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Table 5 Illustrative quotes related to preferences regarding an mHealth intervention and facilitators for engagement with mHealth

From: Perceptions of patients with chronic obstructive pulmonary disease and their health care providers towards using mHealth for self-management of exacerbations: a qualitative study

Theme Quote
Preferences regarding content of an mHealth intervention
Providing information Q19 P05: “Well to be specific, I think that the information on symptoms would be a really good one…Whether your symptoms are severe or not, or whether it’s in an early stage or not. I really think that’s what’s really important.”
Action plan for decision support Q20 P11: “Sometimes when you are so short of breath, you forget things because of that, or you skip a step…and eh…For me, it would be useful to have the right steps clear for myself or to be able to adjust these steps for myself, right? That you follow the right steps in case you are short of breath...What is it? What to do? How to breath? Is there anyone you should consult? Who to consult? And what kind of medicine?” H02: “So when the app gives a certain score or something like that, or you get a specific score over two days, that the app gives you a fitted advice based on that, like: ‘You need to contact your general practitioner or pulmonary nurse’.”
Reminders Q21 P03: “For people who are recently diagnosed with COPD, the reminders could be useful. They won’t have to re-invent things for themselves, like I had to do.” H02: “Yes, for example, I think of reminders…Maybe for recently diagnosed patients, for example to use their inhaler or medication.”
Self-monitoring of symptoms Q22 P01: “To be honest, I don’t know if I would use it…[...] With all the respect, we are talking about some kind of app. I just have my doubts because I actually want to be confronted with my illness as less as possible…” P05: “Well, it depends…on the length of the questionnaire you need to fill out, that’s what I think.” H06: “I think that after a while, a lot of patients just say ‘it’s going fine or everything is okay’. And why would you fill out the questionnaire then?”
Information exchange with HCP Q23 P10: “What I don’t want is that the app communicates directly with my caregiver. I want to be able to control that myself. That’s a decision I want to make. So when I think it’s important, I believe I should be able to communicate that. But I want to be the one that can make that decision to do so.”
Facilitators for engagement with mHealth
Targeting and tailoring of mHealth Q24 P01: “I wonder if you shouldn’t make a distinction in the app between patients with mild COPD and patients with more severe COPD.” H01: “If so, it needs to be personalized.” H06: “On the other side, it needs to be manageable as well [...] For every healthcare professional. Maybe I do know of my own patients how the app has been tailored, but what if my patient comes to see you? You should be able to directly see what it is about as well.”
Attractiveness Q25 H05: “I think it’s important to focus on the essence of the application. In my opinion, it needs to be small and simple with a very specific goal.” H03: “It needs to be manageable for the patient category. When you think about the elderly, it could already be difficult with mobile devices. It shouldn’t be too difficult with all kinds of dots and lines. Then I think that they will stop using the app soon.”
Positive confirmation or rewards Q26 P01: “What might stimulate me to use the app, is to insert positive things, like: ‘I am seeing a physiotherapist twice a week, well done!’” H04: “A reward is the best thing that works of course. […] A reward structure, so that when you have filled in things correctly, you will receive a compliment. […] People are simple, just something with illustrations: positive confirmation.”
Focus on patients own decisions Q27 P09: “But it’s possible to use the app for advice right? You always remain in control right?” (Moderator asks: ‘Would you like to receive an advice based on the questions you answered?’) P10: “Well maybe if it’s really an advice [...] I don’t want to have to; I want to be able to make my own decision to do it yes or no.”
Having skills and a positive attitude Q28 H06: “You need to be open minded.” H03: “I noticed in my own practice (while testing another app) that half, or maybe more than half, of the patients couldn’t deal with it and were also not willing to use it. The other patients, a smaller group, are really enthusiastic about it and highly motivated. In that case, it doesn’t matter that much what kind of self-management intervention you offer from a distance.” (Moderator asks: “And what was the reason for that difference?”) “I think it depends on their cognitive skills, how they cope with their disease.”
HCP perspectives towards their role regarding mHealth use
Adequate positioning of responsibilities Q29 H03: “You try to leave it with the patient, but then you notice that it just doesn’t always work that way. And that you yourself need to take a proactive role to reach out to the patient again” H04: “It’s preferable to give patients more responsibility in their self-management and that you try to work towards that, so that should be the aim.[…] That includes making proper arrangements about how it’s going to be when it works out, and of course emphasize that when things don’t work out, they can always count on help.”
Perceived control by increasing patient responsibilities Q30 H04: “That’s rewarding for patients. When you report your symptoms in the app and it leads to advice and you reach out for help. Then something happens which makes that you can prevent things. As a health care provider you can say at the beginning ‘Well you’re in control. If you use the app, you can experience the benefits yourself.’ And with that the app becomes more important.”
Monitoring by an HCP can be unsafe Q31 H06: “I would think that would be dangerous too. Because, well…I read my messages every fifteen minutes. If I don’t do that for a couple of hours then I could miss things, you don’t want that to happen [...]. For instance, you insert a really bad value, like you have a fever or your saturation is low… when patients don’t get a call from the nurse or doctor at that time, they could think ‘Well it’s probably not that important.’”
Time investment for HCP Q32 H02: “I really wonder if as a nurse or primary care nurse you would really have the time for that. Because when I think about self-management, it’s the patient’s responsibility to do something with the information he or she gets out of the app, instead of the nurse or somebody else receiving notifications and having to call all the patients.”
Goal of self-management Q33 H01: “I really wonder if it’s still self-management then…” H05: “Especially the danger of patients thinking they can have a passive role and don’t have to do anything themselves anymore. That, of course, does not correspond with the goal of self-management.”