JMIR Publications

ABSTRACT

Background:

The use of digital technologies is increasing in healthcare. However, studies evaluating digital health technologies can be characterized by selective non-participation of older people, although older people represent one of the main user groups in healthcare.

Objective:

We examined whether and how participation in an exergame intervention study was associated with age, gender and heart failure (HF) symptom severity.

Methods:

A subset of data from the HF-Wii study was used. The data come from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective non-participation was examined as resulting from two processes: (non-)recruitment and self-selection. Baseline information on age, gender, New York Heart Association (NYHA) Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for non-participation were evaluated.

Results:

Of the screened 1632 patients, 71% did not participate. The non-recruitment rate was 21% and based on this eligible sample, the refusal rate was 61%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of non-recruitment. Gender had no effect. The most common reasons for non-recruitment and self-selection were related to physical limitations and lack of time respectively.

Conclusions:

Results indicate that selective non-participation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such a systematic selection can lead to biased research results which inappropriately inform research, policy, and practice.