Patients' acceptability of self-selected digital health services to support diet and exercise among people with complex chronic conditions: Mixed methods study

Abstract

Objective: The acceptability of being offered a choice from a suite of digital health service options to support optimal diet and exercise behaviors in adults with complex chronic conditions was evaluated. This study sought to understand many areas of acceptability including satisfaction, ease of use, usefulness and user appropriateness and perceived effectiveness.

Methods: This mixed-methods study was embedded within a randomized-controlled feasibility trial providing digital health services managing diet and exercise for adults from specialist kidney and liver disease clinics. Post study surveys and semistructured interviews were used to determine patients' acceptability of the trial interventions. Quantitative (surveys) and qualitative (surveys and interviews) results were merged using integrative analysis and mapped to each construct of the modified version of the Theoretical Framework of Acceptability.

Results: Seventeen interviews (intervention group) and 50 surveys (n = 24 intervention, n = 26 comparator) completed from a possible 67 participants were analyzed. In the intervention group, the survey results revealed high areas of acceptability for the digital health services including overall support received, ease of use, timely advice and feeling safe. The interviews also revealed high areas of acceptability including convenience, ability to adopt healthier behaviors and having regular interactions with health professionals. However, the interviews also revealed lower areas of acceptability as a result of absence of individualization, low digital literacy, and limitations from life circumstances.

Conclusions: Recipients of digital health services that supported diet and exercise interventions found these useful, effective, and safe. Individualized care, technical support and patient confidence remain important to improve the acceptability of digital health service interventions.

Keywords: Digital health; chronic disease; eHealth; exercise; health service; kidney disease; liver disease; mHealth; nutrition; telehealth.

Figure 1.

A bar graph showing how they feel about the exercise app (n = 22) and the nutrition app (n = 21) for those who selected these digital health service options in the intervention group. Agree refers to agree and strongly agree combined; and disagree refers to disagree and strongly disagree combined. The top half of the graph relates to the exercise app and bottom half relates to the nutrition app. Please note that the participants who selected these digital health service options but did not use the app were not included in this graph.

Figure 2.

A bar graph showing perceived ease of use of the features embedded in the exercise app (n = 22) and nutrition app (n = 21) for those who selected these digital health service options in the intervention group. Easy refers to easy and very easy combined; and difficult refers to difficult and very difficult combined. The top half of the graph relates to the exercise app and bottom half relates to the nutrition app. Please note that the participants who selected these digital health service options but did not use the app were not included in this graph.

Figure 3.

A bar graph showing the perceived effectiveness of the comparator (n = 23) or intervention (n = 24) at improving motivation, confidence and understanding of diet and exercise for both groups. Effective refers to effective and very effective combined; and ineffective refers to ineffective and very infective combined. The top half of the graph relates to exercise and bottom half relates to diet.