透過流動科技支援照顧者：電子繪畫流動應用程式的可行性研究 The 15th World Congress on Long Term Care in Chinese Communities cum 25th Annual Congress of Gerontology & 7th Cross-border Elderly Care Seminar Symposium on Geron-technology and Nursing Care 第十五屆世界華人地區長期照護會議 暨第二十五屆老年學周年會議及第七屆跨境安老服務研討會 Supporting Caregivers by Mobile Technology: A Feasibility Study of the E-painting Mobile App 透過流動科技支援照顧者：電子繪畫流動應用程式的可行性研究 Angela Y. M. Leung, PhD 梁綺雯 博士 Associate Professor, School of Nursing, 護理學院 副教授 Director of Centre for Gerontological Nursing, 老年護理研究中心總監 The Hong Kong Polytechnic University 香港理工大學

Outline 大綱 Background 背景 Study Aims & Objectives 研究目的 Methods 研究方法 Results 研究結果 Discussion & Conclusion 研究討論及總結

Background 背景 Sources of caregivers’ stress… Persons with dementia’s (PWD) dependency in activities of daily living Severity and frequency of behavioural symptoms PWD often performed problematic behaviors that might affect others Caregivers’ feeling of overload (subjective stressor) 照顧者壓力來源…… 患者於日常生活的依賴 嚴重及頻繁的行為症狀 患者經常表演出奇怪或讓人煩擾的行為 照顧者覺得自己負擔太重（主觀的壓力來源） (Kang et al., 2006; Lee et al., 2017; Son et al., 2007) Consequence of high stress level encountered by caregivers: Poor sleeping was linked to diminished quality of life, depression and cardiovascular risk (Cupidi et al., 2012). Caregivers of PWD often presented as secondary patients (Richardson et al., 2013). 照顧者遇到高壓力的後果： 睡眠質量差與漸降的生活素質，抑鬱及心血管疾病風險有聯繫 認知障礙症患者的照顧者經常以二級患者的身份出現

Background 背景 A review (Slayton et al., 2010) summarized that a brief period of painting significantly reduced… anxiety score (Sandmire et al., 2012; Curry & Kasser, 2005) distress (Franks & Whitaker, 2007) depression (Gussak, 2006) but increased mental alertness and sociability (Rusted, Sheppard, & Waller, 2006) 一篇評論 (Slayton et al., 2010) 總結出短暫的繪畫時段可顯著縮短...... 焦慮評分 (Sandmire et al., 2012; Curry & Kasser, 2005) 憂慮 (Franks & Whitaker, 2007) 抑鬱 (Gussak, 2006) 但提高了精神警覺性和社交能力 (Rusted, Sheppard, & Waller, 2006)

Aims & Objectives 研究目的 This study aims to assess the feasibility of this e-painting mobile app among the caregivers who frequently provide care to persons with dementia. 本研究旨在評估認知障礙症患者的恆 常照顧者於使用這種電子繪畫流動應用程式的可行性。 Objectives 目的: To assess the process of the use of the e-painting app for 8 weeks; To collect the app users’ views on the app after the intervention. To preliminarily assess the effect of the app on social and psychological aspects. 評估使用電子繪畫應用程序 (8週) 的情況 ; 收集使用者對電子繪畫應用程式的評價 ; 初步評估干預後心理及情緒的變化。

Study Design 研究設計 This is a mixed-method study with quantitative component (a pre-test & post-test survey) and qualitative component (focus group interviews, FGI) Pre-intervention Focus Group Interviews (pre-FGI) Post-intervention Focus Group / individual Interviews (post-FGI) Data collection: from Jan 2018 to May 2018 這是一個具有質性和量性的混合研究 量性成分（使用程式前後的問卷調查） 質性部分（干預前後的焦點小組 / 個人訪談） 數據收集：2018年1月至2018年5月

Quantitative & Qualitative component 質性和量性部分 Subjects 對象 Quantitative & Qualitative component 質性和量性部分 Inclusion criteria: aged 18 or above provide direct care to a person with dementia able to read Chinese or communicate in Cantonese or Putonghua able to travel to the designed interview venue independently (for qualitative component only) 納入條件： 年滿18歲或以上 為患有認知障礙症的人提供直接護理 能夠閱讀中文或以粵語或普通話交流 能夠獨立前往設計的面試場所 （僅限質性部分） Exclusion criteria: having fever, influenza symptoms being hospitalized living in residential care homes 排除條件： 有發燒，流感症狀 正在住院 住在安老院

Measures used in survey 問卷測量工具 Primary Outcome 主要目標： Caregivers’ level of stress 照顧者壓力水平 measured by a 11-item Zarit Burden Interview, CZBI-Short (Tang et al., 2015) Secondary Outcomes 次要目標： Self-rated health status 自評健康 measured by the 1-item Self-rated Health scale Depressive symptoms 抑鬱症狀 measured by a 9-item Patient Health Questionnaire (PHQ-9) (Cheng & Cheng, 2007) Instrumental and emotional social support 社會情感支持 measured by a 8-item Modified Medical Outcome Study Social Support Survey (mMOS-SS) (Moser et al., 2012)

Data analysis 數據分析 Quantitative data: Descriptive analysis (frequency, means, standard deviation) Paired t-tests were used to compare the outcomes before and after the 8-week intervention Qualitative data: Content analysis was used 量性數據： 敘述統計分析（頻率，均值，標準差） 配對檢定 (Paired t-tests) 用於比較使用8週電子繪畫應用程式前 後的結果 質性數據： 使用內容分析法

Chatroom 聊天室 Painting 畫畫 E-painting: Allowing caregivers to express their feelings 電子繪畫：讓照顧者表達自己的感受 Chatroom 聊天室 Painting 畫畫 Five features: Painting Sharing the Pictures Announcement Chatroom Mood Self-Assessment

E-Painting Guidelines 電子繪畫指南 Eight Painting Topics: A Person I like A Plant I like A place I like An Animal I like A task I often do Something I want to do when I am free A place I want to go when I am free Some food I want to eat 八週畫畫主題: 我喜愛的人物 我喜愛的植物 我喜愛的地方 我喜愛的動物 一件我恆常會做的事 當我空閒時會想做的事 當我空閒時會想去的地方 一些我想吃的食物

Examples of drawings shared by app users 電子繪畫程式用戶畫作分享例子 Topic: A place I want to go when I am free 當我空閒時會想去的地方 Topic: A plant I like 我喜愛的植物

Demographics 照顧者背景 Out of the 32 recruited subjects, 28 caregivers used the app. Only 22 completed the 8-week trial. 28名照顧者使用了該應用程式，但只有22名完成了為期8週的試驗。 Dropout rate: 21.4%

Engagement in E-Painting App 使用電子繪畫程式的參與度 Figure 1. Frequency of login and picture sharing in the e-painting app. Notes.* Frequency of Login were counted every 24 hours. ** Photos were also counted as pictures. Replicated sharing were excluded. 圖1. 電子繪畫應用程式中用戶登錄和圖片共享的頻率 (每24小時紀錄)

Accumulated count of pictures sharing 累計畫作上傳紀錄 Figure 2. Time for painting and sharing in a day. Notes. Photos were also counted as pictures. Replicated sharing were excluded. 圖2. 照顧者繪畫並分享畫作的時間

Usage of the e-painting app 使用電子繪畫應用程式 Login frequency Painting frequency

Picture sharing Favourite functions in the app

Reasons for not using the app

Caregivers’ Feedback after App Usage 使用電子繪畫應用程式用戶的意見 Caregivers believed that there was stress alleviation after the use of the e-painting app. After painting, it would make yourself become more positive, and my mood is better. (26 May 2018 CGPWD_Epainting_PostFGI; line 23-24) Well, I think one of the best things (of the app) is that everyone could see (pictures of)…each other. And even though other app users might not ‘like’ or respond to your pictures, you could still see others’ (pictures)…you might see, oh the pictures drawn were quite similar, or…. Still it could have a motivation effect on each other, that the interaction is quite good, that is…helpful, is helpful. (26 May 2018 CGPWD_Epainting_PostFGI; line 26-30) 照顧者認為使用電子繪畫程式後可以減輕壓力。

Changes in outcomes after the app intervention 使用應用程式前後的變化 App users who had a higher login frequency than average would be categorized as frequent users, and the one who had a lower login frequency than average would be categorized as non-frequent app users. In average, every user managed an approximate 7 login frequencies during the 8-week trial.

Discussion 討論 Non-frequent app users seemed to experience more burden before they used the app. Although the CGPWD reported the increased burden over time, their depressive symptoms were not exaggerated. The app seemed to help to break the geographic distance for connections and social support A fairly increase in instrumental and emotional social support scores 非頻繁用戶使用應用程序後遇到更多負擔。 雖然照顧者反映隨著時間的推移他們的負擔會相應增加，但他們的抑 鬱症狀並沒有明顯變化。 該應用程式似乎有助於打破地理界限 社會情感支持度有相當增幅。

Is E-painting App feasible? 電子繪畫應用程式可行嗎？ The e-painting intervention was generally welcome by the caregivers. This was an alternative platform for expressing emotion and relieving stress. The findings of the study supported the refinement of the development of the E-Painting app. app users used the app more than the planned schedule (8 weeks) most frequently used time of the app was in midnight or at 3pm Our next step: Further investigation is needed to assess the efficacy of this electronic platform on caregivers’ mental health. 照顧者普遍接受電子繪畫程式。 這是表達情感和緩解壓力的另一種平台。 該研究的結果有助改進電子繪畫應用程式的開發。 用戶使用該應用程式超過預定計劃的時間表（8週） 應用程式最常用的時間是在午夜或下午3點 需要進一步調查以評估該電子平台對改善照顧者心理健康的效果。 The development of the app is intended to develop CGPWD’s health literacy by providing a platform for self-assessing emotional level and encouraging decision to alleviate stress through e-painting. 該應用程式透過提供一個平台予照顧者自我評估情緒水平和鼓勵他們通過電子繪畫緩解壓力，從而推動照顧者的健康素養。

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Your comments are welcome. Thank you! Your comments are welcome. 謝謝！歡迎提問。 Angela Y. M. Leung, PhD 梁綺雯 博士 angela.ym.leung@polyu.edu.hk