A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial

Abstract

BackgroundElectronic health (eHealth) interventions have proven effective, but implementation in clinical practice is difficult. More research focusing on the implementation process of eHealth interventions is necessary.ObjectiveThe objective of this study was to describe the process evaluation of a perioperative eHealth intervention, aiming to enhance recovery after laparoscopic abdominal surgery.MethodsA process evaluation was carried out alongside a multicenter randomized controlled trial. Patients aged between 18 and 75 years who were scheduled for a laparoscopic cholecystectomy, hernia inguinal surgery, or laparoscopic adnexal surgery were included. The eHealth intervention comprised a website and mobile phone app with the possibility to develop a personalized convalescence plan, a section with information about the surgical procedure and the recovery period, the possibility to ask questions via an electronic consultation (eConsult), and an activity tracker. The process evaluation was carried out using the model of Linnan and Steckler, measuring components such as reach, dose delivered, dose received, fidelity, and participants’ attitudes. Implementation scores were calculated based on the average of the four components. Quantitative data were collected by means of an electronic questionnaire, a logistic database, a weblog, and medical files. Qualitative data were collected by conducting interviews with a subsample of the study participants.ResultsA total of 344 of the 863 eligible patients were included in the study, which accounted for a reach of 39.9%, and 173 participants were randomized to the intervention group. The implementation scores of the different functions of the intervention ranged between 60% and 65%. The website, mobile phone app, and activity tracker were rated 7.3 to 7.6 on a scale of 1 to 10. Almost all participants who were interviewed about the eConsult function rated it as being of additional value if combined with the usual care but not as a replacement for usual care.ConclusionsAlthough participants were overall satisfied with the intervention, the implementation scores of the different functions of the intervention were fair. More research is needed to evaluate the barriers and facilitators for implementation of this perioperative eHealth intervention in normal practice outside study setting.Trial RegistrationNetherlands Trial Registry NTR4699; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4699 (Archived by WebCite at http://www.webcitation.org/6vr02V4KK)

A Practical Do-It-Yourself Recruitment Framework for Concurrent eHealth Clinical Trials: Simple Architecture (Part 1)

“…Of the 6525 participants who have completed the prescreening survey, 5337 (81.54%) consented to participate in the registry and agreed to be contacted at a later date for future center studies. The majority of participants enrolled reported hearing about the center via digital recruitment strategies (eg, Instagram, Reddit) and research registries (eg, ResearchMatch) [ 17 ]. Of the 14,557 records in the referral tracking database, 770 (5.29%) have been enrolled in a clinical trial.…”

“…Other advantages include the ability to balance recruiter caseloads using features that support monitoring and assignment or reassignment of cases to other staff. The capture of objective data pertaining to study eligibility at each stage of the recruitment pipeline allowed for ongoing adjustments and optimization of recruitment strategies to improve efficiency and cost-effectiveness (see Lattie et al [ 17 ] for a more detailed description). In addition to staff-facing advantages, participant-facing advantages include the ability to take the survey from a browser or mobile device at any time and it is an easy way to send contact information.…”

“…Participant recruitment methods included digital strategies (eg, social media, Craigslist), print advertisements (eg, flyers, posters on public transportation), research registries, clinics, and traditional media strategies (eg, press releases), which directed prospective participants to the center website and/or a prescreening Web survey via various links. The second part of this paper outlines detailed descriptions of the center’s recruitment strategies [ 17 ].…”

“…This paper characterizes the important features of this framework and discusses the uptake and use at a single academic research center. The second part to this paper by Lattie and colleagues describes the use of the DIY-RSF to identify the most cost-effective and time-efficient recruitment strategies for eHealth clinical trials and provide a guide for recruitment decision making [ 17 ].…”

Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden

“…Further, a recent systematic review of barriers and facilitators to implementation included 47 studies and identified factors such as patient and professional acceptance of e-mental health and fit with existing technologies [ 44 ]. In addition, while implementation of e-health interventions more generally is well covered in existing research [ 45 - 51 ], there have been recent calls to place more focus on implementation of e-health [ 52 ] to enable health care organizations to benefit from the promises of e-health solutions [ 53 ].…”