JMIR Publications

ABSTRACT

Background:

Digital technologies have influenced many aspects of modern-day life, including healthcare. In the context of elective surgeries, there is a strong association between pre-operative physical and psychological preparedness, and improved post-operative outcomes. Health behaviour changes made in the pre- and post-operative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of elective surgical patients is central to motivating health behaviour changes. Integrating digital and mobile health technologies within the elective surgical pathway could be one strategy to remotely deliver behavioural change advice and offer lifestyle support to patients.

Objective:

We conducted a meta-ethnographic systematic review to explore digital interventions supporting elective surgical patients in health behaviour change, specifically: physical activity, weight loss, dietary intake, and mental health support.

Methods:

A literature search was conducted in October 2019 across six electronic databases (PROSPERO: CRD42020157813). Qualitative studies were included if they evaluated the use of digital health technologies supporting behaviour change(s) in adult elective surgical patients during the pre- or post-operative period. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. A meta-ethnographic approach was used to synthesise existing qualitative data, using the ‘seven phases of meta-ethnography’ according to Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of four overarching themes from the data.

Results:

Eighteen studies were included, covering bariatric (11%, n=2), cancer (72%, n=13), and orthopaedic surgeries (17%, n=3). The four overarching themes appear key in understanding and determining the effectiveness of digital and mobile health interventions to support surgical patient cohorts. To successfully motivate health behaviour change, technologies should: 1) provide motivation and support, 2) enable patient engagement, 3) facilitate peer networking, and 4) meet individualised patient needs. Self-regulatory features, such as goal-setting, heightened patient motivation. The personalisation of difficulty levels in virtual reality-based rehabilitation was positively received. Internet-based cognitive behavioural therapy reduced depression and distress in surgical cancer patients. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed desire for digital interventions to be individually tailored, according to their physical and psychological needs before and after surgery.

Conclusions:

These findings have the potential to influence the future design of patient-centred digital and mobile health technologies. Findings demonstrate a multipurpose role for digital technologies in the elective surgical pathway, by motivating health behaviour change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimisation and emphasise the importance of tailored content to suit individual patients and surgical procedures. There is significant rationale for involving patients in the co-creation of digital health technologies to enhance engagement, better support behaviour change, and improve surgical outcomes.