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Family interventions have been shown to be effective for adolescents with behavior problems. Current literature supports both adaptive treatments and technology-assisted interventions as highly promising innovations for treating at-risk adolescents. The purpose of this investigation was to develop and test the efficacy of a computer-assisted version of an established office-based multicomponent family therapy. Eighty Hispanic and Black Non-Hispanic adolescents and their families participated in the study and were randomized to either Immediate Computer-Assisted CIFFTA or Delayed Computer-Assisted CIFFTA. Significant between-groups effects were found from baseline to posttreatment showing the superiority of the Immediate CA CIFFTA condition on both the Conduct Disorder (B = -5.17, SE = 1.73, p < .01, CI [-8.55, -1.79]) and Socialized Aggression (B = -2.04, SE = .83, p < .05, CI [-3.67, -.41]) subscales of the Revised Behavior Problem Checklist, on the Youth Self Report Externalizing scale (B = -4.22, SE = 1.40, p < .01, CI [-6.95, -1.48]), and on both the parent (B = 1.34, SE = .50, p < .01, CI [.36, 2.32]) and adolescent (B = 1.31, SE = .46, p < .01, CI [.41, 2.21]) reports of the Family Environment Scale's family cohesion subscale. Baseline to 6-weeks posttreatment (T1-T3) analyses showed that these significant within-subjects effects were sustained for the treatment group. Results highlight that adolescent behavior problems can be significantly impacted by a computer-assisted intervention that replaces psychoeducational face-to-face meetings with computer-delivered modules.

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BACKGROUND: Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. RESULTS: The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. CONCLUSIONS: Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.

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Technology holds promise in terms of providing support to older adults. To date, there have been limited robust systematic efforts to evaluate the psychosocial benefits of technology for older people and identify factors that influence both the usability and uptake of technology systems. In response to these issues, we developed the Personal Reminder Information and Social Management System (PRISM), a software application designed for older adults to support social connectivity, memory, knowledge about topics, leisure activities and access to resources. This trail is evaluating the impact of access to the PRISM system on outcomes such as social isolation, social support and connectivity. This paper reports on the approach used to design the PRISM system, study design, methodology and baseline data for the trial. The trial is multi-site randomized field trial. PRISM is being compared to a Binder condition where participants received a binder that contained content similar to that found on PRISM. The sample includes 300 older adults, aged 65-98 years, who lived alone and at risk for being isolated. The primary outcome measures for the trial include indices of social isolation and support and well-being. Secondary outcomes measures include indices of computer proficiency, technology uptake and attitudes towards technology. Follow-up assessments occurred at 6 and 12 months post-randomization. The results of this study will yield important information about the potential value of technology for older adults. The study also demonstrates how a user-centered iterative design approach can be incorporated into the design and evaluation of an intervention protocol.

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We conducted a feasibility study of a home telehealth system that monitored blood pressure and bodyweight. A total of 34 participants with hypertension (10 males and 24 females) had the telemedicine system installed in their homes. Their mean age was 72 years and 94% of them self-identified as Hispanic. The telehealth system transmitted blood pressure and bodyweight data to a server. There was also a messaging function that was used to send a daily reminder to the participants. Participants used the telehealth system for six months. Ten participants were lost to follow up and 24 participants completed the entire study. Participants had strong positive perceptions regarding the usability and usefulness of the telemedicine system. Most of them (92%) found the device easy to use and 96% felt that the training they received prepared them to use the device. The providers indicated that use of the system improved their ability to manage their patients. The results of the study suggest that use of the telehealth system for home monitoring in Hispanic patients with hypertension is feasible.

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BACKGROUND/OBJECTIVES: Available services and intervention programs for dementia caregivers are often underutilized because of issues such as cost, logistics, lack of knowledge about available services, or insufficient support from others. Information technologies offer the potential of removing these barriers and facilitating the ability of caregivers to access needed support. This project evaluated the feasibility and efficacy of technology-based psychosocial intervention among minority family caregivers of dementia patients. DESIGN: A feasibility and efficacy trial. SETTING: Participants' homes in the Greater Miami Community. PARTICIPANTS: One hundred ten (56 Hispanic American and 54 African American) caregivers of patients with dementia. INTERVENTION: A technology-based multi-component psychosocial intervention was delivered in-home and via videophone technology over 5 months. The intervention was modeled after the REACH II intervention and targeted known areas of caregiver risk. MEASUREMENT: Standardized measures of depression, caregiver burden, social support, and the caregivers' perception of the caregiver's experience were administered at baseline and 5 months post-randomization. RESULTS: Overall, caregivers who received the intervention reported a decrease in burden, an increase in perceived social support and positive perceptions of the caregiving experience. No effect was observed for depression. Most participants indicated that the intervention improved their caregiving skills and found the technology to be easy to use. CONCLUSIONS: A technology-based format was feasible for delivering a multi-component intervention to minority family dementia caregivers. The intervention improved caregiver outcomes for both Hispanic and African American caregivers. The results suggest that technology may help eliminate disparities in access to caregiver intervention programs.

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OBJECTIVE: The use of the internet as a source of health information and link to healthcare services has raised concerns about the ability of consumers, especially vulnerable populations such as older adults, to access these applications. This study examined the influence of training on the ability of adults (aged 45+ years) to use the Medicare.gov website to solve problems related to health management. The influence of computer experience and cognitive abilities on performance was also examined. DESIGN: Seventy-one participants, aged 47-92, were randomized into a Multimedia training, Unimodal training, or Cold Start condition and completed three healthcare management problems. MEASUREMENT AND ANALYSES: Computer/internet experience was measured via questionnaire, and cognitive abilities were assessed using standard neuropsychological tests. Performance metrics included measures of navigation, accuracy and efficiency. Data were analyzed using analysis of variance, χ(2) and regression techniques. RESULTS: The data indicate that there was no difference among the three conditions on measures of accuracy, efficiency, or navigation. However, results of the regression analyses showed that, overall, people who received training performed better on the tasks, as evidenced by greater accuracy and efficiency. Performance was also significantly influenced by prior computer experience and cognitive abilities. Participants with more computer experience and higher cognitive abilities performed better. CONCLUSIONS: The findings indicate that training, experience, and abilities are important when using complex health websites. However, training alone is not sufficient. The complexity of web content needs to be considered to ensure successful use of these websites by those with lower abilities.

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The aging of the population and, concomitantly, of the workforce has a number of important implications for governments, businesses, and workers. In this article, we examine the prospects for the employability of older workers as home-based teleworkers. This alternative work could accommodate many of the needs and preferences of older workers and at the same time benefit organizations. However, before telework can be considered a viable work option for many older workers there are a number of issues to consider, including the ability of older workers to adapt to the technological demands that are typically associated with telework jobs and managerial attitudes about older workers and about telework. Through an integrated examination of these and other issues, our goal is to provide a comprehensive understanding of the challenges associated with employing older workers as teleworkers. We also present findings from a questionnaire study that assessed managers' perceptions of worker attributes desirable for telework and how older workers compare to younger workers on these attributes. The sample included 314 managers with varying degrees of managerial experience from a large variety of companies in the United States. The results presented a mixed picture with respect to the employability of older workers as teleworkers, and strongly suggested that less experienced managers would be more resistant to hiring older people as teleworkers. We conclude with a number of recommendations for improving the prospects for employment of older workers for this type of work arrangement.

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This article explores the role of age, cognitive abilities, prior experience, and knowledge in skill acquisition for a computer-based simulated customer service task. Fifty-two participants aged 50-80 performed the task over 4 consecutive days following training. They also completed a battery that assessed prior computer experience and cognitive abilities. The data indicated that overall quality and efficiency of performance improved with practice. The predictors of initial level of performance and rate of change in performance varied according to the performance parameter assessed. Age and fluid intelligence predicted initial level and rate of improvement in overall quality, whereas crystallized intelligence and age predicted initial e-mail processing time, and crystallized intelligence predicted rate of change in e-mail processing time over days. We discuss the implications of these findings for the design of intervention strategies.

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The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults. The sample included 1,204 individuals ranging in age from 18-91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption.

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