Patient experience of using a digital health application for self-management support in Chronic Obstructive Pulmonary Disease

The problem

Effective self-management of chronic obstructive pulmonary disease (COPD) has the potential to improve outcomes such as patient quality of life and reduce hospital admissions. Digital health applications are increasingly seen as a way to bridge the gap between professional care and patient self-management. A recent Cochrane review of tele-health care for COPD concluded that further research is needed to understand how such interventions might contribute to improving outcomes. Interventions delivered using digital health applications are complex, and our understanding of them can be improved by focusing on patients’ experiences through their own accounts and stories of what is important to them.

The approach

Patients, given a digital health device (tablet computer) for COPD following randomisation to the intervention group of a clinical trial, were invited to take part in a longitudinal qualitative study using purposeful sampling strategies. Following consent, participants were interviewed twice, once before they received the device and once following trial completion at 12 months. Interview data were audio recorded, transcribed and analysed using thematic analysis. Data were managed using NVivo.

Findings

Twenty-five participants (nine women) were recruited to the interview study. Of these, 23 were interviewed twice. Patients were 56 to 81 years old (mean 71 years), eight participants lived on their own and six participants had never taken part in a rehabilitation programme. Interviews lasted between 15 and 55 minutes. Participants found the application easy to use, regardless of age or prior computer experience. Three aspects appeared crucial in the way participants engaged and perceived the digital health application: existing co-morbidities , where managing other health conditions may be more important to them than COPD; prior relationship with health care professionals impacted on perceived benefits of the digital health application; and level of engagement . Based on Schermer’s framework, engagement ranged from compliant self-management where patients either merely focused on self-monitoring, or engaged with the intervention on a more interpretative level, to concordant self-management where patients used the digital health application to make decisions about their care based on their knowledge, skills and experience.

Consequences

Interventions delivered through digital health applications can be easy to use for patients, across all age ranges and regardless of prior computer experience. Yet for patients to engage with such interventions as effectively as possible, we need to assess their health care priorities, particular for those with co-morbidities. We also need to understand patients’ ability and willingness to self-manage. For some patients compliant self-monitoring, which would still require clinicians to make decisions, may be most appropriate whereas other patients may want to utilise a digital health intervention on a more interpretative level. Yet positive relationships between patients and primary health care professionals, as perceived by patients, remain crucial for effective self-management.

Credits

• Veronika Williams
• Lionel Tarassenko
• Andrew Farmer