Engagement with a preventive eHealth intervention in older adults (the HATICE trial): Predictive factors and associations with dementia and cardiovascular risk

Abstract

AbstractBackgroundEngagement with digital health tools ihas not been well‐studied in older populations. We aimed to describe engagement with a preventive eHealth intervention designed to reduce dementia and cardiovascular risk, identify factors associated with engagement, and examine associations between engagement and changes in dementia and cardiovascular risk factors.MethodWe analyzed data from the 18‐month randomized controlled ‘Healthy Ageing Through Internet Counselling in the Elderly’ (HATICE) trial. Participants, enrolled in Finland, France, and the Netherlands, were aged 65+ with at least basic computer literacy and either ≥2 cardiovascular risk factors or history of cardiovascular disease/diabetes. The intervention group (N=1389) received access to an interactive Internet platform, designed to encourage lifestyle changes, with remote support from a lifestyle coach. The control group (N=1335) received access a static Internet platform containing basic health information. Engagement with the intervention platform was assessed via number of logins, lifestyle goals set, messages sent to the coach, monitoring measurements entered, and amount of advice and education materials read. These metrics were combined into a composite engagement score.ResultMost intervention group participants engaged with the platform to some extent: 90% set ≥1 goal, 86% sent ≥1 message and 80% entered ≥1 measurement. The median (IQR) number of logins per participant during follow‐up was 29 (16‐48). Regular computer use was the strongest baseline predictor of engagement. Those already working on or with short‐term plans for lifestyle improvement, and better cognition also engaged more. Compared to the control group, after adjustment, intervention group participants who engaged more with the platform showed significantly more improvement over 18‐months in systolic blood pressure, BMI, physical activity, Mediterranean diet score, and cardiovascular/dementia risk scores. Intervention group participants with a low engagement score showed no improvement compared to the control group.ConclusionEngaging older people in a digital lifestyle self‐management intervention was feasible. Better engagement led to more improvement in dementia and cardiovascular risk factors. Older adults who are infrequent computer users, have poorer cognition, and no concrete plans to change their lifestyle may need extra support for digital lifestyle interventions. Disparities in engagement may be further emphasized in real‐world settings.