End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review

Helen Slater, Jared M Campbell, Jennifer N Stinson, Megan M Burley, Andrew M Briggs, Helen Slater, Jared M Campbell, Jennifer N Stinson, Megan M Burley, Andrew M Briggs

Abstract

Background: Chronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative.

Objective: The aim of this study was to identify, appraise, and synthesize available qualitative evidence on users' experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers).

Methods: A systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived.

Results: Twelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma, chronic self-harm, and attention deficit hyperactivity disorder. Quality ratings were higher for implementer compared with end user studies. Both complementary and unique user themes emerged. Themes derived for end users of mHealth included (1) Experiences of functionality that supported self-management, (2) Acceptance (technical usability and feasibility), (3) Importance of codesign, and (4) Perceptions of benefit (self-efficacy and empowerment). For implementers, derived themes included (1) Characteristics that supported self-management (functional, technical, and behavior change); (2) Implementation challenges (systems level, service delivery level, and clinical level); (3) Adoption considerations for specific populations (training end users; specific design requirements); and (4) Codesign and tailoring to facilitate uptake and person-centered care.

Conclusions: Synthesizing available data revealed both complementary and unique user perspectives on enablers and barriers to designing, developing, and implementing mHealth technologies to support young people's management of their chronic NCDs.

Trial registration: PROSPERO CRD42017056317; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD 42017056317 (Archived by WebCite at http://www.webcitation.org/6vZ5UkKLp).

Keywords: chronic disease; health policy; health services research; musculoskeletal pain; noncommunicable disease; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Helen Slater, Jared M Campbell, Jennifer N Stinson, Megan M Burley, Andrew M Briggs. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.12.2017.

Figures

Figure 1
Figure 1
Flow diagram of study identification and selection adapted from preferred reporting items for systematic review and meta-analysis (PRISMA) flowchart. PI=phenomenon of interest; mHealth=mobile health.
Figure 2
Figure 2
A representation of the review findings is mapped against relevant elements of the Holistic Framework and applied here as a theoretical underpinning to guide our discussion. Themed categories for end users are represented above the blue line and implementers below. Implementation phases are represented by the central blue line, which indicates a left to right movement showing the continuous and iterative cycles of mobile health (mHealth) development. This includes phases from predevelopment (enquiry or value specification), to design and implementation (operationalization), with formative feedback guiding iterations of mHealth technologies. Note, both complementary and unique user perspectives are evident.

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