A Qualitative Study of Patients’ Perspectives regarding Digital Health Technology to Support Self-management and to Improve Integrated Stroke Care: The ValueCare study.

Abstract

Background: Digital technologies, such as mobile apps and robotics, provide opportunities to involve stroke patients better in the care process and to promote self-management. Previous pilot studies suggest that technology could be a meaningful tool for post-acute stroke care. However, barriers exists constraining the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for technology. Co-design enables patients to reflect on their experiences of a service and to identify improvement priorities. This study uses data from co-design sessions with stroke patients conducted as part of the ValueCare study.
 Objective: The aim of this study is to explore what stroke patients’ perspectives are towards how digital health technology could support self-management regarding health and well-being, and integrated stroke care.
 Methods: A qualitative study was conducted to understand patient perspectives. Data was collected in co-design sessions of the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on socio-demographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach.
 Results: Patients held mixed attitudes towards how digital health technologies could support their self-management and the care they receive. Suggested digital features by stroke patients included (i) an easily accessible online library with relevant information regarding stroke-related health and care issues, (ii) a personal health record (PHR) by which patients can retrieve and manage their own health information, and (iii) a physical exercise module to empower patients to organize rehabilitation support at home. Regarding the user interface of future digital health technology, patients emphasized the need for a very easy-to-use and simple design.
 Conclusions: Stroke patients mentioned easy-to-find and credible health information, a PHR, and online-rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the ‘voice of the stroke patients’, with regard to both functionality and the characteristics of the interface. The findings of this study provide insight in the needs and preferences of stroke patients for using ICT to manage their health and care. These findings serve as touch points that can be explored further in co-design sessions. 
 Keywords: stroke patients, digital health technology, self-management, co-design, user-requirements, user-centered design, qualitative research