Toward Integration of mHealth in Primary Care in the Netherlands: A Qualitative Analysis of Stakeholder Perspectives

Abstract

Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views.Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis.Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers.Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation.

Acceptability, Barriers and Facilitators of Mobile Text Message Reminder System Implementation in Improving Child Vaccination: A Qualitative Study in Northwest Ethiopia

“…In another study, it was stated that key strategies to facilitate the integration of mHealth interventions in existing health systems demand collaboration between stakeholders. 59 Evidence also indicated that there is a huge interest by the government of Ethiopia to integrate and implement mHealth initiatives for various health programs. 8 , 11 Hence, multi-sectoral collaboration is very important for the success of mHealth initiatives in Ethiopia since its implementation is dependent on the collaboration of various sectors including Ethio-Telecom and non-governmental organizations.…”

Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study

“…The lack of knowledge of effective apps seems to be the main barrier [ 15 , 16 ]. Dutch GPs seem to have a supporting or mixed attitude toward the integration of mHealth in primary care [ 17 ]. A German survey [ 18 ] conducted with 1070 GPs showed that “skeptical physicians”—who are concerned about data security, reliability of apps, legal questions, and additional burdens—are more numerous (44%) than the “open-minded physicians” (35%), who emphasized motivational and compliance advantages.…”

Using a Clinical Workflow Analysis to Enhance eHealth Implementation Planning: Tutorial and Case Study

“…To ensure that adaptations enhance compatibility and remain within the adaptable periphery, it is suggested that the investigators and clinic staff collaborate to develop adaptations. In addition to engaging the clinical staff stakeholders, a key construct of CFIR and a critical component of integrating eHealth into primary care, this collaboration increases the likelihood of meeting two additional constructs within the CFIR process domain: identifying clinical champions and garnering the support of opinion leaders [ 19 , 22 , 23 ].…”