Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review

Abstract

Background Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. Objective This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. Methods A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. Results A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality–based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. Conclusions These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

“…This study contributes further evidence to support gaps in the literature, which relate to the timing of intervention use, including the initiation and continuation points of intervention use. This gap has also been acknowledged in recent systematic reviews and research by Jansson et al [16], Mirkovic et al [67], and our research team [12,27]. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial.…”

“…Interviews were conducted with participants over the telephone or by using video call-based software, such as Zoom and Microsoft Teams, and all participants were offered the choice of which they would prefer. The semistructured interview topic guide was developed based on 3 pilot interviews and covered key issues identified through a systematic literature review [12], meta-ethnography [27], and narrative review [28]. These issues included participants' understanding and experiences of surgery, awareness of perioperative lifestyle behavior change, perspectives on digital health technology use within the surgical pathways, and the optimal design of such technologies.…”

The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

“…Prehabilitation involves health-optimizing interventions and has been shown to enhance health and treatment outcomes. In the setting of the COVID-19 pandemic, prehabilitation may counteract the unintended consequences of shielding, that may result in physical deconditioning and immobility [ 29 , 30 , 31 ]. Our program involved regular “check-ins” with our patients and a multi-modal approach to prehabilitation.…”

A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study

“…Taken together, the interventional features of this app highlight the potential of meeting individualized patient needs, providing motivation, enhancing patient engagement and adherence, and facilitating human interaction. These themes are considered the determinants for the effectiveness of a mobile intervention to support surgical patients [ 37 ].…”