JMIR Publications

ABSTRACT

Background:

The development and evaluation of eHealth in clinical care should be followed-up by how interventions are implemented. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was developed to support the implementation scale-up of health technology programs, offering a structure for studying the unfolding of such initiatives in real time. Healthcare provider perspectives applied to such a theoretical framework for implementation provide insights for an early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. However, studies of eHealth interventions that explore longer time frames encompassing processes of scaling up and sustainability within a complex real-world healthcare environment are lacking.

Objective:

To explore healthcare professionals’ experiences and views about the implementation of an eHealth intervention in pediatric healthcare applying the NASSS framework for theorizing and evaluating the conditions for eHealth implementation.

Methods:

Semi-structured interviews were conducted with healthcare providers at the staff and management level within a university pediatric hospital (N=10). Data were collected alongside a clinical trial of the development and evaluation of an eHealth application for self-management in pediatric care after hospital discharge. In an abductive approach, interviews were analyzed qualitatively and then applied to the seven domains of the NASSS framework to identify determinants for implementation, including facilitators, barriers, and levels of complexity.

Results:

The nature of pediatric care was characterized by the family as unit of care and by patient heterogeneity. eHealth, although usable and adaptable, was described as a trade-off between safety and flexibility and a lack of healthcare integration. Child participation and secrecy, especially for adolescents, contributed to complexity in using eHealth. Healthcare professionals described high eHealth literacy, thus challenges concerning adoption were related to work adaptations and the risk of ‘app overload’. The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, healthcare professionals raised concerns related to regulatory requirements for documentation, public procurement, and data safety. The lack of an overview of accessible eHealth in a large organization was also brought forward as making implementation in a wider context complex.

Conclusions:

Important perspectives for implementation included considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular healthcare. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders. Clinical Trial: ClinicalTrials.gov registration identifier: NCT04150120