JMIR Publications

ABSTRACT

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. Though, 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, as well as pedometers were used as triggers to increase usage. After having access to the tool for three months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months access to the tool, seven (five 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 non-user/seldom-users depending on the number of logins and minutes of usage per month.

Results:

Three main categories; ambiguous impact basic conditions for usage and approaching capability emerged from the analysis, which, together with their subcategories, reflects the participants' experiences of using the eHealth tool. Non-user/seldom-users¬ reported low motivation, a higher need for technical support, a negative view about the disease and self-management and had problematic health literacy. The latter as measured by the communicative and critical health literacy scale. Users felt comfortable with IT-tools, had a positive view on triggers and had sufficient health literacy. Benefits including behavior changes, were mainly expressed after 12 months had passed, and among users.

Conclusions:

Findings of this study indicate that level of motivation, comfortability with IT-tools as well as the level of health literacy seem to affect usage of an eHealth tool over time. Also, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months regarding behavioral changes, thus suggesting that eHealth tools can be a suitable media for supporting COPD-specific self-management skills – however 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. Clinical Trial: ClinicalTrials. gov: NCT02696187