Patients' perspectives on digital health tools

The increasing global population age and shortage of clinical specialists are straining the international healthcare industry. Digital health technologies, including smart devices and wearables, offer potential solutions to address this imbalance by enhancing patient empowerment and engagement. However, most digital health technologies have been designed from a technological perspective, with limited focus on patients' perspectives. This top-down approach often leads to low uptake and acceptance. While digital tools offer convenience and easier access to health records, most lack patient involvement in the design process. This paper reviews current research to integrate knowledge about patients' perspectives on digital health tools, identify facilitators and barriers to uptake, and explore future research directions.

The literature extensively recommends involving patients in the design process from the outset, highlighting the need to incorporate the patient's voice into the design of digital health technologies. Participatory design, originating in Scandinavia, offers an approach to support user involvement in designing products and services. Studies demonstrate the importance of collaborating with patients and healthcare providers to design effective digital health tools. For example, one study explored challenges in designing a mobile health application for remote cardiac device monitoring, finding that discrepancies between patient and clinician perspectives needed to be addressed for meaningful design. This emphasizes the need for a participatory approach in the design of future digital health technologies, but existing research offers varying factors and criteria of patients’ views of digital health tools.

This research employed a critical review method to analyze English articles published from January 2010 to November 2021 in Scopus and Google Scholar databases. Search strings using keywords such as 'patient,' 'perspective,' 'technology,' 'telemedicine,' 'patient engagement,' and 'eHealth' were employed. The initial search yielded 1722 articles. After screening titles and abstracts, 319 articles remained. Following full-text review, 71 articles met the inclusion criteria for data analysis. Thematic and qualitative content analyses were used to analyze the data. Thematic analysis identified and analyzed themes or patterns, categorizing them using labels and codes. Content analysis was then used to interpret the qualitative data. Data analysis yielded two major categories: 'Facilitators' (factors promoting uptake) and 'Barriers' (factors hindering uptake).

The analysis revealed three major facilitators of patient uptake: patient empowerment, self-management, and personalization. Patient empowerment was linked to increased participation in decision-making, control, and learning about their health. However, some studies found that digital health technologies could perpetuate feelings of powerlessness, particularly when patients perceived clinicians as experts. Self-management was facilitated by better understanding of health conditions and improved patient-clinician relationships. However, challenges included remembering login details across multiple patient portals and the need for user-friendly, integrated systems. Personalization, tailoring the user experience to individual needs, increased patient engagement and improved outcomes. Effective communication, particularly personalized communication, was vital for personalization. Barriers to uptake included digital literacy, health literacy, and privacy concerns. Digital literacy was a significant barrier, especially among older adults, impacting confidence and interest. Health literacy concerns were raised regarding understanding medical information and terminology in electronic medical records. Privacy concerns, particularly regarding data misuse by third parties, also played a significant role. However, some studies indicated that personalization could mitigate privacy concerns by building trust between patients and healthcare providers.

This review highlights the disconnect between digital health tool development and patient needs, with engaged patients benefiting most from digital health tools. The facilitators identified (patient empowerment, self-management, and personalization) can help shift towards more patient-centered healthcare models. However, challenges remain in balancing the needs of patients and clinicians, such as addressing the workload increase for clinicians from increased online communication while also maintaining patient satisfaction. The barriers identified (digital literacy, health literacy, and privacy concerns) point to the need for a modified approach to designing digital health tools, involving patients, clinicians, and technicians collaboratively to ensure usability and meet patients' needs.

This review explored patients' perspectives on digital health tools, identifying facilitators and barriers to use. Future research should utilize participatory design methods to create patient-centered digital tools, addressing issues of digital and health literacy, privacy concerns, and the balance between clinician workload and patient engagement. Incorporating patients' voices from the beginning of the design process is key to successful digital health technology implementation and uptake.

The review was limited to English-language articles published between 2010 and 2021 in two databases, potentially excluding relevant studies. The methodological diversity across included studies might limit the generalizability of some findings. The focus was primarily on patients’ perspectives, with less emphasis on clinician perspectives. Further research is needed to fully understand and overcome barriers related to digital and health literacy and address privacy concerns.