Usability of Behavioural Recording Application (BRA) for Coping With Behavioural and Psychological Symptoms of Dementia

ABSTRACT

This study developed the Behavior Recording Application (BRA) based on Applied Behavior Analysis (ABA) to support non‐pharmacological interventions for Behavioral and Psychological Symptoms of Dementia (BPSD), and examined its usability among care professionals. Thirty‐one care staff members from elderly care facilities in Japan used the application during ABA‐based consultations and evaluated its usability using a 10‐item Likert scale. While overall ease of use was rated positively, differences were observed in participants' willingness to use it regularly and in their perception of how much they needed to learn to use it effectively. Stepwise multiple regression analysis using the Akaike Information Criterion (AIC) identified age, caregiving experience, and digital device usage as significant predictors of usability. These findings suggest that although BRA demonstrates good usability, additional support may be necessary for care professionals of advanced age, with less experience, or with limited digital proficiency.

Non‐pharmacological interventions are recommended as the first choice for addressing behavioural and psychological symptoms of dementia (BPSD), except when symptoms remain distressing, disabling, or dangerous [1, 2].These interventions require identifying triggers and creating appropriate coping strategies [1]. However, it is often challenging for care professionals in care settings to record BPSD and to investigate the triggers due to their workload.

Amongst the systems developed to help caregivers record BPSD, identify the triggers, and construct strategies, BPSDiary is a systematic framework for them to record the time, severity, and triggers of BPSD episodes. Physicians analyse the data to provide appropriate interventions [3]. The Dementia care‐assist AI system (DeCaAI) records BPSD via a tablet and automatically collects biometric (pulse rate and step count) and environmental data (temperature, humidity, illumination, and atmospheric pressure) through sensors. These data are combined, and artificial intelligence (AI) predicts BPSD occurrences and suggests interventions [4]. However, BPSDiary imposes considerable burdens on caregivers because they need to record events on paper. Moreover, these interventions rely on the expertise of physicians, who are not non‐pharmacological experts. While DeCaAI is technologically advanced compared with BPSDiary, the accumulated data are limited to biometrics and room environmental information and lack records of BPSD occurrence and coping. Additionally, its usability is low, and suggested AI interventions have been ineffective [4].

To address these limitations, we developed an Android‐based behavior recording application (BRA) that allows professionals to record the occurrence of both the targeted BPSD and the strategies they used to cope, by touching each button on the tablet's screen. We created BRA for use in consultations based on applied behavior analysis (ABA) [5], which has been shown to be effective in several systematic reviews of non‐pharmacological interventions for BPSD [6]. The ABA framework values behaviors (BPSD) and pre‐ and post‐contexts (antecedents and consequences), including coping and related situations. This study examined the usability of the BRA assessed by care professionals in elderly care facilities.

Ethical approval was obtained from the ethical review board of the Institute of Human Sciences at the University of Tsukuba before study commencement, and the study was performed in accordance with the ethical standards of the Declaration of Helsinki. Written consent was received from the participants after they were informed of the protocol. Participants were 31 care staff (17 men; M _age = 43.2 ± 12; and 11.4 ± 6.6 years of caregiving experience) from five care units amongst four elderly care facilities in Japan. Of them, 71.0% were full‐time employees, and the highest smartphone or tablet use in those using them was for > 30 min (74.2%), followed by 20–30 min (12.9%), and ≤ 10 min (12.9%) per day. One BPSD case was targeted in each care unit for nocturnal insomnia, expressing a desire to go home, urinating outside the toilet, delusions, and socially inappropriate behaviour (e.g., giving one's own food to others).

Consultations for BPSD were conducted by the first author using an ABA‐based protocol [7] that requires information on BPSD to create a new coping plan and examine its effects. After a BRA e‐learning program, the participants recorded occurrences of the targeted BPSD and the coping implementations. After the consultation, we asked them to complete a five‐point Likert scale based on the work of Loi et al. [7] ranging from ‘strongly agree’ to ‘strongly disagree’, comprising 10 items of usability; the total scores ranged from 10 to 50. The internal consistency (α) of the scale in this study was 0.81. The study data were analysed using R statistical software version 4.4.0.

The findings revealed that the item that received the most positive response (combining ‘strongly agree’ and ‘tend to agree’) was ‘Most people can quickly learn how to use it’ (80.65%), followed by ‘It was very difficult to use’ (reverse item scored; 70.97%) (Table 1). These results were higher than those in a previous study [5] and suggest that the care staff members considered BRA easy to use. However, the items ‘I need to learn a lot to master it’ (reverse scored; 29.03%) and ‘I want to use it frequently’ (35.48%) were the lowest. Hence, we conducted a stepwise multiple regression analysis using Akaike information criterion (AIC) to reveal variables influencing the two lowest items using the sum of scores. The model with the lowest AIC (11.71) included the following variables: career duration, age, smartphone/tablet use frequency, and BPSD with night‐time records (R ²  = 0.31, adjusted R ²  = 0.18). The results were significant (p < 0.05) for career duration (β = 0.56, longer > shorter), age (β = ‐0.42, younger > older), and smartphone/tablet use frequency (β = 0.37, more > less). This means that BRA's usability was good; however, professionals with shorter careers, older ages, and unfamiliarity with smartphones/tablets need assistance with its use. The BRA was used in ABA in this study but can be applied in various settings. The usefulness should be further examined in the future.

TABLE 1.

Responses to items in the usability scale.

Items	Strongly agree	Tend to agree	Can't say either	Tend to disagree	Strongly disagree
Most people can quickly learn how to use it (%)	25.81	54.84	16.13	3.22	0.00
It is very difficult to use a (%)	0.00	3.22	25.81	32.26	38.71
It has many contradictions a (%)	0.00	0.00	35.48	22.58	41.94
It can be mastered (%)	19.36	45.16	35.48	0.00	0.00
It has some very complex points a (%)	0.00	6.45	32.26	12.90	48.39
It is easy to use it (%)	19.36	35.48	41.94	3.22	0.00
It is functionally well‐organised (%)	9.67	41.94	41.94	6.45	0.00
I need experts' assistance to master it a (%)	6.45	16.13	29.03	19.36	29.03
I want to use it frequently (%)	6.45	29.03	38.71	19.36	6.45
I need to learn many things to master it a (%)	6.45	22.58	41.94	22.58	6.45

Note: The scores were ‘strongly agree’ (five points), ‘tend to agree’ (four points), ‘can't say’ (three points), ‘tend to disagree’ (two points), ‘strongly disagree’ (one point).

^a Regarding reverse‐scored items: ‘strongly agree’ and ‘tend to agree’ were scored as negative answers; ‘strongly disagree’ and ‘tend to disagree’ as positive items.

Disclosure

The authors have nothing to report.

Ethics Statement

This study was approved by the ethical review board of the Institute of Human Sciences in the University of Tsukuba and has been performed in accordance with the ethical standards of the Declaration of Helsinki.

Consent

Written consent was received from the professionals after they were informed about the protocol.

Conflicts of Interest

The authors declare no conflicts of interest.

Ishikawa A., Onchi E., and Yamanaka K., “Usability of Behavioural Recording Application (BRA) for Coping With Behavioural and Psychological Symptoms of Dementia,” Psychogeriatrics 25, no. 4 (2025): e70061, 10.1111/psyg.70061.

Data Availability Statement

Data are available within the article.