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Table 3 Characteristics of articles included in the systematic review of studies exploring patient experiences with technology enabled care (n = 21), in alphabetic order

From: Patient experiences with technology enabled care across healthcare settings- a systematic review

Authors/Country Title Aim Design Technology explored Setting Sample, including participants’ characteristics Summary of relevant findings
Ando, Ashcroft-Kelso, Halhead, Chakrabarti, Young, Cousins, Angus 2019
United Kingdom (UK) [40]
Experience of telehealth in people with motor neurone disease using noninvasive ventilation. To explore subjective experiences of telehealth as facilitated by the Careportal® device as a regular monitoring service amongst people with motor neuron disease (MND) who were using noninvasive ventilation (NIV). Semi-structured interviews after completing a 24-week trial. Telemonitoring system, using the
DocoboLtdCareportal® device.
Allows for monitoring symptom changes, noninvasive ventilation (NIV) related issues, nocturnal blood oxygen saturation levels, and patient-ventilator interaction data.
In addition a messaging system for patient-clinician communication.
At home An opportunity sample of 7 patients with MND on NIV were recruited.
Age: 49–71 years (mean 63 years)
Gender: 2 women and 5 men
Diagnosis: Amyotrophic lateral sclerosis
Five themes identified:
- benefits of timely intervention
- reducing the unnecessary
- increased self-awareness
- taking initiative
- technical challenges
Cherry, Chumbler, Richards, Huff, Wu, Tilghman, Butler
2015
United States (US) [41]
Expanding stroke tele-rehabilitation services to rural veterans: a qualitative study on patient experiences using the robotic stroke therapy delivery and monitoring system programs. To determine participants’ general impressions about the benefits and barriers of using robotic therapy device for in-home rehabilitation. Qualitative in-depth semi-structured interviews after 3-months usage periode of 2 h of daily Robotic Assisted Therapy (RAT). In-home robotic rehabilitation device: Individuals with residual upper limb impairments were given a Hand Mentor™device, while individuals with residual lower limb impairments were given the Foot Mentor™. The device is comprised a hand or foot peripheral component wired into a processing unit containing the pneumatic pump and a touchscreen interface. The device also has a cellular modem so that data from the therapy could be sent to a secure server to be monitored by a therapist. The device is powered through a wall-outlet. At home A convenient sample of 10 veterans who had experienced a unilateral ischemic or hemorrhagic stroke.
Either hand function or foot function significantly limits activities of daily living
Age: 52–88 years (mean 62 years)
Gender: 10 men
Benefits of use:
- increased mobility
- a sense of control over therapy and scheduling
- an outlet for physical and mental tension and anxiety
- increased independence and mood improvement
Barriers to use were few:
- size and placement of the device
- technical difficulties
- wearing and adjusting the device
Fairbrother, Pinnock, Hanley, McClughan, Sheikh, Pagliari, McKinstry
2013
United Kingdom (UK) [42]
Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial. To explore patients and healthcare professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease (COPD). Semi-structured interviews six months into the randomized controlled trial. Telemonitoring At home A purposively sample of 38 patients
Age: 44–85 years (mean 67,4 years)
Gender: 20 women and 18 men
Diagnosis: COPD
Telemonitoring increased knowledge of their condition, reinforced their decisions to adjust to treatment or seek professional advice; and, through practitioner monitoring, provided a sense of reassurance.
-Knowledge and empowerment
-Accessibility and reassurance
Fisher, Hammerla, Rochester, Andras, Walker
2016
United Kingdom (UK) [43]
Body-worn sensors in Parkinson’s disease: evaluating their acceptability to patients. To evaluate the acceptability of wrist-worn sensors in a Parkinsons disease population following assessment after both brief and prolonged periods of wearing. Questionnaire with Lickert-style questions and free-text responses after use for 4 h in a research facility and after 1 week of continuously use at home. Remote monitoring of symptoms in Parkinson’s disease PD) (using body-worn bilateral wrist-worn sensors. Both in a research facility and at home A sample of 34 patients
Age: 50–86 years (mean 69 years)
Gender not reported.
Diagnosis: Parkinsons disease. Average duration of PD: 10 years (2–26 years)
94,1% were willing to wear the sensors at home, and 85,3% to wear it in public.
-The sensors looks like it is well made
-The sensor is comfortable to wear
-The sensor does not feel heavy on my arm
-The sensor is easy to take on and off
Appearance: Physical properties could be improved. Wearing in public varied from not covering it up, to not like it to be questioned.
Usability and Comfort were both positive and negative.
Georgsson, Staggers 2017
Sweden (Swe) [44]
Patients’ perceptions and experiences of a mHealth diabetes self-management system To understand patients’ perceptions of (1) longer-term use of a specific mHealth system called Care4Life, (2) specific improvements needed for Care4Life, and (3) their needs for future diabetes self-management Questionnaire and semistructured interviews after exit from a 6-month randomized controlled trial Care4Life, an interactive short messaging service (SMS) diabetes self-management system for patients. Patients send in blood glucose, blood pressure, weight, exercises and medication adherence values, and receive reminders and advice about various aspects of their disease. At home A random sample of 10 patients participating in a larger RCT.
Age: 50% were 60–69 years
Gender: 5 women and 5 men
Diagnosis: Type 2 Diabetes
Patients saw clear benefits in using the technology, and had favorable behavioral disease outcomes after using Care4Life.
Attitudes:
Positive overall system perception and general perception.
Behavioral outcomes:
Positive reminder, control and independence.
Suggested improvements for behavioral support (highly individual): Information and disease related, and food and lifestyle related support.
Gorst, Coates, Armitage
2016
United Kingdom (UK) [39]
“It’s sort of a lifeline”: chronic obstructive pulmonary disease patients’
experiences of home telehealth
To explore the beliefs and perceptions of patients with chronic obstructive pulmonary disease (COPD) currently using home telehealth and who are not enrolled in a trial. Semistructured interviews with patients who had been using telehealth from 6 months up to 3 years, with a mean of 17 months use. Small-sized telehealth equipment allowing the patient to attach peripheral devices to take readings of their vital signs, with the individual readings displayed on the equipment. Larger sized telehealth equipment additionally allowed patients to view their data in graphs and charts. At home A sample of 8 patients as part of a larger study recruiting patients with COPD and/or Chronic heart failure.
Age: 58–84 years (mean 68 years)
Gender: 5 women and 3 men
Diagnosis: COPD
Average duration of COPD: 9 years (4–18 years)
Four superordinate themes:
-perceiving benefits of “being watched over” as providing peace of mind
-learning about the health condition and the impacts on self-management behaviour
-active engagement in health service provision and better access to health care
- valuing the importance of in-person care
Hanley, Ure, Pagliari, Sheikh, McKinstry
2013
United Kingdom (UK) [45]
Experiences of patients and professionals participating in the HITS home blood pressure (BP) telemonitoring trial: a qualitative study. To qualitatively explore the experiences of patients and professionals taking part in a trial of BP telemonitoring based in a usual care setting, to identify what contributes to the effectiveness of the intervention, what limited its effectiveness and what may be required for success of the trial to be translated into routine care. Semistructured interviews within a RCT of BP telemonitoring in routine care. A validated electronic home blood pressure (BP) monitor and mobile phone technology that enabled the transfer of BP readings via SMS to secure website which was accessible to the user and their doctor and nurse, and also provided automated feedback to the patient. The BP monitor linked to a mobile phone wirelessly, via Bluetooth. At home A sample of 25 patients (20 from the intervention arm and 5 from control arm)
Age:
<  50 years: 5
50–59 years: 10
70+ years: 10
Gender: 10 women and 15 men
Diagnosis:
Hypertension
Patients became more engaged in the clinical management of their condition.
The home monitoring system provided better evidence for action, facilitating rapid tailoring of medication.
The role of telemetry-enabled home monitoring was motivating, an incentive to improve self-care and evidence which facilitated meaningful conversation and dialogue with professionals.
Jalil, Myers, Atkinson, Soden
2019
Australia (AU) [46]
Complementing a clinical trial with human-computer interaction: Patients’ user experiences with telehealth To investigate how to discover patients’ user experiences in telehealth, eHealth, and mHealth in a clinical trial Semi structured interviews and survey within a RCT. A tablet computer, an automatic glucometer, and an automatic sphygmomanometer At home A sample of 9 patients
Age: 52–74 years (mean 62 years)
Gender: 4 women and 5 men
Diagnosis: Type 2 diabetes mellitus for at least 12 months.
Two themes were identified:
(1) the current design and how that fits with the patients’ needs
-Lack of wireless capability
-Undesirable experience from sphygmomanometer
-Lack of visual data
-Lack of medication name
- Mismatch with life due to immobility of the device
- Glucometer discomfort and pain
(2) the patients experience of using the device depicted through their feelings and perceptions
-Motivation
-Build a habit
-Awareness
-Feel safe
-Reduced doctor visits
-Frustrations
-Difficulty in measurement of blood pressure
Jamison, Mei, Ross 2018
USA
(US) [47]
Longitudinal trial of a smartphone pain application for chronic pain patients: Predictors of compliance and satisfaction To determine the long-term effects of using a smartphone pain app that allows chronic pain patients to assess, monitor, and communicate their condition to their physicians and that offers pain management strategies for users. A longitudinal 6-month trial using a questionnaire at three and six months. An app to assess, monitor and communicate patients’ status to their providers. Included an activity monitor and a Fitbit to track daily activity. At home A sample of 90 patients with chronic pain
Age: 18–79 years (mean 47 years)
Gender: 58 women and 32 men
Diagnosis: Cancer and noncancer-related chronic pain for longer than six months
The app was easy to use.
Those who used the app more often were more satisfied with the program. Satisfaction ratings diminished over time. Greater use of the app and frequent daily assessment entries were found to be related to an overall improvement in mood, but did not have a positive effect on pain or activity. Those who were more satisfied with the app reported more pain-related disability and were less active.
Kardas, Lewandowski, Bromuri 2016
Poland (PL) [38]
Type 2 diabetes patients benefit from the COMODITY12
mHealth system: Results of a randomised trial.
To assess patients’ assessment of their experience with COMMODITY12 system use within 6 weeks’ long clinical trial in DM2 patients- the “COMMODITY12” trial. A 6 weeks RCT using a questionnaire at endpoint COMMODITY12 system, composed of smart phone, and wireless connected sensors:
-A Bluetooth-enabled glucometer, blood pressure reader and scale
-A Bluetooth-enabled sensor of ECG, heart rhythm, and respiratory movements
-A triaxial accelerometer – already built in the SmartHub (mobile phone)
-MEMS™ - a patient adherence monitor, which has been used to assess patient adherence with oral antidiabetic agents they were using
At home A sample of 60 patients (30 from the active arm and 30 from the control arm)
Age: Mean 59 years
Gender: 24 women and 36 men
Diagnosis: Diabetes type 2 for at least six months prior to study
All telehealth system dimensions reached mean values of above four in a five-point scale, with maximum values for clearness of instructions, and ease of use (4.80 and 4.63 respectively), followed by general assessment, reliability of results and time spent on system use daily. Systems users asked for its strengths said system being fast, enabled them systematic self-monitoring and was easy to use.
Weaknesses were frequent need to recharge and problems with glucometer strips.
Knudsen, Laustsen, Petersen, Hjortdal, Angel 2019
Denmark (DK) [48]
Experience of cardiac tele-rehabilitation: analysis of patient narratives To explore patients’ experiences of tele-rehabilitation and the perceived gains of taking part in the program Interviews after a 12-week hospital-based rehabilitation in an outpatient setting (phase II) Monitoring equipment with a heart rate monitor with a sensor device, blood pressure monitor, weight scale, smartphone with built-in alarm and website.
Information transferred from smartphone to a website. The patients and healthcare professionals had access to shared data on website.
At home A sample of 7 patients.
Age: 46–70 years (mean 58 years)
Gender: 7 men
Diagnosis: Ischemic heart disease or undergone heart valve surgery
Patients valued the cardiac tele-rehabilitation because it was not restricted to the hospital setting. Flexibility was assumed as an advantage. If activities were part of their daily lives, it lead to greater acknowledgement and commitment to the program. If not, the program was experienced as an extra challenge.
Lee, Greenfield, Pappas 2018
United Kingdom (UK) [49]
Patients’ perception of using telehealth for type 2 diabetes management: a phenomenological study To explore patients’ perceptions of using telehealth for type 2 diabetes management Semi-structured interviews with patients who had used telehealth from 1.5 years to 3.5 years. Telehealth to monitor blood glucose, blood pressure and weight. At home A sample of 10 patients.
Age: 49–77 years (mean 63 years)
Gender: 8 women and 2 men
Diagnosis: Type 2 diabetes for 4 to 33 years, mean time of 15.4 years.
Three themes for facilitating positive patient experience or acceptance of telehealth:
Technology consideration
-Initial perception of using technology for self-management
-Telehealth usability concerns
Service perceptions
-Sense of security and comfort
-Easy and convenience access to healthcare services
-Privacy concerns
-Continuity of care
Empowerment
-Patient education
-Supporting self-care with telehealth system’s health trend analysis
Maglalang, Yoo, Ursua, Villanueva, Chesla, Bender 2017
USA
(US) [50]
“I don’t have to explain, people understand”: acceptability and cultural relevance of a mobile health lifestyle intervention for Filipinos with Type 2 Diabetes To access the acceptability and cultural relevance of the PilAm Go4Health program A pilot randomized control trial using semi-structured post-program individual interviews after 3-months intervention and 3-months maintenance. PilAm Go4Health program. A culturally adapted mobile weigth-loss lifestyle intervention including virtual social networking. Included using a Fitbit accelerometer, self-reporting of food/calorie intake and weight using the Fitbit diary app, and participate in a private Facebook group. At home A sample of 45 patients (22 from intervention group and 23 from an active wait-list control group).
Age: Mean 58 years
Gender: 28 women and 17 men
Diagnosis: Non-insulin dependent Type 2 Diabetes
Four major themes were identified:
-Culturally tailored support enhanced engagement
-Mobile technology promoted personal agency
-Progression from despair to self-efficacy
-Further cultural tailoring addressing support mechanisms and improved site accessibility were suggested to improve intervention acceptability.
Maguire, Ream, Richardson, Connaghan, Johnston, Kotronoulas, Pedersen, McPhelim, Pattison, Smith, Webster, Taylor, Kearney 2015
United Kingdom (UK) [15]
Development of a novel remote patient monitoring system: the advanced symptom management system for radiotherapy to improve the symptom experience of patients with lung cancer receiving radiotherapy. To (a) explore the feasibility and acceptability of the Advanced Symptom Management System in patients with lung cancer receiving radiotherapy and clinicians involved in their care and (b) assess changes in patient outcomes during implementation of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy in clinical practice A repeated-measures, single-arm, mixed-methods study design involving poststudy semi-structured interviews and semis-structured questionnaires at baseline and end of treatment. The Advanced Symptom Management System-R (ASyMS-R) enables real-time collection of PROM data as a mobile phone–based symptom monitoring system. Patients received self-care advice on their mobile phone or alerts were generated to a pager held by a health professional at the clinical site when symptoms were of clinical concern. At home A sample of 16 patients.
Age: 42–85 years (mean 64 years)
Gender: 11 women and 5 men
Diagnosis: Lung cancer receiving radiotherapy
Only rarely did patients report problems in using the handset. They felt that the system covered all relevant symptoms, helped them manage the symptoms and effectively communicate with clinicians.
Minatodani, Chao, Berman 2013
USA (US) [51]
Home telehealth: facilitators, barriers, and impact of nurse support among high-risk dialysis patients. To evaluate patients’ perceived effectiveness of and satisfaction with home telehealth self-monitoring and remote care nurse (RCN) support and to identify perceived facilitators and barriers encountered with RT use. Mixed methods approach using semistructured interviews as part of a RCT Remote technology to self-monitor the health (physiological measurements and answering 10 subjective health questions specific to end-stage renal disease and dialysis treatment) at home. At home A sample of 33 patients
Age: 37–87 years (mean 60 years)
Gender: 13 women and 20 men
Diagnosis: End stage renal disease and dialysis treatment
Receiving efficient feedback from RCT.
Were better able to identify changes in their health status. Experienced enhanced accountability, self-efficacy and motivation to make health behaviour changes.
The most frequently cited barriers related to malfunctioning equipment or trouble with Internet connections, forgetfulness, and felling poorly.
Nordin, Michaelson, Eriksson, Gard 2017
Sweden (Swe) [52]
It’s about me: patients’ experiences of patient participation in the web behavior change program for activity in combination with multimodal pain rehabilitation To explore patients’ experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) in primary health care Semistructured interviews with open-ended questions as part of a RCT. Behavior Change Program for Activity in combination with multimodal rehabilitation (Web-BCPA). An eHealth solution for a biopsychosocial treatment of persistent musculoskeletal pain. The modules contained information, assignments, exercises, educational texts, videos and writing tasks. At home A consecutively sample of 19 patients at their 4-month follow-up of the RCT.
Age: 27–60 years (Mean 45 years)
Gender: 15 women and 4 men
Diagnosis: Persistent musculoskeletal pain with a duration of at least three months in the back, neck, shoulder and/or generalized pain.
One theme: It’s about me with 4 categories:
-take part in a flexible framework of own priority
-acquire knowledge and insights
- ways towards change
- personal and environmental conditions influencing participation
Reeder, Demiris, Marek 2013
USA (US) [53]
Older adults’ satisfaction with a medication dispensing device in home care. To examine the level of frail older adults’ satisfaction with medication dispensing device and assess perceived usefulness of the device by older adult home care patients. A survey after 9 months as part of a prospective, longitudinal, three-arm RCT conducted over a one-year period The MD.2 medication dispensing machine automatically dispenses pre-loaded medication and gives alerts to individuals about medication times. At home A sample of 96 patients
Age: mean 80 years
Gender: 63 women and 33 men
Diagnoses: Chronic conditions present including diabetes, depression, COPD, dementia and heart disease.
Nearly all patients perceived the medication dispensing device as very easy to use, very reliable, helpful in the management of their medications, gave them peace of mind, and they would like to use the machine in the future.
Vatnøy, Thygesen, Dale 2017
Norway (NO) [54]
Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: patients’ experiences To investigate how the patients experienced follow-up using a TM intervention, and the extent to which it supported and improved coping resources and independence. Individual semi-structured interviews after a duration of 10 to 21 days of use. The technological solution consisted of 1)a tablet with a video camera and pulse oximetry device for daily monitoring of pulse and oxygen saturation transmitted wirelessly to the tablet application, 2) software consisting of a questionnaire to measure subjective symptoms, 3) a questionnaire for symptom self-evaluation The follow-up included nurse with real-time follow-up video communication At home A convenient sample of 10 patients discharged to their homes after hospitalization.
Age: 55–83 years (mean 65 years)
Gender: 3 women and 7 men
Diagnosis: COPD exacerbation
Two themes and 5 categories:
The TM solution was experienced as comprehensible and manageable and provided meaning in daily life.
-Handling and understanding the technology
-Feelings related to technology use
The TM solution intervention contributes to stress reduction caused by illness burden and facilitates living as normally as possible
-Confidence and trust in the health service
-Impact on independence and self-management
-Integrity and meaning in life
Wall, Ward, Cartmill, Hill, Porceddu 2017
Australia (AU) [55]
Examining user perceptions of SwallowIT: a pilot study of a new telepractice application for delivering intensive swallowing therapy to head and neck cancer patients To explore patients’ perceptions of SwallowIT and the delivery of preventive swallowing therapy during CRT via an asynchronous telepractice model. A mixed methods approach using structured questionnaire at baseline and on completion of CRT and semi-structured phone –interviews at 3–12 months post-CRT. An electronic app hosted on a secure external server and provided on a tablet. The system was designed to assist patients to complete independent home-practice of preventative swallowing exercises during CRT, and included instructional videos, images and text. Free text for communication between patient and speech pathologist.   A sample of 15 patients
Age: 46–70 years (mean 59 years)
Gender: 15 men
Diagnosis: Oropharyngeal squamous cell carcinoma (SCC) planned for curative-intent chemo-radiotherapy
Patients felt comfortable, confident, motivated, supported, and that the method was effective.
Few technical difficulties, and would not prefer face-to-face consultation in hospital.
Themes identified were:
-“It was really easy to use” (design, system inclusions, convenience)
-“You’re motivated to do something” (extrinsic and intrinsic motivators)
-“Difficult circumstances” (treatment side-effects, time constraints) –“You’re on the right track, but…” (Service delivery preferences, design preferences).
Welch, Balder, Zagarins 2015
United Kingdom (UK) [56]
Telehealth program for type 2 diabetes: usability, satisfaction, and clinical usefulness in an urban community health center. To examine the usability, satisfaction, and clinical impact of a 3-month diabetes telehealth intervention for poorly controlled type 2 diabetes (T2D) patients. A queationnaire at the 3-month follow-up An electronic pillbox integrated into an existing diabetes remote home monitoring (RHM) device suite comprising a Blutooth®-enabled blood glucose meter and an automatic blood pressure monitor connected to a cellular hub for data uploaded to a clinical application.
Telehealth nurse received regular RHM data alerts and called patients by phone at scheduled intervals.
At home A sample of 29 patients
Age: mean 61 years
Gender: 17 women and 12 men
Diagnosis: Diabetes type 2, not on multiple daily insulin therapy
High ratings of usability and program satisfaction from patients. Patients reported the home monitoring devices to be easy to use, easy to fit into daily routines and set up in a convenient place at home. The pillbox was in addition helping to organize medications, and easy to understand how to refill.
Woodend, Sherrard, Fraser, Stuewe, Cheung, Struther 2008
USA (US) [57]
Telehome monitoring in patients with cardiac disease who are at high risk of readmission. To determine whether telehome monitoring of patients with cardiac disease at high risk of readmission would reduce hospital readmissions, improve functional status, and improve quality of life over usual care. A randomized controlled trial using a questionnaire at 1 month, 3 months, and 1 year postdischarge for datacollection. 3 months of video conferencing with a nurse, daily transmission of weight and blood pressure, and periodic transmission of 12-lead electrocardiogram. Data were transmitted by telephone lines. At home A sample of 124 patients discharged from hospital
Age: mean 66 years
Gender: 75% men
Diagnosis: 62 patients with heart failure and 62 with angina
Overall, the equipment was easy to use. Some difficulties with ECG and Video-conferencing.
Relieved of worries.
Increased confidence.