Patient Acceptability of Home Monitoring for Neovascular Age-Related Macular Degeneration Reactivation: A Qualitative Study

Abstract

Neovascular age-related macular degeneration (nAMD) is a chronic, progressive condition and the commonest cause of visual disability in older adults. This study formed part of a diagnostic test accuracy study to quantify the ability of three index home monitoring (HM) tests (one paper-based and two digital tests) to identify reactivation in nAMD. The aim of this qualitative research was to investigate patients’ or participants’ views about acceptability and explore adherence to weekly HM. Semi-structured interviews were held with 78/297 participants (26%), with close family members (n = 11) and with healthcare professionals involved in training participants in HM procedures (n = 9) (n = 98 in total). A directed thematic analytical approach was applied to the data using a deductive and inductive coding framework informed by theories of technology acceptance. Five themes emerged related to: 1. The role of HM; 2. Suitability of procedures and instruments; 3. Experience of HM; 4. Feasibility of HM in usual practice; and 5. Impediments to patient acceptability of HM. Various factors influenced acceptability including a patient’s understanding about the purpose of monitoring. While initial training and ongoing support were regarded as essential for overcoming unfamiliarity with use of digital technology, patients viewed HM as relatively straightforward and non-burdensome. There is a need for further research about how use of performance feedback, level of support and nature of tailoring might facilitate further the implementation of routinely conducted HM. Home monitoring was acceptable to patients and they recognised its potential to reduce clinic visits during non-active treatment phases. Findings have implications for implementation of digital HM in the care of older people with nAMD and other long-term conditions.

Artificial intelligence for home monitoring devices

“…Importantly, this should be alongside human physicians, instead of replacing them, and artificial intelligence outputs should be transparent and verifiable wherever possible. Prospective randomized trials, real-world studies, and economic evaluations are highly important to demonstrate the value of artificial intelligence-based home monitoring, and should include patient-reported outcome measures and qualitative studies to evaluate patients’ experiences and attitudes [52 ▪ ]. These have been conducted for some approaches and indications and are ongoing or planned for others.…”

Home vision monitoring in patients with maculopathy: current and future options for digital technologies

“…Despite studies reporting positive usability data and favourable responses from patients, researchers have noted the possible difficulties of introducing some patients to digital technologies. It should be noted that studies reporting usability or patient satisfaction data are in the minority, and only one reports rich qualitative data on patient experience [ 70 ]. Data from the MONARCH study, obtained from semi-structured interviews, has shown home monitoring methods to be acceptable to patients with nAMD and their caregivers [ 70 ].…”

“…It should be noted that studies reporting usability or patient satisfaction data are in the minority, and only one reports rich qualitative data on patient experience [ 70 ]. Data from the MONARCH study, obtained from semi-structured interviews, has shown home monitoring methods to be acceptable to patients with nAMD and their caregivers [ 70 ]. Obtaining further data of this kind will allow greater understanding of how remote monitoring technologies can be developed and implemented to best meet patient need and maximise engagement.…”

Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration

“…The Monitoring for Neovascular Age-Related Macular Degeneration Reactivation at Home (MONARCH) study was a multicenter, diagnostic accuracy cohort study to estimate the performance of 3 home-monitoring vision tests in detecting nAMD activation in patients undergoing treatment for active nAMD. Additional details can be found in the published protocol and an article using qualitative methodology to capture patient acceptability during the study . Ethical approval was granted by the Northern Ireland Health and Social Care Research Ethics Committee A (Reference number: 17/NI/0235) on January 29, 2018, and our study design and execution adhered to the Declaration of Helsinki.…”