Designing an eHealth service for post-hospitalization self-management support in long-term illness – a user-centered qualitative study. (Preprint)
Authors: Wathne Hege , Morken Ingvild Margreta , Storm Marianne , Husebø Anne Marie Lunde 
Published: May 2022

BACKGROUND

For patients with long-term chronic illnesses, such as heart failure (HF) and colorectal cancer (CRC), eHealth interventions have the potential to meet the patients´ post-hospital discharge needs and strengthen their ability for self-management. To ensure the successful implementation of eHealth services, a user-centered co-design approach is suggested to establish the services´ usefulness and acceptability. Co-design could ensure that the eHealth intervention is developed in response to users´ supportive care needs when transitioning to home after treatment in the hospital. Therefore, by involving different stakeholders (ie, patients, health care professionals [HCPs]) in co-design processes throughout the development phase of eHealth interventions, feasible, acceptable, and usable solutions may emerge.

OBJECTIVE

The objective of this study was to explore the perspectives of patients with HF, patients with CRC and HCPs on self-management needs following discharge from the hospital, and to investigate how a nurse-assisted eHealth service could best be designed to ensure acceptability and usefulness.

METHODS

A qualitative, explorative, and descriptive approach was used. We conducted 38 semi- structured interviews with 10 patients with HF, nine patients surgically treated for CRC with curative intent, six registered nurses recruited as nurse navigators (NNs) of a planned eHealth service and 13 general practitioners (GPs) experienced with HF and CRC treatment and follow-up care. Patients were recruited from HF and CRC out-patient clinics and nurses were recruited from the cardiology and gastro-surgical departments of a university hospital in the south-western region of Norway. The GPs were recruited from primary care centers in surrounding municipalities. Semi-structured interview guides were used for data collection, and the data were analyzed using thematic analysis.

RESULTS

Three main themes were derived from the data analysis: 1) expecting information, reassurance and guidance when using eHealth for HF and CRC self-management, 2) expecting eHealth to be comprehensible, supportive and knowledge-promoting and, 3) both benefits and disadvantages are expected when using eHealth for HF and CRC self-management. Each main theme were supported by two sub-themes. The data generated from the interviews described the diverse needs for self-management support of patients with CRC and patients with HF after discharge from the hospital, such as unmet information and psychosocial needs. Furthermore, valuable suggestions regarding the design and content of the eHealth service were noted. However, there were differing opinions on whether the eHealth service would be beneficial to all patients during the transition from hospital to home.

CONCLUSIONS

Accessibility, usability, personalization, and interaction with support from HCP are important facilitators for the use of eHealth. The findings from this study add value to the planning and development of eHealth interventions for patients with long-term chronic illnesses.