Design and Integration of Mobile Health Technology in the Treatment of Orthopaedic Surgery: A Qualitative Study

Abstract

Background The use of mobile health (mHealth) technologies has dramatically increased in the past year. A critical component in the discussion about telehealth and mHealth technologies is the importance of integrating the voices of patients, caregivers, and their clinicians. Methods This study was performed at a tertiary center in Houston consisting of 7 hospitals (1 academic and 6 community hospitals). The clinically integrated mHealth technology consisted of a mHealth education and monitoring platform that used patient-centered emails and text messages over a 50-day period, from prior to the orthopaedic total joint replacement surgery to posthospital discharge to provide education and health monitoring at home. Study participants included patients who were scheduled for total joint replacement surgery between July 2018 and November 2019, and their caregivers. The study involved two components: (1) focus group study (n = 15); split into two groups of participants who had not used the mHealth technology (α-testing during the design phase, prior to implementation); and (2) a content analysis of 377 free-text comments from patients who used the mHealth technology, and who responded to questions about their use of the mHealth platform (β-testing; after implementation, during the execution phase). Thematic analyses methods were used. Results Three key themes emerged during the design phase including: (1) monitoring, bidirectional questions asking patients to respond to a question can feel invasive and/or annoying unless framed in a reciprocal, contextual-based way; (2) text messages should be used selectively for time-sensitive, critical information; and (3) information should be contained within the body of the message. Three themes emerged during the execution phase include: (1) the content should be divided into small, digestible chunks at the times that patients need that information; (2) the tone of the messages should be approachable and friendly, as opposed to detached and professional; and (3) mHealth technologies make patients calmer and more confident and less inclined to draw on hospital personnel, enabling patients to be managed by the automated program without escalating to human care. Limited, bidirectional engagement can foster interactivity and patient monitoring without becoming excessive or burdensome to health care professionals. Conclusion The use of mHealth for patient care is likely to be more effective and used in this multihospital mHealth technology study of patients undergoing orthopaedic surgery, if they are clinically integrated with staff who can respond to escalated problems as needed, to enable better adoption, uptake, and sustainability of technology.

Design and Integration of a Texting Tool to Keep Patients’ Family Members Updated During Hospitalization: Family Members’ Perspectives

“…However, modest levels of interactivity with close-ended, option responses, allow patients to feel meaningfully connected. (21,22) We believe this study supports our earlier finding that families also respond favorably to most levels of interactivity. (21,22) This finding suggests that family-clinician connectedness can be achieved without becoming administratively burdensome.…”

“…(21,22) We believe this study supports our earlier finding that families also respond favorably to most levels of interactivity. (21,22) This finding suggests that family-clinician connectedness can be achieved without becoming administratively burdensome. (23) The findings on security features are also insightful.…”

“…A more nuanced interpretation would suggest that there is a range of diverse situations in which families become motivated to create authentic family-clinician relationships. (21,22) Specifically, our data suggests that it is the content—clinicians’ willingness to write personalized free-text messages based on families’ informational needs and avoiding scripted, canned messages—that allows families to feel engaged. Families can tell whether messages sent are genuine attempts to keep them meaningfully and intentionally updated on the day's plan of care or health progress versus ones that are “robotic” sounding and sent for “compliance” purposes.…”