Patient Capability

Patient Motivation

Patient Opportunity

Intervention Technology

Intervention Functionality

Intervention Interaction Design

Organizational Environment

Physical Environment

Social Environment

Patient Capability

Patients’ knowledge and skills to use digital health technologies and confidence in completing digital health tasks

Knowledge and Skills

Positive Factors

  • Familiarity with the technology
  • Previous positive experience with digital health

Negative Factors

  • Low literacy (language, technology; or health)
  • Previous negative experiences with digital health (eg, failure to achieve goals and disappointment with the DHIs

___________

Confidence Levels

Negative Factors

  • Lack of confidence in skills
  • Perceived inability to use technologies or services
  • Misunderstanding digital health tasks 

___________

How to address……

  •  
  • Identify patients’ knowledge and skill levels by understanding their technology, language, and health literacy; 
  • Consider their previous experiences and current confidence level in using digital health; 
  • Improve their actual literacy and correct their inaccurate self-perception; 
  • Tailor the design to their abilities.
  •  

Patient Motivation

Patients' perceived advantages, perceived disadvantages, and initial mindsets.

PERCEPTION (perceived advantages and disadvantages)

POSITIVE

  • Perceived sense of security, independence, empowerment, convenience and access to care, and less sense of vulnerability
  • Prepared for emergencies or hospital visits 
  • Intact social networks
  • A suitable goal setting

NEGATIVE

  • Perceived no benefits 
  • Perceived threats to security, privacy, independence, or an individual’s sense of identity
  • Worried digital health would replace traditional appropriate (face-to-face) health care services
  • Impede social life or interfere with patient-to-provider relationships
  • Cause additional burden (being bombarded with too many messages)

___________

MINDSET

POSITIVE

  • Prefer digital solutions
  • Strong desire to keep healthy or gain knowledge

NEGATIVE

  • Computer anxiety
  • Overreliance
  • Loss of interest
  • Lack of motivation

DOUBLE-EDGED

  • Patient preferences, expectations, desires, priorities, understanding, or beliefs
  • Reliance 
  • Trust in technology

___________

How to address……

  •  
  •  
  • Understand patients’ mindsets and their perceived advantages and disadvantages of using digital health; 
  • Inform them of the benefits of using digital health; 
  • Reduce their concerns and worries; 
  • Understand their expectations and needs; 
  • Tailor the design to their preferences.
  •  
  •  

Patient Opportunity

Patients' identity and health status.

Identity

POSITIVE

  • Younger age (eg, easier access to the internet)
  • DHIs fit into patient’s daily routine

NEGATIVE

  • Older age (eg, with age-related barriers)
  • Low socioeconomic status (eg, lack of access to digital health)
  • Business (eg, travel required, household responsibilities)

DOUBLE-EDGED

  • Gender differences

___________

Health status

POSITIVE

  • The earlier stages of illness and partial or full remission

NEGATIVE

  • Advanced chronic disease and complex comorbidities
  • The acute stages of illness
  • Out of control health condition
  • Cognitive barriers

DOUBLE-EDGED

  • Gender differences

___________

How to address……

  •  
  • Identify patients' demographic information and health status;
  • Consider their accessibility and affordance to digital health; 
  • Tailor the design to their conditions.
  •  

Intervention Technology

Technical usability, technical features, and delivery media.

Technical Usability

POSITIVE

  • Ease of use and understanding
  • Ready-to-use applications and devices
  • Automatic and seamless system updating
  • Adaptive interface
  • Avoiding error prompts

NEGATIVE

  • Difficulty to use 
  • Equipment or battery failure
  • High system complexity (eg, complex software downloads and account or password settings)
  • Data transmission and input difficulties
  • Unstable internet connection or slow loading of website
  • Low accessibility
  • Low error tolerance
  • Poor picture and sound quality
  • Low visibility on small screens

___________

Technical Features

POSITIVE

  • Detect an improvement from digital health data or share data with HCPsc
  • Medication or appointment reminders or altering
  • Symptoms tracking dairies or tools
  • Timely feedback or motivational feedback notifications
  • Ability to print or email information
  • Ability to take voice commands
  • Nutrition calculator
  • Clinical measurements
  • A security password for record access
  • Agenda setting
  • Recommender systems
  • Summary reports for supporting shared decision-making
  • Input or review information at any point

NEGATIVE

  • Access to changeless or worse physiological data over time

DOUBLE-EDGED

  • Access to data

___________

Delivery media or devices

POSITIVE

  • Mobile technology
  • Video- or audio-based technology (for users with sensory impairments)
  • Assisted equipment (eg, provide headphones for people with hearing difficulties and larger monitors with improved lighting for people with visual impairments)

NEGATIVE

  • Web-based technology

DOUBLE-EDGED

  • Types of devices (eg, mobile phones or computers)
  • Device ownership (eg, personal devices or devices without personal identifiers)
  • Types of channels (eg, SMS text message or videos)

___________

How to address……

  •  
  • Improve technical usability; 
  • Promote ease of use, ready-to-use, and timely feedback on digital health;
  • Fit technical features, delivery media, and devices to patients’ preferences and needs.
  •  

Intervention Functionality

Patients' perceived advantages, perceived disadvantages, and initial mindsets.

Intervention Goals

POSITIVE

  • Individualized or timely feedback
  • Remotely consultation with HCPs
  • Provide sufficient health information

NEGATIVE

  • Be forced to share data with HCPs, which is undesired by patient
  • Under long-term video-based monitoring

DOUBLE-EDGED

  • Remote data monitoring
  • Self-management support
  • Health information provision and patient education
  • Shared decision-making

___________

Social support

POSITIVE

  • Interact with a real human being
  • Regular and continuous patient-to-physician interaction
  • Connect with peers
  • Exchange health information and advice with family and friends

NEGATIVE

  • Replace interpersonal connections with HCPs
  • Lack of physical human contact with HCPs
  • Unable to contact HCPs directly or obtain timely feedback

DOUBLE-EDGED

  • Remote connection

___________

Performed Quality

POSITIVE

  • Reliability and credibility (eg, owner’s credibility, maintenance, third party verification, research support, involvement of clinical experts in the design process, and empirical evidence for successful implementation)
  • Regulation compliance
  • Flexibility

NEGATIVE

  • Less accuracy of clinical assessments
  • Lack of availability and accessibility
  • Lack of safety and privacy (eg, incorrect intervention dosage and the absence of privacy notifications)
  • Without well-defined or safely standardized clinical indicators

___________

Intervention Structure

POSITIVE

  • A structured format or regular weekly contact with HCPs
  • Longer duration
  • Flexible interventions

NEGATIVE

  • Structured interventions not tailored to patients’ individual symptoms and preferences
  • Structured interventions that constantly remind patients of their symptoms

DOUBLE-EDGED

  • The intensity, frequency or duration of interventions
  • Prefixed interventions

___________

Theoretical Background

POSITIVE

  • Presence of multiple underlying theories (BCTsd, EBIse, and persuasive technology)

Intervention Interaction Design

Personalized design, information design, navigation design, interface design, and design procedures.

Personalized design

POSITIVE

  • Individualized feedback, tailored features, or customization
  • Be able to choose the topic, content, and language of received messages
  • Be able to select the timing and frequency of the delivered interventions

___________

Design Procedures

POSITIVE

  • User-centered design or human-centered design
  • Interorganizational collaboration
  • Co-design or participatory development methodology
  • Inclusive design
  • Involvement of multistakeholder and multidisciplinary teams in the early design stages

___________

Navigation Design

POSITIVE

  • Instruction manuals and extra user training
  • Technical support or assistance
  • Interactive elements

NEGATIVE

  • Lack of clear navigation or instruction design

___________

Visual Design

POSITIVE

  • Visualized health data
  • Tailored, attention-grabbing, simple, and consistent layout design (eg, appealing graphic presentation, pleasing and coherent color scheme, high text quantity, suitable font and interface size, and striking button appearance and location)
  • Unobtrusive wearable devices

NEGATIVE

  • Unappealing user interfaces
  • Poorly crafted interface
  • Low visibility of the content
  • Bulkiness
  • Nonportability
  • Small screen or font size

___________

Information Design

POSITIVE

  • A reliable, trusted, credible information source
  • An unmarked sender
  • Multimedia messages
  • Detailed and comprehensive information
  • Diverse and updated information
  • A short, concise, personalized, clear, and direct message
  • Formal or clinical language for some functions (description of pathologies)
  • Informal language for others (evaluation of conduct)
  • A motivational, friendly, encouraging, polite, respectful, congratulatory, personalized, upbeat, positive, humorous, and relatable tone
  • Layered medication information and warnings from basic to advanced

NEGATIVE

  • Overload of information
  • Technical language

DOUBLE-EDGED

  • Information source
  • Information language

Organizational Environment

Cost, health care providers, and health information systems.

Cost and Time

POSITIVE

  • Less travel costs and waiting time
  • Complete tasks at patients’ own pace
  • Less time consuming
  • Faster response
  • Real-time feedback or timely support 

___________

Design Procedures

POSITIVE

  • User-centered design or human-centered design
  • Inter-organizational collaboration
  • Co-design or participatory development methodology
  • Inclusive design
  • Involvement of multi-stakeholder and multidisciplinary teams in the early design stages

NEGATIVE

  • High start-up costs, ongoing costs, and costs related to loss of revenue
  • The cost of damage to equipment
  • Unrealistic financial reimbursement and higher costs relevant to internet or equipment
  • Time consuming for daily monitoring or recharging devices
  • Energy to complete “one more task”
  • Disruption to the daily routine
  • Lack of timely feedback
  • Long waiting times for digital health calls 

___________

Health Care Providers

POSITIVE

  • Many more HCPs
  • Clinical positive opinion and approval
  • Polite attitudes
  • Good communication skills

NEGATIVE

  • Clinician resistance (eg, less positive views on digital health)
  • Undermined clinical capacity and professional identity
  • Increased clinical workload
  • Impeded communication with patients
  • Over-treatment

___________

Health Information Systems

POSITIVE

  • The compatibility, interoperability, integration, sustainability, and completeness of systems
  • The clarity and transparency on accountability, workflow, and data processing
  • Clear information on required stakeholder responsibility

NEGATIVE

  • Lack of compatibility and interoperability of the system with different mobile operating systems and terminals
  • Poor integration and working relationship between the service team
  • Lack of adequate installation
  • Connectivity issues between medical devices and mobile terminals
  • Limitation on scalability

___________

How to address……

  •  
  • Reduce equipment or service cost and time; 
  • improve health care providers’ professional ability, communication skills, and service attitudes across the use of digital health; 
  • increase workflow transparency and clarify accountability; 
  • improve system integration and compatibility.
  •  

Physical Environment

The tangible surroundings (such as space, light, or sound) around patients.

Place

POSITIVE

  • Stay in a familiar and relaxing environment; not restricted to the hospital setting

NEGATIVE

  • Environmental distractions (eg, background noise and lighting) 

___________

How to address……

  • Provide a familiar, warm, and comfortable environment rather than cold and unfamiliar settings; 
  • reduce environmental distractions (eg, background noise or lighting).

Social Environment

The cultural environment (such as policy, business, or customs)

Culture

NEGATIVE

  • The absence of or inadequate supporting policies and legislation
  • Lack of a plausible business case
  • Unrealistic financial reimbursement
  • Lack of well-established socio-technical infrastructure

___________

How to address……

  • Provide adequate support policies and legislation; 
  • develop plausible business cases.