Tahsin Farah, Austin Tujuanna, McKinstry Brian, Mercer Stewart W, Loganathan Mayura, Thavorn Kednapa, Upshur Ross, Steele Gray Carolyn
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
JMIR Hum Factors. 2022 Nov 30;9(4):e37684. doi: 10.2196/37684.
Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors that affect patients' use behavior.
The aim of this study was to explore the social and behavioral factors contributing to patients' use behavior of an mHealth app called the electronic Patient-Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models.
A descriptive qualitative study was used to analyze interview data collected for a larger mixed methods pragmatic trial. The original 15-month trial was conducted in 6 primary care teams across Ontario, Canada, between 2018 and 2019. The eligibility criteria for patients were being aged ≥60 years with ≥10 visits within the previous 12 months of study enrollment. For this analysis, patients were classified as long-term or short-term users based on their length of use of the ePRO app during the trial. The Social Cognitive Theory by Bandura was used to categorize social-behavioral factors that contributed to patients' decision to continue or discontinue using the app.
The patient-provider relationship emerged as a key factor that shaped patients' experiences with the app and subsequent decision to continue using the app. Other factors that contributed to patients' decision to continue using the app were personal and social circumstances, perceived usefulness, patients' previous experience with goal-related behaviors, and confidence in one's capability. There was an overlap of experience between long- and short-term app users but, in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term app users. This observation was complicated by the fact that patient health-related goals were dynamic and changed over time.
Complex patients' use behavior of a goal-supporting mHealth app is shaped by an array of sociobehavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs.
ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954.
尽管移动健康（mHealth）应用程序越来越多地被用于支持患有多种慢性病（多病共存）的患者，但大多数mHealth应用程序的交互性较低，最终会被用户弃用。为了解决这一参与度问题，在开发mHealth项目时，了解影响患者使用行为的社会行为因素非常重要。
本研究旨在探讨影响患者使用一款名为电子患者报告结局（ePRO）的mHealth应用程序的社会和行为因素。ePRO应用程序支持跨学科初级保健模式中以目标为导向的护理服务。
采用描述性定性研究方法，对为一项更大规模的混合方法实用试验收集的访谈数据进行分析。最初为期15个月的试验于2018年至2019年在加拿大安大略省的6个初级保健团队中进行。患者的纳入标准为年龄≥60岁，在研究入组前12个月内就诊次数≥10次。在本次分析中，根据患者在试验期间使用ePRO应用程序的时长，将其分为长期或短期用户。采用班杜拉的社会认知理论对影响患者决定继续或停止使用该应用程序的社会行为因素进行分类。
患者与提供者之间的关系成为塑造患者使用该应用程序体验以及随后决定继续使用该应用程序的关键因素。促成患者决定继续使用该应用程序的其他因素包括个人和社会情况、感知有用性、患者之前与目标相关行为的经验以及对自身能力的信心。长期和短期应用程序用户之间存在经验重叠，但总体而言，长期用户比短期用户认为该应用程序更有用，且他们的目标更有意义。患者与健康相关的目标是动态变化的，这一事实使这一观察结果变得复杂。
目标支持型mHealth应用程序复杂的患者使用行为受到一系列可能演变的社会行为因素的影响。为应对这种动态变化，应强调创建适应性强的健康技术，这些技术易于患者定制，并能够响应他们不断变化的环境和需求。
ClinicalTrials.gov NCT02917954；https://clinicaltrials.gov/ct2/show/NCT02917954 。
