Implementation of a multicomponent telemonitoring intervention to improve nutritional status of community-dwelling older adults: a process evaluation

Objective The present study aimed to conduct a process evaluation of a multicomponent nutritional telemonitoring intervention implemented among Dutch community-dwelling older adults. Design A mixed-methods approach was employed, guided by the process evaluation framework of the Medical Research Council and the Unified Theory of Acceptance and Use of Technology. The process indicators reach, dose, fidelity and acceptability were measured at several time points within the 6-month intervention among participants and/or nurses. Setting The intervention was implemented in the context of two care organisations in the Netherlands. Subjects In total, ninety-seven participants (average age 78 years) participated in the intervention and eight nurses were involved in implementation. Results About 80 % of participants completed the intervention. Dropouts were significantly older, had worse cognitive and physical functioning, and were more care-dependent. The intervention was largely implemented as intended and received well by participants (satisfaction score 4 center dot 1, scale 1-5), but less well by nurses (satisfaction score 3 center dot 5, scale 1-5). Participants adhered better to weight telemonitoring than to telemonitoring by means of questionnaires, for which half the participants needed help. Intention to use the intervention was predicted by performance expectancy (beta=0 center dot 40; 95 % CI 0 center dot 13, 0 center dot 67) and social influence (beta=0 center dot 17; 95 % CI 0 center dot 00, 0 center dot 34). No association between process indicators and intervention outcomes was found. Conclusions This process evaluation showed that nutritional telemonitoring among older adults is feasible and accepted by older adults, but nurses' satisfaction should be improved. The study provided relevant insights for future development and implementation of eHealth interventions among older adults.