Digital health experiences reported in chronic disease management: An umbrella review of qualitative studies

Abstract

Introduction Digital health interventions can be useful for the management of chronic disease. The aim of this study was to draw out universal themes to understand how people with chronic conditions experience digital health services, programmes, and interventions, and consequently, better inform future digital health delivery. Methods An umbrella review was conducted to identify qualitative systematic reviews reporting digital health experiences in chronic disease. Themes for each included review were independently extracted and appraised by two review authors. Data analysis was conducted using the Constant Comparative method. Results Twenty-two systematic reviews containing 240 individual studies were selected for inclusion. Mental health was the most common condition ( n = 5, 23%), followed by cancer ( n = 4, 18%) or a combination of chronic diseases ( n = 4, 18%). Common themes across the conditions were categorised under nine headings, including: (i) participation and engagement (strong usability and engagement vs reluctance to use digital health when these concepts are ignored), (ii) trust, confidence, and competence (users felt reassured, however technology illiteracy led to a perceived lack of control), (iii) perceived value, perceived effectiveness, transaction cost (gained from efficient aspects of digital health, but also lost through the burden of keeping up with data entry), (iv) perceived care quality (requiring tailoring and fostering motivation), (v) barriers and threats (related to technology risks and challenges), (vi) health outcomes (improved self-management capability), (vii) relationships (improved participant-health professional interaction, but interpersonal aspects such as face-to-face contact were lacking), (viii) unplanned benefit (where digital health often led to users feeling more empowered in their health journey), and (ix) diversity of experiences (reflecting ambivalence of experiences and discipline-specific experiences). Conclusion People with chronic conditions perceive digital health provides feelings of reassurance and the ability to self-manage their condition. While there is ambivalence across the participant experiences reported within the major themes, this umbrella review has outlined a need for future interventions that are user-friendly, flexible, and tailored to individual users. This will be best achieved through a co-design model, with the consumer actively involved in the planning and design of digital health products and services.

A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice

“…46 There was insufficient evidence to understand the benefits and limitations of incorporating clinicians into the intervention; however, a recent umbrella review (2022) collated patient experiences of digital health in disease management and found patients did not want mHealth to replace the interpersonal relationship between patient and clinician. 47…”

“…46 There was insufficient evidence to understand the benefits and limitations of incorporating clinicians into the intervention; however, a recent umbrella review (2022) collated patient experiences of digital health in disease management and found patients did not want mHealth to replace the interpersonal relationship between patient and clinician. 47 Incorporating stakeholders in the design of these interventions was a component in 5 publications. Codesign is vital in ensuring usable and acceptable support is provided to people living with stroke and their caregivers.…”

Implementing a virtual emergency department to avoid unnecessary emergency department presentations

“…5 The acceptability and satisfaction of virtual care has grown enormously and now, based on over 30 years of literature, is strong to support its continued exploration as a patientcentred and clinically suitable alternative model to in-person care. 23 However, we note that we surveyed only GP referrers and no other clinicians and services were surveyed, and we did not survey our patients. This limits our interpretation slightly around adoption and satisfaction.…”

“…Similarly, the Canadian observational study total of 1036 paediatric patients reported a 87% satisfaction rating 5 . The acceptability and satisfaction of virtual care has grown enormously and now, based on over 30 years of literature, is strong to support its continued exploration as a patient‐centred and clinically suitable alternative model to in‐person care 23 . However, we note that we surveyed only GP referrers and no other clinicians and services were surveyed, and we did not survey our patients.…”

Trust and confidence in using telehealth in people with chronic kidney disease: A cross-sectional study

“…User perceptions of telehealth are influenced by trust in healthcare professionals and the impact on self-management. 10 Patient trust in telehealth could become a major obstacle to delivering effective, safe and sustainable healthcare, the more healthcare delivery becomes digitally disrupted. 18,19 Trust is considered paramount in healthcare delivery, 20 and high levels are associated with increased treatment adherence, optimal health outcomes and patient satisfaction.…”