Healthcare professional and commissioners' perspectives on the factors facilitating and hindering the implementation of digital tools for self-management of long-term conditions within UK healthcare pathways

Physical activity is important in the self-management of long-term conditions (LTCs). However, implementing physical activity into clinical practice is challenging, due to complex barriers including access to programmes, time pressures, and transport costs, for people with comorbidities, managing multiple responsibilities. Various digital tools exist to overcome these barriers and support wide-scale implementation to help people stay physically active. We explored the experiences, needs and preferences of healthcare professionals and commissioners, regarding the use of digital tools to support people with LTCs to self-manage using physical activity. This included barriers and facilitators to implementing digital tools to support people with LTCs in NHS settings. Semi-structured interviews were conducted (April 2021 to January 2022) in Wessex, southern England, UK. Purposive sampling was used to recruit general practitioners and healthcare professionals, and convenience sampling to recruit commissioners (n = 15). Transcripts were coded to develop conceptual themes allowing comparisons between and among perspectives, with the Normalisation Process Theory (NPT)'s four constructs used to aid interpretation. Results showed that most digital tools supporting physical activity for LTCs, are not well implemented clinically. Current digital tools were seen to lack condition-specificity, usability/acceptability evidence-base, and voluntary sector involvement (i.e., NPT: coherence or 'making sense'). Healthcare professionals and commissioners were unlikely to engage with use of digital tools unless they were integrated into health service IT systems and professional networks (i.e., NPT: cognitive participation), or adaptable to the digital literacy levels of service users and staff (i.e., NPT: collective action-needs for implementation). In practice, this meant being technically, easy to use and culturally accessible (i.e., NPT: collective action-promoting healthcare work). COVID-19 changed professional attitudes towards digital tools, in that they saw them being viable, feasible and critical options in a way they had not done before the pandemic. Implementation was also influenced by endorsement and trustworthiness enhancing the perception of them as secure and evidence-based (i.e., NPT: reflective monitoring). Our findings highlight that consideration must be given to ensuring that digital tools are accessible to both healthcare professionals and patients, have usability/acceptability, and are adaptable to specific LTCs. To promote clinical engagement, digital tools must be evidence-based, endorsed by professional networks, and integrated into existing health systems. Digital literacy of patients and professionals is also crucial for cross-service implementation. </p

Additional file 1: of Applying a new concept of embedding qualitative research: an example from a quantitative study of carers of people in later stage dementia

Carer Questionnaire. (DOC 367 kb

sj-docx-2-dhj-10.1177_20552076221089778 - Supplemental material for Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review

Supplemental material, sj-docx-2-dhj-10.1177_20552076221089778 for Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review by Paul Clarkson, Aoife Stephenson, Chloe Grimmett, Katherine Cook, Carol Clark, Paul E Muckelt, Philip O’Gorman, Zoe Saynor, Jo Adams, Maria Stokes and Suzanne McDonough in Digital Health</p

The effectiveness of digital tools to maintain physical activity among people with a long-term condition(s): a systematic review and meta-analysis

Objective: Given the well-accepted health benefits, it is important to identify scalable ways to support people with long-term conditions (LTCs) to remain physically active. This systematic review aimed to evaluate the effect of digital tools on the maintenance of physical activity (PA) amongst this population.Methods: Electronic databases were searched for randomised controlled trials investigating the effect of digital tools on PA maintenance at least three months post-intervention compared with a non-digital control in participants with long-term conditions. Meta-analyses were conducted at post-intervention and longest maintenance timepoint; subgroup analyses explored the effect of the type of control. Prospero registration: CRD42022299967.Results: Twenty-three studies (n = 5350 participants) were included, with the majority at unclear/high risk of bias. Web-based tools were commonly used (18 studies), 10 monitored PA with a sensor, and digital interventions were often combined with supervised exercise/walks. The overall meta-analysis showed no significant difference in PA between digital interventions compared with any type of control (device-based outcomes: SMD = -0.07, 95% CI [-0.35, 0.21]; self-reported outcomes: SMD = 0.11, 95% CI [-0.01, 0.24]). However, this was moderated by type of control group with subgroup analyses suggesting that the effect of digital interventions on PA surpassed that of an inactive/minimal control at post-intervention (SMD = 0.29) and maintenance timepoints (SMD = 0.24).Conclusions: This review provides preliminary evidence that interventions incorporating digital tools may be more effective than minimal controls at supporting people with LTCs to maintain PA. Given the quality of the evidence, confidence in these findings is very low and may change with future research.</p

Digital tools to support the maintenance of physical activity in people with long-term conditions: a scoping review

Objective: This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings. Methods: Searches were conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and clinical trial databases, for studies published between 2009 and 2019, across a range of long-term conditions. Screening and data extraction was undertaken by two independent reviewers and the Preferred Reporting Items for Scoping Reviews guidelines informed the review's conduct and reporting. Results: A total of 38 results were identified from 34 studies, with the majority randomised controlled trials or protocols, with cardiovascular disease, type 2 diabetes mellitus and obesity the most common long-term conditions. Comorbidities were reported in >50% of studies but did not clearly inform intervention development. Most digital tools were web-browser-based ± wearables/trackers, telerehabilitation tools or gaming devices/components. Mobile device applications and combination short message service/activity trackers/wearables were also identified. Most interventions were supported by a facilitator, often for goal setting/feedback and/or monitoring. Physical activity maintenance outcomes were mostly reported at 9 months or 3 months post-intervention, while theoretical underpinnings were commonly social cognitive theory, the transtheoretical model and the theory of planned behaviour. Conclusions: This review mapped the literature on a wide range of digital tools and long-term conditions. It identified the increasing use of digital tools, in combination with human support, to help people with long-term conditions, to maintain physical activity, commonly for under a year post-intervention. Clear gaps were the lack of digital tools for multimorbid long-term conditions, longer-term follow-ups, understanding participant's experiences and informs future questions around effectiveness.</p

sj-docx-1-dhj-10.1177_20552076221089778 - Supplemental material for Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review

Supplemental material, sj-docx-1-dhj-10.1177_20552076221089778 for Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review by Paul Clarkson, Aoife Stephenson, Chloe Grimmett, Katherine Cook, Carol Clark, Paul E Muckelt, Philip O’Gorman, Zoe Saynor, Jo Adams, Maria Stokes and Suzanne McDonough in Digital Health</p

sj-pdf-1-ijq-10.1177_16094069221077521 – Supplemental Material for Engaging Stakeholders in Realist Programme Theory Building: Insights from the Prospective Phase of a Primary Care Dementia Support Study

Supplemental Material, sj-pdf-1-ijq-10.1177_16094069221077521 for Engaging Stakeholders in Realist Programme Theory Building: Insights from the Prospective Phase of a Primary Care Dementia Support Study by S. Griffiths, L. Weston, S. Morgan-Trimmer, H. Wheat, A. Gude, L. Manger, T. M. Oh, P. Clarkson, C. Quinn, R. Sheaff, M. Clark, I. Sherriff, and R. Byng in International Journal of Qualitative Methods</p