mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience

Perspectives and Needs of Malaysian Patients With Diabetes for a Mobile Health App Support on Self-Management of Diabetes: Qualitative Study

BACKGROUND

Effective self-management of diabetes is crucial for improving clinical outcomes by maintaining glucose levels and preventing the exacerbation of the condition. Mobile health (mHealth) has demonstrated its significance in enhancing self-management practices. However, only 20% of Malaysians are familiar with mHealth technologies and use them for health management.

OBJECTIVE

This study aims to explore the perceived benefits and challenges, needs and preferences, and willingness of patients with diabetes to use mHealth apps for self-management of diabetes.

METHODS

The study involved one-on-one semistructured online interviews with a total of 15 participants, all of whom were aged 18 years or older and had been diagnosed with diabetes for more than 6 months. An interview guide was developed based on the constructs of the Technology Acceptance Model (TAM), the Health Information Technology Acceptance Model (HITAM), and the aesthetics factor derived from the Mobile Application Rating Scale. All interviews were recorded in audio format and transcribed verbatim. The interview content was then organized and coded using ATLAS.ti version 8. Thematic analysis was conducted in accordance with the recommended guidelines for analyzing the data.

RESULTS

From the interviews with participants, 3 key themes emerged regarding the perceived benefits of using mHealth app support in diabetes self-management. These themes were the ability to track and monitor diabetes control, assistance in making lifestyle modifications, and the facilitation of more informed treatment decision-making for health care professionals. The interviews with participants revealed 4 prominent themes regarding the perceived barriers to using mHealth app support for diabetes self-management. These themes were a lack of awareness about the availability of mHealth support, insufficient support in using mHealth apps, the perception that current mHealth apps do not align with users' specific needs, and limited digital literacy among users. The interviews with participants unveiled 4 key themes related to their needs and preferences concerning mHealth app support for diabetes self-management. These themes were the desire for educational information, user-friendly design features, carbohydrate-counting functionality, and the ability to engage socially with both peers and health care professionals. The majority of participants expressed their willingness to use mHealth apps if they received recommendations and guidance from health care professionals.

CONCLUSIONS

Patients generally perceive mHealth app support as beneficial for diabetes self-management and are willing to use these apps, particularly if recommended by health care professionals. However, several barriers may hinder the utilization of mHealth apps, including a lack of awareness and recommendations regarding these apps from health care professionals. To ensure the effective development of mHealth app support systems for diabetes self-management, it is crucial to implement user-centered design processes that consider the specific needs and preferences of patients. This approach will help create apps that are tailored to the requirements of individuals managing diabetes.

Organisation and integrated healthcare approaches for people living with HIV, multimorbidity, or both: a systematic review

BACKGROUND

Universal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses.

METHODS

We reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions.

RESULTS

A total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11).

CONCLUSION

The data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users' knowledge as assets along those phases.

TRIAL REGISTRATION

PROSPERO number CRD42020194117.

Understanding Use Intention of mHealth Applications Based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) Model in China

The COVID-19 pandemic has significantly impacted the healthcare industry, especially public health resources and resource allocation. With the change in people's lifestyles and increased demand for medical and health care in the post-pandemic era, the Internet and home healthcare have rapidly developed. As an essential part of Internet healthcare, mobile health (mHealth) applications help to fundamentally address the lack of medical resources and meet people's healthcare needs. In this mixed-method study, we conducted in-depth interviews with 20 users in China (mean age = 26.13, SD = 2.80, all born in China) during the pandemic, based on the unified theory of acceptance and use of technology 2 (UTAUT-2) mode, and identified four dimensions of user needs in mHealth scenarios: convenience, control, trust, and emotionality. Based on the interview results, we adjusted the independent variables, deleted the hedonic motivation and the habit, and added the perceived trust and perceived risk as the variables. Using a structural equation model (SEM), we designed the questionnaire according to the qualitative results and collected data from 371 participants (above 18 years old, 43.9% male) online to examine the interrelationships these variables. The results show that performance expectancy (β = 0.40, p < 0.001), effort expectancy (β = 0.40, p < 0.001), social influence (β = 0.14, p < 0.05), facilitating condition (β = 0.15, p < 0.001), and perceived trust (β = 0.31, p < 0.001) had positive effects on use intention. Perceived risk (β = -0.31, p < 0.001) harmed use intention, and price value (β = 0.10, p > 0.5) had no significant effects on use intention. Finally, we discussed design and development guidelines that can enhance user experience of mHealth applications. This research combines the actual needs and the main factors affecting the use intention of users, solves the problems of low satisfaction of user experience, and provides better strategic suggestions for developing mHealth applications in the future.

A Voice App Design for Heart Failure Self-management: Proof-of-Concept Implementation Study

BACKGROUND

Voice user interfaces are becoming more prevalent in health care and are commonly being used for patient engagement. There is a growing interest in identifying the potential this form of interface has on patient engagement with digital therapeutics (DTx) in chronic disease management. Making DTx accessible through an alternative interaction model also has the potential to better meet the needs of some patients, such as older adults and those with physical and cognitive impairments, based on existing research.

OBJECTIVE

This study aimed to evaluate how participants with heart failure interacted with a voice app version of a DTx, Medly, through a proof-of-concept implementation study design. The objective was to understand whether the voice app would enable the participants to successfully interact with the DTx, with a focus on acceptability and feasibility.

METHODS

A mixed methods concurrent triangulation design was used to better understand the acceptability and feasibility of the use of the Medly voice app with the study participants (N=20) over a 4-week period. Quantitative data included engagement levels, accuracy rates, and questionnaires, which were analyzed using descriptive statistics. Qualitative data included semistructured interviews and were analyzed using a qualitative descriptive approach.

RESULTS

The overall average engagement level was 73% (SD 9.5%), with a 14% decline between results of weeks 1 and 4. The biggest difference was between the average engagement levels of the oldest and youngest demographics, 84% and 43%, respectively, but these results were not significant-Kruskal-Wallis test, H(2)=3.8 (P=.14). The Medly voice app had an overall accuracy rate of 97.8% and was successful in sending data to the clinic. From an acceptability perspective, the voice app was ranked in the 80th percentile, and overall, the users felt that the voice app was not a lot of work (average of 2.1 on a 7-point Likert scale). However, the overall average score for whether users would use it in the future declined by 13%. Thematic analysis revealed the following: the theme feasibility of clinical integration had 2 subthemes, namely users adapted to the voice app's conversational style and device unreliability, and the theme voice app acceptability had 3 subthemes, namely the device integrated well within household and users' lives, users blamed themselves when problems arose with the voice app, and voice app was missing specific, desirable user features.

CONCLUSIONS

In conclusion, participants were largely successful in using the Medly voice app despite some of the barriers faced, proving that an app such as this could be feasible to be deployed in the clinic. Our data begin to piece together the patient profile this technology may be most suitable for, namely those who are older, have flexible schedules, are confident in using technology, and are experiencing other medical conditions.

Design of a Patient Voice App Experience for Heart Failure Management: Usability Study

BACKGROUND

The use of digital therapeutics (DTx) in the prevention and management of medical conditions has increased through the years, with an estimated 44 million people using one as part of their treatment plan in 2021, nearly double the number from the previous year. DTx are commonly accessed through smartphone apps, but offering these treatments through additional platforms can improve the accessibility of these interventions. Voice apps are an emerging technology in the digital health field; not only do they have the potential to improve DTx adherence, but they can also create a better user experience for some user groups.

OBJECTIVE

This research aimed to identify the acceptability and feasibility of offering a voice app for a chronic disease self-management program. The objective of this project was to design, develop, and evaluate a voice app of an already-existing smartphone-based heart failure self-management program, Medly, to be used as a case study.

METHODS

A voice app version of Medly was designed and developed through a user-centered design process. We conducted a usability study and semistructured interviews with patients with heart failure (N=8) at the Peter Munk Cardiac Clinic in Toronto General Hospital to better understand the user experience. A Medly voice app prototype was built using a software development kit in tandem with a cloud computing platform and was verified and validated before the usability study. Data collection and analysis were guided by a mixed methods triangulation convergence design.

RESULTS

Common themes were identified in the results of the usability study, which involved 8 participants with heart failure. Almost all participants (7/8, 88%) were satisfied with the voice app and felt confident using it, although half of the participants (4/8, 50%) were unsure about using it in the future. Six main themes were identified: changes in physical behavior, preference between voice app and smartphone, importance of music during voice app interaction, lack of privacy concerns, desired reassurances during voice app interaction, and helpful aids during voice app interaction. These findings were triangulated with the quantitative data, and it concluded that the main area for improvement was related to the ease of use; design changes were then implemented to better improve the user experience.

CONCLUSIONS

This work offered preliminary insight into the acceptability and feasibility of a Medly voice app. Given the recent emergence of voice apps in health care, we believe that this research offered invaluable insight into successfully deploying DTx for chronic disease self-management using this technology.

Effects and Processes of an mHealth Intervention for the Management of Chronic Diseases: Prospective Observational Study

Background

Mobile health (mHealth) interventions for self-management are a promising way to meet the needs of patients with chronic diseases in primary care practices. Therefore, an mHealth intervention, TelePraCMan, was developed and evaluated for patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, high blood pressure, or heart failure in a German primary care setting. TelePraCMan entails a symptom diary, an appointment manager, a manager to document goals, and a warning system. The app should foster the self-management of participating patients.

Objective

We aimed to examine the effects of TelePraCMan on patient activation and quality of life and explored the underlying contextual factors, impacts, and degree of implementation.

Methods

In a prospective observational study design, we collected data by using interviews and written questionnaires from participating patients (intervention and control groups) and primary care workers (physicians and practice assistants). The primary outcomes of interest were patient-reported quality of life (12-Item Short Form Survey) and patient activation (patient activation measure). The quantitative analysis focused on differences between patients in the intervention and control groups, as well as before (T0) and after (T1) the intervention. Interviews were analyzed by using qualitative content analysis via MAXQDA (VERBI GmbH).

Results

At baseline, 25 patients and 24 primary care workers completed the questionnaire, and 18 patients and 21 primary care workers completed the follow-up survey. The patients were predominantly male and, on average, aged 64 (SD 11) years (T0). The primary care workers were mostly female (62%) and, on average, aged 47 (SD 10) years (T0). No differences were observed in the outcomes before and after the intervention or between the intervention and control groups. In the additional interviews, 4 patients and 11 primary care workers were included. The interviewees perceived that the intervention was useful for some patients. However, contextual factors and problems with implementation activities negatively affected the use of the app with patients. The main reasons for the low participation were the COVID-19 pandemic and the target group, which seemed to have less interest in mHealth; the interviewees attributed this to the older age of patients. However, the respondents felt that the app would be better accepted in 5 or 10 years.

Conclusions

Although the TelePraCMan app was rated as very good and important by the participants, few patients used it. The digital intervention was hardly implemented and had limited impact in the current setting of German primary care.

Trial Registration

German Clinical Trials Register DRKS00017320; https://tinyurl.com/4uwrzu85

Digital Self-monitoring of Multiple Sclerosis: Interview Study With Dutch Health Care Providers on the Expected New Configuration of Roles and Responsibilities

Background

Digital self-monitoring allows patients to produce and share personal health data collected at home. This creates a novel situation in which health care providers and patients must engage in a reconfiguration of roles and responsibilities. Although existing research pays considerable attention to the perceptions of patients regarding digital self-monitoring, less attention has been paid to the needs, wishes, and concerns of health care providers. As several companies and public institutions are developing and testing digital self-monitoring at the time of writing, it is timely and relevant to explore how health care providers envision using these technologies in their daily work practices. Our findings can be considered in decision-making processes concerning the further development and implementation of digital self-monitoring.

Objective

This study aims to explore how health care providers envisage using smartphone apps for digital self-monitoring of multiple sclerosis (MS) in their daily work practices, with a particular focus on physician-patient communication and on how health care providers respond to self-monitoring data and delegate tasks and responsibilities to patients.

Methods

We conducted semistructured in-depth interviews with 14 MS health care providers: 4 neurologists, 7 MS specialist nurses, and 3 rehabilitation professionals. They are affiliated with 3 different hospitals in the Netherlands that will participate in a pilot study to assess the efficiency and effectiveness of a specific smartphone app for self-monitoring.

Results

The interviewed health care providers seemed willing to use these smartphone apps and valued the quantitative data they produce that can complement the narratives that patients provide during medical appointments. The health care providers primarily want to use digital self-monitoring via prescription, meaning that they want a standardized smartphone app and want to act as its gatekeepers. Furthermore, they envisioned delegating particular tasks and responsibilities to patients via digital self-monitoring, such as sharing data with the health care providers or acting on the data, if necessary. The health care providers expected patients to become more proactive in the management of their disease. However, they also acknowledged that not all patients are willing or able to use digital self-monitoring apps and were concerned about the potential psychological and emotional burden on patients caused by this technology.

Conclusions

Our findings show that health care providers envisage a particular type of patient empowerment and personalized health care in which tensions arise between health care providers acting as gatekeepers and patient autonomy, between patient empowerment and patient disempowerment, and between the weight given to quantitative objective data and that given to patients’ subjective experiences. In future research, it would be very interesting to investigate the actual experiences of health care providers with regard to digital self-monitoring to ascertain how the tensions mentioned in this paper play out in practice.

Nurses' experiences of using AsthmaTuner - an eHealth self-management system for healthcare of patients with asthma

Objective

This study describes nurses' experiences of using eHealth for assessment in the healthcare of patients with asthma.

Methods

Five nurses with experience of using AsthmaTuner in the healthcare of patients with asthma participated in the study. Individual semi-structured interviews were conducted with the nurses to understand their experiences of using the eHealth system. The transcribed interviews were analyzed using qualitative content analysis.

Results

The results show that nurses as well as patients find the tool useful and easy-to-handle. AsthmaTuner gives the nurses access to more and better information about the patients, which facilitates assessments and makes their work more efficient. The patients become more involved in their care, gain increased control and take more responsibility for their illness and treatment.

Conclusions

The nurses appreciate eHealth in asthma care. Using AsthmaTuner makes the nurses' work more efficient and the patients become more involved in their care.

Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach

The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.

Exploring the perspectives of primary care providers on use of the electronic Patient Reported Outcomes tool to support goal-oriented care: a qualitative study

BACKGROUND

Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers' usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs.

METHODS

This qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5-6 months after ePRO implementation) and end-point (i.e. 9-12 months after ePRO implementation) of the trial. Interviews explored providers' experiences and perceptions of integrating the tool within their clinical practice. Interview data were analyzed using a hybrid thematic analysis and guided by the Technology Acceptance Model. Data from thirteen providers from three distinct primary care sites were included in the presented study.

RESULTS

Three core themes were identified: (1) Perceived usefulness: perceptions of the tool's alignment with providers' typical approach to care, impact and value and fit with existing workflows influenced providers' intention to use the tool and usage behaviour; (2) Behavioural intention: providers had a high or low behavioural intention, and for some, it changed over time; and (3) Improving usage behaviour: enabling external factors and enhancing the tool's perceived ease of use may improve usage behaviour.

CONCLUSIONS

Multiple refinements/iterations of the ePRO tool (e.g. enhancing the tool's alignment with provider workflows and functions) may be needed to enhance providers' usage behaviour, perceived usefulness and behavioural intention. Enabling external factors, such as organizational and IT support, are also necessary to increase providers' usage behaviour. Lessons from this study advance knowledge of technology implementation in primary care.

TRIAL REGISTRATION

Clinicaltrials.gov Identified NCT02917954. Registered September 2016, https://www.clinicaltrials.gov/ct2/show/study/NCT02917954.

Engagement with consumer smartwatches for tracking symptoms of individuals living with multiple long-term conditions (multimorbidity): A longitudinal observational study

Introduction

People living with multiple long-term conditions (multimorbidity) (MLTC-M) experience an accumulating combination of different symptoms. It has been suggested that these symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices.

Aim

The aim of this study was to investigate longitudinal user engagement with a smartwatch application, collecting survey questions and active tasks over 90 days, in people living with MLTC-M.

Methods

‘Watch Your Steps’ was a prospective observational study, administering multiple questions and active tasks over 90 days. Adults with more than one clinician-diagnosed long-term conditions were loaned Fossil® Sport smartwatches, pre-loaded with the study app. Around 20 questions were prompted per day.

Daily completion rates were calculated to describe engagement patterns over time, and to explore how these varied by patient characteristics and question type.

Results

Fifty three people with MLTC-M took part in the study. Around half were male ( = 26; 49%) and the majority had a white ethnic background (n = 45; 85%). About a third of participants engaged with the smartwatch app nearly every day. The overall completion rate of symptom questions was 45% inter-quartile range (IQR 23–67%) across all study participants. Older patients and those with greater MLTC-M were more engaged, although engagement was not significantly different between genders.

Conclusion

It was feasible for people living with MLTC-M to report multiple symptoms per day over 3 months. User engagement appeared as good as other mobile health studies that recruited people with single health conditions, despite the higher daily data entry burden.

Health information technology to improve care for people with multiple chronic conditions

OBJECTIVE

To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps.

DATA SOURCES

We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020.

STUDY DESIGN

We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making.

DATA COLLECTION/EXTRACTION METHODS

Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers.

PRINCIPAL FINDINGS

The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality.

CONCLUSIONS

Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.

Combining mHealth and health-coaching for improving self-management in chronic care. A scoping review

BACKGROUND

Self-management approaches are widely used to improve chronic care. In this context, health care professionals call for efficient tools to engage patients in managing their illness. Mobile health (mHealth), defined by WHO as medical and public health practice supported by mobile devices, is demonstrated to enhance self-management and health-coaching as an engaging tool in supporting behaviour change. Nevertheless, it is unclear how health-coaching and mHealth can benefit from each other.

OBJECTIVE

We conducted a scoping review to provide a literature-overview and identify any existing gaps in knowledge of mHealth in combination with health-coaching interventions for improving self-management in patients with chronic diseases.

PATIENT INVOLVEMENT

No patients were involved in the review process.

METHODS

The five-stage framework by Arksey and O'Malley was used. The review surveys; PubMed, CINAHL, Embase, Scopus, and PsycInfo. Two independent reviewers performed review selection and characterization.

RESULTS

The review points at two approaches; (i) coaching used to support mHealth and (ii) mHealth as support for coaching. The findings suggest that patients prefer physical interactions to telecommunication. mHealth was primarily used to facilitate telecommunication and to monitor disease aspects.

DISCUSSION

We found that mHealth and health-coaching interventions benefit from each other. The review report on a considerable unclarity in the coaching-methods and that the patients were more satisfied with physical interactions than mHealth. We suggest to prioritize human contact and to explore more personalized health technology.

PRACTICAL VALUE

This scoping review can provide a framework for researchers and care providers to support discussion and introduction of new approaches and technology in self-management for patients with chronic diseases, thereby improving patients' quality of life.

Design of a Care Pathway for Preventive Blood Pressure Monitoring: Qualitative Study

Background

Electronic health (eHealth) services could provide a solution for monitoring the blood pressure of at-risk patients while also decreasing expensive doctor visits. However, a major barrier to their implementation is the lack of integration into organizations.

Objective

Our aim was to design a Care Pathway for monitoring the blood pressure of at-risk patients, in order to increase eHealth implementation in secondary preventive care.

Methods

A qualitative design study was used in this research. Data were collected by conducting visual mapping sessions including semistructured interviews with hypertension patients and doctors. The data were transcribed and coded and thereafter mapped into a Care Pathway.

Results

Four themes emerged from the results: (1) the current approach to blood pressure measuring has disadvantages, (2) risk and lifestyle factors of blood pressure measuring need to be considered, (3) there are certain influences of the at-home context on measuring blood pressure, and (4) new touchpoints between patients and health professionals need to be designed. These in-depth insights combined with the visualization of the current blood pressure process resulted in our Care Pathway design for monitoring the blood pressure of at-risk patients as secondary preventive care.

Conclusions

The Care Pathway guides the implementation of eHealth devices for blood pressure self-measurement. It showcases the pathway of at-risk patients and increases their involvement in managing their blood pressure. It serves as a basis for a new service using eHealth.

Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development

BACKGROUND

A high burden of non-communicable diseases (NCDs) is contributing to high mortality and morbidity in India. Recent advancements in digital health interventions, including mHealth, eHealth, and telemedicine, have facilitated patient-centered care for NCDs.

OBJECTIVE

This systematic review aims to evaluate the current evidence on digital interventions for people living with NCDs in India and the outcomes of those interventions.

METHODS

We adopted PRISMA guidelines and systematically reviewed articles from MEDLINE, CINAHL, PsycINFO, ERIC, and Scopus databases with following criteria: journal articles presenting digital intervention(s) used by people with at least one of the NCDs, reporting health outcomes following the intervention, studies conducted in India among Indian population.

RESULTS

Among 1669 articles retrieved from multiple sources, only 13 articles met our criteria. Most (n = 7) studies were conducted in southern states of India; eight studies included patients with diabetes, followed by neuropsychiatric disorders and other NCDs. Five studies recruited participants from tertiary hospitals; six interventions used text-messaging for delivering health services, and 10 studies reported randomized controlled trials. All the studies reported positive health outcomes following the intervention, including better self-management, increased patient-provider communication, improved medication adherence, and reduced disease symptoms. Most studies scored moderate to high in quality assessment checklist of Downs and Black.

CONCLUSION

Current evidence suggests a low number of interventions with positive outcomes. Future research should explore avenues of advanced technologies ensuring equitable and sustainable development of digital health interventions for people living with NCDs in India.