Patients' Perspectives on the Usability of a Mobile App for Self-Management following Spinal Cord Injury

"I think it was helpful but not as helpful as it could have been" - a qualitative study of the experiences and perspectives of using fitness apps among manual wheelchair users with spinal cord injury

PURPOSE

To gain knowledge of the experiences and perceptions of using fitness apps by full-time wheelchair users with spinal cord injury (SCI) and to explore experiences and perceptions of using these apps in relation to barriers to and facilitators of physical activity (PA).

MATERIALS AND METHODS

A qualitative design was employed. Semi-structured interviews were conducted with ten manual wheelchair users with SCI. Data were analysed using reflexive thematic analysis.

RESULTS

Four themes were developed: 1) App functionality and experience, 2) Enhancing motivation, 3) Precursors to engagement and 4) Knowledge gaps. Experience and perception were strongly influenced by app design, particularly the presence or absence of features tailored for wheelchair users. Many apps incorporated the use wearable or mountable sensors. Fitness apps were perceived to increase motivation, although, this had its limitations. Conversely, apps were reported to have limited influence on commonly reported barriers to PA. Furthermore, the data highlighted gaps in knowledge which created barriers to effective app use.

CONCLUSIONS

Fitness apps were perceived to increase motivation to engage in PA in manual wheelchair users with SCI. However, more needs to be done to further develop app features for wheelchair users with SCI and to address remaining barriers to engagement.

Parkwood's VIP4SCI platform: A virtual e-health self-management solution for persons with spinal cord injury across the care continuum

Objective

Parkwood VIP4SCI platform is a virtual e-health solution adapted from a version created for Spinal Cord Injury Ontario (SCIO) that focused on self-management skill development for persons with spinal cord injury (SCI) transitioning between stages of care, in partnership with caregivers and clinicians. This evaluation of the platform informs the usability and feasibility of a model to facilitate service care aims postrehabilitation.

Design

Participants: Inpatients and outpatients admitted to the SCI Rehabilitation Program (n = 31), and a mix of interdisciplinary clinicians on the Rehabilitation Team (n = 20). Caregivers participated at the discretion of the patient.Interventions: Inpatients were randomized into two groups (Platform or Standard Care (i.e., delayed access)). Outpatients were given access at enrollment. Pre-post assessments were completed using surveys, and platform analytics were collected. Weekly check-ins were introduced to increase engagement. Focus groups were held with a subset of participants near study completion.

Results

VIP4SCI was viewed as usable and feasible. Platform satisfaction assessed on a -3 to +3 scale ranged from +0.9 to 2.5, demonstrating positive agreement. Self-efficacy related to self-management ranged from 5.4 to 7.6 out of 10. The educational resource hub was identified as the most beneficial feature. Lack of clinician uptake was a barrier to integration into day-to-day practice.

Conclusions

Platform usage was low among all groups despite the perceived need for facilitating care coordination with consistent and intentional self-management programming. Despite the lack of uptake, partly due to challenges associated with the pandemic, conclusions on platform features and barriers to implementation will help to inform future programming.

Perceptions of a self-guided web-based exercise programme for shoulder pain after spinal cord injury: A qualitative study

STUDY DESIGN

Qualitative study.

OBJECTIVES

The benefits of exercise to reduce shoulder pain in people with spinal cord injury (SCI) are well documented. Digital health interventions offer a potential solution to overcome barriers to access rehabilitation support for exercise. The aim of this project was to gain people's perspectives to inform the development of a self-guided web-based exercise intervention. Shoulder Pain Intervention delivered over the interNet (SPIN) is a self-guided web-based intervention to prescribe, monitor, and progress evidence-based exercises for people living with SCI and shoulder pain.

SETTING

Community in Auckland, New Zealand.

METHODS

The Person-Based Approach was used as the framework. Using an Interpretive Descriptive methodology, data were collected in individual and focus group interviews, exploring participants' perceptions of this intervention idea. Data were analysed using conventional content analysis.

RESULTS

Sixteen participants took part and asked Is it right for me?. This had three main sub-themes. Should I use it?, whether I believe it will work for me right now; Can I use it?, whether I can operate the intervention competently and confidently and Will I use it?, whether it will be responsive to my unique needs, and keep me coming back.

CONCLUSIONS

Participants expressed their expectations and tipping points when considering using an intervention like this. These findings will inform and guide design and development of an acceptable technology-based intervention to increase the likelihood of engagement with a self-guided web-based exercise programme. The model developed from these themes could be used to inform future self-guided intervention development.

User experience of a self-management WeChat applet for patients with neurogenic bladder: A qualitative approach

Objectives

This study aimed to determine patients' perceived benefits of a WeChat applet for self-management of patients with neurogenic bladder (NGB) and identify the key factors hindering their adoption.

Methods

In the qualitative study, 19 NGB patients were invited for semi-structured interviews. They were hospitalized in the rehabilitation departments of two tertiary hospitals in Shenzhen and tried out the self-management applet for two weeks. Data were analyzed using the content analysis method.

Results

The results indicated that the WeChat applet of self-management was helpful and embraced by the NGB patients. Three perceived benefits were identified 1) being accessible, flexible, and intuitive to users, 2) driving bladder self-management, and 3) directing the way for care partners and family members. Challenges hindering the adoption of the applet included 1) negative attitudes of patients towards bladder self-management and patient characteristics, 2) concerns about the risks of mHealth, and 3) the necessity of applet upgrading.

Conclusion

This study showed feasibility of the WeChat applet for self-management among NGB patients to meet their needs for access to information during hospitalization and after discharge. The study also identified facilitators and barriers to patient use, providing valuable information for healthcare providers to implement mHealth interventions to promote self-management among NGB patients.

Expectations of a Health-Related Mobile Self-Management App Intervention Among Individuals With Spinal Cord Injury

Background

Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users' expectations and needs.

Objectives

The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI.

Methods

Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis.

Results

Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants' expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app's potential, identified participants' interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants' desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community.

Conclusion

By exploring end-users' expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: A Retrospective Observational Study

BACKGROUND

The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with the reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced.

OBJECTIVE

This study aimed to report the system design and post-introductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination.

METHODS

The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1,500 outpatients. The system, which links the hospital's electronic medical record database with patients' mobile devices, has the following two functions: 1) GPS-based examination check-in processing and 2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatient, implemented a user questionnaire and polling the average time required for patients to respond to call notifications about their turn.

RESULTS

The 3 months average of TR2 users 9 months after the TR 2 system introduction was 17.9% (81,066 of 14,536 patients). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7% (144 of 166 patients) said that the system help reduce the burden of waiting time.

CONCLUSIONS

The app allowed 17.9% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as the coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times.

CLINICALTRIAL

Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study

BACKGROUND

Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population.

OBJECTIVE

The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness.

METHODS

The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g).

RESULTS

Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57).

CONCLUSIONS

The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale.

Quality Assessment of Health-apps using a Public Agency Quality and Safety Seal. The Appsaludable Case

Standards and validation practices regarding mobile health apps need to be established to ensure their proper use and integration into medical practice. This paper proposes an innovative and integrative approach to examine and compare the quality of a certified health mobile applications set. A double classification framework (verified and perceived quality) is proposed and validated to evaluate the quality of 22 verified health mobile apps, particularly to understand whether these apps provide the service demanded by its users. Evaluation of verified quality was based on a certification public program. To analysis user satisfaction, we used content analysis to examine and extract words and expressions contained in online reviews (1,574 reviews were analyzed). The R language was used to scrape data and to perform all statistical analyses. The results did not confirm a significant relationship between both classifications (p > .05). However, the requirements with the highest degree of compliance ("design and relevance" and "quality and safety") of the app accreditation program were the best rated by the users of the apps in their comments. Reflections derived from this paper represent an important contribution to the knowledge base in the expanding research area of mobile health.

Changes in Internet Use Over Time Among Individuals with Traumatic Spinal Cord Injury

OBJECTIVE

To investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI).

DESIGN

Cross-sectional analysis of multicenter cohort study.

SETTING

National SCI Database.

PARTICIPANTS

Persons with traumatic SCI with follow-up data collected between 2012 and 2018 (n=13,622).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Proportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018.

RESULTS

The proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (p<0.001), those with lower annual income (p<0.001), less education (p<0.001), non-White race or Hispanic ethnicity (p<0.001), motor incomplete tetraplegia (p=0.004), or males (p=0.035) were less likely to use internet from 2012 to 2018. By 2018, there were no longer differences in internet use based upon race/ethnicity (p=0.290) or sex (p=0.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012 to 2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (p<0.001), income less than $50,000 (p<0.001), high school diploma or less (p=0.011), or non-Hispanic White race/ethnicity (p=0.001) were associated with less mobile internet use over time. By 2018 there were no differences in mobile internet use by education (p=0.430) and only participants with incomes greater than $75,000/year had greater odds of mobile internet use (p=0.016).

CONCLUSIONS

Disparities associated with internet access are decreasing likely due to mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI.