Exploring exercise-based smartphone apps to improve health outcomes related to poor physical activity levels and digital literacy in users with learning disabilities and their carers.
Research in Sport, Health and Exercise Science at the University of Hull has seen the development of an exercise intervention which shows significant improvements in a range of health markers (strength, power, functional fitness, wellbeing). A smartphone app which facilitates the delivery of the exercise intervention has now been developed. We propose to use this technology to assess the efficacy and accessibility of the app in improving digital literacy and physical activity levels in users accessing day services in the Humber region with a view to rolling out the findings nationally. We will test the hypotheses by establishing the following:
- Are service users and their carers/families confident in accessing mobile technology?
- Do they feel that mobile technology will enhance service delivery and accessibility?
- Do they feel that accessing mobile technology has enhanced their digital literacy?
- Are service users/carers physically active in line with recommended national government guidelines and are they interested in becoming more physically active?
- Do they feel that the use of mobile technology is a good way to increase physical activity and will it break down some of the common barriers to engaging in physical activity?
- Do they feel that engaging with the app has helped to improve their health, fitness and wellbeing?
- What changes need making to the existing version of the app to make it more user friendly and better able to meet service user and carer needs?
These questions will be investigated using the current version of the app with service users, carers and day service staff. During the Alpha phase the above questions will be answered using questionnaires and qualitative data collected via focus groups and one-to-one interviews.
The project will involve input from the Kingston Upon Hull City Council (KUHCC) as the lead, North East Lincolnshire, North Lincolnshire, East Riding councils and University of Hull via focus groups and interviews with day service staff, local carers and day service users. The diverse nature of the local authorities will allow perspectives to be gathered from those living and working in urban and rural areas to achieve optimal development of a service which can be rolled out nationally.
The involvement of four Local Authorities at this stage will provide a strong foundation in preparation of Beta application to establish a product that can be shared nationally.
A PDF is attached giving background / context to the project and outlining outputs already completed on this project.
Research undertaken during the discovery phase supports the hypotheses that using an app has a positive impact on levels of physical fitness and wellbeing of those tested, see attached PDF. Changes to the hypotheses were not necessary for this Alpha phase. We expect to identify the changes that will be required for the app to have the same positive effect on physical fitness and wellbeing as those with LD.
Adults with learning disabilities (LD) frequently experience poorer health than the general population, including health issues associated with lifestyle such as increased sedentary behaviour and low physical activity (NICE guideline NG96). Combined with problems of an ageing population, this puts a major strain on support services such as adult day services. This national problem can be addressed by improving services delivered to adults with LD to help improve their physical activity levels and go some way to addressing the associated health problems. Over 80% of adults with LD engage in physical activity below the minimum recommended by the Department of Health, a much lower level than the general population (53%-64%) (Messent et al., 1998; Robertson et al., 2000a), people of lower ability in more restrictive environments are at further increased risk of inactivity (Robertson et al., 2000a).
NHS are committed to improving care for people with learning disabilities to address health issues related to lack of physical activity
Furthermore, a link has been identified between the physical activity levels of carers and those they care for. Common barriers to engaging in physical activity include lack of time and money, factors exacerbated in groups such as carers, for whom time is at a premium and may have to give up work due to their caring commitments. Carers frequently report their role negatively impacts on physical and mental health (Carers UK, 2011). Longer term, this situation poses a challenging budget and resource pressure on local authorities and Clinical Commissioning Groups (CCGs).
This project aims to address both physical health and digital literacy of carers and people with LD via mobile technology and will be included in the service user journey during engagement with local authority via direct participation in day centres, see user journey PDF attached. This will be further supported by provision of training in the use of mobile technology for service users and carers to ensure ongoing and sustainable engagement with this aspect of the service, including home based exercise.
Approximately 1.5 million UK residents are registered with LD, 350,000 of whom are diagnosed with a severe LD (NHS, 2019). This represents a significant body of people who require additional support from local authorities and CCG services and consequently a significant financial cost nationally.
In the Humber region an estimated 20,000 residents aged 18+ are diagnosed LD, a further 400 residents with Down’s Syndrome and 8000 residents considered to be on the Autistic Spectrum (Joint Strategic Needs Assessment (JSNA), 2018). The 2011-12 Health and Lifestyle Survey in Hull confirmed that 16% of respondents were carers. A 2015 estimate suggested that of these carers, 5118 were aged 65 and over (JSNA, 2018). The JSNA report identifies a need to offer high quality, integrated and accessible services for those with LD and their carers, including appropriate choices to improve their health and wellbeing.
As stated previously a person with a Learning Disability is more likely to experience poorer health than the general population impacting on their quality of life. Through a high BMI alone the cost to the Health Service for people with a LD is circa £400m p.a. (NICE QSAC briefing paper 2015) based on costs in 2007 raising to £1.2bn by 2050.
An individual with Learning Disabilities may be supported by:
(Costs source: Dept of Health Reference Costs 2015-16, a unit of care is a nationally standardised term for a care contact)
- Community Nurse £45 per unit
- Occupational Therapist £63 per unit
- Physiotherapist £63 per unit
- Ambulance service £243 per unit
- Hospital day case £733 per unit
- Elective inpatient £3749 average per stay
- Non-elective inpatient £1609 average per stay
- Outpatient attendance £117 per unit
- A&E attendance £138 per unit
If 1% of the individuals with a LD avoided one instance of each of the above in a year due to increased physical and mental health, the saving to the NHS would be over £1.35m; nationally the potential savings could be over £100m.
To estimate the costs of a potential beta, the outcomes of the alpha phase would be reviewed to determine if any changes are required to the model to conduct a successful beta. Consideration will be given to how many users can be included in the beta from each local authority and the resources required to support those users on the journey. The benefits mentioned previously will be further explored to support a beta bid.
A project steering group will be established to include membership from all 4 local authorities and from experts at the University of Hull. The steering group will oversee the project and meet regularly to ensure progress is being made as planned. This group will be the authority on deciding the direction to take in light of any feedback that triggers changes to the app to ensure a collaborative, iterative approach is maintained throughout. Work programmes will be set up in the initial stages of the project and updated following review on an ongoing basis.
Slack or Trello will be utilised to organise the project providing easy visibility of task status to all members. The partners are all part of an embedded regional approach across the four CCG’s and Local Authorities to enable collaborative working; these networks, Boards and Strategic Groups will all be utilised to actively engage with partners and to support the progression of the project.
Channels of communication via Skype, Webex, social media will be exploited by the project group to ensure the physical distance between partners is not a barrier to success.
Governance will be in place with the project group reporting to KUHCC, as the lead authority, via the Adult Social Care Senior Leadership Team in line with PRINCE 2 and Agile principles and processes. Adult Social Care in turn is monitored by the Scrutiny Board consisting of elected members. This will provide a robust governance structure for the group although the individual partner authorities will in turn report to their senior leaders and updates will be provided to the Local Digital Roadmap Board as the overarching authority for the project with representation from KUHCC’s Director for Digital.
The project will be overseen by a research assistant based at the University. The researcher will conduct focus groups and interviews with the various stakeholders and implementation and training related to the use of the app and delivery of exercise interventions. The researcher will also sit on and feed directly into the steering group. Each meeting will include a review of work conducted during the preceding phase of research to allow for updates and discussion of incoming data, as well as addressing any issues encountered during the process or raised during data collection.
Project partners would benefit from taking part in a course on Agile for Teams supplied by the Local Digital Collaboration Unit to align all teams and ensure successful delivery of the project.
All other training needs will be met by sharing existing knowledge across all local authorities and University of Hull.
We will conduct awareness sessions on tools such as Trello and Slack to ensure the project team can collaborate effectively. One of the local authorities will run these sessions.
Additional support to maintain the app beyond the lifecycle of the Alpha project to address the skills gap in coding across all local authorities involved in this project. The project team would benefit from attending Introduction to User Centred Design from Local Digital Fund and Product manager – working level to address this need.