"Sometimes I don't have a pulse … and I'm still alive!" Interviews with healthcare professionals to explore their experiences of and views on population-based digital health technologies

Healthcare professionals' attitudes towards digital health interventions and perspectives on digital health inequalities in cardiometabolic care: a qualitative study

BACKGROUND

The ue of digital health interventions (DHIs) for the management of cardiometabolic diseases has increased but may exacerbate existing health inequalities. Healthcare professionals (HCPs) play a vital role in recommending and supporting healthcare users to use these tools. There is a need to understand the role of HCPs in managing the implementation of digital health in communities at risk of health inequalities.

OBJECTIVE

To explore the views of HCPs regarding digital health and its impact on health inequalities, focusing on cardiometabolic diseases and the South Asian population in the UK.

DESIGN

We conducted online semi-structured interviews and focus groups with HCPs. These explored HCPs' experiences and attitudes towards digital health, their perceptions of healthcare users' barriers and facilitators to use such tools, as well as digital inequalities among specific healthcare user groups, and the impact of the COVID-19 pandemic on their practice in relation to digital health. After informed consent, transcription and coding, a reflexive thematic approach was taken for analysis.

SETTING

Primary, community and secondary care provided for cardiometabolic disease in the UK.

PARTICIPANTS

HCPs in general practice (n=3), cardiometabolic specialities (n=3), pharmacy (n=4) and other practices (n=8).

RESULTS

HCPs recognised the potential benefits of DHIs to improve access and delivery of care and healthcare user outcomes but described several barriers to successful implementation. HCPs demonstrated a good understanding of the challenges their healthcare users face in relation to wider inequalities, barriers to health behaviours and healthcare access, and digital health. Of particular concern was the impact of increasing reliance on digital interventions in healthcare on the exclusion of some population groups. Participants recommended improvement of the design and implementation of DHIs offered to healthcare users through working with at-risk populations throughout the process. Finally, participants emphasised the importance of ensuring non-digital services remained available to ensure equitable access to health and social care.

CONCLUSIONS

HCPs described the complexities of delivering care to underserved communities. DHIs were identified as a potential way to improve health outcomes for some, while over-reliance risked exacerbating inequalities. HCPs made recommendations related to design, implementation and engaging target populations and provided practical examples to address digital health inequalities, such as working with other sectors to take a community approach.

Transitioning Perspectives in Digital Health Through Phenomenology Integration

The evolution of digital health, from its early days as eHealth to its current expansive scope, reflects a significant transformation in health care delivery and management. This transition underscores the integration of digital technologies across the health continuum from prevention and diagnosis to treatment and rehabilitation. The emergence of digital health has introduced innovative solutions but also posed challenges, particularly in aligning technological advancements with health needs, human experiences, and ethical considerations. This position paper aims to explore the integration of phenomenology in digital health, advocating for a paradigm that emphasizes the centrality of human experience in the design and implementation of digital health solutions. It specifically seeks to address challenges related to relevance for individuals who "speak" different languages, ensuring long-term use, addressing digital and health literacy, coordinating various sources, and navigating ethical issues in the rapidly evolving digital health landscape. Drawing upon years of research and practical experience in communication technologies and health, this paper uses a reflective approach to examine the intersection of digital health and phenomenology. It reviews the historical development of digital health, identifies the challenges faced during its evolution, and discusses the potential of phenomenological methods to enhance user-centered design and ethical practices in digital health. The integration of phenomenology into digital health facilitates a deeper understanding of user experiences, enabling the development of more responsive and ethical digital health solutions. Participatory design models, informed by phenomenological perspectives, offer a pathway to bridge the gap between technological innovation and human-centric health care. The paper highlights successful practices in digital health development, including mobile apps for vaccination decision-making and platforms for managing chronic conditions, illustrating the benefits of a phenomenological approach. Transitioning perspectives in digital health through phenomenology integration represents a critical step toward realizing the full potential of digital technologies in health care.

Views and experiences of healthcare practitioners supporting people with COPD who have used activity monitors: "More than just steps"

INTRODUCTION

Activity monitors (apps and wearables) are increasingly used by the general population, including people with Chronic Obstructive Pulmonary Disease (COPD). There is potential for activity monitors to support increases in physical activity for people with COPD and healthcare practitioners (HCPs) are likely to be key in supporting their use, but little is currently known about HCPs' views or experiences. This qualitative research aimed to explore HCPs' views and experiences of supporting people with COPD who have used activity monitors.

METHODS

Seventeen semi-structured telephone or online interviews were conducted with HCPs between September 2020 and May 2021. HCPs included two nurses, an occupational therapist, a physician, and 13 physiotherapists. Participants were recruited via social media advertisements. They all had experience of supporting people with COPD who had used activity monitors. Interviews were analysed using reflexive thematic analysis.

FINDINGS

Four themes were developed highlighting the challenges and benefits of HCPs supporting patients with using activity monitors and utilising patient-collected activity data; 1) Skills and experience are needed to increase accessibility and engagement, 2) Objectively monitored physical activity can support exercise prescription, 3) Applications of activity monitors vary across different settings, and 4) Support is needed for future use of activity monitors.

DISCUSSION

HCPs recognised the potential for activity monitors to impact patients' ability to self-manage their COPD. However, there is a lack of guidance and information to support integration within practice. Future research is needed to co-develop information and guidelines for people with COPD and HCPs.

The effects of digitalisation on health and social care work: a qualitative descriptive study of the perceptions of professionals and managers

BACKGROUND

Today, digitalisation is strongly present in health and social care, and it increasingly affects the organisation of work, work requirements, tasks and tools. Due to the constant change in work, up-to-date knowledge is needed about these micro-level effects of digitalisation and how professionals experience the effects in their work. Furthermore, even though managers play a key role in implementing new digital services, their perceptions of the effects of digitalisation and whether they match the views of professionals remain unknown. This study examined how health and social care professionals and managers perceive the effects of digitalisation on the work of professionals.

METHODS

We used a qualitative approach and conducted eight semi-structured focus group interviews with health and social care professionals (n = 30) and 21 individual interviews with managers in 2020 in four health centres in Finland. The qualitative content analysis included both an inductive and a deductive approach.

RESULTS

Digitalisation was perceived to have changed professionals' 1) workload and pace, 2) the field and nature of work, 3) work community communication and interaction, and 4) information flow and security. Both professionals and managers identified effects such as accelerated work, reduction in workload, constant learning of technical skills, complicated work due to vulnerable information systems, and reduction in face-to-face encounters. However, managers did not bring up all the effects that professionals considered important, such as the creation of new work tasks, increased and duplicated work, or insufficient time to get acquainted with the systems.

CONCLUSIONS

The findings suggest that some of the effects of digitalisation on professionals' work and changes in the workplace may receive too little or no recognition from managers. This increases the risk that the potential negative effects may be overlooked and that managers will adopt systems that do not support the work of professionals. To reach a common understanding of the effects of digitalisation, continuous discussions between employees and different management levels are required. This contributes to professionals' well-being and adaptation to changes, as well as the provision of quality health and social services.

Healthcare provider experiences of deploying a continuous remote patient monitoring pilot program during the COVID-19 pandemic: a structured qualitative analysis

Objective

To describe the healthcare provider (HCP) experience of launching a COVID-19 remote patient monitoring (CRPM) program during the global COVID-19 pandemic.

Methods

We conducted qualitative, semi-structured interviews with eight HCPs involved in deploying the CRPM pilot program in the Military Health System (MHS) from June to December 2020. Interviews were audio recorded, transcribed, and analyzed thematically using an inductive approach. We then deductively mapped themes from interviews to the updated Consolidated Framework for Implementation Research (CFIR).

Results

We identified the following main themes mapped to CFIR domains listed in parentheses: external and internal environments (outer and inner settings), processes around implementation (implementation process domain), the right people (individuals domain), and program characteristics (innovation domain). Participants believed that buy-in from leadership and HCPs was critical for successful program implementation. HCP participants showed qualities of clinical champions and believed in the CRPM program.

Conclusion

The MHS deployed a successful remote patient monitoring pilot program during the global COVID-19 pandemic. HCPs found the CRPM program and the technology enabling the program to be acceptable, feasible, and usable. HCP participants exhibited characteristics of clinical champions. Leadership engagement was the most often-cited key factor for successful program implementation.

Embedding digital sleep health into primary care practice: A triangulation of perspectives from general practitioners, nurses, and pharmacists

Introduction

While digital health interventions (DHIs) can potentially address the unmet needs for sleep health services, little is known about their implementation in practice. The current study aimed to explore primary care health providers' attitudes and beliefs towards DHIs for sleep and implementation into practice.

Methods

A cross-sectional online survey was administered to Australian primary care health professionals: general practitioners (GPs), community nurses, and community pharmacists. Semi-structured interviews were conducted within a sub-sample of participants exploring their experiences with DHIs and perceived barriers/facilitators for embedding DHIs into primary care. Semi-structured interviews were thematically analysed using the framework approach to contextualise survey findings.

Results

Ninety-six surveys were returned (GPs  =  36, nurses = 30, and pharmacists = 30) and 45 interviews conducted (GPs  =  17, nurses = 14, and pharmacists  =  14). From the survey, GPs were more likely to endorse familiarity (p  =  0.009) and use (p < 0.001) of sleep DHIs in clinical practice than pharmacists and nurses. GPs were more interested in utilising the diagnostic features within a sleep DHI (p  =  0.009) compared to other professionals. Thematic analysis of the interviews revealed three major themes, contextualised by profession: (1) Scope for DHIs in Current Practice, (2) Practice Gaps and Training Needs, and (3) Envisioning a Model of Care Using Sleep DHIs. While DHIs can potentially improve care, greater clarity of care pathways and reimbursement structures are needed for integration into practice.

Conclusion

Primary care health professionals highlighted the training, care pathway and financial models required to realise the potential for translating findings from efficacy studies for DHIs into primary care to optimise sleep health.

Collecting and sharing self-generated health and lifestyle data: Understanding barriers for people living with long-term health conditions - a survey study

Background

The growing popularity of collecting self-generated health and lifestyle data presents a valuable opportunity to develop our understanding of long-term health conditions and improve care. Barriers remain to the effective sharing of health and lifestyle data by those living with long-term health conditions which include beliefs around concepts of Trust, Identity, Privacy and Security, experiences of stigma, perceptions of risk and information sensitivity.

Method

We surveyed 250 UK adults who reported living with a range of long-term health conditions. We recorded data to assess self-reported behaviours, experiences, attitudes and motivations relevant to sharing self-generated health and lifestyle data. We also asked participants about their beliefs about Trust, Identity, Privacy and Security, stigma, and perceptions of risk and information sensitivity regarding their health and lifestyle data.

Results

Three-quarters of our sample reported recording information about their health and lifestyle on a daily basis. However, two-thirds reported never or rarely sharing this information with others. Trust, Identity, Privacy and Security concerns were considered to be 'very important' by those with long-term health conditions when deciding whether or not to share self-generated health and lifestyle data with others, with security concerns considered most important. Of those living with a long-term health condition, 58% reported experiencing stigma associated with their condition. The greatest perceived risk from sharing with others was the potential for future harm to their social relationships.

Conclusions

Our findings suggest that, in order for health professionals and researchers to benefit from the increased prevalence of self-generated health and lifestyle data, more can be done to address security concerns and to understand perceived risks associated with data sharing. Digital platforms aimed at facilitating the sharing of self-generated health and lifestyle data may look to highlight security features, enable users to control the sharing of certain information types, and emphasise the practical benefits to users of sharing health and lifestyle data with others.