Understanding Delivery and Engagement With a Digital Self-Management Intervention for Chronic Obstructive Pulmonary Disease Across Two Clinical Settings: Qualitative Study.

چکیده اصلی

BACKGROUND: Adherence to chronic obstructive pulmonary disease (COPD) self-management plans can improve health outcomes, yet access to pulmonary rehabilitation remains limited. Digital self-management interventions, such as myCOPD, offer a potential means to extend support across care pathways. However, little is known about how these tools are delivered in routine practice or how delivery influences patient engagement across different clinical settings. OBJECTIVE: This study explored perceived barriers and facilitators to the delivery of and engagement with myCOPD by examining the perspectives of both patients and health care professionals (HCPs) across 2 National Health Service settings. METHODS: This qualitative study was conducted between November 2023 and April 2024 across 2 contrasting clinical pathways: community pulmonary rehabilitation and a hospital discharge service following acute exacerbation of COPD. Semistructured interviews were conducted with patients using myCOPD and HCPs involved in its delivery. Topic guides covered health background, digital technology use, and experiences of engaging with the intervention. A convenience sampling approach, with elements of purposive sampling, ensured representation across settings. Clinical data were obtained from health records with consent, and usage data were provided by my mhealth Ltd. Data were analyzed using abductive thematic analysis informed by the Medical Research Council's process evaluation framework. RESULTS: Thirty interviews were completed (16 patients and 14 HCPs). Patients described how multimorbidity, perceived digital ability, and socioeconomic context shaped their engagement with myCOPD, operating as "layers of vulnerability" that influenced whether COPD self-management could be prioritized. HCPs highlighted organizational and workflow constraints that shaped how the intervention was introduced and supported. Delivery approaches differed markedly between settings: community teams adopted proactive, relationship-based support that enabled iterative discussion, tailored recommendations, and continuity, whereas hospital teams described passive, onboarding-focused delivery shaped by time pressures, staffing constraints, and discharge priorities. These contrasting delivery models influenced engagement patterns, with proactive support associated with more multifaceted engagement (characterized as routine and sustained) and passive onboarding associated with single-aspect engagement (characterized as short-term and transactional). Participants also identified perceived barriers (eg, usability concerns, limited integration with in-person care) and perceived benefits (eg, improved inhaler technique, increased confidence, lifestyle adjustments). CONCLUSIONS: Delivery context and local workflows play a central role in shaping how patients engage with digital self-management tools. Proactive, relational support appears to facilitate deeper and more sustained engagement, whereas passive onboarding may limit the intervention's potential. Implementation strategies should align digital tools with local capacities, staffing structures, and patient characteristics, attending to layered vulnerabilities such as multimorbidity and digital confidence. Further work is needed to understand how proactive delivery models can be resourced and integrated within routine COPD care.

ترجمه فارسی چکیده

پایبندی به برنامه‌های خودمدیریت بیماری‌های انسدادی مزمن ریه (COPD) می‌تواند نتایج سلامت را بهبود بخشد، اما دسترسی به بازتوانی ریه همچنان محدود است. مداخلات خودمدیریت دیجیتال مانند myCOPD، فرصتی برای گسترش حمایت در مسیر مراقبت ارائه می‌دهند. این مطالعه با بررسی دیدگاه‌های بیماران و متخصصان سلامت در دو محیط خدمات سلامت ملی، موانع و تسهیل‌گران درک شده در انتقال و مشارکت با myCOPD را بررسی کرد. این مطالعه کیفی بین نوامبر ۲۰۲۳ و آوریل ۲۰۲۴ در دو مسیر بالینی متضاد انجام شد: بازتوانی ریه در جامعه و خدمات ترخیص بیمارستان پس از تشدید حاد COPD. مصاحبه‌های نیمه‌ساختاریافته با بیماران و متخصصان سلامت انجام شد. تحلیل موضوعی استنتاجی با استفاده از چارچوب ارزیابی فرآیند شورای تحقیقات پزشکی انجام شد. نتایج نشان داد که بیماران چگونگی مشارکت خود را تحت تأثیر بیماری‌های همراه، توانایی دیجیتال درک شده و زمینه اقتصادی-اجتماعی شکل می‌دهند. رویکردهای انتقال در دو محیط متفاوت بود: تیم‌های جامعه رویکرد فعال و مبتنی بر رابطه را اتخاذ کردند، در حالی که تیم‌های بیمارستان رویکرد منفعل و متمرکز بر ورود کاربر را توصیف کردند. مشارکت در محیط‌های با رویکرد فعال بیشتر پیچیده و پایدار بود. موانع و مزایای درک شده نیز شناسایی شد.

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