Demensia KITA© mobile app: development, validation, usability assessment and factors associated with usability for supporting dementia caregivers in Malaysia

Dementia has profound impact on both patients and their caregivers, often leading to mental health challenges. Caregivers especially, need diverse skills and support which are frequently underestimated. Technology, such as mobile apps, can help alleviate caregiver anxiety by providing information and access to services, improve caregiving skills, and increase confidence. However, there were lack of culturally tailored and affordable mobile app that target caregivers of people living with dementia (PLwD) in the Malaysian context. The objective of this research is to i) develop culturally tailored mobile app content in Bahasa Malaysia for PLwD caregivers; ii) develop the mobile app and evaluate its content validity, and iii) assess the apps’ usability and the associated factors. This cross-sectional study consisted of three stages. Phase I centred on content development through Nominal Group Technique (NGT) with five dementia caregivers and Focus Group Discussions (FGD) with eight multidisciplinary expert panel. In Phase II, the mobile app was developed, and its content validity was assessed. Phase III evaluated the app's usability among ninety-two dementia caregivers at University Malaya Medical Centre and Kuala Lumpur Hospital using the Malay Version of the mHealth App Usability Questionnaire (M-MAUQ). The sociodemographic data and their relationship with M-MAUQ total and domain average scores (ease of use, interface and satisfaction, and usefulness) were evaluated using descriptive and inferential statistics ─ Simple and Multiple Linear Regression analyses by SPSS. Pairwise associations among variables were assessed and the coefficient of determination (R²) measured the variance explained by the independent variable. All continuous variables were expressed as means and standard deviations, with a P-value of ≤ 0.05 considered statistically significant. The NGT revealed three main themes: Knowledge, Services, and Support, leading to modules on 'Patient Care for Caregivers' and 'Caregivers’ Wellbeing', with twelve sub-modules identified by FGD. Key topics included dementia basic knowledge, behaviour management, patient care, nutrition, oral care, exercises, memory rehab, services, support groups, stress management, welfare, and motivation. All respondents (100%) reported a usability score of ≥ 72 on the M-MAUQ, with a mean usability score of 6.00 (SD ± 0.61), indicating high usability. The highest mean scores were in ease of use, followed by interface and satisfaction, and usefulness [6.25 (SD ± 0.71), 6.04 (SD ± 0.67), and 5.75 (SD ± 0.66)] respectively. Data had a normal distribution. SLR showed usability was significantly associated with ethnicity, religion, marital status, environment, and caregiver’s relationship with PLwD. MLR revealed that only marital status, environment, and caregiver’s relationship with PLwD were significantly associated with app usability. Being single (95% CI: -0.96, -0.28), and being a spouse caregiver (95%CI: -0.89, -0.18) were associated with lower usability, while living in rural environment was associated with higher usability. The MLR, with an R² value of 0.264, explained 26.4% of the variation in usability scores. The research findings could promote digital health adoption in caregiving and aging, supporting the National Dementia Plan. They may drive app improvements and attract interest from researchers, healthcare providers, and policymakers. Future studies should assess caregivers' knowledge, attitudes, practices, and app acceptance to address the needs of Malaysian dementia caregivers. A randomized controlled trial is needed to evaluate Demensia KITA's effectiveness in reducing caregiver burden, particularly in urban and rural settings.