Assessing the Usability of iPREPARED: an Application-Based, Non-Pharmacological Delirium Prevention Intervention

Introduction: Non-pharmacologic prevention measures reduce incident delirium by up to 30-40%% in inpatient and ED settings, but consistent application is often difficult. A mobile health application, titled iPREPARED (Improve Prevention and Recovery by Engaging Patients and FAmily-Caregivers to End Delirium) was co-developed with patients and their care partners to prepare them for delirium and empower them to use non-pharmacological prevention measures. This study assessed the feasibility, acceptability, and usability of iPREPARED in the emergency department (ED). Methods: An IRB-approved prospective study enrolled a convenience sample of ED patients over age 60 and/or their care partners. Participants were provided a tablet with the iPREPARED application and were given time to review the contents and ask questions. Then, either the patient, care partner, or both completed a 20-item validated anonymous questionnaire including: 1) accessibility, 2) understandability, and 3) educational value. We used the validated Mobile health Apps Usability Questionnaire (MAUQ), with a 1 “strongly disagree” to 7 “strongly agree” Likert scale. Acceptability was measured by the satisfaction and perceived value of the app, and feasibility was measured by the practical implementation in the real-world setting. Results: Slightly less than one half of the approached patients accepted to participate in the study. Questionnaires were completed by 40 participants (50% female). Questions addressing understandability, educational value, and ease of use had median ratings of 6 (IQR 5, 7) or 7 (6, 7). Individuals were less positive about iPREPARED improving access to healthcare services or managing health effectively (median 5 [4-7]) and noted a requirement for internet access. Reasons for declining participation included a language barrier (12%), feeling tired or not interested (17%), and feeling overwhelmed or uncomfortable (20%). Conclusion: It is feasible to implement mobile health applications in real world settings including the ED. Patients and care partners perceived iPREPARED positively, particularly in terms of understandability and educational value.