Center for Digital Health Innovation, University of California, San Francisco, CA, United States.
Department of Medicine, University of California, San Francisco, CA, United States.
JMIR Mhealth Uhealth. 2024 Mar 20;12:e51236. doi: 10.2196/51236.
Patient engagement attrition in mobile health (mHealth) remote patient monitoring (RPM) programs decreases program benefits. Systemic disparities lead to inequities in RPM adoption and use. There is an urgent need to understand patients' experiences with RPM in the real world, especially for patients who have stopped using the programs, as addressing issues faced by patients can increase the value of mHealth for patients and subsequently decrease attrition.
This study sought to understand patient engagement and experiences in an RPM mHealth intervention in lung transplant recipients.
Between May 4, 2020, and November 1, 2022, a total of 601 lung transplant recipients were enrolled in an mHealth RPM intervention to monitor lung function. The predictors of patient engagement were evaluated using multivariable logistic and linear regression. Semistructured interviews were conducted with 6 of 39 patients who had engaged in the first month but stopped using the program, and common themes were identified.
Patients who underwent transplant more than 1 year before enrollment in the program had 84% lower odds of engaging (odds ratio [OR] 0.16, 95% CI 0.07-0.35), 82% lower odds of submitting pulmonary function measurements (OR 0.18, 95% CI 0.09-0.33), and 78% lower odds of completing symptom checklists (OR 0.22, 95% CI 0.10-0.43). Patients whose primary language was not English had 78% lower odds of engaging compared to English speakers (OR 0.22, 95% CI 0.07-0.67). Interviews revealed 4 prominent themes: challenges with devices, communication breakdowns, a desire for more personal interactions and specific feedback with the care team about their results, understanding the purpose of the chat, and understanding how their data are used.
Care delivery and patient experiences with RPM in lung transplant mHealth can be improved and made more equitable by tailoring outreach and enhancements toward non-English speakers and patients with a longer time between transplant and enrollment. Attention to designing programs to provide personalization through supplementary provider contact, education, and information transparency may decrease attrition rates.
移动医疗（mHealth）远程患者监测（RPM）项目中的患者参与度下降会降低项目效益。系统性差异导致 RPM 的采用和使用存在不平等现象。迫切需要了解患者在真实世界中对 RPM 的体验，尤其是对于已经停止使用该程序的患者，因为解决患者面临的问题可以提高 mHealth 对患者的价值，从而降低流失率。
本研究旨在了解肺移植受者 RPM mHealth 干预中的患者参与度和体验。
在 2020 年 5 月 4 日至 2022 年 11 月 1 日期间，共有 601 名肺移植受者入组了一项 mHealth RPM 干预措施以监测肺功能。使用多变量逻辑回归和线性回归评估患者参与度的预测因素。对在第一个月参与但停止使用该程序的 39 名患者中的 6 名进行了半结构化访谈，并确定了共同主题。
在入组该项目前接受移植手术超过 1 年的患者参与度降低了 84%（优势比 [OR] 0.16，95%CI 0.07-0.35），提交肺功能测量结果的可能性降低了 82%（OR 0.18，95%CI 0.09-0.33），完成症状检查表的可能性降低了 78%（OR 0.22，95%CI 0.10-0.43）。与英语为母语的患者相比，主要语言不是英语的患者参与度降低了 78%（OR 0.22，95%CI 0.07-0.67）。访谈揭示了 4 个突出的主题：设备使用挑战、沟通中断、希望与护理团队进行更多的个人互动并获得关于他们结果的具体反馈、理解聊天的目的以及理解他们的数据是如何使用的。
通过针对非英语患者和移植与入组之间时间较长的患者进行外展和增强工作，可以改进和实现肺移植 mHealth 中 RPM 的患者护理和体验公平性。通过补充提供者联系、教育和信息透明度来设计个性化方案，以提供个性化服务，可能会降低流失率。
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