Swiss Paraplegic Research, Nottwil, Switzerland.
Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
JMIR Mhealth Uhealth. 2020 Dec 9;8(12):e22452. doi: 10.2196/22452.
Mobile health applications can offer tailored self-management support to individuals living with chronic health conditions. However, there are several challenges to the adoption of these technologies in practice. Co-design is a promising approach to overcoming some of these challenges by enabling the development of solutions that meet the actual needs and preferences of the relevant stakeholder groups.
Taking spinal cord injury as a case in point, the overall objectives of this study were to identify the perceived benefits of a co-designed self-management app that could promote its uptake and to explore the factors that may impede adoption.
We adopted a qualitative research approach guided by the Technology Acceptance Model. Data were collected through semistructured interviews with individuals with spinal cord injury (n=15) and two focus groups with health care professionals specialized in spinal cord injury (n=7, n=5). Prior to the interviews and focus groups, study participants were given time to explore the app prototype. All interviews were transcribed verbatim and analyzed using inductive thematic analysis.
Findings of our analysis indicate that study participants perceived the app prototype as potentially useful for supporting individuals with spinal cord injury in preventing pressure injuries. In particular, we identified three concrete use cases highlighting the benefits of the app for different audiences: (1) a companion for newly injured individuals, (2) an emergency kit and motivational support, and 3) a guide for informal caregivers and family members. We also uncovered several challenges that might impede the adoption of the self-management app in practice, including (1) challenges in motivating individuals to use the app, (2) concerns about the misuse and abuse of the app, and (3) organizational and maintenance challenges.
This study adds to a growing body of research that investigates individuals' adoption and nonadoption behavior regarding mobile health solutions. Building on earlier work, we make recommendations on how to address the barriers to the adoption of mobile health solutions identified by this study. In particular, there is a need to foster trust in mobile health among prospective users, including both patients and health care professionals. Moreover, increasing personal relevance of mobile health solutions through personalization may be a promising approach to promote uptake. Last but not least, organizational support also plays an instrumental role in mobile health adoption. We conclude that even though co-design is promoted as a promising approach to develop self-management tools, co-design does not guarantee adoption. More research is needed to identify the most promising strategies to promote the adoption of evidence-based mobile health solutions in practice.
移动健康应用程序可以为患有慢性健康状况的个人提供量身定制的自我管理支持。然而，这些技术在实践中的采用存在一些挑战。共同设计是一种很有前途的方法，可以通过开发满足相关利益相关者群体实际需求和偏好的解决方案来克服其中的一些挑战。
以脊髓损伤为例，本研究的总体目标是确定可以促进其采用的共同设计自我管理应用程序的预期收益，并探讨可能阻碍采用的因素。
我们采用了定性研究方法，以技术接受模型为指导。通过对 15 名脊髓损伤患者和两组专门从事脊髓损伤的医疗保健专业人员（n=7，n=5）的半结构化访谈收集数据。在访谈和焦点小组之前，研究参与者有时间探索应用程序原型。所有访谈均逐字记录，并使用归纳主题分析进行分析。
分析结果表明，研究参与者认为应用程序原型有可能支持脊髓损伤患者预防压疮。特别是，我们确定了三个具体的用例，突出了该应用程序对不同受众的好处：（1）新受伤个体的伴侣，（2）紧急情况套件和激励支持，（3）非正式照顾者和家庭成员的指南。我们还发现了一些可能在实践中阻碍自我管理应用程序采用的挑战，包括（1）激励个人使用应用程序的挑战，（2）对应用程序误用和滥用的担忧，以及（3）组织和维护挑战。
本研究是对研究移动健康解决方案个人采用和不采用行为的不断增长的研究的补充。在此基础上，我们就如何解决本研究确定的移动健康解决方案采用障碍提出了建议。特别是，需要在潜在用户（包括患者和医疗保健专业人员）中建立对移动健康的信任。此外，通过个性化来提高移动健康解决方案的个人相关性可能是促进采用的一种很有前途的方法。最后但同样重要的是，组织支持在移动健康采用中也起着重要作用。我们的结论是，即使共同设计被宣传为开发自我管理工具的一种很有前途的方法，但共同设计并不能保证采用。需要更多的研究来确定促进实践中采用基于证据的移动健康解决方案的最有前途的策略。
