Tina Sadarangani

Background: Adult day services (ADS) provide care and social support for adults with complex health needs, yet they remain an understudied long-term care sector whose impact on patient outcomes is unclear. Objective: To inform an updated research agenda that supports a coordinated approach to measuring impact of ADS and gaps in services in an evolving policy landscape. Methods: We convened 32 stakeholders in partnership with the National Adult Day Services Association. Following a pre-convening evidence review, a facilitated discussion took place. Rapid qualitative synthesis of notes was used to identify themes and consensus priorities. Results: Participants’ priority was strengthening data infrastructure. They wished to leverage data to identify workforce shortages, implement evidence-based interventions, advance policymaker understanding of ADS, and address uneven reimbursements. The agenda prioritizes standardizing outcome measures, supporting workforce capacity, and translating research into policy. These stakeholder-informed priorities can guide research and policy to demonstrate impact and expand access to ADS.

Background: Family caregivers often struggle to track daily caregiving tasks (eg, managing medications, appointments). To address this, our team developed CareMobi, a mobile app designed to make caregiving more organized, collaborative, and manageable. Objective: We sought to evaluate early user satisfaction, real-world utility, and perceived value of CareMobi among informal caregivers. Methods: A cross-sectional survey was administered between October 2023 and January 2024 to CareMobi users. The survey included Likert-scale items assessing satisfaction and usability, and open-ended prompts exploring use cases and improvement suggestions. Descriptive statistics summarized quantitative data, and open-ended responses were analyzed using inductive content analysis. Results: Among respondents (N = 51), 82% reported being satisfied or very satisfied with the app, and 76% found it easy or very easy to use. Highly valued features included appointment/calendar tracking (32 selections), health progress monitoring (30 selections), and file storage (20 selections). Caregivers use CareMobi across diverse contexts, from elder care to self-management, to coordinate care among multiple individuals and streamline information access. Open-ended responses revealed 3 primary areas of impact: improved communication, centralized information management, and support for symptom and medication tracking. Users requested enhancements to support care team coordination, emphasizing the importance of simple, functional tools for daily caregiving. Conclusion: Preliminary findings, based on a small, self-selected sample, suggest CareMobi is a user-friendly tool that supports informal caregivers and facilitates care coordination. Results highlight the importance of caregiver-centered app design and indicate the need for further evaluation through longitudinal, mixed-methods research to assess long-term outcomes and integration into care routines.

Background: Adult day centers (ADC) are well-positioned to address social isolation among the rapidly growing population of people living with dementia but are underused relative to other forms of long-term care. Mistrust of these centers among family caregivers remains a barrier to their use. Digital health tools offer a promising approach to enhance transparency, improve communication, and build trust between caregivers and ADCs. As such, researchers at New York University (NYU) developed CareMobi, a user-centered mobile app that supports care coordination between ADC, care providers, and caregivers. Objective: This study aimed to evaluate the real-world usability, acceptability, and feasibility of CareMobi among staff in ADCs and the caregivers of people living with dementia who attend centers. Methods: Guided by the Goal–Question–Metric (GQM) framework, we conducted a low-burden field usability evaluation of CareMobi in 2 ADCs. Data included baseline caregiver surveys, app usage logs, administration of the Post-Study System Usability Questionnaire, and participant interviews. Feasibility benchmarks were established a priori using STOP-AMEND-GO criteria for evaluable retention, usability, satisfaction, engagement, and acceptability. Quantitative analyses summarized demographics, caregiver confidence, and app usability (7-point scale and median scores). Qualitative analyses used thematic coding of interviews and written feedback to identify perceived benefits, barriers, and recommendations for implementation. Results: Family caregivers (n=15) from 2 ADCs participated in a mixed-methods pilot. Participants were primarily female (87%), non-Hispanic White (93%), and middle-aged or older (67% aged 30-64 years). Most were sole caregivers (80%). Baseline confidence in managing dementia-related care was high, particularly in communication with providers. Of 15 enrolled caregivers, 14 (93%) logged into CareMobi at least once, and the majority “agreed/strongly agreed” that the app was easy to use (6/8, 75%) and easy to learn (7/8, 87.5%); 75% (6/8) of the participants liked the interface and found the information well organized. All staff (n=3) indicated the CareMobi app was easy to use, easy to learn, and well organized (3/3, 100%). Willingness to use the app beyond the study period was high among caregivers (6/8, 75%) and staff (3/3, 100%). Open-ended caregiver responses emphasized reassurance from daily updates, user-friendliness, and time savings. Staff reported reduced “phone tag” streamlining coordination, particularly for new ADC enrollees. However, established caregivers tended to use the app passively, defaulting to phone calls. Themes highlighted the need for structured logging guidance, role-specific templates, and integration with existing systems. Caregivers and staff noted that routine updates fostered trust, improved decision-making about attendance, strengthened communication with health care providers, and provided peace of mind. Conclusions: CareMobi offers a promising approach to modernizing ADC in ways that respect resource limitations and caregiver needs, through combining digital transparency with low-burden communication. Future efforts should center on equity and focus on linguistic inclusion, infrastructure support, and engagement in underserved communities.

Adult day services (ADSs) are key providers of community-based care for persons with dementia (PWD) and their family caregivers. In this study, the researchers focused on one state, Mississippi, to evaluate the availability of ADS centers for PWD. Using R software, the researchers mapped the locations of all known ADS centers in the state ( N = 48) along with estimates of the number of PWD by county and then overlaid these maps with US Census data. Findings revealed that ADS centers were primarily located in counties with high concentrations of PWD, Black residents, and lower-income residents; however, there was a shortage of availability across every county in the state. While ADS centers were generally located in areas of greatest need, PWD and family caregivers across Mississippi are underserved and lack access to ADS. Policymakers and funding agencies should use data-driven strategies to expand ADS, particularly in high-need, underserved areas.

Researchers and advocates recognize that adult day services (ADS) play a key role in delivering person-centered care to individuals living with Alzheimer’s Disease and related dementias (ADRD). However, few ADS centers are routinely measuring person-centered outcomes, thereby limiting our ability to understand the impact of ADS on these key indicators of well-being. Guided by Kitwood’s framework of person-centered dementia care, this study aimed to identify valid, reliable, and practical person-centered outcome measures that reflect ADRD quality-of-life domains. Twenty-two ADS practitioners and researchers ( N = 22) participated in a two-round e-Delphi review to evaluate 10 potential outcome measures across four person-centered domains: meaning and purpose; engagement; social networks; and sense of belonging. Based upon scores on select characteristics in Round 1 of the e-Delphi review (e.g., ease of administration, relevance to population), consensus was reached in Round 2 (66.67% supermajority) on the following measures: the PROMIS Meaning and Purpose in Life Scale (76%); the Friendship Scale (76%); and the General Belongingness Scale (67%). Panelists could not reach consensus on the Life Engagement Test (52%) and the Engagement in Meaningful Activities Scale (48%), so both were retained for future evaluation. The scales identified in this e-Delphi review will now be incorporated into real-world data collection beta-testing to evaluate feasibility, practicality and impact of ADS on these person-centered outcomes.

BACKGROUND Adult day centers (ADC) are well-positioned to address social isolation among the rapidly growing population of people living with dementia but are underused relative to other forms of long-term care. Mistrust of these centers among family caregivers remains a barrier to their use. Digital health tools offer a promising approach to enhance transparency, improve communication, and build trust between caregivers and ADCs. As such, researchers at New York University (NYU) developed CareMobi, a user-centered mobile app that supports care coordination between ADC, care providers, and caregivers. OBJECTIVE This study aimed to evaluate the real-world usability, acceptability, and feasibility of CareMobi among staff in ADCs and the caregivers of people living with dementia who attend centers. METHODS Guided by the Goal–Question–Metric (GQM) framework, we conducted a low-burden field usability evaluation of CareMobi in 2 ADCs. Data included baseline caregiver surveys, app usage logs, administration of the Post-Study System Usability Questionnaire, and participant interviews. Feasibility benchmarks were established a priori using STOP-AMEND-GO criteria for evaluable retention, usability, satisfaction, engagement, and acceptability. Quantitative analyses summarized demographics, caregiver confidence, and app usability (7-point scale and median scores). Qualitative analyses used thematic coding of interviews and written feedback to identify perceived benefits, barriers, and recommendations for implementation. RESULTS Family caregivers (n=15) from 2 ADCs participated in a mixed-methods pilot. Participants were primarily female (87%), non-Hispanic White (93%), and middle-aged or older (67% aged 30-64 years). Most were sole caregivers (80%). Baseline confidence in managing dementia-related care was high, particularly in communication with providers. Of 15 enrolled caregivers, 14 (93%) logged into CareMobi at least once, and the majority “agreed/strongly agreed” that the app was easy to use (6/8, 75%) and easy to learn (7/8, 87.5%); 75% (6/8) of the participants liked the interface and found the information well organized. All staff (n=3) indicated the CareMobi app was easy to use, easy to learn, and well organized (3/3, 100%). Willingness to use the app beyond the study period was high among caregivers (6/8, 75%) and staff (3/3, 100%). Open-ended caregiver responses emphasized reassurance from daily updates, user-friendliness, and time savings. Staff reported reduced “phone tag” streamlining coordination, particularly for new ADC enrollees. However, established caregivers tended to use the app passively, defaulting to phone calls. Themes highlighted the need for structured logging guidance, role-specific templates, and integration with existing systems. Caregivers and staff noted that routine updates fostered trust, improved decision-making about attendance, strengthened communication with health care providers, and provided peace of mind. CONCLUSIONS CareMobi offers a promising approach to modernizing ADC in ways that respect resource limitations and caregiver needs, through combining digital transparency with low-burden communication. Future efforts should center on equity and focus on linguistic inclusion, infrastructure support, and engagement in underserved communities.

Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting.

Background: CareMOBI (mhealth for Organization to Bolster Interconnectedness) is a user-centered mobile application that supports secure communication between adult day health centers, primary care providers, and family caregivers. The aim of this study was to examine the acceptability of CareMOBI in the primary care setting and identify factors contributing to the likelihood of adoption among primary care providers. Methods: We used a mixed-methods concurrent triangulation design. We, first, collected quantitative data using the Technology Acceptance Model questionnaire. Follow-up interview questions allowed participants to elaborate on their experience interacting with CareMOBI. We developed an informational matrix based on major themes within the Technology Acceptance Model (ease of use, value in clinical care, fit within existing workflows, and likelihood of adoption) in which qualitative data were embedded and compared. Results: Our sample included 10 primary care providers. Participants rated CareMOBI high in ease of use ( M = 6.71 out of 7), value in clinical care ( M = 6.79), and likelihood of adoption ( M = 6.71). They found specific functions of CareMOBI helpful, including the summary of health progress and the patient profile. In contrast, participants reported the lowest score for the fit of CareMOBI within existing workflows ( M = 5.52). Qualitative feedback attributed this score to concerns over the lack of interoperability between CareMOBI in its current form and electronic health record systems used in the primary care setting. Conclusion: Providers found CareMOBI valuable and easy to use, and there was a high likelihood of eventual adoption. However, apprehensions regarding workflow and electronic health records integration arose, which the team will have to consider as they move forward to the next phase of the application's development.

Family caregivers of persons living with dementia (PLWD) are often expected to coordinate and manage all aspects of a loved one’s day-to-day care across settings with limited modern, user-friendly resources to support them. We developed CareMOBI, a mHealth app prototype that aims to support improved care coordination and communication between care team members. A concurrent mixed-methods triangulation design was used to assess the acceptability and likelihood of adopting CareMOBI among family caregivers of PLWD. Caregivers ( n = 13) completed the Technology Acceptance Model questionnaire (quantitative) and semi-structured interviews (qualitative). Integration occurred using the four themes of the Technology Acceptance Model. There was strong agreement among family caregivers that CareMOBI had a high perceived value for care ( M = 6.23/7), was easy to use ( M = 6.20/7), and enhanced current workflows ( M = 5.86/7). However, training in utilizing mHealth apps and the need for a Spanish-language version were cited as necessary enhancements to increase the widespread adoption of CareMOBI.