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Publicatie

Tailoring mHealth to Support Self-management of Patients with Chronic Arthritis

Boek - Dissertatie

Chronic arthritis (CA) is an umbrella term for inflammatory rheumatic and other musculoskeletal diseases including rheumatoid arthritis, spondyloarthropathies, juvenile idiopathic arthritis, septic arthritis and gout. These diseases cause joint pain, swelling, stiffness, instability and joint destruction, resulting in progressive impairment of mobility when insufficiently controlled. Long-term commitment to comply with the medication regimen as well as self-management between consultations is required. Patients are advised to engage in physical activity to reduce loss of mobility and flexibility and increase cardiovascular endurance and muscle strength. Unfortunately, compliance to this enduring, demanding therapy is low. mHealth apps, i.e., mobile applications that assist patients in self-management of their disease might provide a solution. These health apps are able to offer comprehensive guidance and allow patients to keep a close watch on their condition. In addition to the direct therapeutic benefits, health apps can also improve patient engagement and motivation to adhere to therapy. To increase engagement with mHealth apps, designers and developers can turn to persuasive or motivational design, i.e., design and development that focuses on achieving behavior change through a product's or service's features or characteristics. However, for mHealth to be effective in motivating patients, a different approach may be desired for each patient due to differences in disease status or motivation. Hence, this tailoring of mHealth requires an in-depth understanding of differences in CA patient types as well as which motivational techniques are suitable to address these differences. This thesis describes the exploration of mHealth apps and their (motivational) features, the design, development and tailoring of an mHealth application to support self-management of CA patients and the evaluation of this application by patients. The research described in this thesis aims to address three objectives: 1) to determine the current state of motivational features used in mHealth apps for patients with CA, 2) to determine what patients with CA want in terms of an mHealth app and 3) to design, develop and evaluate a motivational mHealth application for patients with CA. To achieve these objectives, first, a study was conducted to determine what is available to patients with CA in terms of mHealth apps. These apps were analyzed on the presence of motivational features. Next, using the outcome of this research, a catalog of motivational features and their underlying psychological theories was created. Secondly, focus groups and semi-structured interviews were conducted to determine what patients with CA want. Thirty-one patients with CA were interviewed and six patients and six healthcare professionals participated in two focus groups to determine their preference for different self-management and motivational features for an mHealth application. Additionally, four patient types (defeated, worrier, warrior and cruiser) were established, based on the data gathered during the interviews and focus groups. Thirdly, based on these findings, an mHealth application for patients with CA was designed and developed using a user-centered design approach. Finally, this application was evaluated during an adoption study with seven patients. The feature patients used most was logging for reporting to healthcare professionals, second came physical activity monitoring, third consulting previously logged health parameters. However, patients also remarked that the current sensor system is not performing enough to accurately detect physical activity. Six out of seven patients continued to use the application, and are still using the application to this day (end of June, 2019), frequently logging pain data or notes.
Jaar van publicatie:2019
Toegankelijkheid:Open