JMIR Publications

ABSTRACT

Background:

The introduction of digital and mobile technologies has 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 and mobile 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 and sub-themes from the data.

Results:

Nineteen studies were included, covering bariatric (11%), cancer (73%), and orthopaedic surgeries (16%). The four overarching themes and sub-themes appear key in understanding and determining the effectiveness of digital and mobile health interventions to support behavioural change in surgical patients. Notably, the themes concern an interventions ability to: 1) provide motivation and support, 2) enable patient engagement, 3) facilitate peer-support, and 4) meet individualised patient needs.

Conclusions:

Our novel findings have the potential to influence future design features of patient-centred digital and mobile health technologies. This study also demonstrates the important role of digital and mobile health technologies in the elective surgical pathway; not only can they help to motivate physical behaviour change, such as improved activity levels and dietary intake, but they can successfully provide psychological support too. We believe 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.