R. D. Sinyard1, 2, R. Anteby1, J. Margo2, Z. Kaelberer2, G. Molina2, 5, C. Cauley1, 2, M. Brindle2, A. Haynes4, J. Onnela3, N. Panda1, 2 1Massachusetts General Hospital, Dept Of Surgery, Boston, MA, USA 2Ariadne Labs, Brigham & Women’s Hospital & Harvard T.H. Chan School Of Public Health, Boston, MA, USA 3Harvard T.H. Chan School of Public Health, Dept Of Biostatistics, Boston, MA, USA 4Dell Medical School, University of Texas at Austin, Dept Of Surgery And Perioperative Care, Austin, TX, USA 5Brigham & Women’s Hospital, Dept Of Surgery, Boston, MA, USA
Introduction:
The objective of this study was to explore the patient-perceived acceptability and perioperative applications of mobile health technology (mHealth).
Methods:
This was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify patients within 30-90 days following major operations (≥10% composite morbidity) across 7 specialties: gynecologic oncology, orthopedics, surgical oncology, vascular, thoracic, burns/plastics, and colorectal surgery. Sekhon’s Acceptability Framework informed the development of a semi-structured interview guide and codebook. Phone or video interviews were conducted (May-August 2021) and associated transcripts were de-identified, coded by two team members using an intercoder agreement process, and analyzed deductively by theme, allowing for emergent subthemes.
Results:
Twenty-five patients were interviewed prior to achieving saturation. Patients overwhelmingly had a positive affective attitude regarding using mHealth in perioperative processes, with the strongest motivator being surgeon recommendation (Figure 1). Interviewees demonstrated significant intervention coherence, most commonly requesting that mHealth centralize pre- and postoperative discharge instructions, simplify communication channels, and easily share media. Areas of perceived effectiveness of mHealth included improved preoperative expectation management via patient- and disease-specific educational materials, as well as point-of-care preoperative instructions. Postoperatively, interviewees perceived mHealth could reduce in-person encounters (e.g., outpatient clinics, emergency room) and complement telemedicine-based care. Patients also reported that mHealth offered the opportunity to track their physical recovery, which would be motivating when comparing with the progress of other patients. Though the simplicity of sharing media was considered improved with mHealth, most described their current digital patient portal as adequate. Adding mHealth to the perioperative care cycle was perceived as a minimal burden, though there was concern about the frequency of surveys. Few patients were concerned about the ethicality of data collection associated with mHealth, especially if limited to a prespecified time around surgery. While all but one interviewee expressed high self-efficacy when engaging mobile technology, a majority expressed accessibility concerns regarding disadvantaged populations, such as the elderly, cognitively impaired, or those of lower socioeconomic status.
Conclusions:
Patients recovering from major operations representing multiple specialties perceived mHealth to be acceptable and effective for improving perioperative care, especially preoperative education and postoperative communication. These findings have the potential to inform the effective implementation of mHealth to optimize patient-centered surgical care.
