Table 1.

Learnings from Engaging Homebound Elders and Caregivers in Research through Tablet-Based Videoconferences

Take away	Illustration/observation
Use recruitment and retention strategies designed for diverse elders
Strategies for older adults	Minimal exclusion criteria, teach-to-goal informed consent, monetary incentives, training team members in unique needs of older adults, keep team members consistent over time
Strategies for diverse elders	Assemble diverse research team, recruit through direct mailings, community ambassadors, or health care providers
Simplify and test extensively before distributing devices
Choose and simplify the device to serve your purpose	GrandPad® tablets have improved sound for hearing impaired individuals and screens created specifically for moisture and sensation changes in the fingers of elders. They also have fewer and larger buttons, applications with simple interfaces (e.g., one-touch connections), and a charging dock rather than a cable.
	The GrandPad tech team customized the tablets for our study to include only three buttons: “Zoom,” “Help,” and “Study Information.” All other applications (games, e-mail, etc.) were removed. GrandPad also provided administrative capabilities that allowed us to remotely push updates (e.g., change time zone for time display) and monitor device activity (we could track a lost device and monitor battery level).
Before deployment of devices to participants, conduct extensive mock videoconferences with multiple team members testing all settings and developing how-to visual guides	Practice allowed us to anticipate challenges and device solutions (presetting the meeting ID so that it was a “recent” number and did not have to be manually entered each time). However, there were many settings we learned needed to be changed after devices had been delivered. (see examples immediately hereunder)
Disable settings that are likely to be problematic or are not necessary	Default Zoom settings require extra taps to connect separately to audio and video; changing these to connect automatically removed a tedious step for participants. Another default setting in the Zoom app triggers “driving mode” when one swipes from left to right from the home screen, and this mode disables video and mutes the microphone. When a participant accidentally swiped the wrong way from the home screen, it was very hard to guide their return to regular meeting settings since communication was cutoff in one direction.
Prepare for multiple iterations of training and navigation assistance for varied levels of ability or experience
Offer multiple trainings on how to use the device; more if long gaps between use	Every participant received an in-person visit and visual instruction guide. This allowed us to conduct an informal assessment of participant abilities as well as to prepopulate the device with the Zoom meeting number. Half the participants needed help joining every meeting due to the Zoom research interface.
Ensure keys skill are taught during trainings	Participants spanned the spectrum in terms of tech-savviness. Several participants had never used a tablet computer, whereas others were not familiar with how to swipe. Some did not know the word “swipe” so we said “slide” instead. Some had difficulty tapping the device buttons and needed reminders that a stylus was available. Teach-back method help ensure participant understanding of swiping to view different screens (e.g., to view video feeds of additional participants).
Plan to provide individual technological assistance for participants before and during each meeting	We changed meeting schedules to accommodate people who needed assistance connecting. At one site meetings started 10 minutes early; at the other site team members called participants 15 minutes in advance to help connect. During meetings, one team member in a separate office was devoted to “tech support” to help participants join before the meeting and to enable the meeting to continue running smoothly when people dropped the connection, forget which way to swipe, and so on. The GrandPad team also offered assistance through a support hotline accessible through a phone number or through the device.
Use a comparable tablet with the same settings when problem-solving with the participant	Despite the simplified tablet, the extensive Zoom menu options lured participants down incorrect paths to connect to the group meetings. Our team relied on an extra tablet not deployed for the study to recreate the scenario and backtrack through the menus to get to the correct meeting link.
Create backup plans for anticipated and unanticipated problems
Appoint one team member to attend only to technological issues during a meeting	Even after all participants successfully joined a meeting, other technological issues arose. Having a member with cohost privileges to mute/unmute and attend to individual issues during the call was paramount to the overall success and flow of the meeting.
Expect technological challenges and build healthy buffer into meeting timeline	Every meeting required 10–15 minutes to help everyone join. Therefore, incorporate this delayed-start “buffer” into your scheduling and agenda. Before starting, double check that people are connected and able to see and hear to make sure no one has been left behind.
Devise a plan for when technology fails completely	A backup option for people with persistent tech issues during the meeting was to have them call in by phone and broadcast the call over speaker so they could participate through audio. This fostered continued inclusion of all participants.
Devices plan for when human issues occur	One bedbound individual could not reach the GrandPad after a paid caregiver quit earlier in the day before a scheduled meeting; we were able to help her participate through the phone.
Provide extra support to participants
Prepare participants ahead of the meeting	GrandPad had an administrator dashboard that displayed online the battery power of each of the tablets in our study. We called participants whose devices had low battery the night before meetings to make sure they placed it on the charging dock and to remind them of the time, send paper agenda/slides, check device battery status, and remind to charge.
Foster camaraderie among participants as well as between researchers and participants	Ice breakers and free space for a bit of socializing at beginning of meetings allowed participants to feel like they knew their peers. Friendships developed: one participant volunteered prayers for another, one took initiative of typing instructions for ordering groceries online for another.