End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review

Abstract

BackgroundChronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative.ObjectiveThe aim of this study was to identify, appraise, and synthesize available qualitative evidence on users’ experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers).MethodsA systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived.ResultsTwelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma, chronic self-harm, and attention deficit hyperactivity disorder. Quality ratings were higher for implementer compared with end user studies. Both complementary and unique user themes emerged. Themes derived for end users of mHealth included (1) Experiences of functionality that supported self-management, (2) Acceptance (technical usability and feasibility), (3) Importance of codesign, and (4) Perceptions of benefit (self-efficacy and empowerment). For implementers, derived themes included (1) Characteristics that supported self-management (functional, technical, and behavior change); (2) Implementation challenges (systems level, service delivery level, and clinical level); (3) Adoption considerations for specific populations (training end users; specific design requirements); and (4) Codesign and tailoring to facilitate uptake and person-centered care.ConclusionsSynthesizing available data revealed both complementary and unique user perspectives on enablers and barriers to designing, developing, and implementing mHealth technolog...

Proposing an Ecosystem of Digital Health Solutions for Teens With Chronic Conditions Transitioning to Self-Management and Independence: Exploratory Qualitative Study (Preprint)

“…The HCP team also needs to work on effective information resource use for timely access. To maximize efficacy, collaborative codesign with patients and continuous improvement of solutions should be considered [2]. Within this context, gamifying the CDM concept to promote engagement, sustainable self-management, and communication is another possible approach for digital-health development.…”

“…Slater et al [2] underlined that mHealth interventions have failed to integrate into real-world settings and adoption practices. The impact of using self-management digital communication tools on relationships among parents, teens, and HCP was unclear [8].…”

“…Digital solutions developed in recent years assist patients in self-management. Youth especially use healthcare management technologies (e.g., telehealth and mobile health) enabling greater self-management [2].…”

Perspectives on implementing mobile health technology for living kidney donor follow‐up: In‐depth interviews with transplant providers

“…These studies show that LKDs are willing to engage with mHealth technology, and use of mHealth for LKD follow-up would be feasible in this population if transplant centers were to design and implement mHealth systems. Risk factors for missing LKD follow-up data include younger age, black race, lower educational attainment, living out-of-state from the transplant center, and living outside the United States.2,4 Indeed, mHealth interventions in the areas of weight management and chronic disease management have been observed to be effective among all age groups, including young adults[31][32][33] ; therefore, younger donors are both an important target for improved follow-up, and a group that is well-suited to an mHealth platform. .Concerns about meeting national follow-up requirements were reported by multiple participants in this study, as well as a belief that mHealth might help centers to maintain communication with donors that have traditionally been harder to reach.…”

“….Concerns about meeting national follow-up requirements were reported by multiple participants in this study, as well as a belief that mHealth might help centers to maintain communication with donors that have traditionally been harder to reach. Risk factors for missing LKD follow-up data include younger age, black race, lower educational attainment, living out-of-state from the transplant center, and living outside the United States.2,4 Indeed, mHealth interventions in the areas of weight management and chronic disease management have been observed to be effective among all age groups, including young adults[31][32][33] ; therefore, younger donors are both an important target for improved follow-up, and a group that is well-suited to an mHealth platform. Likewise, mHealth interventions in the areas of cardiovascular disease and weight loss have been shown to improve health behaviors and healthcare engagement among African Americans 34,35.…”