Early-Stage Feasibility of a Mobile Health Intervention (Copilot) to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Multimethods Approach

Abstract

Background There is an emergence of mobile health (mHealth) interventions to support self-management in patients with chronic obstructive pulmonary disease (COPD). Recently, an evidence-driven mHealth intervention has been developed to support patients with COPD in exacerbation-related self-management: the Copilot app. Health care providers (HCPs) are important stakeholders as they are the ones who have to provide the app to patients, personalize the app, and review the app. It is, therefore, important to investigate at an early stage whether the app is feasible in the daily practice of the HCPs. Objective The aim of this study is to evaluate the perceived feasibility of the Copilot app in the daily practice of HCPs. Methods A multimethods design was used to investigate how HCPs experience working with the app and how they perceive the feasibility of the app in their daily practice. The feasibility areas described by Bowen et al were used for guidance. HCPs were observed while performing tasks in the app and asked to think aloud. The System Usability Scale was used to investigate the usability of the app, and semistructured interviews were conducted to explore the feasibility of the app. The study was conducted in primary, secondary, and tertiary care settings in the Netherlands from February 2019 to September 2019. Results In total, 14 HCPs participated in this study—8 nurses, 5 physicians, and 1 physician assistant. The HCPs found the app acceptable to use. The expected key benefits of the app were an increased insight into patient symptoms, more structured patient conversations, and more tailored self-management support. The app especially fits within the available time and workflow of nurses. The use of the app will be influenced by the autonomy of the professional, the focus of the organization on eHealth, costs associated with the app, and compatibility with the current systems used. Most HCPs expressed that there are conditions that must be met to be able to use the app. The app can be integrated into the existing care paths of primary, secondary, and tertiary health care settings. Individual organizational factors must be taken into account when integrating the app into daily practice. Conclusions This early-stage feasibility study shows that the Copilot app is feasible to use in the daily practice of HCPs and can be integrated into primary, secondary, and tertiary health care settings in the Netherlands. The app was considered to best fit the role of the nurses. The app will be less feasible for those organizations in which many conditions need to be met to use the app. This study provides a new approach to evaluate the perceived feasibility of mHealth interventions at an early stage and provides valuable insights for further feasibility testing.

Interventions Aimed at Enhancing Health Care Providers’ Behavior Toward the Prescription of Mobile Health Apps: Systematic Review

“…The studies varied regarding study participants; some were focused on HCPs in primary care settings [23][24][25], whereas others targeted specific specialties, such as dietitians [26,27], behavioral health providers [28,29], providers in weight management clinics [30], clinical nutrition and physician assistant students [31], or interdisciplinary groups [32,33]. Most studies (8/11, 73%) had a sample size ranging from 5 to 40 HCPs, apart from 3 (27.3%) studies that reported the results of interventions conducted over multiple years or many training sessions in which the sample size ranged from 78 to 760 [28,29,31].…”

“…The functions of the mHealth apps used in these studies included weight management [27,30] or diet and activity tracking [26,31]. A total of 45% (5/11) of the studies used a list of approved apps for a range of health conditions [23,25,28,29,32], and 9% (1/11) used an app for chronic obstructive pulmonary disease (COPD) [33]. An overview of the characteristics of the individual studies included in the systematic review is provided in Multimedia Appendix 2 [23][24][25][26][27][28][29][30][31][32][33].…”

“…The most common changes resulting from the intervention were self-reported changes in knowledge, confidence, or self-efficacy [28,[30][31][32][33].…”

“…RenderX to use or recommend the app [33], and 1 (1/11, 9%) study evaluated app acceptance and use in dietetic care [27]. However, the outcomes were objectively estimated using the change in the number of apps prescribed in 36% (4/11) studies [23][24][25]32].…”

“…The studies by Armstrong et al [28,29] and Byambasuren et al [25] did not present P values to compare outcome measures at pretest and posttest. The details of the quality assessment are presented in Multimedia Appendix 3 [23][24][25][26][27][28][29][30][31][32][33].…”