Using a mobile health application to support self-management in COPD: a qualitative study

Abstract

The mHealth applicationThe EDGE (sElf-management anD support proGrammE) COPD project aims to evaluate the efficacy of a multi-component mHealth intervention, delivered via a tablet computer, to improve quality of life in patients with COPD.12 This mHealth intervention focused on simplicity of use (touch screen, no keyboard), and consisted of a symptom diary (Figure 1), 13 remote self-monitoring (pulse oximetry) (Figure 2), and multimedia educational and self-management materials (videos, text, and images).Patients were asked to complete the symptom diary and pulse oximetry daily to understand individual variability. These data were reviewed at regular intervals (but not daily) by a respiratory research nurse, but patients were aware that they would have Abstract BackgroundTelehealth shows promise for supporting patients in managing their long-term health conditions, such as chronic obstructive pulmonary disease (COPD). However, it is currently unclear how patients, and particularly older people, may benefit from these technological interventions. AimTo explore patients' expectations and experiences of using a mobile telehealth-based (mHealth) application and to determine how such a system may impact on their perceived wellbeing and ability to manage their COPD. Design and settingEmbedded qualitative study using interviews with patients with COPD from various community NHS services: respiratory community nursing service, general practice, and pulmonary rehabilitation. MethodAn embedded qualitative study was conducted to which patients were recruited using purposive sampling to achieve maximum variation. Interviews were carried out prior to receiving the mHealth system and again after a 6-month period. Data were analysed using a grounded theory approach. ResultsThe sample comprised 19 patients (aged 50-85 years) with varied levels of computer skills. Patients identified no difficulties in using the mHealth application. The main themes encapsulating patients' experience of using the mHealth application related to an increased awareness of the variability of their symptoms (onset of exacerbation and recovery time) and reassurance through monitoring (continuity of care). ConclusionPatients were able to use the mHealth application, interpret clinical data, and use these within their self-management approach regardless of previous knowledge. Telehealth interventions can complement current clinical care pathways to support self-management behaviour.

Factors that influence older people’s engagement with digital health technology

“…This DHT resource supported self-management and users reported that it helped them to feel more in control of their condition when interviewed 6 months after commencing use of the DHT. These users also reported having a better understanding of what their oxygen saturations should be and less need for reassurance from healthcare professionals (Williams et al 2014). Another example of successful ongoing use is the website-based dizziness management programme reported by Essery et al (2017).…”

“…However, literature identifies some very successful DHT introductions that encouraged ongoing use. One example is the study by Williams et al (2014) using a tablet-computer based intervention for people with chronic obstructive pulmonary disease (COPD). This DHT resource supported self-management and users reported that it helped them to feel more in control of their condition when interviewed 6 months after commencing use of the DHT.…”

“…A number of smart phone based applications in the NHS apps library include behaviour change focussed technology (McMillan et al 2016). Although these are most commonly aimed at changing unhealthy behaviours in people without long-term conditions, a number of these DHT interventions include behaviour change techniques that enable users to set individualised goals (Devi et al 2014, Algeo et al 2017) and encourage them to monitor their progress using diaries, such as recording the amount of exercise they take or trends in symptoms (Devi et al 2014, Williams et al 2014. Exercise-based interventions can give positive feedback at regular intervals and reassure or inform users of their progress and thereby encourage ongoing use (Doyle et al 2014, Essery et al 2016).…”

eHealth: where next?

“…The past 20 years has seen a huge increase in the use of telephone consultations, 4 and it is likely that the next 20 years will see a similar increase in other forms of consultation, including use of e-mail and telehealth. 2,3,14 It is also likely that the current move from reactive care (where we see the individuals who present most often) towards proactive care (where we identify and target patients with most need) will continue. This will require more sophisticated use of data in electronic medical records to identify patients with greatest healthcare needs.…”

Living with asthma and chronic obstructive airways disease: Using technology to support self-management – An overview

“…81 Earlier qualitative work had also suggested that interacting with a telehealth intervention and receiving feedback from the health professional can increase satisfaction in relation to factors such as continuity of care, understanding of symptom variability and encouragement of self-management behaviour. 82 While participants were mostly positive about their role in telemonitoring, several were glad to hand their devices back at the end of this short (3-6 month) study, stating that they were getting bored using it everyday. This raises the question about long-term sustainability of such interventions requiring regular work by the patients that increase their overall treatment burden.…”