TABA for The HOPE App: An Immersive Telehealth Solution for Older Adults with Diabetes

Type 2 diabetes (T2DM) is an epidemic. An estimated 34 million people in the US have T2DM and 84 million have pre-diabetes - nearly half of whom are adults 65+ yo, putting many older adults at higher risk of unhealthy aging and cognitive decline. A healthy lifestyle can treat and even reverse T2DM. But making lifestyle changes is hard and many people fail, contributing to $327B in US healthcare costs. Diabetes group visits (DGV) and diabetes self- management education and support (DSME/S) help people with T2DM to learn and sustain complex disease management skills. Yet, access to DSME/S is limited such participation in DSME/S programs is reportedly as low as 7% among adults with T2DM. New technologies supporting DSME/S programs are emerging, but most fail to meet the unique needs of older adults with limited technology fluency, creating a new digital divide. See Yourself Health (SYH) aims to bridge this digital health gap for older adults with a newly designed immersive learning and telehealth application – the HOPE App – designed to deliver high-impact, high engagement diabetes care and DSME/S tailored for older adults with diabetes. Advancements in virtual reality software, new cloud gaming technology and user interface design have enabled our team to envision a new telehealth and immersive learning environment to support chronic disease self- management needs of older adults with diabetes. We use virtual reality, telecommunication technology and social gaming strategies to offer real-time peer support, care coaching, and 28 modules of live-action experiential learning programs to help participants master complex diabetes self-management skills. In our Phase I SBIR project, we reached the following milestones: prototyped the HOPE App platform with cloud access and new navigation and communication features; completed usability testing (SUS = 71) with 20 target users and feasibility testing (100% participation) of the HOPE App platform; developed new DSME content for older adults. In Phase II, we will further develop the HOPE App patient engagement and population health management features and capabilities and then assess its efficacy in a fully powered clinical trial. Specific Aim 1: Develop the HOPE App’s state-of-the-art immersive patient engagement experience with automated onboarding, social networking and gamified DSME/S features to support long-term patient retention. Specific Aim 2: Develop the HOPE App’s predictive analytic capabilities for population health management. Specific Aim 3: Clinical validation of the HOPE App intervention on six-month clinical outcomes (A1c), patient reported outcomes (diabetes distress) and engagement (patient retention, adherence to DSME/S). SYH has assembled an expert business team to sell the HOPE APP to our target customer, health care payors. The HOPE APP offers a simple, high- impact, highly engaging, immersive telehealth experience with the potential to become a ubiquitous diabetes management tool to transform diabetes patients into high performing drivers of their own care.