Digital Literacy and Associated Factors in Older Adults Living in Urban South Korea: A Qualitative Study.

This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels.

Post-traumatic responses to workplace violence among nursing professionals: a collaborative and comparative study in South Korea and Hong Kong.

BACKGROUND: Workplace violence has had a significant and negative psychological impact on nursing professionals worldwide. Concerted worldwide efforts to improve work environments have not yet removed nursing professionals from the threat of violence. It is highly essential to conduct comparative research in various working environments where the nurses of each country have unique experiences of workplace violence. The aim of this study was to examine the differences in the rate, associated factors, and post-traumatic responses to workplace violence between South Korean and Chinese nurses in Hong Kong among East Asian countries. METHODS: A cross-sectional, correlational study design recruited a total of 471 registered nurses (319 South Korean nurses and 152 Chinese nurses in Hong Kong; overall response rate = 78.5%) at online communities in South Korea and Hong Kong. The data were collected by conducting a Qualtrics survey from January 15, 2020, to July 24, 2021. A structured questionnaire was administered for data collection, including rate of workplace violence, perception of workplace violence, attitudes toward workplace violence, coping styles, post-traumatic cognitions, post-traumatic stress disorder, post-traumatic growth, and mental health indicators (depression, anxiety, and stress). T-test, chi-squared, and binary logistic regression analyses were conducted. RESULTS: In our sample, 30.7% South Korean nurses and 31.6% Chinese nurses in Hong Kong had experienced workplace violence. South Korean and Chinese nurses in Hong Kong with experience of workplace violence had lower perceptions of it. Nurses with experience of workplace violence reported lower levels of mental health, and this trend was more prominent among South Korean nurses. CONCLUSIONS: Our study findings showed a positive association between workplace violence and post-traumatic responses in both settings. We found that the close monitoring of post-traumatic responses associated with workplace violence could be improved by enhancing nurses' perception of workplace violence.

Comparing workplace violence among nurses and other professionals using online articles: A social network analysis.

AIM: To investigate workplace violence in online articles and compare workplace violence-related words characteristics of nurses and other professionals using social network analysis. BACKGROUND: Workplace violence is a widespread problem across nursing practice. Online articles are useful for the timely identification and management of nurse violence problems. METHODS: This descriptive exploratory study involved data extraction focused around the search term workplace violence from sources published during January 1990-December 2020 listed in the BIGKinds database, a Korean integrated news database system. The connections between the extracted terms were determined through social network analysis using the software UCINET and NetDraw. RESULTS: Our search found 675 articles for nurses and 5797 articles for other professionals related to workplace violence. Work burden was found to be the primary cause of violence among both nurses and other professionals. Specifically, being a woman was closely related to violence among nurses, and abuse of power was closely related to violence among other professionals. CONCLUSION: Nurses and other professionals have different vulnerabilities to violence, which require a different approach to addressing violence. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should provide a healthy work environment, sufficient workforce and flexible work schedules to protect nurses from workplace violence.

Workplace bullying and different levels of post-traumatic stress symptoms of nurses: A quantile regression approach for effective coping strategies.

AIM: This study aimed to investigate effects of workplace bullying on different post-traumatic stress symptoms and coping among hospital nurses. BACKGROUND: Workplace bullying is a traumatic event that negatively affects the quality of patient care and nurses' mental health. METHOD: This cross-sectional, correlational study used an online survey among hospital nurses. Ordinary least square and quantile regression analyses were conducted using Stata version 16. RESULTS: The study included 233 registered nurses from South Korea who had provided direct care to patients in a hospital for at least 6 months. Overall, 28% self-identified as victims or witnesses and 37% as victims and witnesses simultaneously. 'Victim' and 'passive coping' were significantly associated with the 25th, 50th and 75th percentiles groups of post-traumatic stress symptoms, while 'witness' was significant in the 95th percentile group. CONCLUSION: Our study findings explore nurses' workplace bullying, detect high-risk subgroups and suggest the development of coping interventions for reducing workplace bullying and post-traumatic stress symptoms. IMPLICATIONS FOR NURSING MANAGEMENT: The study identified associations among bullying experience types, severity of post-traumatic stress symptoms and passive coping. It is critical to explore traumatic experience types and severity of post-traumatic stress symptoms for nurses at risk of workplace bullying.

The development of a shortened, Korean version of the Anticipated Turnover Scale for hospital nurses.

This study was a psychometric validation of a Korean version of the Anticipated Turnover Scale (ATS) involving translation, transcultural adaptation, and validation. We used data from a cross-sectional online survey of 287 Korean practicing nurses in hospitals. Confirmatory factor analysis (CFA) assessed the validity of the one-factor structure that was hypothesized in the original version. We removed any items that did not enhance the scale's reliability and validity. Test and retest reliability was performed on 206 of the nurses who completed the survey again two weeks later. The mean age of the 287 nurses was 33 years, and 278 (97%) of them were female. The final 6-item Korean version of the ATS demonstrated a satisfactory model fit in the CFA (χ2 = 22.67; degree of freedom = 9; goodness-of-fit index= 0.97; comparative fit index = 0.98; Tucker-Lewis Index = 0.97; root mean square error of approximation = 0.07; and standard root mean residual = 0.03). The intraclass correlation coefficient with the test-retest reliability for the 2-week interval was 0.81, with a good internal consistency (Cronbach's alpha = 0.85; McDonald's omega coefficient reliability = 0.92). The 6-item revised ATS is a reliable and valid scale to assess the turnover intention of Korean nurses who work in hospitals. It can be used in an acute setting and predict the anticipated turnover rate for monitoring purposes.

Smart Patch for Skin Temperature: Preliminary Study to Evaluate Psychometrics and Feasibility.

There is a need for continuous, non-invasive monitoring of biological data to assess health and wellbeing. Currently, many types of smart patches have been developed to continuously monitor body temperature, but few trials have been completed to evaluate psychometrics and feasibility for human subjects in real-life scenarios. The aim of this feasibility study was to evaluate the reliability, validity and usability of a smart patch measuring body temperature in healthy adults. The smart patch consisted of a fully integrated wearable wireless sensor with a multichannel temperature sensor, signal processing integrated circuit, wireless communication feature and a flexible battery. Thirty-five healthy adults were recruited for this test, carried out by wearing the patches on their upper chests for 24 h and checking their body temperature six times a day using infrared forehead thermometers as a gold standard for testing validity. Descriptive statistics, one-sampled and independent t-tests, Pearson's correlation coefficients and Bland-Altman plot were examined for body temperatures between two measures. In addition, multiple linear regression, receiver operating characteristic (ROC) and qualitative content analysis were conducted. Among the 35 participants, 29 of them wore the patch for over 19 h (dropout rate: 17.14%). Mean body temperature measured by infrared forehead thermometers and smart patch ranged between 32.53 and 38.2 °C per person and were moderately correlated (r = 0.23-0.43) overall. Based on a Bland-Altman plot, approximately 94% of the measurements were located within one standard deviation (upper limit = 4.52, lower limit = -5.82). Most outliers were identified on the first measurement and were located below the lower limit. It is appropriate to use 37.5 °C in infrared forehead temperature as a cutoff to define febrile conditions. Users' position while checking and ambient temperature and humidity are not affected to the smart patch body temperature. Overall, the participants showed high usability and satisfaction on the survey. Few participants reported discomfort due to limited daily activity, itchy skin or detaching concerns. In conclusion, epidermal electronic sensor technologies provide a promising method for continuously monitoring individuals' body temperatures, even in real-life situations. Our study findings show the potential for smart patches to monitoring non-febrile condition in the community.

Nurses' post-traumatic stress symptoms and growth by perceived workplace bullying: An online cross-sectional study.

AIM: The aim of this study was to explore the relationship between workplace bullying and mental health, focusing on the indirect effect of post-traumatic stress responses and moderation of nurses' perception of workplace bullying. BACKGROUND: Post-traumatic stress symptoms frequently result from workplace bullying, but how nurses' individual appraisals relate to negative consequences is unclear. METHOD: A cross-sectional online survey was conducted with 319 Korean nurses; participants were divided into the perceived and non-perceived workplace bullying groups. Moderated mediation models were tested using structural equation modelling with Stata version 16. RESULTS: Regardless of nurses' appraisals, higher levels of workplace bullying were associated with poor mental health. Post-traumatic stress symptoms indirectly impacted the relationship in both groups, but post-traumatic growth did not. The perceived group showed a partial negative association between post-traumatic growth and mental health. CONCLUSION: It is necessary to develop systems for early detection of mental health problems to create safe work environments not only for nurses who perceive workplace bullying but also for those who do not. IMPLICATIONS FOR NURSING MANAGEMENT: Staff education and institutional support that consider PTSS are recommended for all nurses.

Health behaviors influencing depressive symptoms in older Koreans living alone: secondary data analysis of the 2014 Korean longitudinal study of aging.

BACKGROUND: Geriatric depression is a societal problem, specifically in those living alone in Korea. This study aims are to investigate (1) how sociodemographic factors, health status, and health behaviors are differently associated with depressive symptoms in older Koreans living alone compared to those living with others and (2) how living arrangements attenuated or strengthened the associations between four types of health behaviors and depressive symptoms. METHODS: This secondary data analysis was conducted using data from the 2014 Korean Longitudinal Study of Aging. A structured survey assessing sociodemographic factors, health status, and health behaviors was conducted with people aged 65 or older who lived alone (n = 1359) and living with others (n = 2864). A multiple linear regression with interaction terms was conducted between mean-centered health behaviors and the status of living alone. All statistical analyses were performed using SPSS Statistics 23.0, and the two-tailed level of significance was set at 0.05. RESULTS: Those living alone reported higher levels of depressive symptoms than those living with others (Mdiff = 2.129, SE = 0.005, p <  0.001). The variance of depressive symptoms explained by 13 variables was 18.1% for those living alone compared to 23.7% for those living with others. Compared to health behaviors, sociodemographic factors and health status more explained depressive symptoms, specifically with psychiatric disorders, pain, and impaired functionality as risk factors. Smoking, alcohol abstinence, physical inactivity, and social inactivity were associated with more depressive symptoms. Living arrangements moderated the association between depressive symptoms and each health behavior, except for physical inactivity (all p values < 0.001). CONCLUSIONS: Older Koreans living alone were exposed to different risk factors for depressive symptoms compared to those living with others. Non-modifiable sociodemographic and health status factors were highly associated with depressive symptoms relative to health behaviors; thus, it is important to conduct early assessment and classification of vulnerable subgroups regarding geriatric depression. Specific assessment instruments should be prepared in practice according to living arrangements among older Koreans. Targeted interventions are essential to addressing living arrangements and modifying health behaviors to reduce smoking, alcohol consumption, and social inactivity, specifically in those living alone.

A comparative study to identify factors of caregiver burden between baby boomers and post baby boomers: a secondary analysis of a US online caregiver survey.

BACKGROUND: Baby boomers' position in the caregiving context is shifting from caregiver to care recipient as the population ages. While the unique characteristics of baby boomer caregivers are well established in caregiving literature, there is limited information about the next caregiving group after the baby boomers. In this study, the sociodemographic and caregiving-related characteristics of the two generations are compared and specific factors contributing to caregiver burden between baby boomer and post baby boomer caregivers are identified. METHODS: This cross-sectional and correlational study used secondary analysis of data from the National Alliance for Caregiving and the American Association of Retired Persons. A structured online survey was conducted in 2014 with randomly selected samples (n = 1069) in the United States focusing on sociodemographics, caregiving-related characteristics, and burden of care. Descriptive statistics, multivariate linear regression analyses, and Steiger's Z-test were used to identify group differences in multivariate factors related to caregiver burden in two generational groups. RESULTS: Baby boomers and post baby boomers experienced caregiver burden to a similar degree. Caregiving-related factors are more likely to increase burden of care than sociodemographics in both groups. Caregiving without choice and spending longer hours on caregiving tasks were common factors that increased the burden in both generational groups (all p values < 0.01). However, post baby boomer caregivers reported additional challenges, such as unemployment during caregiving, the dual responsibility of both adult and child care, and a family relationship with the care recipient. CONCLUSIONS: Due to the aging population of baby boomers, post baby boomers encounter different challenges related to caregiving burden, which is often considered an additional workload in their life course. Current policy and program tailored to baby boomers should be re-designed to meet the different needs of emerging caregivers. Specific vulnerable subgroups should have priority to receive the benefits of specific policies, such as those without choice and younger, working caregivers.

A nurse-led mHealth intervention to alleviate depressive symptoms in older adults living alone in the community: A quasi-experimental study.

BACKGROUND: The prevalence of geriatric depression has increased worldwide, becoming a major contributor to the burden of health care costs. Geriatric depression is difficult to detect in daily life because of its atypical presentation for each person. Therefore, there is an emerging need to develop personalised mHealth interventions for older adults with depression based on data from an ecological momentary assessment. OBJECTIVE: To develop and evaluate the effect of a nurse-led mHealth intervention of geriatric depression in older adults living alone. DESIGN: A quasi-experimental research design was used, and the study followed the transparent reporting of evaluations with a nonrandomised design statement. SETTING: The nurse-led mHealth intervention was developed and evaluated in a community senior centre in Seoul, Korea. PARTICIPANTS: Sixty-four older adults living alone with depressive symptoms were recruited between 1 October 2018 and 1 October 2019. METHODS: Study participants were randomly assigned to the intervention or control groups by drawing lots. In the intervention group, nurses repeatedly assessed older adults' depressive symptoms using an ecological momentary assessment via a mobile tablet. The intervention consisted of weekly sessions, which included (1) standardised mHealth device training, (2) a nurse-led mHealth programme, and (3) art activities. The control group received care as usual. Intra- and inter-group differences were evaluated using paired t-tests and analysis of covariance was used to assess subjective depression symptoms. A linear mixed-model was used to analyse the relationship between groups and momentary scores over time. RESULTS: The average age of the final sample was 76.2 years (SD = 6.06), 63.6 % (28/44) of whom were female. Compared with the control group (n = 23), the intervention group (n = 21) showed a decreased depression score (t = 4.041, p = .027). There was no statistical difference between the intervention and control groups based on traditional scales and the ecological momentary assessment. However, our data from the ecological momentary assessment captures clear fluctuating patterns across the days during the study, which traditional scales could not measure. CONCLUSIONS: Most of the older adults successfully participated in a nurse-led mHealth intervention that included multiple components of a non-pharmacological approach to address depression. Mental health nurses should perform critical roles to personalise mHealth activities considering the older adult's autonomy and supportive decision-making, specifically when using high-technological intervention. Future research should maximise the methodological and clinical advantage of an ecological momentary assessment of geriatric depression. REGISTRATION: Clinical Research Information Service number KCT0005073.

Reliability and validity of the Korean 12-item Perception of Aggression Scale.

WHAT IS KNOWN ON THE SUBJECT?: The importance of and interest in nurses' attitudes towards and subjective experience with workplace violence in clinical settings is increasing. The prevalence of patient-perpetrated violence against Korean nurses in hospital settings is highly prevalent. Only few instruments are available to measure the nurses' perception of patient aggression in Korea. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to assess the linguistic and psychometric reliability and validity of an instrument that evaluates the attitude of Korean nursing staff towards patient-perpetrated workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This valid and reliable instrument could be used to assess and monitor the nurses' attitudes towards aggressive tendencies in the workplace. The results could contribute to the development of relevant interventions for coping with violence by patients towards nursing staff and the implementation of practical training to cultivate healthy perceptions towards patients to foster therapeutic nurse-patient relationships. ABSTRACT: Introduction Despite the high prevalence of patient-perpetrated violence against Korean nurses globally, reliable and valid measures of patient aggression are lacking in Korean. Aim We translated the 12-item Perception of Aggression Scale (POAS) into Korean and psychometrically assessed its utility in measuring nurses' attitudes towards aggression. Methods The 12-item Korean POAS was obtained through forward-backward translation and cognitive debriefing. It was administered online to 319 nurses (mean age = 32.64 years; females = 96.2%), of which 206 completed it again after two weeks. Confirmatory factor analysis validated the 3-factor structure as hypothesized in the original version. The intra-class correlation coefficient was used to assess the test-retest reliability. Results The originally hypothesized 3-factor structure showed a good fit. The 3 dimensions: aggression as a dysfunctional or undesirable phenomenon, aggression as a functional or comprehensible phenomenon, and aggression as a protective measure had internal consistencies of 0.74, 0.86 and 0.90 and corresponding ICCs of 0.70, 0.86 and 0.90, respectively. Discussion The 12-item Korean POAS is a valid and reliable scale that might aid investigating nurses' attitudes towards patient aggression. Implications for practice The 12-item Korean POAS can help Korean nurses adopt protective behaviours and develop interventions to cope with aggression.

Description and Evaluation of the AACN Synergy Model for Patient Care Employing the Critique Frameworks of Chinn and Kramer (2011) and Fawcett and DeSanto-Madeya (2013).

This study describes and evaluates the AACN Synergy Model for Patient Care that aligns nurses' competencies with the needs of patients and their families, developed by the American Association of Critical-Care Nurses. The description focuses on objectively explaining the theory, while the evaluation is based on established standards to determine its viability for application in nursing practice. This study applies Chinn and Kramer's (2011) theoretical description method and Fawcett and DeSanto-Madeya's (2013) theory analysis method to evaluate the AACN Synergy Model for Patient Care. Focusing on the patient-nurse relationship, the theory is appropriate for various nursing applications.

Impact of COVID-19 on post-traumatic stress symptoms in the general population: An integrative review.

The coronavirus pandemic highlights the urgent need for increased support related to mental health concerns. This study aimed to synthesize the findings of empirical studies reporting the post-traumatic stress symptoms in the general population during the coronavirus pandemic. Whittemore and Knafl's (Journal of Advanced Nursing, 52, 546, 2005) integrative review methodology was used to analyse and synthesize the peer-reviewed studies. Five electronic databases, PubMed, CINAHL, PsychINFO, Cochrane and Google Scholar were searched using terms related to the coronavirus pandemic and post-traumatic stress symptoms. The quality of the studies was screened and evaluated using the Mixed Methods Appraisal Tool. The sample size of the 16 studies included in this review ranged from 41 to 3480 participants, with a total of 18 039 participants. The majority of the participants' ages ranged from 30 to 39 years, and 57% of the participants were female. The following factors related to post-traumatic stress symptoms during the coronavirus pandemic were identified as follows: (i) risk factors included social discrimination, fear of uncontrolled contagion and financial burden or economic instability; and, (ii) protective factors included social support and timely government action. A traumatic experience itself can trigger the onset of post-traumatic stress disorder; however, depending on the risk and protection factors, each individual can experience different post-traumatic stress symptoms. Thus, mental health nurses should comprehensively understand how to reduce the influence of risk factors and enhance protective factors when dealing with the pandemic and related trauma. This study's findings are beneficial for identifying, preventing and managing post-traumatic stress symptoms associated with the coronavirus and future pandemics.

Korean Version of the Swedish Occupational Fatigue Inventory among Construction Workers: Cultural Adaptation and Psychometric Evaluation.

The Swedish Occupational Fatigue Inventory (SOFI) has been tested in different languages and populations; thus, there is a need for a culturally adapted Korean version. We evaluated the psychometric properties of a Korean version of the SOFI among construction workers. The SOFI was translated into Korean and reviewed through a back-translation process involving standardized scaling procedures. Its reliability and validity were evaluated with a sample of 193 construction workers using internal consistency, item-subscale correlations, test-retest reliability, and content, construct, and concurrent validity. The Cronbach's alpha coefficients of the total scale and each subscale were satisfactory. Item-subscale correlations and test-retest reliability were both at acceptable levels. Confirmatory factor analyses revealed that the five-factor model had acceptable model fits corresponding to the structure of the original instrument. However, some modifications were made to improve in the new context from model fit (such as χ2(95) = 113.905 (p = 0.091), CFI = 0.994, and RMSEA = 0.033, as well as the lowest AIC = 383.905). Correlation analysis showed a significant relationship of SOFI with other fatigue measures in terms of total and subscale scores. Occupational fatigue is one of the important risk factors associated with workers' health and safety at work. The new translated instrument is a reliable and valid tool for assessing fatigue among Korean construction workers. However, this instrument should be tested extensively in other working populations to devise specific interventions concerning fatigue reduction.

Depression Prediction by Using Ecological Momentary Assessment, Actiwatch Data, and Machine Learning: Observational Study on Older Adults Living Alone.

BACKGROUND: Although geriatric depression is prevalent, diagnosis using self-reporting instruments has limitations when measuring the depressed mood of older adults in a community setting. Ecological momentary assessment (EMA) by using wearable devices could be used to collect data to classify older adults into depression groups. OBJECTIVE: The objective of this study was to develop a machine learning algorithm to predict the classification of depression groups among older adults living alone. We focused on utilizing diverse data collected through a survey, an Actiwatch, and an EMA report related to depression. METHODS: The prediction model using machine learning was developed in 4 steps: (1) data collection, (2) data processing and representation, (3) data modeling (feature engineering and selection), and (4) training and validation to test the prediction model. Older adults (N=47), living alone in community settings, completed an EMA to report depressed moods 4 times a day for 2 weeks between May 2017 and January 2018. Participants wore an Actiwatch that measured their activity and ambient light exposure every 30 seconds for 2 weeks. At baseline and the end of the 2-week observation, depressive symptoms were assessed using the Korean versions of the Short Geriatric Depression Scale (SGDS-K) and the Hamilton Depression Rating Scale (K-HDRS). Conventional classification based on binary logistic regression was built and compared with 4 machine learning models (the logit, decision tree, boosted trees, and random forest models). RESULTS: On the basis of the SGDS-K and K-HDRS, 38% (18/47) of the participants were classified into the probable depression group. They reported significantly lower scores of normal mood and physical activity and higher levels of white and red, green, and blue (RGB) light exposures at different degrees of various 4-hour time frames (all P<.05). Sleep efficiency was chosen for modeling through feature selection. Comparing diverse combinations of the selected variables, daily mean EMA score, daily mean activity level, white and RGB light at 4:00 pm to 8:00 pm exposure, and daily sleep efficiency were selected for modeling. Conventional classification based on binary logistic regression had a good model fit (accuracy: 0.705; precision: 0.770; specificity: 0.859; and area under receiver operating characteristic curve or AUC: 0.754). Among the 4 machine learning models, the logit model had the best fit compared with the others (accuracy: 0.910; precision: 0.929; specificity: 0.940; and AUC: 0.960). CONCLUSIONS: This study provides preliminary evidence for developing a machine learning program to predict the classification of depression groups in older adults living alone. Clinicians should consider using this method to identify underdiagnosed subgroups and monitor daily progression regarding treatment or therapeutic intervention in the community setting. Furthermore, more efforts are needed for researchers and clinicians to diversify data collection methods by using a survey, EMA, and a sensor.

Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study.

BACKGROUND: Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. OBJECTIVE: This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. METHODS: The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. RESULTS: Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. CONCLUSIONS: A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting.