JMIR Publications

ABSTRACT

Background:

The adoption and use of technology has significantly changed healthcare delivery. Patient experience has become a significant factor in the whole spectrum of patient-centered healthcare delivery. Digital Health (DH) is a facilitator to further improving and empowering patient experiences. The design of DH is therefore served by insights into barriers and facilitators of digital patient experience (dPEx).

Objective:

To systematically review influencing factors and design considerations of patient experiences (PEx) in DH from the literature, and to generate design guidelines for further improving PEx in DH.

Methods:

We performed an umbrella systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched the Scopus, PubMed and Web of Science databases. Two rounds of small random samples (20%) were independently reviewed by two reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed through the Fleiss-Cohen coefficient (k1=.88, k2=.80). We applied thematic analysis to analyze the extracted data based on a small set of a priori categories.

Results:

The search resulted in 173 records, of which we selected 45 reviews for data analysis. Findings and conclusions showed a great diversity, most studies presented a set of themes (n=19) or descriptive information only (n=16). dPEx-related influencing factors were classified in nine categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment and social environment. These can have three types of impact: positive, negative or double-edge. We captured four design constructs (personalization, information, navigation and visualization) and three design methods (human/user-centered design, co-design/participatory design, and inclusive design) as design considerations.

Conclusions:

We propose the following definition for dPEx: “Digital patient experience is the sum of all interactions affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health”. We produce a design and evaluation framework contains four phases, which are define design, define evaluation, design ideation and design evaluation, to help DH designers or developers think about how best to address dPEx in the whole design process. We also created nine design guidelines that considered the combination of design considerations and influencing factors to guide the design ideation process. Finally, we propose six directions for future dPEx-related research. and influencing factors for guiding the design ideation process.