Sophia Greisner

Background and Objectives: Hospital-to-home transitions constitute vulnerable periods during which health systems increasingly rely on unpaid care partners to help care recipients execute discharge plans. We examine how mutuality and incongruence within care partner–care recipient dyads may shape discharge preparedness and dyadic self-efficacy during care transitions. Research Design and Methods: We conducted a secondary qualitative analysis of PROJECT ACHIEVE focus groups and key informant interviews with 248 participants (138 care recipients, 110 care partners) across 6 U.S. health systems, examining their experiences of hospital-to-home transitions. A multidisciplinary team conducted thematic analysis and compared themes across stakeholder groups, guided by Social Cognitive Theory and Interdependence Theory. Results: Care recipients and care partners shared goals but often differed in their appraisals of discharge readiness and post-discharge roles. Three domains of incongruence emerged: (1) preparedness for transitions home, as care recipients prioritized going home despite ongoing symptoms while care partners worried about premature discharge and inadequate training; (2) burdensomeness and struggle for independence, as care recipients desired to preserve autonomy while care partners absorbed the emotional and practical strain of supporting such desires; and (3) role changes and evolving relational identities, as spouses and adult children assumed caregiving roles that disrupted prior identities in the relationship. Lower mutuality was linked to reduced dyadic self-efficacy and, consequently, increased risk of readmission. Discussion and Implications: Findings highlight dyadic incongruence as a target for intervention in care transitions. Care strategies that assess care recipient–care partner mutuality may enhance dyadic self-efficacy and improve post-discharge outcomes.

BACKGROUND Diabetes self-management education and support (DSME/S) and diabetes group visits (DGV) improve outcomes for older adults but remain difficult to scale. Some digital technologies offer DSME/S content, but few are designed for the needs and preferences of older adults. OBJECTIVE We developed the Healthy Opportunities and Personal Empowerment (HOPE) App, an immersive digital health program, to deliver live, virtual DSME/S in a group visit format to older adults with type 2 diabetes (T2DM). Immersive technology allowed gamified, active learning programs to enhance self-management mastery. METHODS We conducted two phases of iterative HOPE App development and usability testing using a user-centered design process. Findings informed application revisions and updates. Two groups of patient advisors (PAG1, n=21, and PAG2, n=8) comprised of older adults with T2DM completed usability testing on the HOPE App prototype. Outcomes were assessed using scores from the System Usability Scale (SUS) and key informant interviews on user experience. Transcripts and observation notes were analyzed thematically RESULTS Highly valued HOPE App features include simplified navigation, avatar customization, self-paced tutorials, peer matching program, and immersive DSME/S content. Mean SUS scores increased from 71.0 in Phase 1 to 80.0 in Phase II. Participants highlighted the importance of intuitive navigation, large text, real-time voice communication, and peer interaction. Three user experience themes emerged: 1) identification with customized avatars, 2) social learning and immersive presence through peer discussion and mentorship, and 3) simulations and gamified training activities in the 3D virtual environment. Participants also identified barriers to the desired user experience, including limited avatar phenotypes, interference with voice communication, and tutorial navigation challenges. CONCLUSIONS User testing supported the usability of the HOPE App to deliver group-based, live action DSME/S with immersive technology. Findings highlight design priorities for scalable digital diabetes interventions tailored to older adults.