Evaluating the implementation of a personal health record for chronic primary and secondary care: a mixed methods approach

Abstract

BackgroundPersonal health records (PHRs) provide the opportunity for self-management support, enhancing communication between patients and caregivers, and maintaining and/or improving the quality of chronic disease management. Their implementation is a multi-level and complex process, requiring a holistic approach that takes into account the technology, its users and the context of implementation. The aim of this research is to evaluate the fidelity of a PHR in chronic care (the degree to which it was implemented as intended) in order to explain the found effects.MethodsA convergent parallel mixed methods design was used, where qualitative and quantitative data were collected in parallel, analyzed separately, and finally merged. Log data of 536 users were used to gain insight into the actual long-term use of the PHR (the dose). Focus group meetings among caregivers (n = 13) were conducted to assess program differentiation (or intended use). Interviews with caregivers (n = 28) and usability tests with potential end-users (n = 13) of the PHR were used to understand the responsiveness and the differences and similarities between the intended and actual use of the PHR.ResultsThe results of the focus groups showed that services for coaching are strongly associated with monitoring health values and education. However, the PHR was not used that way during the study period. In the interviews, caregivers indicated that they were ignorant on how to deploy the PHR in current working routines. Therefore, they find it difficult to motivate their patients in using the PHR. Participants in the usability study indicate that they would value a PHR in the future, given that the usability will be improved and that the caregivers will use it in daily practice as well.ConclusionsIn this study, actual use of the PHRs by patients was influenced by the responsiveness of caregivers. This responsiveness is likely to be strongly influenced by the perceived support when defining the differentiation and delivery of the PHR. A mixed-methods approach to understand intervention fidelity was of added value in providing explanations for the found effects that could not be revealed by solely focusing on the effectiveness of the technology in an experimental trial.

Integrating People, Context, and Technology in the Implementation of a Web-Based Intervention in Forensic Mental Health Care: Mixed-Methods Study

“…Consequently, a mixed-methods approach where different types of quantitative and qualitative data are triangulated does justice to the complex integration of factors related to people, technology, and context. This is required for wielding a holistic approach toward the evaluation of eHealth implementation [35][36][37][38].…”

Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review

“…The education function can include resources from trusted websites [ 45 , 90 ], health information libraries [ 22 , 30 ], video resources [ 46 , 59 , 95 ], or government supported information [ 95 ]. The information can consist of lifestyle management [ 45 , 57 , 71 ], first-aid information [ 40 , 70 ], discharge instructions [ 31 ], surgical procedure [ 77 ], physical activities guidance [ 96 ], or health-specific education such as pregnancy [ 97 , 98 ], mental health [ 45 , 61 ], or chronic diseases–related education [ 90 , 95 ]. Figure 8 shows an example of the education page in the Maternity Information Access Point [ 97 ].…”

“…Patients can manage their own health related to nutrition and diet information such as weight [ 30 , 33 , 39 , 58 , 66 , 67 , 72 , 85 , 86 , 90 , 98 , 100 - 102 ], height [ 39 , 58 , 66 ], physical activity or exercise [ 30 , 33 , 58 , 66 , 70 , 96 , 98 , 100 , 101 ], and food and meals [ 33 , 66 , 98 ]. Patients can also manage their vital sign data such as temperature [ 26 , 44 ], blood pressure [ 30 , 33 , 44 , 58 , 66 , 67 , 70 , 72 , 85 , 90 , 98 , 101 , 103 ], blood glucose [ 30 , 58 , 66 , 70 , 72 , 85 , 86 , 98 , 103 ], and heart rate [ 90 ]. Patients can also monitor other self-health data such as sleep [ 33 , 66 , 95 , 100 , 101 ], period [ 33 , 100 ], moods [ 98 , 100 , ...…”

“…A PHR may add a section to guide patients about the features in the PHR [46,54,59,61,65,83,90,96,118] and quick access to the essential functionalities [37,48,108]. The use of user-interface elements like buttons and a dropdown menu can enhance the user-friendliness and simplicity of the PHR interface [25,100].…”

Psychometric Evaluation of the TWente Engagement with Ehealth Technologies Scale (TWEETS): Evaluation Study

“…It seems reasonable to expect engagement to change after getting more acquainted with the app, and when actually trying to use the app for a longer period in daily life. As integrating technology in daily life is often one of the largest struggles in eHealth and specifically DHIs [ 36 ], being able to do so or not might be an obvious reason for a change in engagement. Taking these factors into account, it may be even more remarkable to see that participants’ initial engagement, based on only 1 day of using a DHI, is still as related to engagement at a later stage.…”