Brandt Carl Joakim, Søgaard Gabrielle Isidora, Clemensen Jane, Søndergaard Jens, Nielsen Jesper Bo
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark.
J Med Internet Res. 2018 Jul 5;20(7):e237. doi: 10.2196/jmir.9791.
Success with lifestyle change, such as weight loss, tobacco cessation, and increased activity level, using electronic health (eHealth) has been demonstrated in numerous studies short term. However, evidence on how to maintain the effect long-term has not been fully explored, even though there is a pressing need for long-term solutions. Recent studies indicate that weight loss can be achieved and maintained over 12 and 20 months in a primary care setting using a collaborative eHealth tool. The effect of collaborative eHealth in promoting lifestyle changes depends on competent and skilled dieticians, nurses, physiotherapists, and occupational therapists acting as eHealth coaches. How such health care professionals perceive delivering asynchronous eHealth coaching and which determinants they find to be essential to achieving successful long-term lifestyle coaching have only been briefly explored and deserve further exploration.
The aim of this study is to analyze how health care professionals perceive eHealth coaching and to explore what influences successful long-term lifestyle change for patients undergoing hybrid eHealth coaching using a collaborative eHealth tool.
A total of 10 health care professionals were recruited by purposive sampling. They were all women aged 36 to 65 years of age with a mean age of 48 years of age. A total of 8/10 (80%) had more than 15 years of experience in their field, and all had more than six months of experience providing eHealth lifestyle coaching using a combination of face-to-face meetings and asynchronous eHealth coaching. They worked in 5 municipalities in the Region of Southern Denmark. We performed individual, qualitative, semistructured, in-depth interviews in their workplace about their experiences with health coaching about lifestyle change, both for their patients and for themselves, and mainly how they perceived using a collaborative eHealth solution as a part of their work.
The health care professionals all found establishing and maintaining an empathic relationship essential and that asynchronous eHealth lifestyle coaching challenged this compared to face-to-face coaching. The primary reason was that unlike typical in-person encounters in health care, they did not receive immediate feedback from the patients. We identified four central themes relevant to the health care professionals in their asynchronous eHealth coaching: (1) establishing an empathic relationship, (2) reflection in asynchronous eHealth coaching, (3) identifying realistic goals based on personal barriers, and (4) staying connected in asynchronous coaching.
Establishing and maintaining an empathic relationship is probably the most crucial factor for successful subsequent eHealth coaching. It was of paramount importance to get to know the patient first, and the asynchronous interaction aspect presented challenges because of the delay in response times (both ways). It also presented opportunities for reflection before answering. The health care professionals found they had to provide both relational communication and goal-oriented coaching when using eHealth solutions. Going forward, the quality of the health care professional-patient interaction will need attention if patients are to benefit from collaborative eHealth coaching fully.
众多研究已证明，在短期内，利用电子健康（eHealth）手段进行生活方式改变，如减肥、戒烟和提高活动水平，是有成效的。然而，尽管迫切需要长期解决方案，但关于如何长期维持这种效果的证据尚未得到充分探索。最近的研究表明，在初级保健环境中，使用协作式电子健康工具，体重减轻可以在12个月和20个月内实现并维持。协作式电子健康在促进生活方式改变方面的效果取决于有能力且熟练的营养师、护士、物理治疗师和职业治疗师担任电子健康教练。对于这些医疗保健专业人员如何看待提供异步电子健康教练服务，以及他们认为哪些决定因素对于实现成功的长期生活方式指导至关重要，目前仅进行了简要探索，值得进一步研究。
本研究的目的是分析医疗保健专业人员如何看待电子健康教练服务，并探讨使用协作式电子健康工具进行混合电子健康教练服务时，哪些因素会影响患者成功实现长期生活方式改变。
通过目的抽样法共招募了10名医疗保健专业人员。她们均为女性，年龄在36至65岁之间，平均年龄为48岁。10人中有8人（80%）在其领域拥有超过15年的经验，并且所有人都有超过六个月使用面对面会议和异步电子健康教练相结合的方式提供电子健康生活方式指导的经验。她们在丹麦南部地区的5个市政当局工作。我们在她们的工作场所进行了个人、定性、半结构化的深入访谈，了解她们在为患者和自己进行生活方式改变的健康指导方面的经验，主要是她们如何看待将协作式电子健康解决方案作为工作的一部分。
医疗保健专业人员都认为建立和维持共情关系至关重要，并且与面对面指导相比，异步电子健康生活方式指导对这一点提出了挑战。主要原因是，与医疗保健中典型的面对面接触不同，她们没有从患者那里得到即时反馈。我们确定了与医疗保健专业人员的异步电子健康教练服务相关的四个核心主题：（1）建立共情关系；（2）在异步电子健康教练服务中进行反思；（3）基于个人障碍确定现实目标；（4）在异步教练服务中保持联系。
建立和维持共情关系可能是后续成功进行电子健康教练服务的最关键因素。首先了解患者至关重要，异步互动方面由于响应时间的延迟（双向）带来了挑战。它也为回答前的反思提供了机会。医疗保健专业人员发现，在使用电子健康解决方案时，他们必须提供关系沟通和目标导向的指导。展望未来，如果患者要充分受益于协作式电子健康教练服务，医疗保健专业人员与患者互动的质量将需要得到关注。
