JMIR Publications

ABSTRACT

Background:

Home telemonitoring programs are increasingly deployed to support older adults living with chronic illnesses such as heart failure. While these interventions show promise for improving health outcomes and reducing care burden, their success hinges on patients' and caregivers' ability to integrate digital tools into their daily routines and care relationships. Few studies have examined these experiences using conceptual frameworks that capture both functional and relational dimensions of care.

Objective:

This study aimed to explore the experiences of older adults and their informal caregivers participating in a home telemonitoring program for heart failure. Drawing on two complementary frameworks, the Person-Based Approach (PBA) and Person-Centred Practice (PCP) framework, we sought to understand how participants engaged with both the techno-functional and relational dimensions of the intervention.

Methods:

We conducted a qualitative descriptive study involving 34 patients, 28 informal caregivers, and 20 nurses recruited from three primary care organizations in Quebec, Canada. The intervention included four digital devices (a connected scale, smartwatch, smart pill dispenser, and a voice-activated tablet) used by patients, as well as the Proximity mobile app designed for informal caregivers to receive alerts, monitor patient activity, and communicate with patients and nurses. The digital tools were supported by remote nursing follow-up. Data were collected through semi-structured interviews and field notes. Analysis was conducted using directed content analysis.

Results:

Participants’ experiences revealed both enabling and constraining factors across two core dimensions. Techno-functional engagement, interpreted through the PBA, was influenced by users’ digital literacy, emotional responses to technology, alignment with daily routines, and the availability of technical and social support. Relational and experiential aspects of care, analyzed using the PCP framework, were shaped by perceived professional presence, opportunities for shared decision-making, and the degree of emotional reassurance or burden. While some participants reported increased autonomy and confidence, others experienced frustration, fatigue, or disengagement. The quality of nursing follow-up and caregiver involvement emerged as critical moderators of sustained engagement.

Conclusions:

This study underscores the complex interplay between digital technologies, relational care processes, and individual user contexts in shaping the adoption and sustainability of home telemonitoring interventions. Findings point to the need for personalized onboarding, proactive and empathetic clinical follow-up, and flexible, context-sensitive system design. Applying both techno-functional and relational lenses offers a more comprehensive understanding of user experiences and supports the development of inclusive, person-centred implementation strategies for home telemonitoring programs.