1. Ready~Steady: Theory- based Technology to Enhance Motivation for Physical Activity that Reduces Fall Risk Siobhan Mc Mahon, PhD, MPH, GNP-BC Mithra Vankipuram, PhD Julie Fleury, RN, PhD, FAAN

2. Acknowledgements John A. Hartford Foundation/Building Academic Geriatric Nursing Capacity Program Pre-Doctoral Scholarship Program National Institutes of Health /National Institute of Nursing Research Grant # F31NR01235 Arrowhead Agency on Aging ElderCircle

3. An iPod touch® application was used to measure physical activity behavior and augment a wellness motivation intervention Approaches used in design Pilot test of application prototype Purpose

4. Growing rates of injurious falls among older adults creates social and financial burden Biomechanical efficacy of leg strength / balance activities established Majority of older adults have sedentary lifestyles Limited attention to motivational processes central to adopting and maintaining physical activity behaviors Rationale

5. Research is needed, which –builds upon knowledge of biomechanical effects by integrating theory-based strategies addressing motivation for behavior change –creates new solutions for measuring physical activity and augmenting motivational content of interventions in older adults at risk of falls Rationale

6. Accelerometers built-in to mobile computers and phones have been used to measure physical activity Mobile phone apps communicate accelerometry data to users through persuasive tools providing feedback about physical activity Rationale

7. Design Accepted theory-guided strategies Accepted user-specific strategies Wellness Motivation Theory Knowledge of accelerometer technology built-in to iOS platforms Methods

8. Accepted Theory-Guided Strategies

9. Accepted User-Specific Strategies

10. Used to specify what, when, how motivational content would be operationalized in the technology Wellness Motivation Theory  Biologic factors  Environmental factors  Social factors  Self knowledge  Motivation appraisal  Self regulation  Behavior  Health Risk

11. Triaxial accelerometer built-in to iPod touch® Frequency, duration, and intensity of physical activities Preliminary energy expenditure estimates Physical Activity Measurement

12. Background Processing Sensing Analyzing Accumulating Storing Interface Display Real-time activity metaphors Motivational messages Trended history feedback Physical Activity Measures Frequency Duration Intensity Initial Application PrototypeReady~Steady

13. Volunteers / Older Adult Expert Panel –Content Validity of theoretically relevant motivational messages –Usability and Acceptability –Accuracy in the Field Structured Interview Ready~Steady use for 4-7 days Prototype Evaluation

14. Survey Items Addressed: Clarity of motivational content Internal consistency of content within each motivational frame –Scoring sheet –5 point scales 1 strongly disagree 5 strongly agree Content Validity

15. Survey items addressing Learnability Effectiveness Satisfaction Scoring sheet –5 point scales »1 strongly disagree »5 strongly agree Low fidelity images Usability & Acceptability

16. 4 members of older adult expert panel used the iPod touch® over 4-7 days Activity journal Details about iPod touch® –Location worn –Time frame worn during the day –Time charged Accuracy in the Field

17. Descriptive statistics Spearman’s Rank Correlation Coefficient Narrative data Analysis

18. MeasureFinding Content Validity: Understandability 4.2 - 4.8 Content Validity: Relevance to theory construct 3.1 - 4.78 Usability4.4 – 4.6 Response to low fidelity image Blooming garden plus numeric information Accuracy: SensingSensed reported activities Accuracy: Battery operation10-12 hours per day Accuracy: Estimation of energy expenditure p =.68 -.92 with inconsistencies requiring attention Results

19. Narrative Data Suggestions for additional motivational statements Initial leaning and user directions should include 1:1 demo plus illustrated written instructions Preferred the combination of metaphorical picture and numbers as a way to gauge / evaluate progress Graph y-axis needs to be expanded Activity minutes accumulated when the iPod touch® was on the car seat, but not when wearing it on a belt while in the car, Elastic belt (SPI) was most comfortable

20. Content validity of theory-based motivational content Ready~Steady within an iPod touch®, may be learnable, effective, and satisfying among some older adults Blooming garden, a sun that acts as a gauge, and numerical feedback are preferred images Accelerometer function in Ready~Steady senses various intensities of physical activity for up to 12 hours research is still needed to establish methods for estimating energy expenditure representing sedentary, light, moderate and vigorous physical activity among older adults Implications

21. Improvements implemented into updated prototype Conclusions

23. Interventions designed to promote motivation for physical activity among older adults are essential Ready~Steady enhances motivation by targeting social contextual resources and behavioral change processes Theory-based iPod-touch® applications may be a promising adjunct to promoting motivation for physical activity in older adults Conclusions

24. Thank you