Identifying Opportunities, and Motivation to Enhance Capabilities, Influencing the Development of a Personalized Digital Health Hub Model of Care for Hip Fractures: Mixed Methods Exploratory Study
Authors: Yadav Lalit , Gill Tiffany K , Taylor Anita , De Young Jennifer , Chehade Mellick J 
Published: June 2021

Background
Most older people after a hip fracture injury never return to their prefracture status, and some are admitted to residential aged care facilities. Advancement of digital technology has helped in optimizing health care including self-management and telerehabilitation.

Objective
This study aims to understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub.

Methods
We conducted a mixed methods study in South Australia involving patients aged 50 years and older, their family members, and residential aged caregivers. Quantitative data analysis included basic demographic characteristics, and access to digital devices was analyzed using descriptive statistics. Spearman rank-order correlation was used to examine correlations between the perceived role of a personalized digital health hub in improving health and the likelihood of subsequent use. Findings from qualitative analysis were interpreted using constructs of capability, opportunity, and motivation to help understand the factors influencing the likelihood of potential personalized digital health hub use.

Results
This study recruited 100 participants—55 patients, 13 family members, and 32 residential aged caregivers. The mean age of the patients was 76.4 (SD 8.4, range 54-88) years, and 60% (33/55) of the patients were female. Approximately 50% (34/68) of the patients and their family members had access to digital devices, despite less than one-third using computers as part of their occupation. Approximately 72% (72/100) of the respondents thought that personalized digital health hub could improve health outcomes in patients. However, a moderate negative correlation existed with increasing age and likelihood of personalized digital health hub use (Spearman ρ=–0.50; P<.001), and the perceived role of the personalized digital health hub in improving health had a strong positive correlation with the likelihood of personalized digital health hub use by self (Spearman ρ=0.71; P<.001) and by society, including friends and family members (Spearman ρ=0.75; P<.001). Most patients (54/55, 98%) believed they had a family member, friend, or caregiver who would be able to help them use a personalized digital health hub. Qualitative analysis explored capability by understanding aspects of existing knowledge, including willingness to advance digital navigation skills. Access could be improved through supporting opportunities, and factors influencing intrinsic motivation were considered crucial for designing a personalized digital health hub–enabled model of care.

Conclusions
This study emphasized the complex relationship between capabilities, motivation, and opportunities for patients, their family members, and formal caregivers as a patient networked unit. The next stage of research will continue to involve a cocreation approach followed by iterative processes and understand the factors influencing the development and successful integration of complex digital health care interventions in real-world scenarios.