Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 24, 2021
Date Accepted: Dec 19, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Understanding Patients’ Intention to Use Digital Health Apps that Support Post-discharge Symptom Monitoring by Providers: A Survey Study in Patients with Acute Coronary Syndromes
ABSTRACT
Background:
After hospital discharge, patients with acute coronary syndromes (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of post-discharge symptoms by healthcare providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients.
Objective:
To assess ACS patients’ intention to use digital health apps that support post-discharge symptom monitoring by healthcare providers and identify patient-perceived facilitators and barriers to app use.
Methods:
Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts healthcare system between December 2020 and April 2021 to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. Intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as “If this app were available to me, I would use it.” Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis.
Results:
Among 100 respondents (response rate=8.1%), 45% completed the survey by phone. The respondents were, on average, 68 years old (standard deviation=13), with 94% White, 40% women, and 88% having access to the internet or mobile phone. Most participants (65 out of 100) agreed or strongly agreed that they would use the app, among which 53 (84%) would use the app as often as possible. The percent of participants with intention to use was 75% in those aged 65-74 and dropped to 44% in those older than 75. The intention to use was higher in online-survey respondents (vs. phone-survey respondents; odds ratio: 3.07, 95% confidence interval: 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified four main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms; and four main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interfaces; and (4) preference for in-person/phone care.
Conclusions:
There is strong intention of using a symptom monitoring app post-discharge among ACS patients. However, this intent decreased in patients older than 75. The survey identified barriers related to technology use, privacy/security, and care delivery mode. Further research is warranted to determine if such intent translates into app use and better symptom management and healthcare quality.
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