Abstract
Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views.Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis.Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers.Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation.
Highlights
Management of chronic diseases has become a major priority for healthcare systems around the world [1, 2]
The analysis of exploratory interviews indicated that most stakeholders were supportive of the integration of Mobile health (mHealth) in primary care, differences exist in their level of influence (Table 3)
This study shows that interests and values of stakeholders may contradict each other and have substantial influence on the potential integration of mHealth in primary care
Summary
Management of chronic diseases has become a major priority for healthcare systems around the world [1, 2]. The rising prevalence of chronic diseases combined with severe shortages of medical staff pressures the ability of systems to meet the demand for chronic care services [2, 3]. Given these circumstances, many Western countries implemented policies to make the shift from an acute model of care toward an integrated and proactive approach to chronic disease management [4]. Many Western countries implemented policies to make the shift from an acute model of care toward an integrated and proactive approach to chronic disease management [4] One such a comprehensive approach is the chronic care model (CCM). The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views
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