The home is more than a physical space; it is a crucial determinant of health and a place of belonging [1]. When older adults experience functional decline, most of them continue to live in traditional homes (eg, houses or apartments), which often reflect their preferred choice of residence [2]. However, challenges may arise in performing essential daily activities, such as personal hygiene [3], especially when the home environment has not been adapted to meet their evolving needs. An adapted living environment significantly contributes to enabling older adults to age in place safely. It helps reduce falls, enhances health-related quality of life, and increases social participation [4-6].

A quasi-experimental (before-and-after) study by Petersson et al [7] demonstrated a statistically significant improvement in self-rated ability in everyday life in the intervention group (who received home adaptations) compared to the control group (on a waiting list). Participants who benefited from the home improvement program reported fewer difficulties and increased safety when performing personal hygiene tasks in the bathroom. Similarly, a prospective quasi-experimental (before-and-after) study showed that home modifications led to significant and sustained improvement in the participants’ perception of their ability to carry out daily activities at home over a 2-year period. The authors concluded that home adaptations can be beneficial for older adults wishing to age in place [2].

The search for environmental design solutions is often initiated by older adults or their families when bathroom-related issues arise. In such cases, adapting the bathroom with assistive devices, such as bath seats or grab bars, is a commonly recommended strategy to promote safety and autonomy [8,9]. Moreover, home modifications are frequently recommended by occupational therapists to reduce environmental barriers and improve the functional performance of individuals with limitations [10].

In Quebec, various options are available for older adults who wish to adapt their home environment. They may obtain recommendations from companies that provide assistive devices, such as pharmacies or specialized suppliers. It is also possible to access the services of occupational therapists within the public health and social services system or to consult occupational therapists in private practice. When home modifications are more extensive and the older adult has permanent disabilities, an application can be submitted to the Home Adaptation Program (HAP), a government initiative that partially or fully covers the costs of necessary adaptations (eg, zero-threshold shower and access ramp).

Despite the availability of these resources, older adults and their families often face significant challenges, such as long waiting times, complex administrative processes, and limited accessibility to professional support. These barriers highlight the need to explore alternative and complementary approaches that can provide timely, accessible, and practical guidance.

In this context, digital technologies are emerging as promising tools to help circumvent or mitigate several of these obstacles. By providing autonomous assessment tools and facilitating the collection and sharing of essential information, digital innovations can support older adults and their caregivers in decision-making while reducing reliance on lengthy and centralized health care processes. Two digital innovations, Hygiene 2.0 [11] and MapIt [12], illustrate how technological approaches can directly address these challenges and support the adaptation of older adults’ homes.

The Hygiene 2.0 application [11] aims to allow for the rapid identification of appropriate assistive devices for bathroom adaptations (eg, shower chair and grab bars) and target persons needing occupational therapist consultations. It thus helps accelerate access to practical solutions for older adults, reducing the pressure on professional services. The MapIt mobile app [12] allows users to generate a photorealistic 3D model of a room in just a few minutes, facilitating remote assessment, information sharing with various stakeholders, and the preparation of more effective interventions.

The objective of this action study is to cocreate and evaluate the implementation within the ecosystem of older adults of the Hygiene 2.0 and MapIt innovations, as well as to assess their impact on supporting older adults who experience difficulties with personal hygiene or who are in the process of adapting their home environment. Specifically, the objectives of the study are as follows:

The i-PARIHS (integrated-Promoting Action on Research Implementation in Health Services) framework [13] will guide this study by identifying and defining the characteristics of innovations, as well as informing the facilitation strategies needed to support their use within the ecosystem of older adults engaged in home adaptation processes. The model proposes that the successful implementation of an innovation results from the interaction between 4 key elements: innovation (what is being implemented, eg, a new practice), recipients (individuals, teams, or organizations expected to adopt the innovation), context (the internal and external environment in which the innovation is implemented), and facilitation (the active process of enabling and supporting implementation). In essence, the i-PARIHS model conceptualizes successful knowledge implementation as the result of effectively facilitating innovation, in collaboration with recipients, within the context in which the implementation occurs. This approach emphasizes the dynamic interplay between the innovation, the recipients, the context, and the facilitation process.

The pilot study is grounded in participatory action research (PAR), an approach that values collaboration between researchers and practitioners. It emphasizes colearning, mutual benefit, and long-term engagement. PAR integrates theory, participation, and practice within the research process [14]. More than simply involving the community, it aims to connect participation, shared decision-making, local knowledge, and existing practices in a meaningful process of change. This approach is particularly well suited to this study, as it enables the inclusion of diverse stakeholders (older adults, informal caregivers, researchers, and organizational representatives) in cocreating the implementation process, while fostering collaboration firmly anchored in real-world community contexts. The cocreation process for implementing the MapIt and Hygiene 2.0 innovations involves exploring the relevance and appropriateness of their use with various stakeholders, including older adults. In this study, implementation fidelity is defined at the level of the digital tools’ core functional components rather than uniform patterns of use. MapIt and Hygiene 2.0 are designed as decision-support technologies whose technical execution is standardized, while their integration into practice may vary according to context, user roles, and situational needs. Such variability is considered an intended feature of implementation, consistent with the study’s design emphasizing practitioner and user agency.

To operationalize this participatory approach and capture the complexity of real-world contexts, the study employs a multiple case study design with a convergent mixed methods strategy [15,16]. This design integrates the strengths of both quantitative and qualitative methods [17]. Each “case” will represent either an older adult undergoing a home adaptation process or an assistive technology advisor (eg, an occupational therapist) using one or both digital innovations.

Participants will include older adults and their informal caregivers, assistive technology advisors (eg, occupational therapists), and representatives from Regional County Municipalities responsible for implementing the HAP.

Participants will include older adults, informal caregivers, and assistive technology advisors. Older adults’ inclusion criteria are as follows: (1) aged 55 years or older, (2) residing in the Bas-Saint-Laurent (BSL) region, (3) deemed clinically capable of providing informed consent, and (4) expressing having difficulty or fear related to bathing or showering. Informal caregivers refer to a person who provides unpaid care and assistance to someone with a chronic illness, disability, or other long-lasting health or personal care needs, typically a family member or close friend. No specific number of support hours is required. An assistive technology advisor is a person who provides guidance to older adults in adapting their home or bathroom (eg, occupational therapist, personal support worker, and assistive device consultant).

A nonprobability convenience sampling method will be used [18]. The target sample includes 66 participants: 8 dyads of older adults and informal caregivers using MapIt, 20 dyads using Hygiene 2.0 or the combination of Hygiene 2.0 and MapIt, and 10 assistive technology advisors using at least one of both digital tools. This sample size is justified by the recruitment challenges and the exploratory nature of this pilot study [11], which primarily aims to assess feasibility, refine methodological procedures, and identify necessary adjustments before conducting a larger-scale study.

Except for the case where older adults use Hygiene 2.0 independently, participant recruitment will be carried out through intermediaries. For assistive technology advisors and occupational therapists, recruitment will occur via their employers or affiliated organizations. Assistive technology advisors may refer eligible older adults and informal caregivers whom they have supported. If older adults verbally agree, the advisors will forward their contact information to the research team so that the team members may contact them to provide additional information about the project. For older adults and informal caregivers using Hygiene 2.0 independently, recruitment will involve posters (see Multimedia Appendix 1) displayed in community spaces, such as pharmacies and post offices. The project will also be promoted through local media (eg, municipal newspapers) and community groups serving older adults.

This pilot study was approved by the research ethics board of the BSL Integrated Health and Social Services Center (project 2024‐459), as well as the Université TÉLUQ (project 2024‐80) and Université Laval (project 2024‐345) research ethics boards. In all cases, a member of the research team will introduce the project, answer questions, and obtain written informed consent.

For Hygiene 2.0, the data collected will be limited to user responses, associated with an anonymized digital identifier, and no directly identifiable personal data (eg, name, address, image, or IP address) will be collected. All data will be stored on a secure institutional server in accordance with ethical standards and governance policies. For MapIt, the digitization of home environments is performed only after obtaining informed consent, and the digital representations remain stored locally on the device without automatic transfer to external servers. User training will emphasize confidentiality principles, including limited data retention periods, and the systematic deletion of data once its intended use has been fulfilled. When sharing with occupational therapists is required, files will be transmitted via a secure server through an institutional Microsoft Teams environment that complies with health data security standards.

The project is led by a steering committee composed of 11 partners from the health and social services network, home adaptation services, research, and a citizen partner. Different implementation scenarios will be explored: the Hygiene 2.0 and MapIt innovations, individually or in combination, will be implemented across 3 distinct scenarios encompassing 10 contexts (Figure 1).

The term “contexts” refers to the variety of service points where older adults may access these tools, either independently or with support. These include settings where they are introduced to Hygiene 2.0 or receive assistance with home adaptation planning through MapIt. Three primary situations have been identified, each representing a distinct configuration of needs and interventions and involving the use of Hygiene 2.0, MapIt, or a combination of both: (1) simple situation—difficulty with personal hygiene: Hygiene 2.0 is used to support older adults who experience challenges with bathing or showering, without the need for broader home adaptation; (2) complex situation—difficulty with personal hygiene and home adaptation needs: a combined use of Hygiene 2.0 and MapIt is applied for older adults facing both hygiene-related difficulties and requiring home modifications; and (3) home adaptation only: MapIt is used independently to support the adaptation of the home environment for older adults who do not currently face hygiene challenges but are undergoing home modifications.

We will document which stakeholders adopt the tools, how their use is operationalized, how frequently they are used, and the benefits perceived by users. Additionally, we will track the reasons for nonuse or refusal to adopt the innovations, as well as the facilitators and barriers to their implementation. Two barriers have already been identified by the steering committee, which allowed for the immediate development of solutions: (1) a training module for the use of MapIt, available free of charge and online through the website of the Quebec Order of Occupational Therapists and (2) the loan of equipment to ensure access to the applications, including electronic tablets (iPad Pro) and smartphones (iPhone 16). Data sources will include research team logbooks, accountability reports, and records of participation in training sessions and presentations of the innovations (Multimedia Appendix 2).

To evaluate the impact of implementation, the data will be collected from the inclusion point (T0) of older adults in the study, using the mode of communication they prefer (online, by telephone, or in person).

For the Hygiene 2.0 innovation, applied in simpler situations involving challenges with bathing or showering (contexts 1-8 in Figure 1), the study period will span 6 months. Data will be collected at baseline, 3 months, and 6 months (T0, T1, and T2), which should be sufficient to capture potential clinical improvements. In addition, clinical-administrative databases from local community service centers will be consulted to obtain information on older adults who have received occupational therapy recommendations for bathroom or home adaptations.

In cases involving the combined use of both innovations (MapIt+Hygiene 2.0), the study period will range from 6 to 12 months. This applies to individuals experiencing more complex challenges with bathing or showering that require occupational therapy assessments (contexts 1-8), as well as those involved in home adaptation without HAP (context 9). Data will be collected every 3 months up to 6 months (T0, T1, and T2), with the possibility of extending to 12 months (T3 and T4), if there are delays in accessing occupational therapy services.

For home adaptation cases involving the HAP (context 10), the study period will extend to 24 months, reflecting the typically longer intervention timelines. In these cases, the data will be collected at 4-month intervals beginning at T0.

Semistructured interviews (Multimedia Appendix 3) will be conducted with dyads (older adults and informal caregivers, where applicable) as well as with assistive technology advisors. These interviews aim to explore participants’ experiences with the innovations (MapIt or Hygiene 2.0) and the home adaptation process. Each interview with an older adult and informal caregiver is expected to last up to 60 to 90 minutes, whereas interviews with assistive technology advisors will last up to approximately 45 minutes. When the same assistive technology advisor works with multiple older adults, a brief 5- to 10-minute follow-up interview will be conducted to capture additional insights.

We focused on a cost analysis [19] only and a longitudinal examination of quality-adjusted life years (QALYs) within participants, rather than on incremental cost-effectiveness or cost-utility analyses.

Costs will be categorized into 2 main variables: direct costs and indirect costs (Table 1). Direct costs include the remuneration of occupational therapists, authorized agents (mandataries), and expenses related to the implementation of the innovations and the HAP. Indirect costs refer to out-of-pocket expenses incurred by older adults and their informal caregivers, as well as any additional expenses related to participation in the HAP (eg, adaptation solutions not covered by the HAP).

Cost data for older adults and informal caregivers will be collected using a validated tool called the Costs for Patients Questionnaire (CoPaQ) [20-22]. The CoPaQ was developed through a systematic review and a Delphi process, ensuring strong content validity. Its psychometric properties have been evaluated in multiple studies. Test-retest reliability analyses report intraclass correlation coefficients (ICCs) that ranged from −0.02 to 0.99 (median 0.62) and κ coefficients that ranged from −0.11 to 1.00 (median 0.86), indicating moderate-to-excellent reliability for most items. The structure and wording of the questions were validated to guarantee clarity and relevance for patients and caregivers. These findings confirm that the CoPaQ is a robust instrument for measuring costs borne by patients and their caregivers in economic evaluations.

Utility, expressed as QALYs, enables the integration of both the quality and quantity of life into a single measure. QALYs will be assessed using the Short Form-6 Dimensions, version 2 (SF-6Dv2), a validated, generic, health-related quality-of-life questionnaire [23]. It includes 6 dimensions: physical functioning, role limitations, social functioning, pain, mental health, and vitality. Test-retest reliability analyses report ICC for SF-6Dv2 utility scores as 0.866, indicating good reliability [24]. Among individual dimensions, the physical functioning dimension shows the highest reliability (Gwet agreement coefficient=0.669). The SF-6Dv2 demonstrates a high responsiveness (standardized response means=0.788). The standardized response means is a distribution-based index that quantifies sensitivity to change by standardizing the mean difference with respect to the variability of change scores. The average minimal clinically important difference value for the SF-6Dv2 is 0.078 [25].

Occupational performance and satisfaction will be measured using the Canadian Occupational Performance Measure, research version [26]. This semistructured tool is recognized for its content validity, established through expert consensus and patient involvement, and construct validity, demonstrated by correlations with functional measures. The instrument shows strong test-retest reliability (ICC values typically >0.80) and moderate interrater reliability, ensuring consistency across administrations [27]. Responsiveness is considered moderate to high, with a minimal clinically important difference of 2 points [28], supporting its sensitivity to change in clinical interventions. These properties make the Canadian Occupational Performance Measure a robust tool for assessing occupational performance and satisfaction among older adults.

Satisfaction will be assessed using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), which uses a 5-point Likert scale [29,30]. The QUEST psychometric properties are well established. The tool demonstrates excellent reliability (ICC 0.82-0.91) and consistency between self-administered and interviewer versions (ICC 0.76-0.91). Content validity was ensured through input from both individuals who use assistive devices and international experts.

Informal caregiver burden will be measured using the French 12-item short version of the Zarit Burden Interview (ZBI) [31-33]. It evaluates the emotional and material burden on the primary informal caregiver, using a 5-point scale ranging from 0 (“never”) to 4 (“almost always”). This tool will be used only when an informal caregiver is involved in supporting the older adult. The ZBI is a valid and reliable instrument for measuring the burden experienced by caregivers. The Cronbach α value for the ZBI items is 0.93, and the intraclass correlation coefficient for the test-retest reliability of the Zarit burden score is 0.89 [34].

Usability will be assessed with the System Usability Scale (SUS) [35], a widely used tool consisting of 10 items rated on a 5-point scale. The SUS has excellent psychometric properties [36]. Research has consistently shown the SUS to have reliabilities at or just over 0.90, far above the minimum criterion of 0.70. The SUS has also been shown to have acceptable levels of concurrent validity and sensitivity [36]. The French version of the SUS demonstrates high reliability [37]. If a single assistive technology advisor supports multiple older adults, the SUS will be completed only once by that assistive technology advisor.

Occupational therapists will complete a structured logbook (Multimedia Appendix 4) to document their use of MapIt, including context and observed impacts [38]. An online questionnaire (Multimedia Appendix 5) will be administered to older adults or informal caregivers after completing Hygiene 2.0 or viewing its associated videos.

To track implementation changes and decisions, research professionals will maintain a logbook [39], recording key decisions, challenges, facilitators, and successes. Steering committee meeting minutes will be used to document the project’s evolution and provide a shared reference for committee members. These minutes will also capture implementation processes, challenges, solutions, and contextual factors influencing the adoption of the innovations.

In conclusion, this pilot PAR provides an opportunity to cocreate and evaluate the implementation of Hygiene 2.0 and MapIt while fostering a more inclusive and collaborative approach to innovation. By involving older adults and other stakeholders directly in the research and implementation processes, this pilot study will contribute to the development and implementation of digital innovations that are better aligned with the realities of aging in place. Beyond the immediate context, the findings will offer actionable insights into the conditions, facilitators, and challenges associated with integrating digital tools into home adaptation practices. These insights may inform future provincial and national strategies for home adaptation and digital health by supporting evidence-informed decisions regarding the adoption of user-centered technologies within publicly funded programs. Knowledge transfer activities generated through this project will extend beyond the regional scope through dissemination within professional and policy networks, targeted training initiatives, and dialogue with decision-makers, thereby supporting scalability and sustainability. Ultimately, this work aims to strengthen health systems’ capacity to respond to demographic aging, reduce inequities in access to rehabilitation services, and foster a sustained culture of innovation in home adaptation.