Human-centred recommendations to maximise the potential for digital health in the management of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) negatively impacts the quality of life and mortality of patients and is very costly for healthcare systems to manage. Digital health (DH) has been proposed as a novel solution to support self-management, reduce exacerbations and decrease hospitalisations. However, despite the promises, evidence demonstrating significant outcomes for patients, or for the management of the disease, are limited and unconvincing. To smooth adoption and mitigate sustained engagement challenges, human-centred design (HCD) approaches are recommended when designing digital health interventions (DHI) as they emphasise the importance of situating user experiences, needs and preferences as the driver of the intervention design. However, recent research has identified there is an absence of a core principle in HCD, user-involvement, in the development of DHIs in COPD with user-experience issues commonly cited as reasons for poor levels of adoption for both HCPs and patients. To address these shortcomings and to contribute new insights to an area lacking in empirical research, this thesis explored the perceptions of HCPs and patients regarding the potential for DH in the management of COPD. The thesis employed a qualitative study design, namely semi-structured interviewing. The sample consisted of n=30 patients and n=32 HCPs. Thematic analysis was conducted on the data using NVivo 12 software. The research also involved conducting a systematic review that explored the use of HCD principles in the design of DHIs in COPD randomised controlled trials (RCT). The findings identified there is an absence of user-involvement in the design of COPD DHIs, and that the needs of patients and HCPs are rarely the foundation or driver of the design process. The findings also offer previously unexplored insights regarding the potential for DH to address the needs of COPD patients and HCPs. The findings show there are several opportunities for DH to enhance patient self-management practices such as symptom management, improving patient self-efficacy and engagement, and increasing the delivery of preventative and personalised care which to date, have not been researched elsewhere. Furthermore, the findings provide new insights regarding the barriers and facilitators patients and HCPs perceive facing the adoption and implementation of DHIs. The findings highlight substantial individual, structural and social barriers to overcome before DH can be realised as a routinely prescribed intervention in COPD. Patient and HCP digital literacy for example represents a significant individual level barrier, as does the patient’s perception of their illness. Structural barriers however, such as an absence of an evidence-base, or clinical guidelines, for the use of DHIs in COPD represent salient obstacles to overcome. Several facilitators to support the implementation and adoption of DHIs were identified. The facilitators focus largely on education and training, but the participants also placed significant weight on the importance of being aware of patient’s needs as a means to ease the adoption of DHIs. Such facilitators have not been published in the COPD context until now. This thesis offers a comprehensive list of human-centred recommendations for future DHI design in COPD. They propose a number of potential new research trajectories and provide new insights regarding the adoption needs of this cohort which can inform the development of implementation strategies for future DHIs in COPD. Importantly, these recommendations are generated from an empirical exploration of the needs and experiences of the patients and HCPs which has not been conducted thoroughly to date.