TLX score increased 0.84-0.95). At an individual level, 7 primary caregivers saw a over the duration of the study (P=.02; r=0.79, 95% CI statistically significant increase (P<.05 in all cases; see 0.65-0.87). However, at an individual level the NASA TLX Multimedia Appendix 5 for precise P values) in confidence, score only increased over the duration of the study for 3 primary while the remaining 17 remained stable (27 were excluded due caregivers, decreased for 2 caregivers, and did not change for to missingness). Figure 6. (A) Box plot for the weekly NASA TLX score. (B) Box plot for the weekly confidence (in using CareVirtue) survey. We also used the SUS to assess CareVirtue usability and the (SD) was 81.8 (12.8) for the SUS score, indicating “good” Behavioral Intention Scale and Perceived Usefulness Scale to usability and 3.4 (1.0) for perceived usefulness, suggesting assess usefulness. Multimedia Appendix 6 displays histograms above average perceived usefulness. For secondary caregivers for the Behavioral Intention Scale score, SUS score, and the the average (SD) was 2.9 (1.1) for the Behavioral Intention perceived usefulness score for primary caregivers. The average Scale (6/11, 55%, had an average score of at least 3), 77.9 (13.7) (SD) was 3.3 (1.2) for the Behavioral Intention Scale and 72% for the SUS, and 3.4 (0.8) for perceived usefulness (Multimedia (26/36) of primary caregivers reported an average score of at Appendix 7). least 3, indicating an above average intention to use. The average https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 10 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Through analysis of the qualitative interviews, we identified 10 across the care network, and the privacy afforded by controlling categories related to usefulness and 4 categories related to user permissions. Participants further explained that using opportunities to improve usefulness (Table 3). Participants CareVirtue made them feel supported and reduced feelings of described CareVirtue as facilitating connection, exploration, being overwhelmed. We also identified opportunities for and awareness. In addition, CareVirtue allowed for improvement, which included increasing engagement such as documentation and tracking of daily experiences and enabled creating a CareVirtue user support group; adding customization emotional catharsis by facilitating the capture and review of such as additional emoji options for journal posts; refining significant moments in their relationship with the person living navigation such as expanding search types; and additional with ADRD. Additional facilitators of usefulness described by functionality such as document upload and storage. participants included centralization of information, coordination https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 11 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Table 3. Categories of usefulness and opportunities for improvement with illustrative quotations. Categories and subcategories Description Illustrative quotation Usefulness Connection Interaction across the care network The biggest thing was it [CareVirtue] allowed me to bring my brother and sister, both of whom live a thousand or more miles away, closer into the loop...at crucial times...there, you know, were some things going on, and they were actually getting the email reminders, and they were actually logging in and looking at my journal comments and responding in the journal. [P45] Documentation and View, explore, and understand It helped me in terms of measuring my spouse’s progression over those two Tracking trends over time whole months. Because, you know, when you’re with someone every day, 24/7 almost, you may not notice the differences other people do. So, you know, I found that useful to go back and look at what I wrote, you know, a month ago. Because it appears the stage of the disease is, and...that it progresses could go, slow down and could speed up. So, it seemed like the progression was increasing and just help me quantify it to some degree in terms of what her capabilities were. [P50] Emotional Catharsis Capture, share, and recollect experi- But the other day he said, you know, I love you. You’re my favorite. And he ences and important moments in the hadn’t said I love you to me in like, I don’t know, a few years...but to document relationship with the person living a moment like that as a way for me to kind of cathartically capture those moments with ADRD and have those to look back on. [P13] Awareness Real-time understanding of daily [CareVirtue] also allowed me to let my kids know what was going on the same care experiences and status of the time it was happening, as far as what, you know, when I was doing the journaling. caregiver and person living with It also helped my kids to be able to see probably a really good picture of all the ADRD different aspects of what their mom is going through. [P15] Centralization and Orga- Communication, coordination, doc- So, with the CareVirtue, having one spot, like if I’m going to communicate, I’m nization umentation, and tracking in one lo- going to put it in there, and then everybody can just go to that spot to look for cation the information...people can log-in and just have their notifications and know that stuff was going on. And it would be one step there versus me trying to figure out how to get, you know, am I in the right [text message] thread, which infor- mation needs to go to who? [P26] Coordination Seamless, high-quality transitions But the app [CareVirtue] was really helpful, because before a person came in of care for their quote, unquote, shift time, they can have advance information about how things were before they came, so they could be kind of prepared. [P32] Introspection Self-exploration of feelings, care [CareVirtue] just helped me to identify, I guess, where, how I was feeling and strategies, and goals what my plan was for going forward. [P16] Privacy Customizable permissions on a se- [Before CareVirtue] we kind of send stuff through Messenger, which is not cure platform focused only on care necessarily a secure, you know, thing, and this one [CareVirtue] is. So, yeah, it has just created something that was specifically and exclusively for her care, and that, you know, that was good. [P1] Reduce Burden Reduce demands associated with [CareVirtue] was really useful in terms of keeping a journal and telling every- communication, coordination, and body what was going on without having to call every single family member, so documentation they could read [in CareVirtue] what was going on. [P7] Support Accessible and responsive customer When I had a question, I just hit the little blue bubble and it sent a note. And in support absolutely no time somebody [from CareVirtue support]...answered the question or told me how to do what I was, needed to do...It just made it really helpful, really easy to reach out. [P23] Opportunities for improving usefulness Engagement Provide additional interactive con- It’s very personal. Even though they are family members, it’s kind of like do I tent such as private journaling really want them to read about my inner thoughts about this, you know, because space, a support group across Care- it could frighten them. [P37] Virtue users, and a daily checklist of care activities Customization Include additional customization The [emoji] smiley or the sad or whatever, it makes you really think about...I options such as for reminders, and would like it that you could put a couple options in there though [instead of only including more emoji options one]. Because, you know, I might start the entry out in one way and then key in another because it turned. [P44] Navigation Expand search feature A filter to search, you know, for key words, or maybe not even key words, any word search, you know, any text search, I find immensely valuable. [P12] https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 12 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Categories and subcategories Description Illustrative quotation Functionality Add functionality to include allow- It still lacks the ability for it to be the all-inclusive kind of filing cabinet that I ing for an account with multiple personally need it to be. [P26] care receivers and document upload and storage logistics and organization; providing emotional and social What Factors Were Associated With CareVirtue Use? support; and facilitating documentation, tracking, and awareness The following sociodemographic characteristics were associated across the care network. with the number of posts: retired (average of 59.5 posts for Interestingly, participants’ perceived workload associated with retired caregivers as compared with 16.9 for nonretired their caregiving role increased over the study period. It is caregivers), income (13 posts for those reporting >US $100K possible that this result was reflective of the burden of and 55.4 for those reporting <US $100K), relationship to care participating in the study. However, we also found that higher recipient (18.7 posts for child and 56.4 for partners/spouses), caregiving workload was associated with more frequent use of and living situation (44.7 for those who live with the care the CareVirtue journal. It is also possible that this consistent recipient and 13.1 for those who do not). Older care recipients increase in perceived caregiving workload was related to the were associated with fewer posts (r=–0.33, 95% CI –0.55 to increased burden and isolation associated with the COVID-19 –0.06). pandemic during which our study took place [34,35]. A recent The following workload characteristics were associated with survey study [33] found that caregiver burden was not associated the number of posts: NASA TLX score representing the with caregivers’ reported intention to adopt a mobile health perceived workload associated with the caregiving role from (mHealth) intervention. Our finding based on the engagement weeks 2 to 7 (r=0.37-0.46) and the total hours caregiving with the technology intervention, that increased caregiver (r=0.38, 95% CI 0.11-0.60). In other words, higher perceived workload was associated with increased journal posts, provides mental workload associated with the caregiving role and a additional insight into factors that may be influencing greater number of hours spent caregiving were associated with caregivers’ adoption and use of technology interventions. This more journal posts. finding also points to specific components, such as the ability to journal about daily experiences and emotions, that may be Regarding usability, we found that a higher SUS score (r=0.40, more useful during times of higher workload. 95% CI 0.10-0.64) and a higher behavioral intention score (r=0.378, 95% CI 0.11-0.59) were associated with an increased We found that usage varied along 2 axes: total usage and type number of posts. of usage. There was heterogeneity in how the most engaged care networks interacted with the platform; for example, 2 care We found that 3 demographic characteristics were associated networks made heavy use of the calendar event feature (average with the number of log-ins. Retired caregivers had an average of 141 events) with few posts (average of 41), while another of 27.4 log-ins as compared with 11.3 for nonretired caregivers. care network made heavy use of the journal (257 posts) with Both primary caregiver age (r=0.31, 95% CI 0.03-0.54) and the only 1 calendar event. These results confirm the importance of total behavioral intention score (r=0.38, 95% CI 0.11-0.59) technology interventions that can account for caregiver were associated with more log-ins. We found that a higher SUS heterogeneity [36,37]—that caregivers are diverse individuals score was associated with an increased number of secondary who have wide-ranging experiences, needs, and contexts. The caregiver invites sent (r=0.33, 95% CI 0.05-0.57). need for interventions responsive to caregiver heterogeneity has been further supported by the identified importance of multiple Discussion component interventions that are tailorable to specific caregiver needs [5,9-11]. Our findings expand on this by providing Principal Findings insights into the acceptability and feasibility of a technology This study establishes the acceptability and feasibility of intervention at the care network level. Like studies focused on CareVirtue use among care networks of individuals living with primary caregiver technology interventions, our results highlight dementia. The results indicate that CareVirtue was perceived the importance of designing flexible, multicomponent as highly usable and useful, with caregivers indicating a range interventions that allow care networks to tailor their engagement of ways CareVirtue was useful to them, including practically, according to their needs and what is most helpful to them. organizationally, and emotionally. We found that retirees, Importantly, this could also allow for tailoring over time, in spouses/partners of the care recipient, and those who live with which care networks can shift engagement as their needs change the care recipient were more likely to post more frequently in across disease progression. the journal. CareVirtue use was not correlated with caregiver age or education level. This study used a sample size that is much larger than is typical for a feasibility study [38]. Doing so gave us the opportunity to Participants were confident in using CareVirtue, with confidence leverage data analytics to provide insight into how care networks increasing over time, which aligns with their reported engaged with the platform and provided depth to our perceptions of CareVirtue as highly useful and usable. The understanding of what components caregivers find useful [28]. qualitative analysis revealed that CareVirtue is useful across Survey studies have been useful in capturing self-reported multiple dimensions including reducing burden associated with perceptions related to adoption and intention to use [39,40]. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 13 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al Findings such as ours along with others such as Øksnebjerg et future research is to conduct a randomized clinical trial to test al [41] can complement and expand upon findings from the hypothesis that CareVirtue reduces caregiver stress and self-report studies by exploring caregivers’ engagement burden and increases caregiver quality of life. behaviors. Given caregiver and care network heterogeneity Limitations along with the evidence demonstrating the importance of flexible Our results should be considered in light of certain limitations. and tailorable multicomponent interventions [3,12-19], there is First, although our sample size was much larger than is typical a need for future research to continue to explore caregiver and for a feasibility study [38], the sample size should be considered care network engagement behavior with technology when interpreting the univariate results, as it is possible that a interventions to provide additional insight and begin to build small group of people could be driving our findings. Second, an evidence base regarding how to optimally tailor interventions although we achieved enrollment of diversity in terms of income and support engagement according to individual caregiver and and location within the United States, participants were primarily care network needs. To do this, future feasibility trials could White, married, college-educated women of 60 years of age strive to engage larger sample sizes, enabling the use of artificial who lived with the care recipient. Future work will endeavor intelligence and machine learning to increase personalization. to achieve a more sociodemographically diverse sample in terms Further, efficacy/effectiveness trials that typically enroll larger of race/ethnicity, education, age, and distance from the person samples could be used to explore engagement. Doing so may living with dementia. Third, although this study found a broad allow for an increased understanding of the relationship between range of care network sizes consistent with previous literature engagement with the technology intervention and the health [20], it is likely that the context of the COVID-19 pandemic outcomes. may have reduced the number of in-home supports, which may Although the purpose of this study was not to determine the have influenced the number of care network members using effectiveness of CareVirtue on caregiver outcomes, previous CareVirtue. research has demonstrated the potential of technology The results of this study establish the acceptability and feasibility interventions to improve caregiver outcomes [3,12-19]. Research of CareVirtue use among care networks of people living with suggests that the significant unmet needs associated with support ADRD. This study also highlights the importance of designing for communication and coordination among the care network flexible, multicomponent interventions that allow care networks may contribute to the often-suboptimal outcomes experienced to tailor their engagement according to their needs and what is by caregivers such as increased stress and burden [20,24,37]. most useful to them. The results of this feasibility study will be Further, our findings related to caregiving workload and journal used to improve CareVirtue feasibility and acceptability in use combined with our qualitative findings provide some initial preparation for a subsequent randomized trial to test indication that caregivers may experience positive effects such CareVirtue’s effectiveness in improving caregiver outcomes. as reduced burden, increased social support, and increased quality of life from using CareVirtue. Our immediate plan for Acknowledgments The authors acknowledge and thank the many caregivers who voluntarily supported this project. We also thank our community partners in Wisconsin and California who supported this work, including the Alzheimer’s and Dementia Alliance of Wisconsin and Alzheimer’s San Diego. This work was supported by grants (R41AG069607 and P30AG062715) from the NIH National Institute on Aging. Conflicts of Interest CE is the Founder and CEO of Whiplash Technology and the developer of CareVirtue. MZ is the Caregiver Support Officer for Whiplash Technology and supports development of CareVirtue; is an Associate for HFC, which is a 501c3 with a mission of Bringing Light to Alzheimer’s; and is a member of the Alzheimer’s Impact Movement, which is the advocacy affiliate of the Alzheimer’s Association. Multimedia Appendix 1 Walkthrough of CareVirtue features. [MP4 File (MP4 Video), 10989 KB-Multimedia Appendix 1] Multimedia Appendix 2 CareVirtue Care Guide template. [PDF File (Adobe PDF File), 61 KB-Multimedia Appendix 2] Multimedia Appendix 3 Semi-structured interview guide. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 14 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al [DOCX File , 13 KB-Multimedia Appendix 3] Multimedia Appendix 4 Elbow plot for k-means clustering. Each care team is represented by an eight-dimensional vector with the following components: the number of logins, the number of journal posts, the number of journal post replies, the number of calendar events, the number of secondary caregiver invites sent, the number of secondary caregiver invites accepted, the number of Care Guide sections created, and the number of resources accessed through CareVirtue. We clustered all observations using k-means clustering, with a Euclidian distance metric and 10 random initializations. We varied k from 1 to 20 and used the elbow method (on the intra cluster distance) to choose the final k value. Figure A1 displays the intra cluster distance for each k value. [PNG File , 65 KB-Multimedia Appendix 4] Multimedia Appendix 5 P values for caregiver-reported confidence using CareVirtue over the duration of the study for the 24 participants included in the analysis (27 participants were excluded due to missingness). [DOCX File , 14 KB-Multimedia Appendix 5] Multimedia Appendix 6 Histograms for primary caregiver responses to the behavioral intention scale, system usability scale, and perceived usefulness. [PNG File , 52 KB-Multimedia Appendix 6] Multimedia Appendix 7 Histograms for secondary caregiver responses to the behavioral intention scale, system usability scale, and perceived usefulness scale. [PNG File , 54 KB-Multimedia Appendix 7] References 1. Alzheimer's Disease and Related Dementias. Centers for Disease Control and Prevention. URL: https://www.cdc.gov/aging/ publications/features/alzheimers-disease-dementia.html [accessed 2022-07-16] 2. Monica MM, Díaz-Santos M, Vossel K. Alzheimer’s Association 2021: Facts and Figures Report. Mary S. Easton Center for Alzheimer’s Disease Research at UCLA. 2021. URL: https://www.eastonad.ucla.edu/images/E-Newsletter/Summer_2021/ ucla-easton-center-summer-2021-e-newsletter-final.pdf [accessed 2022-07-17] 3. Boots LMM, de Vugt ME, van Knippenberg RJM, Kempen GIJM, Verhey FRJ. A systematic review of Internet-based supportive interventions for caregivers of patients with dementia. Int J Geriatr Psychiatry 2014 Apr 20;29(4):331-344. [doi: 10.1002/gps.4016] [Medline: 23963684] 4. Boots LMM, Wolfs CAG, Verhey FRJ, Kempen GIJM, de Vugt ME. Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox between needing and accepting help. Int. Psychogeriatr 2015 Jan 08;27(6):927-936. [doi: 10.1017/s1041610214002804] 5. Werner NE, Stanislawski B, Marx K, Watkins D, Kobayashi M, Kales H, et al. Getting what they need when they need it. Appl Clin Inform 2017 Dec 20;26(01):191-205. [doi: 10.4338/aci-2016-07-ra-0122] 6. Next Steps for Research on Informal Caregiving. National Institute on Aging. 2012. URL: https://www.nia.nih.gov/sites/ default/files/gerald-summary_11-21-14_0.pdf [accessed 2022-07-17] 7. Recommendations from the NIH AD Research Summit 2015. National Institute on Aging. 2015. URL: https://www. nia.nih.gov/research/recommendations-nih-ad-research-summit-2015 [accessed 2022-07-17] 8. Alzheimer's Association National Plan CareSupport Milestone Workgroup, Borson S, Boustani MA, Buckwalter KC, Burgio LD, Chodosh J, et al. Report on milestones for care and support under the U.S. National Plan to Address Alzheimer's Disease. Alzheimers Dement 2016 Mar;12(3):334-369 [FREE Full text] [doi: 10.1016/j.jalz.2016.01.005] [Medline: 26868060] 9. Hopwood J, Walker N, McDonagh L, Rait G, Walters K, Iliffe S, et al. Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review. J Med Internet Res 2018 Jun 12;20(6):e216 [FREE Full text] [doi: 10.2196/jmir.9548] [Medline: 29895512] 10. Etxeberria I, Salaberria K, Gorostiaga A. Online support for family caregivers of people with dementia: a systematic review and meta-analysis of RCTs and quasi-experimental studies. Aging Ment Health 2021 Jul 02;25(7):1165-1180. [doi: 10.1080/13607863.2020.1758900] [Medline: 32363901] 11. Deeken F, Rezo A, Hinz M, Discher R, Rapp MA. Evaluation of Technology-Based Interventions for Informal Caregivers of Patients With Dementia-A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2019 Apr;27(4):426-445. [doi: 10.1016/j.jagp.2018.12.003] [Medline: 30642650] https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 15 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al 12. Chiu T, Marziali E, Colantonio A, Carswell A, Gruneir M, Tang M, et al. Internet-based caregiver support for Chinese Canadians taking care of a family member with alzheimer disease and related dementia. Can J Aging 2009 Dec;28(4):323-336. [doi: 10.1017/S0714980809990158] [Medline: 19925698] 13. Glueckauf RL, Ketterson TU, Loomis JS, Dages P. Online support and education for dementia caregivers: overview, utilization, and initial program evaluation. Telemed J E Health 2004;10(2):223-232. [doi: 10.1089/tmj.2004.10.223] [Medline: 15319052] 14. Bateman DR, Srinivas B, Emmett TW, Schleyer TK, Holden RJ, Hendrie HC, et al. Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review. J Med Internet Res 2017 Aug 30;19(8):e301 [FREE Full text] [doi: 10.2196/jmir.7814] [Medline: 28855146] 15. Godwin KM, Mills WL, Anderson JA, Kunik ME. Technology-driven interventions for caregivers of persons with dementia: a systematic review. Am J Alzheimers Dis Other Demen 2013 May;28(3):216-222 [FREE Full text] [doi: 10.1177/1533317513481091] [Medline: 23528881] 16. Martínez-Alcalá CI, Pliego-Pastrana P, Rosales-Lagarde A, Lopez-Noguerola J, Molina-Trinidad EM. Information and Communication Technologies in the Care of the Elderly: Systematic Review of Applications Aimed at Patients With Dementia and Caregivers. JMIR Rehabil Assist Technol 2016 May 02;3(1):e6 [FREE Full text] [doi: 10.2196/rehab.5226] [Medline: 28582258] 17. Marziali E, Garcia LJ. Dementia caregivers' responses to 2 Internet-based intervention programs. Am J Alzheimers Dis Other Demen 2011 Feb;26(1):36-43 [FREE Full text] [doi: 10.1177/1533317510387586] [Medline: 21282276] 18. Lewis ML, Hobday JV, Hepburn KW. Internet-based program for dementia caregivers. Am J Alzheimers Dis Other Demen 2010 Dec;25(8):674-679 [FREE Full text] [doi: 10.1177/1533317510385812] [Medline: 21131674] 19. van der Roest HG, Meiland FJM, Jonker C, Dröes RM. User evaluation of the DEMentia-specific Digital Interactive Social Chart (DEM-DISC). A pilot study among informal carers on its impact, user friendliness and, usefulness. Aging Ment Health 2010 May;14(4):461-470. [doi: 10.1080/13607860903311741] [Medline: 20455122] 20. Ponnala S, Werner NE. Exploring Informal Caregiver Workload using a Macroergonomics Lens on Multiple Resources. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2021 Feb 09;64(1):856-860. [doi: 10.1177/1071181320641198] 21. Friedman E, Kennedy D. Typologies of Dementia Caregiver Support Networks: A Pilot Study. Gerontologist 2021 Nov 15;61(8):1221-1230 [FREE Full text] [doi: 10.1093/geront/gnab013] [Medline: 33585929] 22. Esandi N, Nolan M, Alfaro C, Canga-Armayor A. Keeping Things in Balance: Family Experiences of Living With Alzheimer's Disease. Gerontologist 2018 Mar 19;58(2):e56-e67. [doi: 10.1093/geront/gnx084] [Medline: 28633376] 23. Neubert L, Gottschalk S, König HH, Brettschneider C. Dementia care-giving from a family network perspective in Germany: A typology. Health Soc Care Community 2022 Feb 16;30(2):579-591. [doi: 10.1111/hsc.13161] [Medline: 32939908] 24. Tang C, Chen Y, Cheng K, Ngo V, Mattison JE. Awareness and handoffs in home care: coordination among informal caregivers. Behaviour & Information Technology 2017 Nov 27;37(1):66-86. [doi: 10.1080/0144929x.2017.1405073] 25. Werner NE, Brown JC, Loganathar P, Holden RJ. Quality of Mobile Apps for Care Partners of People With Alzheimer Disease and Related Dementias: Mobile App Rating Scale Evaluation. JMIR Mhealth Uhealth 2022 Mar 29;10(3):e33863 [FREE Full text] [doi: 10.2196/33863] [Medline: 35348467] 26. Wozney L, Freitas de Souza LM, Kervin E, Queluz F, McGrath PJ, Keefe J. Commercially Available Mobile Apps for Caregivers of People With Alzheimer Disease or Other Related Dementias: Systematic Search. JMIR Aging 2018 Dec 07;1(2):e12274 [FREE Full text] [doi: 10.2196/12274] [Medline: 31518255] 27. Block L, Gilmore-Bykovskyi A, Jolliff A, Mullen S, Werner NE. Exploring dementia family caregivers' everyday use and appraisal of technological supports. Geriatr Nurs 2020 Nov;41(6):909-915 [FREE Full text] [doi: 10.1016/j.gerinurse.2020.06.019] [Medline: 32665095] 28. Boutilier JJ, Craig T, Sharpe MB, Chan TCY. Sample size requirements for knowledge-based treatment planning. Med Phys 2016 Mar 09;43(3):1212-1221. [doi: 10.1118/1.4941363] [Medline: 26936706] 29. Bangor A, Kortum PT, Miller JT. An Empirical Evaluation of the System Usability Scale. International Journal of Human-Computer Interaction 2008 Jul 30;24(6):574-594. [doi: 10.1080/10447310802205776] 30. Holden RJ, Karsh B. A theoretical model of health information technology usage behaviour with implications for patient safety. Behaviour & Information Technology 2009 Jan;28(1):21-38. [doi: 10.1080/01449290601138245] 31. Asan O, Holden RJ, Flynn KE, Murkowski K, Scanlon MC. Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit. JAMIA Open 2018 Jul 12;1(1):32-41 [FREE Full text] [doi: 10.1093/jamiaopen/ooy020] [Medline: 31528847] 32. Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Quarterly 1989 Sep;13(3):319. [doi: 10.2307/249008] 33. Barry CA, Britten N, Barber N, Bradley C, Stevenson F. Using reflexivity to optimize teamwork in qualitative research. Qual Health Res 1999 Jan 01;9(1):26-44. [doi: 10.1177/104973299129121677] [Medline: 10558357] 34. Aledeh M, Habib Adam P. Caring for Dementia Caregivers in Times of the COVID-19 Crisis: A Systematic Review. AJNR 2020 Jan 24;8(5):552-561. [doi: 10.12691/ajnr-8-5-8] https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 16 (page number not for citation purposes) XSL FO RenderX JMIR AGING Boutilier et al 35. Bacsu J, O'Connell ME, Cammer A, Azizi M, Grewal K, Poole L, et al. Using Twitter to Understand the COVID-19 Experiences of People With Dementia: Infodemiology Study. J Med Internet Res 2021 Feb 03;23(2):e26254 [FREE Full text] [doi: 10.2196/26254] [Medline: 33468449] 36. Young HM, Bell JF, Whitney RL, Ridberg RA, Reed SC, Vitaliano PP. Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions. Gerontologist 2020 Feb 14;60(Suppl 1):S14-S28 [FREE Full text] [doi: 10.1093/geront/gnz148] [Medline: 32057083] 37. Marcum C, Ashida S, Koehly L. Primary Caregivers in a Network Context. J Gerontol B Psychol Sci Soc Sci 2020 Jan 01;75(1):125-136 [FREE Full text] [doi: 10.1093/geronb/gbx165] [Medline: 29304203] 38. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceut. Statist 2005 Oct;4(4):287-291. [doi: 10.1002/pst.185] 39. Wang J, Fu Y, Lou V, Tan S, Chui E. A systematic review of factors influencing attitudes towards and intention to use the long-distance caregiving technologies for older adults. Int J Med Inform 2021 Sep;153:104536. [doi: 10.1016/j.ijmedinf.2021.104536] [Medline: 34325206] 40. Mendez KJW, Budhathoki C, Labrique AB, Sadak T, Tanner EK, Han HR. Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study. JMIR Mhealth Uhealth 2021 Aug 31;9(8):e27926 [FREE Full text] [doi: 10.2196/27926] [Medline: 34463637] 41. Øksnebjerg L, Woods B, Ruth K, Lauridsen A, Kristiansen S, Holst HD, et al. A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns. JMIR Mhealth Uhealth 2020 Jan 17;8(1):e14694 [FREE Full text] [doi: 10.2196/14694] [Medline: 31951217] Abbreviations ADRD: Alzheimer disease and related dementias MARS: Mobile Application Rating Scale mHealth: mobile health NASA-TLX: National Aeronautics and Space Administration-Task Load Index SUS: System Usability Scale Edited by J Wang; submitted 01.02.22; peer-reviewed by AS Rigaud, A Montilha; comments to author 23.02.22; revised version received 29.04.22; accepted 27.06.22; published 04.08.22 Please cite as: Boutilier JJ, Loganathar P, Linden A, Scheer E, Noejovich S, Elliott C, Zuraw M, Werner NE A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study JMIR Aging 2022;5(3):e36975 URL: https://aging.jmir.org/2022/3/e36975 doi: 10.2196/36975 PMID: 35925654 ©Justin J Boutilier, Priya Loganathar, Anna Linden, Eleanore Scheer, Sofia Noejovich, Christian Elliott, Matthew Zuraw, Nicole E Werner. Originally published in JMIR Aging (https://aging.jmir.org), 04.08.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org, as well as this copyright and license information must be included. https://aging.jmir.org/2022/3/e36975 JMIR Aging 2022 | vol. 5 | iss. 3 | e36975 | p. 17 (page number not for citation purposes) XSL FO RenderX
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JMIR Aging – JMIR Publications
Published: Aug 4, 2022
Keywords: Alzheimer disease and related dementias; mHealth; caregivers; dementia caregiving; eHealth; telehealth