Samantha Curriero

Background: Although technology usage is steadily increasing among older adults, adoption and confidence greatly lag behind their younger counterparts. Sociocultural and health disparities intersect with aging to present distinct structural and psychosocial barriers to the adoption of newer technologies. Digital health literacy interventions can improve task-specific skills, technological self-efficacy, and use frequency, but most do not systematically incorporate older adults’ values and goals, which are key drivers of sustained behavior change. Objective: The proposed study aims to develop and evaluate the acceptability and feasibility of a person-directed, values-based, in-home digital literacy intervention for older adults, entitled values-informed solutions for technology adoption (VISTA). Methods: VISTA begins with a values and goals discussion rather than a skills test, mapping “What Matters Most” to individualized, SMART (specific, measurable, achievable, relevant, and time-bound) technology goals. Over 8 to 12 weeks, interventionists co-developed personalized learning plans with participants, delivering up to 6 in-home biweekly visits and interim phone calls. The study provided a tablet and assistance with obtaining home internet when needed. Outcomes included digital literacy (Mobile Device Proficiency Questionnaire), technology and chronic disease self-efficacy, social networks, multimorbidity, and frailty (Fried Frailty Phenotype). Feasibility was assessed via recruitment, retention or completion, data collection rates, survey administration time, withdrawal, intervention fidelity, and per-person cost; acceptability was assessed via a postintervention satisfaction survey (Likert and open-ended items) and willingness to recommend. Results: Funding was secured in November 2023. Institutional review board approval, intervention development, and focus groups were completed throughout 2024. Recruitment and baseline assessments occurred from January 2025 to July 2025, enrolling 21 participants and randomizing 11 to immediate intervention and 10 to waitlist control (waitlist participants received the intervention after a 3-month control period). One consented participant was unable to participate early in the intervention and is not included in analyses. Inclusion criteria included being aged 65 years and older, having English proficiency, and demonstrating a willingness to improve digital literacy. Exclusion criteria involved severe cognitive impairment. At baseline, participants had a mean age of 75.7 (SD 7.74) years and were predominantly female (n=13, 65%) and Black (n=19, 95%); most reported having a low income (10/12, 83%), living alone (12/14, 85.7%), and multimorbidity (mean disease count 3.95, SD 2.46). Follow-up assessments concluded in March 2026; data cleaning and analysis are ongoing, with primary feasibility and acceptability findings anticipated for fall 2026. Conclusions: This protocol offers a unique model centering on the values and goals of older adults to improve access, use, and understanding of technology. Tapping into the motivators of older adults may provide a more beneficial way to encourage older adult technology use. VISTA could be useful in many general contexts, more specifically for older adults who are homebound or have serious illnesses, or as a preintervention for interventions involving advanced technology understanding.

The need for evidence-based services that help older adults thrive in the community aligns with the economic need to lower costs while achieving better outcomes. Some hospitals with global budgets have started paying for community-based care to decrease hospitalizations. We evaluated health, utilization, and cost outcomes associated with CAPABLE, a time-limited intervention to improve daily function, among 205 participants. The Johns Hopkins Hospital has paid for CAPABLE because it may decrease avoidable hospitalizations while improving outcomes. We used a difference-in-difference approach to compare outcomes for participants and non-participants. Avoidable charges were significantly less for CAPABLE participants compared to non-participants (p = 0.02) between 2016 and 2022. While not achieving statistical significance, participants experienced fewer avoidable hospitals stays and readmissions. Participants had significant improvements in functional outcomes and decreased depression scores. Implementing CAPABLE has potential to yield cost-saving and health improving benefits for hospitals with global budgets and insurers by reducing preventable hospitalizations.

UNSTRUCTURED Background: Although technology usage is steadily increasing among older adults, adoption and confidence greatly lags behind their younger counterparts. Sociocultural and health disparities intersect with aging to present distinct structural and psychosocial barriers to adoption of newer technologies. Growing evidence suggests that digital health literacy interventions may improve technology skills, increase technological self-efficacy, and increase frequency of technology use. However, these digital literacy interventions do not systematically consider participants’ values and goals, which we know are key to long term behavior change. Objective: The proposed study aims to develop and evaluate the acceptability and feasibility of a person-directed, values-based digital literacy intervention for older adults. Methods: We enrolled 20 participants in a 1:1 randomized pilot control trial with waitlist control. Inclusion criteria included aged 65 and older with English proficiency and willingness to improve digital literacy. Exclusion criteria involved severe cognitive impairment. Over the course of 8-12 weeks, participants received up to six in-home biweekly visits and interim phone calls based on their individual digital literacy needs and participant-directed goals. Each participant also received internet connectivity and a tablet if not already available. Our main outcome was digital literacy improvement. We also assessed technological self-efficacy, digital health literacy, quality of life, and measures of physical and emotional well-being. Results: - Conclusions: This protocol offers a unique model centering the values and goals of older adults to improve access, use and understanding of technology. Tapping into the motivators of older adults may offer a more beneficial way to encourage older adult technology use. VISTA could be useful in many contexts- home bound or seriously ill older adults or as a pre-intervention for interventions involving advanced technology understanding.

Background: Women and Black and Latino adults face a high burden of cardiovascular disease (CVD), yet remain underrepresented in CVD research. CONNECT (Developing a Learning Community to Increase Engagement and Enrollment in Cardiovascular Clinical Trials) is a participant‐centered learning platform designed to (1) evaluate electronic health record‐informed and community‐engaged recruitment; (2) increase enrollment in CVD research; and (3) increase trust in and awareness of CVD research among 3 priority populations: women and Black and Latino adults. This article describes the rationale, design, and early implementation lessons. Methods: CONNECT uses community‐engaged and digital approaches to recruit and engage women and Black and Latino adults, aiming to enroll 1000 participants. Participants receive 12 months of tailored heart health and research text messages and are connected to CVD research that aligns with their interests. The primary outcome is the proportion of individuals enrolled, by recruitment method and priority population. Other outcomes include proportion of participants who enroll in a CVD study and changes in awareness of and trust in research. CONNECT was codeveloped with a Community Research Council, a group of community consultants, and approved by local institutional review boards. Results: Development and early implementation identified strategies for successful community partnerships, cross‐institutional collaboration, efficient technology infrastructures, tailored education materials, and researcher engagement. Conclusions: CONNECT shows potential to address barriers to research participation, strengthen engagement and recruitment science, and improve diverse research participation. Findings from CONNECT will inform best practices to engage women and Black and Latino adults in CVD research. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06347484.