Cruz-Martínez Roberto Rafael, Wentzel Jobke, Bente Britt Elise, Sanderman Robbert, van Gemert-Pijnen Julia Ewc
Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.
Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands.
JMIR Cardio. 2021 Dec 1;5(2):e31985. doi: 10.2196/31985.
eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before.
This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users.
Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections.
In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient.
Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
电子健康可彻底改变为慢性病患者（如心血管疾病患者）提供自我管理支持的方式。然而，患者实际进行自我管理的动机波动是一个需要考虑的重要因素。根据个人价值观定制和个性化电子健康有望成为一种有效的激励策略。尽管如此，之前尚未明确研究过特定的电子健康技术和设计特征如何可能有助于心血管疾病患者的价值观。
本研究旨在将一组经实证验证的心血管疾病患者与健康相关的价值观与现有的电子健康技术及其设计特征联系起来。该研究寻找设计特征与价值观之间的潜在联系，目标是增进对电子健康技术如何能对终端用户更具意义和激励作用的了解。
进行一项符合价值敏感设计框架的技术调查，对现有的电子健康技术进行内容分析。我们将心血管疾病患者经实证验证的11种价值观与系统评价中先前确定的10种电子健康技术的70个设计特征进行匹配。分析主要包括由研究团队的3名成员独立进行的演绎编码阶段。此外,10种被审查技术中的6种技术的研究人员和开发者提供了有关潜在特征 - 价值联系的信息。
电子健康设计特征与患者价值观之间总共建立了98种联系。这意味着一些设计特征可以有助于多种价值观。重要的是，有些价值观比其他价值观更常被涉及。心血管疾病患者最常涉及的价值观与以下方面有关：（1）拥有或保持健康的生活方式；（2）了解个人健康数据概况；（3）获得可靠的信息和建议；（4）有外在激励因素来实现目标或开展与健康相关的活动；（5）接受个性化护理。相比之下，较少涉及的价值观包括：（6）认为获得医疗保健的门槛低；（7）获得社会支持；（8）保持对生活的自主感；（9）对健康不感到恐惧、焦虑或不安全感。最后，两个基本未被涉及的价值观与以下方面有关：（10）对治疗或实现目标的能力有信心和自我效能感；（11）希望被视为一个人而不是患者。
积极的一面是，现有的电子健康技术可以与心血管疾病患者的价值观相联系，主要是通过与教育支持、自我监测支持、行为改变支持、反馈和激励措施相关的设计特征。其他设计特征，如提醒、提示或线索、基于同伴或专家的人力支持以及一般系统个性化也与价值观有联系，但方式较为有限。在未来的研究中，推断出的特征 - 价值联系必须用来自心血管疾病患者或类似慢性病患者的实证数据进行验证。
