Virtual Outreach and Individualized Coaching Extension

Researchers will use the Self-Care Confidence Scale to measure preliminary efficacy.

The Self-Care of Chronic Illness Inventory (SC-CII) version 4c is a validated tool designed to assess self-care behaviors in individuals managing chronic illnesses. Each item within the SC-CII is rated on a 5-point Likert scale, typically ranging from 1 ("Never") to 5 ("Always"). It evaluates self-care across three key domains: Self-Care Maintenance (Section A), Self-Care Monitoring (Section B), and Self-Care Management (Section C). Also, it examines Self-Care Confidence (Section D).

Scores for each domain are calculated by summing the item responses within that domain. Higher scores indicate better self-care behaviors in the respective domain. A standardized score of 70 or above in any domain is generally considered indicative of adequate self-care. Scores below 70 may suggest areas where the individual could benefit from additional support or intervention to enhance self-care practices.

Modified Computer Self-Efficacy Scale (mCSES) is a modification of the Compeau and Higgins 10-item Computer Self-Efficacy Scale, developed to make it applicable for clinical settings (for use with older people or people with disabilities using everyday technologies). The questions ask respondents to indicate whether "you could use this unfamiliar technology under a variety of conditions". Rated on a 10-point scale of confidence. Principal components analysis yields a two-factor structure: 1. Using the Technology Alone (e.g., "If there was no one around to tell me what to do as I go"), and 2. Using the Technology with the Support of Others (e.g., " If someone else had helped me get started"). Participants with higher levels of technology self-efficacy would be more frequent users of everyday technology.

The Geriatric Depression Scale (GDS) short form uses a 15-item yes/no questionnaire where one point is given for each answer indicating depressive symptoms, with a total score of 5 or more suggesting depression.

0 to 4 points: Normal (depression not likely). 5 to 8 points (or > 5): Suggests mild depression; warrants a comprehensive medical or mental health assessment.

9 to 11 points (or ≥ 10): Moderate depression; almost always indicates clinical depression.

12 to 15 points: Severe depression

The Almere Model is a prominent framework used to evaluate how older adults accept assistive social agents and conversational devices. When adapting the Almere Model for a Smart Speaker acceptance research study, the questionnaire is typically structured around 11-12 core constructs measured on a 5-pointLikert scale (from Totally Disagree to Totally Agree).

A higher score (4.0 - 5.0) generally indicates a strong, positive disposition toward that specific aspect of the smart speaker. A lower score (1.0 - 2.0) signals a barrier to entry or a negative perception.

The PROMIS-29 Adult Profile measure assesses pain intensity using a single 0-10 numeric pain rating item and seven health domains using four items each: physical functioning, fatigue, pain interference, depression, anxiety, ability to participate in social roles and activities, and sleep disturbance. Each item is rated on a Likert-type scale, typically 1 (not at all) to 5 (very much), with response options indicating the frequency or severity of symptoms or experiences. For most PROMIS instruments, a score of 50 is the average for the United States general population, with a standard deviation of 10. Higher scores for Depression, Fatigue, Sleep Disturbance, and Pain Interference indicate worse health than average.

The Medical Outcomes Study Social Support Survey is a 19-item, self-administered questionnaire designed to measure the availability of functional social support for patients with chronic conditions. The survey evaluates four specific domains of social support: Emotional/Informational Support: Having someone to confide in, give advice, or offer empathetic understanding. Tangible (Instrumental) Support: Receiving material or behavioral assistance, such as help with daily chores if you are sick. Affectionate Support: Experiencing expressions of love and affection. Positive Social Interaction: Having someone available to do fun things or pass the time with. Items are typically rated on a 5-point Likert scale (ranging from "none of the time" to "all of the time"). It produces four distinct subscale scores plus an overall functional social support index. Scores are often transformed to a 0-100 range, where higher scores mean greater available support.

The UCLA 3-Item Loneliness Scale consists of three questions assessing how often a person feels lacking companionship, left out, or isolated from others. Each item is rated on a 3-point scale:1 = Hardly ever; 2 = Some of the time; 3 = Often, yielding a total score ranging from 3 to 9, where scores from 3 to 5 indicate low or no loneliness, and scores from 6 to 9 indicate significant or high loneliness

The PROMIS Cognitive Function - Abilities Subset - Short Form 8a is a self-reported tool designed to evaluate a patient's perceived cognitive strengths over the past 7 days. The Abilities Subset features positively worded items focusing on capabilities like mental sharpness, memory, concentration, and thinking speed. Scoring involves calculating a total raw score and then converting it to a standardized T-score. The form consists of 8 items, each rated on a 5-point Likert scale ranging from 1 (Never) to 5 (Always). Scores can range from 8 to 40. PROMIS measures are standardized so that the scale mean is 50 with a standard deviation (SD) of 10.

In clinical practice, scores are typically categorized based on standard deviations from the norm:

T-score ≥ 45: Within normal limits / average cognitive abilities. T-score < 45: Indicates potential cognitive impairment or noticeable cognitive decline compared to the general population.

Tool developed by the team

The research team will extract the text-based Alexa usage data showing verbal commands used by each participant to examine types of verbal commands, frequency, and regularity of smart speaker use to determine participants' engagement in self-management behaviors.