Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics ‘intervention’, ‘context of use’ and ‘user’ were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.

IntroductionInsufficient physical activity is one of the most important risk factors for non-communicable diseases. Physical activity should therefore be intensively promoted in all age groups. Several trials suggest that it can be effectively increased through smartphone interventions.However, few of the smartphone-interventions available on the market have been scientifically evaluated. Therefore, the described study aims to assess the short-term and long-term effects of the smartphone intervention ‘VIDEA bewegt’ to increase physical activity. The trial is designed as a single-armed observational trial to assess effects under real-life conditions.Methods and analysisThe intervention consists of the smartphone-application ‘VIDEA bewegt’, which is a video-based preventative programme to improve physical activity in everyday life. The application contains several features and components including educational videos, documentation of activity and motivational exercises. A sample size of at least 106 participants is aimed for.The primary objective of this study is to determine the effect of the application on physical activity in German adults. Secondary objectives are to evaluate the self-efficacy, health-related quality of life and usability of ‘VIDEA bewegt’.Data collection is based on online questionnaires, as well as system-internal recorded data.Changes of outcomes from baseline to programme completion and follow-up will be calculated.Ethics and disseminationThe Ethics Committee of the Technical University Dresden approved the study on 25 May 2019 (EK 272062019). All data are processed anonymously and stored on servers only accessible by authorised personnel. The results of the study and the results of the usability test are aimed to be published in a scientific journal.Trial registration numberGerman Clinical Trials Registry (DRKS00017392).

As physical inactivity is one of the four leading risk factors for mortality, it should be intensively treated. Therefore, this one-year follow-up study aimed to evaluate the long-term effects of a preventive app to increase physical activity in German adults under real-life circumstances. Data collection took place from July 2019 to July 2021 and included six online questionnaires. Physical activity was studied as the primary outcome based on MET-minutes per week (metabolic equivalent). Secondary outcomes included health-related quality of life based on a mental (MCS) and physical health component summary score (PCS). At the time of publication, 46/65 participants completed the study (median 52 years, 81.5% women). A significant increase of physical activity was observed in people with a low/moderate baseline activity during the first four months of follow-up (median increase by 490 MET-minutes per week, p < 0.001, r = 0.649). Both MCS (median increase by 2.8, p = 0.006, r = 0.344) and PCS (median increase by 2.6, p < 0.001, r = 0.521) significantly increased during the first two months and the BMI significantly decreased during the first six months after the intervention (median decrease by 0.96 kg/m2, p < 0.001, r = 0.465). Thus, this study provides evidence for the medium-term impact of the app, since the effects decreased over time. However, due to the chosen study design and a sizeable loss to follow-up, the validity of these findings is limited.

Background Insufficient physical activity is one of the most important risk factors for non-communicable diseases and should therefore be intensively prevented in all age groups. According to several trials, activity can be effectively increased by smartphone-based interventions. However, the use of digital applications depends on many factors such as user acceptance and intuitive operability. Therefore, usability testing has proven to be important for the successful development of digital interventions. Thus, the German app “VIDEA bewegt” was tested on its usability in order to assess the strengths and weaknesses of the product and to improve of the app.Methods In April 2019 ten interviews were conducted using the think-aloud method and following a standardised protocol. The adult participants were confronted with “VIDEA bewegt” for the first time and had to perform pre-defined tasks covering the main features of the app. Demographics of the participants and their expectations towards an app were collected. The interviews were recorded and transcribed. The analysis of the transcripts was performed independently by two team members following the deductive qualitative content analysis according to Mayring.Results The app was rated positively in terms of design, basic registration process and the largely self-explanatory navigation. Users found the app lacked an explanation of the included components and the basic structure of the programme. Several problems with the usability were described, including technical errors and problems with understanding individual control elements. Four of the ten participants could imagine using the app in the future.Conclusions All test participants were able to use the app independently to a large extent and most of the a priori defined goals were achieved successfully. With certain minor changes, the usability can therefore be assessed as good.Trial registration The performed usability test is the basis of a study named “Evaluation of an app-based activity intervention for statutory health insured people” which is registered in the German Clinical Trials Register (DRKS). DRKS-ID: DRKS00017392 (14 June 2019)