Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions.
No clinical characteristics, particularly not sputum characteristics, can guide antibiotic prescription in patients with mild to severe COPD exacerbations
Background: Patients with chronic obstructive pulmonary disease (COPD) demonstrate reduced levels of daily physical activity (DPA) compared to healthy controls. This results in a higher risk of hospital admission and shorter survival. Performing regular DPA reduces these risks. Objective: To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation. Methods: The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council (MRC) model for complex clinical interventions and the involvement of end users. Participants were healthy adults and persons with COPD. Results: The mobile phone interface met all the set requirements. Participants found that the app was stimulating and that reaching their DPA goals was rewarding. The mean (SD) scores on a 7-point scale for usability, ease of use, ease of learning, and contentment were 3.8 (1.8), 5.1 (1.1), 6.0 (1.6), and 4.8 (1.3), respectively. The mean (SD) correlation between the mobile phone and a validated accelerometer was 0.88 (0.12) in the final test. The idea of providing their health care professional with their DPA data caused no privacy issues in the participants. Battery life lasted for an entire day with the final version, and readability and comprehensibility of text and colors were favorable. Conclusions: By employing a user-centered design approach, a mobile phone was found to be an adequate and feasible interface for an eHealth intervention. The mobile phone and app are easy to learn and use by patients with COPD. In the final test, the accuracy of the DPA measurement was good. The final version of the eHealth intervention is presently being tested by our group for efficacy in a randomized controlled trial in COPD patients.
LINK
AANLEIDING Mensen met Chronic Obstructive Pulmonary Disease (COPD) hebben vaak langdurig fysiotherapie nodig. Symptomen zoals kortademigheid en vermoeidheid, veelal in combinatie met beperkte gezondheidsvaardigheden (46%), beïnvloeden hun leven sterk. Persoonsgerichte zorg is afgestemd op iemands persoonlijke behoeften, wensen en voorkeuren. Dit vereist dat fysiotherapeuten zinvol gebruik maken van meetresultaten. Zinvol betekent meetresultaten integreren in het zorgproces, deze communiceren op een begrijpelijke manier voor de patiënt, om samen te beslissen en zodoende tot persoonsgerichte zorg te komen. Echter, fysiotherapeuten vinden het lastig om meetresultaten zinvol te gebruiken in het zorgproces en de ervaren meerwaarde van gebruik van meetresultaten is beperkt. In de dagelijkse praktijk ontbreekt het fysiotherapeuten aan praktische handvatten om meetresultaten zinvoller te gebruiken ten behoeve van verdere personalisatie van fysiotherapeutische zorg. DOEL Het bevorderen van inzicht, kennis, vaardigheden en attitude van fysiotherapeuten in het zinvol gebruiken van meetresultaten voor patiënten met COPD. Dit willen we bereiken door: • Praktische handvatten voor zinvol gebruik van meetresultaten, wat leidt tot een transparanter, efficiënter en effectiever zorgproces. • Een verschuiving naar meer persoonsgerichte zorg, waarbij patiënten actief betrokken worden bij hun zorgproces en ongelijkheid in zorg wordt verminderd. CONSORTIUM Zuyd Hogeschool, Hogeschool Utrecht, Amsterdam UMC, LUMC, Nivel, Chronisch ZorgNet, KNGF, Longfonds, Mens Achter de Patiënt, 7 eerstelijns fysiotherapiepraktijken. ONDERZOEKSPLAN De doelstellingen worden gerealiseerd met een mixed methods design met vier, onderling samenhangende, werkpakketten (WP) met elk een specifieke focus. WP1: Verdiepend inzicht (maand 1-12) WP2: Handvatten selecteren en (door)ontwikkelen met de praktijk (maand 1-13) WP3: Handvatten testen met de praktijk (maand 13-20) WP4: Disseminatie (maand 13-24) RELEVANTIE Dit project is relevant omdat eerstelijns fysiotherapeuten beter toegerust worden om meetresultaten zinvol te kunnen gebruiken voor persoonsgerichte zorg bij patiënten met COPD. In het verlengde daarvan dragen ze bij aan het verminderen van ongelijkheid in zorg, betere gezondheidsuitkomsten en meer patiënttevredenheid.
