Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach.

Mirjam Ekstedt,Oscar Frykholm,Gunilla Lindqvist,Åsa Kneck,Marie Kirsebom,Maria Flink,Carolina Wannheden

doi:10.3390/ijerph19010391

Abstract

The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients’ engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application—ePATH (electronic Patient Activation in Treatment at Home)—with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.

Highlights

The increasing prevalence of people living with chronic conditions imposes a large burden on healthcare services worldwide [1]
Phase 1 resulted in the specification of twenty-two user needs from the perspectives of patients, family caregivers, and healthcare professionals, which were grouped into five themes (Table 2)
Our study has identified needs related to the self-management of chronic conditions and productive interactions between patients and healthcare professionals that could be supported by means of eHealth services

Summary

Introduction

The increasing prevalence of people living with chronic conditions imposes a large burden on healthcare services worldwide [1]. The most common chronic conditions that account for over two thirds of all deaths globally are heart failure, cancer, chronic obstructive pulmonary disease (COPD), and diabetes [2]. While a person’s illness trajectory may start with one chronic condition, multimorbidity increases substantially with age [3]. Healthcare systems that are designed around single diseases pose great challenges for patients with multimorbidity who need to cope with fragmented care services and recommendations from disease-specific guidelines that may be contradictory and cumbersome to comply with [3,4]. Patients’ engagement in self-managing their condition and maintaining health becomes increasingly important [5].

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Methods

Results

Discussion

Conclusion