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Experiences and factors affecting usage of an ehealth tool for self-management among people with chronic obstructive pulmonary disease: qualitative study
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0001-9688-8101
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2021 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 23, no 4, article id e25672Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.

OBJECTIVE: This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.

METHODS: The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months' access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.

RESULTS: Three main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants' experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.

CONCLUSIONS: Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.

Place, publisher, year, edition, pages
Toronto: JMIR Publications , 2021. Vol. 23, no 4, article id e25672
Keywords [en]
COPD, chronic disease, eHealth, primary care, qualitative content analysis, self-management
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-183265DOI: 10.2196/25672ISI: 000646934500004PubMedID: 33929327Scopus ID: 2-s2.0-85105370296OAI: oai:DiVA.org:umu-183265DiVA, id: diva2:1556077
Funder
Swedish Research Council, K2014-99X-22572-01-4Swedish Heart Lung Foundation, 20130331
Note

Trial Registration: ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187

International Registered Report Identifier: RR2-10.1136/bmjopen-2017-016851

Available from: 2021-05-20 Created: 2021-05-20 Last updated: 2024-03-22Bibliographically approved
In thesis
1. COPD management: exploring conditions for, and experiences of, evidence-based care and eHealth
Open this publication in new window or tab >>COPD management: exploring conditions for, and experiences of, evidence-based care and eHealth
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Behandling av KOL : undersökning av förutsättningar för, och erfarenheter av, evidensbaserad vård och eHälsa
Abstract [en]

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and premature death worldwide. It is a systemic disease that affects the whole person, although dyspnea is the mostprominent symptom. COPD is expected to increase in prevalence during the coming 40 years due to an increase in relevant risk behaviors, and today over 230 million people suffer from COPD worldwide. A common extra pulmonary manifestation of the disease is quadriceps dysfunction, where muscle strength, power, and/or endurance properties are reducedand affect everyday function. However, reference values and valid reference equations are needed to evaluate and offer appropriate treatment for quadriceps dysfunction. Moreover, a crucial part of COPD management is pulmonary rehabilitation, e.g., where disease management and strategies are conveyed and put into practice. However, due to knowledge gaps within health care, we need to develop new ways of informing and supporting people with COPD. One way is through eHealth, although these sources must be evaluated so that they constructively contribute to health care.

Aim: The overall aim of this thesis is to explore the conditions for, and perspectives on, evidence-based care and eHealth in COPD management. This aim is twofold. The first is to explore the experiences, interactions, and context of using eHealth tools in managing COPD in primary carefrom the perspective of people with COPD and health care professionals (HCPs). The second is to develop reference values and equations for quadriceps function.

Method: This dissertation contains three papers (Papers I, II, and III) based on individual interviews analyzed with qualitative research methods in which an eHealth tool, the COPD Web, is evaluated. Lastly, it contains one paper(Paper IV) based on an international multicenter data collection analyzed with quantitative research methods.

Results: Paper I: The findings indicate that the level of motivation, comfortability with IT tools, and health literacy seem to affect the usage of an eHealth tool over time. Some level of use and the passage of time appears to be needed to perceive gained benefits from the eHealth tool. In short, this suggests that eHealth tools such as the COPD Web can be suitable for supporting COPD-specific self-management skills. Paper II: The findings indicated that using the COPD Web provided knowledge support for HCPs and improved the quality of care for people with COPD. However, it seems some barriers need to be addressed to successfully implement the eHealth tool in daily practice. Paper III: Findings lead to the theme “Perceiving enough control to enable action”, which suggests that having or perceiving a certain amount of control is essential to maintain or increase the level of physical activity when one has COPD and uses an eHealth tool. Paper IV: The findings indicate that for people without COPD, age, sex, height, and BMI explained 50 – 70 % of the variance of quadriceps strength, endurance, and power. Our findings also suggested moderate construct validity of the reference equations in people with COPD.

Conclusion: To conclude, the web-based eHealth tool, the COPD Web, seems to support and help when self-managing COPD and treating people with COPD. There are still barriers for people with COPD to use a web-based eHealth tool, and we probably ought to screen people with COPD for health literacy before discussing and deciding on PR strategies with them. There are still barriers to implementing new tools in the health care setting, which should need time, support, and education to circumvent. Findings regarding the developed reference values and equations for quadriceps strength, power, and endurance will make further tailoring of the treatment regime for the individual possible. As such, this, too, should assist in improving disease management, although the construct validity of the equations was moderate.

Abstract [sv]

Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) är en av de vanligaste sjukdoms- och dödsorsakerna i världen. Det är en sjukdom som påverkar hela individen, inte bara lungorna, där andfåddhet är det vanligaste symptomet. Under de kommande 40 åren väntas andelen personer som diagnosticeras med KOL att öka eftersom relevanta riskbeteenden blir vanligare hos befolkningen.En vanlig följd av KOL är en nedsatt styrka, explosivitet (power) och/eller uthållighet i skelettmuskulatur, specifikt quadriceps (lårmuskel), som leder till dysfunktion vid vardagsaktiviteter. För att utvärdera funktionen, samt erbjuda relevant behandling, behövs referensvärden och validerade referensekvationer. Vidare är en av de viktigaste delarna av behandling vid KOL lungrehabilitering, där personer med KOL exempelvis får lära sig hur man kan hantera symptom och ta hand om sig själv på ett bra sätt i relation till sjukdomen. Tyvärr finns kunskapsglapp inom sjukvården vilket innebär att vi behöver hitta nya informationsvägar gällande KOL-specifik kunskap och stöttning åt personer med KOL. Ett av alternativen för kunskapsspridningen är genom eHälsa, vilket fortsatt behöver utvärderas för att säkra att de tillför konstruktiv och användbar hjälp inom vården och hos personer med KOL.

Syfte: Det övergripande syftet i avhandlingen är att utforska förutsättningar för, och perspektiv på, evidensbaserad vård och eHälsa kopplat till behandling av KOL. Syftet är dubbelt. Å ena sidan till att utforska erfarenheter, interaktion och kontext kring behandling av KOL i primärvården utifrån personer med KOLs respektive hälso- och sjukvårdspersonals perspektiv. Å andra sidan syftar avhandlingen till att utveckla referensvärden och referensekvationer för lårmuskelfunktion.

Metod: Avhandlingen innehåller tre intervjustudier (Paper I, II och III) utförda med kvalitativa forskningsmetoder som utvärderat ett eHälsoverktyg, KOLwebben, och en internationell multicenterstudie (Paper IV) som analyserats med kvantitativ forskningsmetod.

Resultat: I de tre intervjustudierna fann vi att det webbaserade eHälsoverktyget, KOLwebben, tycks vara en källa till vidareutbildning och förbättrade behandlingsmöjligheter för både vårdhälsopersonal och personer som har KOL. Bland båda grupper sågs olika facilitatorer och hinder, te.x. behövs ett visst mått av hälsolitteracitet, känsla av kontroll, trygghet kring IT-verktyg och motivation för att personer med KOL ska använda verktyget och märka av förbättring i sitt tillstånd. Hos vårdpersonal behövdes en förankring av den nya arbetsmetoden inom arbetsplatsen eller vårdapparaten för att genomgå en lyckad implementeringsprocess och märka av en förbättring i vården av personer med KOL. För båda grupper gällde att tid var en viktig ingrediens, man behövde tid för att sätta sig in, förstå och implementera nya lärdomar i övriga livet. I den fjärde studien utvecklade vi referensvärden och referensekvationer för styrka, explosivitet (power) och uthållighet i lårmuskulaturen. Resultaten indikerade att för personer utan KOL förklarade ålder, kön, längd och BMI 50 – 70 % av variansen för lårmuskelstyrka, -uthållighet och -explosivitet (power). Utvecklade referensekvationer visade på måttlig begreppsvaliditet bland personer med KOL.

Slutsatser: Det webbaserade eHälsoverktyget, KOLwebben, uppfattas som ett stöd och hjälp när det gäller såväl egenvård som vård av KOL. Det finns dock hinder för att personer med KOL ska kunna använda ett webbaserat eHälsoverktyg såsom KOLwebben och fynden från denna avhandling indikerar att screening av personer med KOL gällande hälsolitteracitet bör övervägas för att kunna erbjuda lämplig lungrehabilitering (digital eller ej). Det finns även hinder för användning av eHälsoverktyg såsom KOLwebben inom vården, där mer tid, stöttning och utbildning tycks krävas för att komma vidare. De utvecklade referensvärderna och referensekvationerna för lårmuskelstyrka, -explosivitet (power) och -uthållighet kommer att möjliggöra ännu bättre personcentrerad vård,vilket i sig kommer att ge en bättre KOL-specifik behandling med måttlig begreppsvaliditetet.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 92
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2221
Keywords
physical activity, chronic obstructive pulmonary disease, COPD, eHealth, interview, eHealth tools, reference equations, muscle dysfunction, COPD management
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-204243 (URN)978-91-7855-975-6 (ISBN)978-91-7855-976-3 (ISBN)
Public defence
2023-02-24, Triple Helix, Samverkanshuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-02-03 Created: 2023-01-31 Last updated: 2023-02-01Bibliographically approved

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Marklund, SarahLundell, SaraSörlin, AnnWadell, KarinNyberg, Andre

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