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Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings.
Objective: The aim of this study was to report challenges experience...
Citations
... Finally, population demographics and individual preferences can impact how a user interacts with digital platforms, and anticipating these factors in advance can minimize later delays. For example, lack of digital literacy, inexperience with trial technology, insufficient digital infrastructure, and lack of confidence using devices are frequently cited reasons for withdrawal in app-based studies [101,102]. Embedding customization features into platforms may address this and encourage use, as has been demonstrated with mHealth applications [103][104][105][106][107][108]. Additionally, customization such as enlarged text functionality or text-to-speech embedded software would accommodate those with accessibility needs. ...
Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.
... All 28 included studies were published between 2014 and 2023, and all but three studies [25][26][27] were conducted in high-or upper-middle-income countries [28]. Most of these (n = 10) were undertaken in Canada [29][30][31][32][33][34][35][36][37][38], followed by 5 studies in Australia [39][40][41][42][43] and 4 studies in the USA [44][45][46][47]. The three studies conducted in lower-middle-income countries were from India [25], Iran [26] and Uganda [27]. ...
... Of the 28 included publications, 17 addressed the research question using a qualitative design [26,29,[32][33][34][35][36][37]39,[42][43][44][45][46][47][48][49], while 5 studies worked with a quantitative design [25,40,[50][51][52] and 5 studies were based on a mixed methods approach [27,30,38,41,53]. One of the included articles was a synthesis of six qualitative and quantitative studies with different study designs, which were mentioned, but not explained in detail (pre-post, pilot studies, RCTs, observational designs) [31]. ...
... With the exception of one study, where a cognitive work analysis was conducted [34], all qualitative research was based on interviews and/or focus groups. The quantitative studies were exclusively online surveys, and the mixed methods studies used quantitative surveys [30,38] as well as interviews and focus groups [27,41], each supplemented by other data sources (process data, e-mail correspondence, etc.). One of the mixed-methods studies was a combination of a survey and focus groups [53]. ...
Due to the coronavirus pandemic, telerehabilitation has become increasingly important worldwide. While the effectiveness of telerehabilitation is considered proven for many indications, there is comparatively little knowledge about the implementation conditions. Therefore, this scoping review summarises the current state of facilitating and inhibiting factors that may influence the uptake of telerehabilitation. The review follows the JBI methodology for scoping reviews. The article search was carried out in five databases (MEDLINE, EMBASE, Web of Science, Cochrane and Psyndex) in May 2022, with an update in October 2023. Two independent researchers identified relevant studies according to the inclusion and exclusion criteria. The Consolidated Framework for Implementation Research served as the theoretical basis for the categorisation of the facilitating and inhibiting criteria in the organisational context. A total of 28 studies (timespan 2012 to 2023) have been included. The most relevant barriers identified are technical issues and a lack of technical skills. The factors considered most favourable for implementation are patients’ motivation and the involvement of high-level leaders. The results provide clear indications of factors that inhibit and facilitate implementation, but also show that further research is needed.
... However, the successful use of technology in clinical practice is likely to be ineffective if user needs are not carefully addressed and incorporated before attempting a full-scale implementation [9,12]. Thoroughness in integrating and understanding user perspectives will have a direct impact on how well the technology is suited for clinical practice [13,14]. ...
Background: A lack of information during an emergency visit leads to the experience of powerlessness for patients and their family members, who may also feel unprepared to cope with acute symptoms. The ever-changing nature and fast-paced workflow in the emergency department (ED) often affect how health care professionals can tailor information and communication to the needs of the patient.
... In general, articles mention a high level of health literacy, digital literacy (or technology, computer, mobile phone, or e-literacy), and eHealth literacy (or digital health or telehealth literacy) as necessary for both user groups. 46,[106][107][108][109][110][111] Required knowledge. Program usage requires health professionals and patients to have knowledge about telerehabilitation. ...
... 42,118 For health professionals, this includes telerehabilitation components, 115 benefits, 119 policies/guidelines, 98 impacts on workflows, workload, and responsibilities, 107,120 implementation strategies, 104 and impacts on patients. 107 Regarding patients, knowledge about telerehabilitation components, methods, risks, and benefits are mentioned. 42,62,121,122 In view of the above-mentioned tasks, health professionals need to be aware of legal/ethical considerations, techniques/processes, risks, and how to do patient training, demonstrations, monitoring, guidance, feedback, or documentation remotely. ...
... Articles identify a lack of technical knowledge for patients and health professionals, 59,80,118,123 and of knowledge on how to use a device for patients. 107,124,125 Further, data security knowledge for both user groups, 108 and knowledge of privacy regulation for health professionals is required. 60,104 In view of the above-mentioned tasks, users need to know how to set up hardware/software, don wearables, adapt a program, or handle technical issues. ...
Background
Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care.
Objective
The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies.
Methods
We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home.
Results
One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear.
Conclusions
Telerehabilitation requires a variety of different competencies from patients and health professionals — going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.
... A second challenge is that patients often need human support to effectively engage in digital therapeutics [53,54,[59][60][61][62]. Successful implementations must provide support to patients to help them engage in use of apps, without overburdening primary care teams [51,53,54,59,63]. Given the known time constraints and competing demands in primary care [25,64], teams may find it infeasible to offer adequate support for engagement in digital therapeutics. It is unknown whether clinicians in primary care can add Glass et al. ...
Background
Experts recommend that treatment for substance use disorder (SUD) be integrated into primary care. The Digital Therapeutics for Opioids and Other SUD (DIGITS) Trial tests strategies for implementing reSET® and reSET-O®, which are prescription digital therapeutics for SUD and opioid use disorder, respectively, that include the community reinforcement approach, contingency management, and fluency training to reinforce concept mastery. This purpose of this trial is to test whether two implementation strategies improve implementation success (Aim 1) and achieve better population-level cost effectiveness (Aim 2) over a standard implementation approach.
Methods/Design
The DIGITS Trial is a hybrid type III cluster-randomized trial. It examines outcomes of implementation strategies, rather than studying clinical outcomes of a digital therapeutic. It includes 22 primary care clinics from a healthcare system in Washington State and patients with unhealthy substance use who visit clinics during an active implementation period (up to one year). Primary care clinics implemented reSET and reSET-O using a multifaceted implementation strategy previously used by clinical leaders to roll-out smartphone apps (“standard implementation” including discrete strategies such as clinician training, electronic health record tools). Clinics were randomized as 21 sites in a 2x2 factorial design to receive up to two added implementation strategies: (1) practice facilitation, and/or (2) health coaching. Outcome data are derived from electronic health records and logs of digital therapeutic usage. Aim 1’s primary outcomes include reach of the digital therapeutics to patients and fidelity of patients’ use of the digital therapeutics to clinical recommendations. Substance use and engagement in SUD care are additional outcomes. In Aim 2, population-level cost effectiveness analysis will inform the economic benefit of the implementation strategies compared to standard implementation. Implementation is monitored using formative evaluation, and sustainment will be studied for up to one year using qualitative and quantitative research methods.
Discussion
The DIGITS Trial uses an experimental design to test whether implementation strategies increase and improve the delivery of digital therapeutics for SUDs when embedded in a large healthcare system. It will provide data on the potential benefits and cost-effectiveness of alternative implementation strategies. ClinicalTrials.gov Identifier: NCT05160233 (Submitted 12/3/2021). https://clinicaltrials.gov/ct2/show/NCT05160233
... Although promising, the implementation of patient-facing apps within routine care is in its infancy [14,23,24], with limited research examining the components of what makes an effective app or how to reach those families most impacted by existing inequities in health care delivery. Although mobile health apps have the potential to reach and engage traditionally underserved families, it is not sufficient to simply create an intervention and expect success. ...
... To date, the Consolidated Framework for Implementation Research (CFIR) [27] has been used broadly in health-related implementation research [28] and increasingly in the domain of mobile health apps [23,24]. The CFIR framework comprises 5 domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and the implementation process. ...
Background
Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special health care needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish appropriate services. Such challenges disproportionately affect families from traditionally underserved communities. Mobile health apps can improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, the implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in health care delivery.
Objective
In study 1, we conducted focus groups to access a broad range of perspectives on the process of navigating the EI system, with the dual goals of identifying ways in which a patient-facing app might facilitate this process and identifying barriers to use with traditionally underrepresented and underserved groups. In study 2, focus group findings informed the development of a patient-facing app, which was subsequently tested with a pilot sample of 5 families.
Methods
In study 1, the focus groups included 29 participants from 4 shareholder groups. Targeted sampling was used to recruit participants from traditionally underrepresented groups. Focus group questions sought information about barriers families experience as they navigate the EI system, ideal features of a patient-facing app designed to track family engagement with the EI system, and potential barriers. Focus group procedures were informed by the Consolidated Framework for Implementation Research framework. In study 2, a pilot app was developed. The app was tested with a sample of 5 families of young children involved in the EI system. Families provided information on app functionality and usability.
ResultsQualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, potential utility of an app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track app and related implementation supports. App features included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. Field testing provided preliminary information about app usability, including identifying future directions.
Conclusions
The results of this study could support the development of a new way for the EI system to communicate and connect with families, provide families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child’s care.
... 11 Therefore, the successful development and implementation of sustainable technologies within healthcare require an understanding of (1) the clinical setting and (2) its potential challenges from a user perspective. 13,14 The current research team recently conducted a study on the needs and preferences of patients and family members having a brief (<24 hours) emergency department (ED) stay. 15 The main findings identified (1) a need for improved opportunities to acquire information continually during the hospital stay, (2) a need for a person-centered summary of discharge information, and (3) improved inclusion of patients' families. ...
Objective
The successful development and implementation of sustainable healthcare technologies require an understanding of the clinical setting and its potential challenges from a user perspective. Previous studies have uncovered a gap between what emergency departments deliver and the needs and preferences of patients and family members. This study investigated whether a user-driven approach and participatory design could provide a technical solution to bridge the identified gap.
Methods
We conducted four workshops, and five one-to-one workshops with patients, family members, healthcare professionals, and information technology specialists to codesign a prototype. Revisions of the prototype were made until an acceptable solution was agreed upon and tested by the participants. The data were analyzed following iterative processes (plan → act → observe → reflect).
Results
The participants emphasized the importance of a person-centered approach focusing on improved information. An already implemented system for clinicians’ use only was redesigned into a unique patient module that provides a process line displaying continually updated informative features, including (1) person-centered activities, (2) general information videos, (3) a notepad, (4) estimated waiting time, and (5) the nurse and physician responsible for care and treatment.
Conclusion
Participatory design is a usable approach to designing an information system for use in the emergency department. The process yielded insight into the complexity of translating ideas into technologies that can actually be implemented in clinical practice, and the user perspectives revealed the key to identifying these complex aspects. The iterations with the participants enabled us to redesign an existing technology.
... Two reviewers (AOS and JMcV) independently categorized the findings from the 20 included studies. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] These reviewers then met to reach a consensus on the name and content of each category. Two reviewers (JD and CL) who were not involved in the categorization process validated these categories following discussion and refinement. ...
... 41 Overall, 20 studies were included in this review. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Characteristics of the included studies are described in Table 1. Quality assessment of the included studies, using the Joanna Briggs Institute critical appraisal checklist for qualitative research, is presented in Table 2. ...
... Poor patient digital literacy was reported to be a barrier to a selfmanagement programme for shoulder pain based on a web-based application ('app'). 22 Participants forgot passwords, were unfamiliar with their Wi-Fi setup at home and had difficulty downloading the app, all of which hindered their ability to engage with the app-based programme. Suggestions that were made to facilitate engagement with the app were to introduce it as part of pre-operative care and to have a practice app. ...
Objective
The objective of this review was to identify barriers and facilitators related to self-management from the perspectives of people with shoulder pain and clinicians involved in their care.
Data sources
CINAHL, MEDLINE, PsycINFO, SPORTDiscus, Embase, ProQuest Health, Web of Science, and Scopus were searched from inception to March 2022.
Review methods
A meta-aggregative approach to the synthesis of qualitative evidence was used. Two independent reviewers identified eligible articles, extracted the data, and conducted a critical appraisal. Two reviewers independently identified and developed categories, with validation by two further researchers. Categories were discussed among the wider research team and a comprehensive set of synthesized findings was derived.
Results
Twenty studies were included. From the perspective of patients, three synthesized findings were identified that influenced self-management: (1) support for self-management, including subthemes related to patient-centred support, knowledge, time, access to equipment, and patient digital literacy; (2) personal factors, including patient beliefs, patient expectations, patient motivation, pain, and therapeutic response; and (3) external factors, including influence of the clinician and therapeutic approach. From the perspective of clinicians, two synthesized findings were identified that influenced self-management: (1) support for self-management, including education, patient-centred support, patient empowerment, time, and clinician digital literacy; and (2) preferred management approach, including clinician beliefs, expectations, motivation, therapeutic approach, and therapeutic response.
Conclusion
The key barriers and facilitators were patient-centred support, patient beliefs, clinician beliefs, pain, and therapeutic response. Most of the included studies focused on exercise-based rehabilitation, and therefore might not fully represent barriers and facilitators to broader self-management.
... For example, a recent review of digital health technologies to manage hypertension found that the settings and context in which interventions are introduced as well as the individuals involved influenced adoption [14]. A 2017 study examining the implementation of mobile apps for patients to support postsurgical rehabilitation in orthopedics found that digital literacy and the impact of the intervention on outcomes and workflow need to be accounted for [15]. Another study examining digital health interventions to improve medication adherence in diabetes and hypertension found no conclusive evidence of improved adherence with technologies that incorporated features such as interactive voice response or telemonitoring [16]. ...
Background
Evaluation of patients with serious mental illness (SMI) relies largely on patient or caregiver self-reported symptoms. New digital technologies are being developed to better quantify the longitudinal symptomology of patients with SMI and facilitate disease management. However, as these new technologies become more widely available, psychiatrists may be uncertain about how to integrate them into daily practice. To better understand how digital tools might be integrated into the treatment of patients with SMI, this study examines a case study of a successful technology adoption by physicians: endocrinologists’ adoption of digital glucometers.
Objective
This study aims to understand the key facilitators of and barriers to clinician and patient adoption of digital glucose monitoring technologies to identify lessons that may be applicable across other chronic diseases, including SMIs.
Methods
We conducted focus groups with practicing endocrinologists from 2 large metropolitan areas using a semistructured discussion guide designed to elicit perspectives of and experiences with technology adoption. The thematic analysis identified barriers to and facilitators of integrating digital glucometers into clinical practice. Participants also provided recommendations for integrating digital health technologies into clinical practice more broadly.
Results
A total of 10 endocrinologists were enrolled: 60% (6/10) male; a mean of 18.4 years in practice (SD 5.6); and 80% (8/10) working in a group practice setting. Participants stated that digital glucometers represented a significant change in the treatment paradigm for diabetes care and facilitated more effective care delivery and patient engagement. Barriers to the adoption of digital glucometers included lack of coverage, provider reimbursement, and data management support, as well as patient heterogeneity. Participant recommendations to increase the use of digital health technologies included expanding reimbursement for clinician time, streamlining data management processes, and customizing the technologies to patient needs.
Conclusions
Digital glucose monitoring technologies have facilitated more effective, individualized care delivery and have improved patient engagement and health outcomes. However, key challenges faced by the endocrinologists included lack of reimbursement for clinician time and nonstandardized data management across devices. Key recommendations that may be relevant for other diseases include improved data analytics to quickly and accurately synthesize data for patient care management, streamlined software, and standardized metrics.
... The rise in the use of mobile health applications (apps) as aids in the self-management of chronic conditions has been shown to be useful. However, uptake and repeated use of apps has been challenging (Lau et al. 2017). Few have been developed in conjunction with patients and this may explain their often limited impact in improving outcomes for patients. ...
Gout is increasing in prevalence despite effective pharmacotherapies. Barriers to effective management are largely educational deficiencies. Sufferers, usually men, need to understand more about gout, especially that maintaining serum urate below 0.36 mmol/L will eliminate recurrent attacks. Also, of great importance is appreciating that sub-optimal adherence to urate-lowering therapy (ULT) will result in a return of attacks. Prescribers also need to understand that acute attacks are likely to occur in the first few months of urate-lowering therapy (ULT), but these can be mitigated by commencing with a dose of ULT reflective of renal function and escalating the dose slowly, every 2–5 weeks until target serum urate is achieved. Prophylaxis against acute attacks over the initial 6 months period of ULT can be enhanced further with concomitant colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs).Gout is largely managed in primary care. Rates of adherence to ULT are 50% or less, worse than most other chronic illnesses. Efforts at educating primary care physicians to, firstly, manage gout effectively and, secondly, to educate their gout patients sufficiently have not been successful. Allied health practitioners, such as nurses, working with prescribers in primary care settings and given the mandate to educate and manage patients with gout, have been spectacularly effective. However, this approach is resource intensive. ‘Personalised’ eHealth interventions show promise as an alternative strategy, notably in improving adherence to ULT.Numerous applications for smart phones (apps) are now available to assist people with chronic health conditions. Their design needs to accommodate the barriers and enablers perceived by patients to maintaining adherence to prescribed therapies. Personalised feedback of serum urate may represent an important enabler of adherence to ULT in the case of gout.Harnessing mobile apps to support patients managing their chronic illnesses represents an important opportunity to enhance health outcomes. Rigorous, patient-centred and driven development is critical. These tools also require careful evaluation for effectiveness.
