Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study (Preprint)

Abstract

BACKGROUND eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients’ needs, it is necessary to account for these changes in needs and contexts of use. OBJECTIVE This study aimed to identify and monitor patients’ needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: “How do novice and more advanced users experience an online health management platform?” “What user expectations support or hinder the adoption of an online health management platform, from a user perspective?” and “How does actual usage relate to user experiences and adoption?” METHODS A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. RESULTS After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. CONCLUSIONS Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients’ needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology. CLINICALTRIAL

Authors 8

1. Britt Elise Bente corresponding

   University of Twente

   Affiliation as printed

   Department of Psychology, Health, and Technology Faculty of Behavioral, Management and Social Sciences University of Twente Enschede NL

   Department of Psychology, Health, and Technology. Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands

2. Jobke Wentzel

   Windesheim University of Applied Sciences · University of Twente

   Affiliation as printed

   Department of Health and Social studies Windesheim University of Applied Sciences Zwolle NL

   Department of Health and Social studies, Windesheim University of Applied Sciences, Zwolle, The Netherlands

   Department of Psychology, Health, and Technology Faculty of Behavioral, Management and Social Sciences University of Twente Enschede NL

   Department of Psychology, Health, and Technology. Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands

3. Celina Schepers

   University of Twente

   Affiliation as printed

   Department of Psychology, Health, and Technology Faculty of Behavioral, Management and Social Sciences University of Twente Enschede NL

   Department of Psychology, Health, and Technology. Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands

4. Linda D. Breeman Aachen Unit of Health, Medical, and Neuropsychology Faculty of Social and Behavioral Sciences Leiden University Leiden NL Unit of Health, Medical and Neuropsychology Faculty of Social and Behavioral Sciences

   Leiden University

   Affiliation as printed

   Unit of Health, Medical, and Neuropsychology Faculty of Social and Behavioral Sciences Leiden University Leiden NL

   Unit of Health, Medical, and Neuropsychology, Faculty of Social and Behavioral Sciences, Leiden University, The Netherlands

5. Veronica R. Janssen Aachen Department of Cardiology Leiden University Medical Center Leiden NL Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology Leiden University Medical Center Leiden NL

   Department of Cardiology, Leiden University Medical Center, The Netherlands

6. Marcel E. Pieterse

   University of Twente

   Affiliation as printed

   Department of Psychology, Health, and Technology Faculty of Behavioral, Management and Social Sciences University of Twente Enschede NL

   Department of Psychology, Health, and Technology. Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands

7. Andrea W.M. Evers

   University of Twente

   Affiliation as printed

   Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, the Netherlands

   Department of Psychology, Health, and Technology Faculty of Behavioral, Management and Social Sciences University of Twente Drienerlolaan

8. Julia E.W.C. van Gemert‐Pijnen

   University of Twente

   Affiliation as printed

   Department of Psychology, Health, and Technology Faculty of Behavioral, Management and Social Sciences University of Twente Enschede NL

   Department of Psychology, Health, and Technology. Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, the Netherlands