JMIR Publications

ABSTRACT

Background:

Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available to laypeople to find, share, and generate health-related information supporting their healthcare process. There is also innovation and interest in home testing enabled by smartphone technology (Smart-HT). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions.

Objective:

This study identifies and models key factors leading to health consumers’ engagement and enablement associated with Smart-HT. We also explore multi-levels of healthcare choices resulting from health consumer empowerment and activation from the Smart-HT use. Understanding factors and choices associated with engagement, enablement, and empowerment and activation helps both research and practice support the intended and optimal Smart-HT use.

Methods:

This study reports on findings of two phases of a more extensive pilot study of a Smart-HT for viral infection. In these two phases, we used mixed methods (semi-structured interviews and surveys) to shed light on the situated complexities of a health consumer making autonomous decisions to engage with, perform, and act on Smart-HT supporting diagnostic aspects of their healthcare. Interview (n= 31) and survey (n=282) participants experienced Smart-HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential Smart-HT use for SARS-CoV-2 diagnosis.

Results:

Our results model reveals Smart-HT engagement and enablement factors as well as choices resulting from empowerment and activation. The model includes factors leading to engagement, specifically, various intrinsic and extrinsic influences. Moreover, the model includes various enablement factors, including quality of Smart-HT and personal capacity to perform Smart-HT. The model also explores various choices resulting from empowerment and activation from the perspective of various stakeholders (public vs. private) and concerning different levels of impact (personal vs. distant).

Conclusions:

The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform Smart-HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and Smart-HT sources can play to better support digitally engaged health consumers in the Smart-HT decision process.