Improving smartphone use after brain injury

INTERVENTION: Systematic Instruction Under this approach, participants will be taught to use an app (Cozi Family Organiser) using a training method that aims to prevent and minimise error commission during learning. Procedure: All participants will have an initial session where baseline measures (smartphone ability, neuropsychological measures and self‐report questionnaires) will be administered. Following this, participants will be randomly allocated to one of the groups. Training will take place in the second session. The functionalities of the app and their real‐life applications will be explained at the beginning of each of four scenarios. Then the trainer will model step by step the correct performance of the task in his/her own smartphone, while the participant follows and repeats the steps in his/her own smartphone. Trainers then provide direct instructions with different levels of prompting (which include full verbal explanation + modelling, verbal explanation + pointing, confirmation of a correct query, and no environmental support), according to the participant's progress. Under this method, errors are prevented as much as possible and if they occur the participant is stopped, and immediate corrective feedback is given. Each task is repeated until 95% of the steps are completed without cuing. Only then, the next scenario will be introduced. A total of four scenarios will be presented and the skills that will be taught include: creating, modifying and sharing a shopping list, creating and modifying an event in the calendar and making use of the smartphone while on a phone call. At the end of the training session there will be a post‐training test in which the participant will be asked to independently complete tasks, similar to the ones practiced before. There will also be one‐ and six‐week follow‐up sessions in which a similar test will be conducted and where other follow‐up measures will be taken. Error‐based Learning Under this approach, participants will be taught to use an app (Cozi Family Organiser) using a training method that teaches self‐regulatory skills, allowing participants to stop, check and modify their actions. The prompts that the trainer provides in the Error‐based learning condition are guided by the following: 1. If an error is self‐corrected the trainer reinforces the participant by emphasising the correct action (Well spotted, you noticed that you had to click “save” before trying to enter the time of the event) 2. If there is no self‐correction, trainer immediately provides a non‐specific prompt (i.e. can I get you to stop for a moment and check where you are up to in the instructions? [tap sheet]). 2.1 If error is self‐corrected, give specific praise (Well done, you need to save that information first before doing that next step) and continue. 2.2 If error is still not self‐corrected, a specific prompt is provided (You need to click on “save” on the top right of your screen before trying to enter the time of the event, otherwise the date of the event will disappear) 3. If the person asks a question or seeks reassurance, the trainer smiles encouragingly and gets them to check the instructions CONDITION: Memory deficits Stroke ; ; ; INCLUSION CRITERIA: 1. Participant suffered from stroke 2. Participant > 18 years 3. Participant reports memory difficulties 4. Participant has a smartphone (iPhone or Android) 5. Participant is interested in learning a new app and improve usage of smartphone 6. Participant lives in Metropolitan Melbourne and is available for 4 sessions with trainer (Approx. 2 months) 7. Participant is fluent in English Procedure: All participants will have an initial session where baseline measures (smartphone ability, neuropsychological measures and self‐report questionnaires) will be administered. Following this, participants will be randomly allocated to one of the groups. Training will take place in the second session. Participants will be encouraged to provide real‐life examples where the functionalities of the app would be useful. Then the participant will read the instructions for each task step‐by‐step, while the trainer provides a correct demonstration. Following this, the trainer allows participants to independently attempt the tasks, to commit errors and to notice and self‐correct them. They will only intervene if errors are not immediately self‐corrected, in which case participants are stopped and provided with non‐specific or/and specific prompts (See next paragraph). Trainer will prompt participants to make self‐predictions of performance, to generate strategies for potential difficulties and will encourage a high level of reflection and self‐regulation following a Stop, Check and Correct approach. Each task is repeated until 95% of the steps are completed without errors. Only then, the next scenario will be introduced. A total of four scenarios will be presented and the skills that will be taught include: creating, modifying and sharing a shopping list, creating and modifying an event in the calendar and making use of the smartphone while on a phone call. At the end of the training session there will be a post‐training test in which the participant will be asked to independently complete tasks, similar to the ones practiced before. There will also be one‐ and six‐weeks follow‐up sessions in which a similar test will be conducted and where other follow‐up measures will be taken. PRIMARY OUTCOME: Accuracy of performance as measured by the number of tasks (max 15) correctly executed with the app in an independent way during post‐training assessments. Three different scenarios, each with 5 tasks (Similar to the scenarios used during the training session), have been specifically designed for this study. ; An assessor (researcher), blinded to the type of training, will provide direct supervision during the execution of the tasks and will indicate whether the participant completed the task independently, without any intervention. Efficiency of performance as measured by the time (in seconds) taken to perform 15 tasks with the app in an independent way during post‐training assessments. Three different scenarios, each with 5 tasks (Similar to the scenarios used during the training session), have been specifically designed for this study. ; An assessor (researcher), blinded to the type of training, will provide direct supervision during the execution of the tasks and will measure, with a stopwatch, how long it takes to the participant to complete all the tasks for each scenario. Generalisation of skills as measured by the number of tasks correctly completed in an untrained app (called 24me) with similar functionalities that the one used for training. ; An assessor (researcher), blinded to the type of training, will provide direct supervision during the execution of the tasks and will indicate whether the participant independently completed the tasks. SECONDARY OUTCOME: Confidence in smartphone use: As measured by a modified section (for the purposes of this study) of the Strategies of PDA/Smartphone Use Questionnaire (Svoboda, Richards, Polsinelli and Guger, 2010). Participant self‐report with a 5‐point Likert‐type scale their confidence in using their functions of their smartphone. Frequency of smartphone use as a memory aid: Indicated by self‐report of frequency of use (5‐point likert‐type scale) in a section of the Strategies of PDA/Smartphone Use Questionnaire developed by Svoboda, Richards, Polsinelli and Guger (2010). Frequency of smartphone use in general: Time (in minutes) spent “on screen” in the previous 7 days as recorded by the smartphone system. Length of training: measured by the total time taken to teach the skills with each training method. The total time will be directly measured by the trainer with a stopwatch, the chronometer function of a smartphone or by recording the staring and ending time of the session. Memory self‐efficacy: As measured by the average of the answers to the items in the 7‐point likert‐type Memory Controllability Inventory (Lachman, Bandura, Weaver, & Elliott, 1995).