Development of a Knowledge Base for an Integrated Older Adult Care Model (SMART System) Based on an Intervention Mapping Framework: Mixed Methods Study.

Abstract

Background: Although mobile health apps integrated with Internet of Things-enabled devices are increasingly used to satisfy the growing needs for home-based older adult care resulting from rapid population aging, their effectiveness is constrained by 3 key challenges: a focus on specific functions rather than on holistic and integrated support, absence of a solid theoretical framework for development, and a lack of personalized, real-time feedback to address diverse care needs. To overcome these limitations, we developed a knowledge-based clinical decision support system using mobile health technology-an intelligent and integrated older adults care model (SMART system).

Objective: This study aims to systematically outline the development process and outcomes of a knowledge base and trigger rules for the SMART system.

Methods: Our study adopted a user-centered approach guided by the nursing process and intervention mapping (IM) framework. We first identified older adult care needs through semistructured, in-depth interviews. Guided by the nursing process and informed by guidance from the World Health Organization's Integrated Care for Older People and World Health Organization International Classification of Functioning, Disability, and Health, along with the North American Nursing Diagnosis Association-I nursing diagnosis, we then determined care problems along with their underlying causes and risk factors and diagnostic criteria. Building on these findings, we applied the first 3 steps of the intervention mapping framework to formulate corresponding long-term and short-term care objectives, select appropriate evidence-based interventions, and match practical implementation approaches, which were grounded in rigorous evidence derived from systematic literature reviews, clinical guidelines, and expert insights. We also developed a set of trigger rules to link abnormalities in older adults with corresponding care problems and interventions in the SMART knowledge base.

Results: The semistructured in-depth interviews identified 5 types of care needs-daily life care, health care, external support, social participation, and self-development-which formed the foundation of the SMART knowledge base. Based on this, we identified 138 care problems, each with associated causes and risk factors and diagnostic criteria. The objective matrix comprised 138 long-term and 195 short-term care objectives. Guided by 15 expert-defined selection criteria, we then selected 450 evidence-based interventions, each paired with at least 1 feasible and practical implementation approach. Additionally, we developed diagnostic rules to match the assessment data with relevant care problems and their causes and risk factors and intervention trigger rules to formulate personalized interventions based on individual characteristics, ensuring tailored care aligned with specific care objectives.

Conclusions: This study outlines the development process and outcomes of the SMART knowledge base and trigger rules. The study methodology offers theoretical support for developing knowledge bases and trigger rules of similar clinical decision support systems for home-based older adult care.