Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Mobile health devices promote self-monitoring of chronic conditions. We conducted an ecological momentary assessment among stroke survivors who used a mobile device to respond to survey questions about their daily life participation for 2 weeks. We report results from in-depth interviews to inquire about perceived barriers to and facilitators of using the device. Results also identify needs and wishes regarding the development and implementation of digital monitoring for long-term stroke outcomes.
Primary Author and Speaker: Joanne N. Chin
Additional Authors and Speakers: Shijia Li, Stephen C. L. Lau
Contributing Authors: Alex Wong
PURPOSE: Occupational therapists desperately need an innovative strategy to promote continuous disease monitoring, self-management, and other long-term outcomes of their post-stroke patients after hospital discharge. Preliminary evidence suggests clinical benefits of using mobile health devices such as ecological momentary assessment (EMA) in self-monitoring for individuals with chronic conditions (McKeon, McCue, Skidmore, Schein, & Kulzer, 2018; Ramsey, Wetherell, Depp, Dixon, & Lenze, 2016). To achieve such benefits in occupational therapy stroke rehabilitation, an essential first step is to explore the acceptability of using these devices for monitoring daily life participation in stroke survivors residing in the community (Chan, Torous, Hinton, & Yellowlees, 2014; Lemke, Rodríguez Ramírez, Robinson, & Signal, 2018). Thus, the objective of this study is to explore subjective experiences of daily life monitoring using EMA in community-dwelling stroke survivors. In particular, we aim to identify potential barriers and facilitators, as well as wishes and needs for further development and implementation of digital monitoring in stroke.
DESIGN: Qualitative study with semi-structured interviews. Study participants with mild-to-moderate stroke were selected from an ongoing EMA project in which they were enrolled through the Washington University Stroke Registry.
METHOD: In-depth interviews were conducted with 176 stroke survivors regarding their 2-week usage of a smartphone-based EMA mobile application (app) used to track their daily life experiences after stroke. We solicited feedback regarding user experiences and factors that contribute to EMA adherence. Needs and wishes for EMA and mobile app usage were also captured for further app development and implementation. Ten participants with the lowest survey completion rate (median = 15%, range = 4.3% to 31.4%) and 10 participants with the highest survey completion rate (median = 100%; range = all 100%) were selected for data coding and analysis. Using a grounded theory approach, interviews were transcribed verbatim and analyzed using direct content analysis to identify key themes until thematic saturation was reached.
RESULTS: Themes pertaining to barriers and facilitators associated with EMA use included: (1) technology/app features, (2) compatibility with life routines, (3) personal factors, (4) perceived benefits, and (5) user support. Themes pertaining to user needs included: personalization of schedule, question types, responses, and number of survey questions. Themes pertaining to wishes for EMA use included additional app features, such as prompts/reminders for activities, question wording, app design with multiple input choices, health data summaries for user feedback and treatment planning, and built-in guidance for additional insight and advice based on personal data.
CONCLUSION: This study has identified several facilitators and barriers as major factors that contribute to EMA adherence. Personalization and app features were also recognized as major user needs and wishes for using EMA. With the recent progressive shift toward telehealth, mobile health–based measures are becoming more prominent in rehabilitation. These findings provide a better understanding of the practical considerations of using EMA as identified by stroke survivors to guide the design and implementation of EMA or other digital monitoring. Our results may also inform further development of a clinically effective and user-friendly mobile health intervention that community-dwelling stroke survivors can access outside of the clinic to address rehabilitative and self-management needs.
References
Chan, S. R., Torous, J., Hinton, L., & Yellowlees, P. (2014). Mobile tele-mental health: Increasing applications and a move to hybrid models of care. Healthcare 2(2), 220-233.
Lemke, M., Rodríguez Ramírez, E., Robinson, B., & Signal, N. (2018). Motivators and barriers to using information and communication technology in everyday life following stroke: A qualitative and video observation study. Disability and Rehabilitation, 1-9.
McKeon, A., McCue, M., Skidmore, E., Schein, M., & Kulzer, J. (2018). Ecological momentary assessment for rehabilitation of chronic illness and disability. Disability and Rehabilitation, 40(8), 974-987.
Ramsey, A. T., Wetherell, J. L., Depp, C., Dixon, D., & Lenze, E. (2016). Feasibility and acceptability of smartphone assessment in older adults with cognitive and emotional difficulties. Journal of Technology in Human Services, 34(2), 209-223.
