Health Technology-Enabled Interventions for Adherence Support and Retention in Care Among US HIV-Infected Adolescents and Young Adults: An Integrative Review.

The objective of this integrative review was to describe current US trends for health technology-enabled adherence interventions among behaviorally HIV-infected youth (ages 13-29 years), and present the feasibility and efficacy of identified interventions. A comprehensive search was executed across five electronic databases (January 2005-March 2016). Of the 1911 identified studies, nine met the inclusion criteria of quantitative or mixed methods design, technology-enabled adherence and or retention intervention for US HIV-infected youth. The majority were small pilots. Intervention dose varied between studies applying similar technology platforms with more than half not informed by a theoretical framework. Retention in care was not a reported outcome, and operationalization of adherence was heterogeneous across studies. Despite these limitations, synthesized findings from this review demonstrate feasibility of computer-based interventions, and initial efficacy of SMS texting for adherence support among HIV-infected youth. Moving forward, there is a pressing need for the expansion of this evidence base.

An Assistive Technology System that Provides Personalized Dressing Support for People Living with Dementia: Capability Study.

BACKGROUND: Individuals living with advancing stages of dementia (persons with dementia, PWDs) or other cognitive disorders do not have the luxury of remembering how to perform basic day-to-day activities, which in turn makes them increasingly dependent on the assistance of caregivers. Dressing is one of the most common and stressful activities provided by caregivers because of its complexity and privacy challenges posed during the process. OBJECTIVE: In preparation for in-home trials with PWDs, the aim of this study was to develop and evaluate a prototype intelligent system, the DRESS prototype, to assess its ability to provide automated assistance with dressing that can afford independence and privacy to individual PWDs and potentially provide additional freedom to their caregivers (family members and professionals). METHODS: This laboratory study evaluated the DRESS prototype's capacity to detect dressing events. These events were engaged in by 11 healthy participants simulating common correct and incorrect dressing scenarios. The events ranged from donning a shirt and pants inside out or backwards to partial dressing-typical issues that challenge a PWD and their caregivers. RESULTS: A set of expected detections for correct dressing was prepared via video analysis of all participants' dressing behaviors. In the initial phases of donning either shirts or pants, the DRESS prototype missed only 4 out of 388 expected detections. The prototype's ability to recognize other missing detections varied across conditions. There were also some unexpected detections such as detection of the inside of a shirt as it was being put on. Throughout the study, detection of dressing events was adversely affected by the relatively smaller effective size of the markers at greater distances. Although the DRESS prototype incorrectly identified 10 of 22 cases for shirts, the prototype preformed significantly better for pants, incorrectly identifying only 5 of 22 cases. Further analyses identified opportunities to improve the DRESS prototype's reliability, including increasing the size of markers, minimizing garment folding or occlusions, and optimal positioning of participants with respect to the DRESS prototype. CONCLUSIONS: This study demonstrates the ability to detect clothing orientation and position and infer current state of dressing using a combination of sensors, intelligent software, and barcode tracking. With improvements identified by this study, the DRESS prototype has the potential to provide a viable option to provide automated dressing support to assist PWDs in maintaining their independence and privacy, while potentially providing their caregivers with the much-needed respite.

Prototype Development of a Responsive Emotive Sensing System (DRESS) to aid older persons with dementia to dress independently.

BACKGROUND: Prior research has critiqued the lack of attention to the stressors associated with dementia related dressing issues, stigmatizing patient clothing, and wearable technology challenges. This paper describes the conceptual development and feasibility testing of an innovative 'smart dresser' context aware affective system (DRESS) to enable dressing by people with moderate memory loss through individualized audio and visual task prompting in real time. METHODS: Mixed method feasibility study involving qualitative focus groups with 25 Alzheimer's family caregivers experiencing dressing difficulties to iteratively inform system design and a quantitative usability trial with 10 healthy subjects in a controlled laboratory setting to assess validity of technical operations. RESULTS: Caregivers voiced the need for tangible dressing assistance to reduce their frustration from time spent in repetitive cueing and power struggles over dressing. They contributed 6 changes that influenced the prototype development, most notably adding a dresser top iPad to mimic a familiar 'TV screen' for the audio and visual cueing. DRESS demonstrated promising overall functionality, however the validity of identification of dressing status ranged from 0% for the correct pants dressing to 100% for all shirts dressing scenarios. Adjustments were made to the detection components of the system raising the accuracy of detection of all acted dressing scenarios for pants from 50% to 82%. CONCLUSIONS: Findings demonstrate family caregiver acceptability of the proposed system, the successful interoperability of the built system's components, and the system's ability to interpret correct and incorrect dressing actions in controlled laboratory simulations. Future research will advance the system to the alpha stage and subsequent testing with end users in real world settings.