The ideal mHealth-application for rheumatoid arthritis: qualitative findings from stakeholder focus groups

Abstract

Background Shifts in treatment strategies for rheumatoid arthritis (RA) have made ambulatory care more labour-intensive. These developments have prompted innovative care models, including mobile health (mHealth) applications. This study aimed to explore the perceptions of mHealth-inexperienced stakeholders concerning these applications in RA care. Methods We performed a qualitative study by focus group interviews of stakeholders including RA patients, nurses specialised in RA care and rheumatologists. The qualitative analysis guide of Leuven (QUAGOL), which is based on grounded theory principles, was used to thematically analyse the data. In addition, the Persuasive Systems Design (PSD) model was used to structure recommended app-features. Results In total, 2 focus groups with nurses (total n = 16), 2 with patients (n = 17) and 2 with rheumatologists (n = 25) took place. Six overarching themes emerged from the analysis. Efficiency of care and enabling patient empowerment were the two themes considered as expected benefits of mHealth-use in practice by the stakeholders. In contrast, 4 themes emerged as possible barriers of mHealth-use: the burden of chronic app-use, motivational aspects, target group aspects, and legal and organisational requirements. Additionally, recommendations for an ideal mHealth-app could be structured into 4 domains (Primary Task Support, Dialogue Support, Social Support and System Credibility) according to the PSD-framework. Most recommended features were related to improving ease of use (Task Support) and System Credibility. Conclusions Although mHealth-apps were expected to improve care efficiency and stimulate patient empowerment, stakeholders were concerned that mHealth-app use could reinforce negative illness behaviour. For mHealth-apps to be successful in practice, challenges according to stakeholders were avoiding long-term poor compliance, finding the target audience and tailoring a legal and organisational framework. Finally, the ideal mHealth-application should above all be trustworthy and easy to use.

Disseminating and assessing implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with patients’ perspectives

“…This agrees with previous studies looking at eHealth and Telehealth literacy in rheumatology 20 21. Current studies22 23 have shown that patients are open to mHealth technologies in care. Indeed, the area of mHealth is growing not least due to the changes accelerated by the COVID-19 pandemic.…”

Using patient-reported data from a smartphone app to capture and characterize real-time patient-reported flares in rheumatoid arthritis

“…They found that daily pain scores and specific individual items from the OMERACT FLARE Instrument appeared effective in classifying new-onset flares, confirming the early feasibility demonstrated by our study of using frequently collected patient-reported measures to predict flares. Some qualitative studies have raised concerns about patients feeling reminded about their disease when doing frequent symptom tracking, resulting in either making patients too preoccupied with their disease or an internal resistance to use the app [ 25 , 26 ]. Additionally, mHealth studies are inherently vulnerable to high attrition rates.…”

Big data analyses and individual health profiling in the arena of rheumatic and musculoskeletal diseases (RMDs)

“…A few principles are used in many mHealth studies such as push notifications or feedback to the participant, yet success rate is not always clear, although mHealth user appreciate these methods. 92 , 93 Some avenues that deserve more attention make use of gamification principles to increase user engagement or foster certain health behaviours. 94 Such persuasive values require specific design techniques including offering praise, providing reminders, and emulating social agents or support.…”

“…MHealth is being employed in various disciplines 96 and procedures of different initiatives can also offer possibilities for patients with RMDs how to use mHealth optimally. However, creating mHealth applications for rheumatology purposes should take the opinion of every stakeholder into account, 92 and the final mHealth product should be a result of a standardized process. These prerequisites seem intuitive, yet many mHealth apps in rheumatology do not seem to adhere to many of these basic principles.…”