Strategies to promote adoption and usage of an application to support asthma self-management: a qualitative observational study

Hui, Chi Yan; McKinstry, Brian; Pinnock, Hilary

doi:10.14236/jhi.v25i4.1056

Cited by 21 publications

(22 citation statements)

References 11 publications

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“…However, their real-life experience enabled them to give examples of IoT features that they considered trustworthy (or not) from personal experience. Finally, the McKnight domains used in this study were limited to perceived functionality, helpfulness, and reliability; other domains such as perceived ease of use, perceived value, and the source of the recommendation (eg, an app recommended by a clinician that the patient believes understands their asthma may engender more trust in technology than an app recommended by a clinician that the patient does not know or trust) [ 21 , 46 ] may also be important to the perceived trust in the asthma self-management IoT system.…”

Section: Discussionmentioning

confidence: 99%

“…People trusted a customized system including elements that imitated human-human (patient-clinician) interactions and provided easy communication channels between the patient and clinician. Furthermore, the involvement of clinicians was pivotal to encourage patients’ adoption and adherence to digitized self-management [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The IoT has been used to support clinical management in a range of contexts (eg, asthma, diabetes, and hypertension), with examples including diagnosis, remote monitoring, remote consultation, self-management, emergency care, and home rehabilitation [ 7 - 13 ]. Traditional trust between patients and their clinicians is associated with improved medication adherence and health outcomes [ 14 - 18 ] and can be harnessed to encourage adoption and continued use of digital health systems [ 19 - 21 ]. Underpinning this is a gradual shift in trust from the clinician to technology.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ and Clinicians’ Perceived Trust in Internet-of-Things Systems to Support Asthma Self-management: Qualitative Interview Study

Hui¹,

McKinstry²,

Fulton³

et al. 2021

JMIR Mhealth Uhealth

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Background Asthma affects 235 million people worldwide. Supported self-management, including an action plan agreed with clinicians, improves asthma outcomes. Internet-of-things (IoT) systems with artificial intelligence (AI) can provide customized support for a range of self-management functions, but trust is vital to encourage patients’ adoption of such systems. Many models for understanding trust exist, some explicitly designed for eHealth, but no studies have used these models to explore trust in the context of using IoT systems to support asthma self-management. Objective In this study, we aim to use the McKnight model to explore the functionality, helpfulness, and reliability domains of patients’ and clinicians’ trust in IoT systems to deliver the 14 components of self-management support defined by the PRISMS (Practical Reviews in Self-Management Support) taxonomy. Methods We used think-aloud techniques in semistructured interviews to explore the views of patients and clinicians. Patients were recruited from research registers and social media and purposively sampled to include a range of ages, genders, action plan ownership, asthma duration, hospital admissions, and experience with mobile apps. Clinicians (primary, secondary, and community-based) were recruited from professional networks. Interviews were transcribed verbatim, and thematic analysis was used to explore perceptions of the functionality, helpfulness, and reliability of IoT features to support components of supported self-management. Results A total of 12 patients and 12 clinicians were interviewed. Regarding perceived functionality, most patients considered that an IoT system had functionality that could support a broad range of self-management tasks. They wanted a system to provide customized advice involving AI. With regard to perceived helpfulness, they considered that IoT systems could usefully provide integrated support for a number of recognized components of self-management support. In terms of perceived reliability, they believed they could rely on the system to log their asthma condition and provide preset action plan advice triggered by their logs. However, they were less confident that the system could operate continuously and without errors in providing advice. They were not confident that AI could generate new advice or reach diagnostic conclusions without the interpretation of their trusted clinicians. Clinicians wanted clinical evidence before trusting the system. Conclusions IoT systems including AI were regarded as offering potentially helpful functionality in mediating the action plans developed with a trusted clinician, although our technologically adept participants were not yet ready to trust AI to generate novel advice. Research is needed to ensure that technological capability does not outstrip the trust of individuals using it.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patients’ and Clinicians’ Perceived Trust in Internet-of-Things Systems to Support Asthma Self-management: Qualitative Interview Study

Hui¹,

McKinstry²,

Fulton³

et al. 2021

JMIR Mhealth Uhealth

Self Cite

View full text Add to dashboard Cite

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“…Although the issue regarding non-usage attrition is well-known, most eHealth studies do not provide information regarding use, despite the possible diminishing of the effects of the intervention by low exposure rates [ 16 – 18 ]. Studies on stand-alone eHealth tools in other chronic diseases (e.g., diabetes and chronic pulmonary disease) showed that after a month the applications were used by fewer than 50% of participants [ 19 ]. Two studies evaluating stand-alone eHealth interventions assisting patients in their preparation for the first consultation with an orthopaedic surgeon, which could be used either one or 2 weeks prior to the consultation, found relatively high user rates (i.e.…”

Section: Introductionmentioning

confidence: 99%

Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis

Pelle

Palen

Graaf³

et al. 2021

BMC Health Serv Res

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Background Self-management is of paramount importance in the non-surgical treatment of knee/hip osteoarthritis (OA). Modern technologies offer the possibility of 24/7 self-management support. We developed an e-self-management application (dr. Bart app) for people with knee/hip OA. The aim of this study was to document the use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee/hip OA. Methods For this study we used backend data for the first 26 weeks of use by the intervention group (N = 214) of an RCT examining the effectiveness of the dr. Bart app. A central element of the dr. Bart app is that it proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’ (e.g. after lunch I rise 12 times from my chair to train my leg muscles). The usability of the app was measured using the System Usability Scale questionnaire (SUS), on a scale of 0–100. To assess the association between the intensity of use of the app and health care utilisation (i.e., consultations in primary or secondary health care) and clinical outcomes (i.e., self-management behaviour, physical activity, health-related quality of life, illness perceptions, symptoms, pain, activities of daily living) we calculated Spearman rank correlation coefficients. Results Of the 214 participants, 171 (80%) logged in at least once with 151 (71%) choosing at least one goal and 114 (53%) completing at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37%) continued to log in for up to 26 weeks, 12 (8%) continued to select new goals from the offered goals and 37 (25%) continued to complete goals. Preformulated goals in the themes of physical activity (e.g., performing an exercise from the exercises library in the app) and nutrition (e.g., ‘eat two pieces of fruit today’) were found to be most popular with users. The mean usability scores (standard deviation) at the three and six month follow-ups were 65.9 (16.9) and 64.5 (17.5), respectively. The vast majority of associations between the intensity of use of the dr. Bart app and target outcomes were weak at ρ < (−) 0.25. Conclusions More than one-third of people with knee/hip OA who started using the app, continued to use it up to 26 weeks, though usability could be improved. Patients appear to have preferences for goals related to physical activity and nutrition, rather than for goals related to vitality and education. We found weak/no associations between the intensity of use of the dr. Bart app and health care utilisation and clinical outcomes. Trial registration (21 September 2017): Dutch Trial Register (Trial Number NTR6693/NL6505)

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“…Persistence may be even worse with health apps, though slightly better if promoted by your clinic. We hear how persistence with an app to support self-management of asthma was only around a month 9. We also hear how the integration of app data into computerised medical record (CMR) systems remains largely aspirational 10…”

Section: Introductionmentioning

confidence: 99%

In this issue – assumptions, openness, apps, collaborative working and a new editor

Lusignan

2018

BMJ Health Care Inform

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Strategies to promote adoption and usage of an application to support asthma self-management: a qualitative observational study

Cited by 21 publications

References 11 publications

Patients’ and Clinicians’ Perceived Trust in Internet-of-Things Systems to Support Asthma Self-management: Qualitative Interview Study

Patients’ and Clinicians’ Perceived Trust in Internet-of-Things Systems to Support Asthma Self-management: Qualitative Interview Study

Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis

In this issue – assumptions, openness, apps, collaborative working and a new editor

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