Introduction
Chronic Disease Management (CDM) in the elderly has become a serious public health concern due to the fast aging of the world’s population. Older adults may be unable to receive CDM because of a lack of health resources and costs. It is possible for patients and healthcare professionals (HCPs) to communicate at a distance thanks to mobile health (m-health), which entails the application of Information and Communication Technology (ICT) to offer healthcare. Remote rehabilitation using smartphone apps or specialized websites is one of the many telehealth approaches that may be implemented (Lee et al., 2018). Health-related information may be found using a variety of online resources, including search engines, health portals, and social media, because of the internet’s openness and interactive characteristics and the large volume of online information that is readily available. The term ‘online health information’ is used to describe this sort of information. For example, m-health interventions and digital health information can save money and time since they can be used anytime or anywhere. These barriers can be addressed by using m-health in CDM. The utilization of m-health and electronic health information in CDM ensures more active and knowledgeable patients in the move towards a patient-centered healthcare delivery paradigm.
Problem Statement
Aside from specialized applications and proofs of concept, m-health studies have so far concentrated on certain applications and proofs of concept. Patients as customers and empowerment via self-management are rarely addressed in this type of research, which tends to focus more on the medical system of healthcare than the socioemotional effects of chronic diseases. Some chronic conditions, such as diabetes, hypertension, and cardiovascular diseases, have reached alarming levels in many industrialized countries because of aging populations and poor lifestyles. Patient and family stress levels are high, and the long-term impact on healthcare delivery and costs is substantial. Empowering patients as equal participants in the provision of their healthcare can help ease this burden. Health care providers will value and respect patients’ decisions if they are well-informed, which is only possible if they are involved in the decision-making process themselves.
Significance of the Study
People and the nation’s economy alike are feeling the impact of chronic diseases at a time when they are growing more commonplace. Information and communication technologies are becoming increasingly important in chronic illness management because of their ability to facilitate the exchange of critical information between patients, caregivers, and healthcare providers. Education and understanding of lifestyle changes that might postpone or prevent the emergence of illnesses like diabetes and heart issues begin this sequence of events (Wildenbos et al., 2018). There are many chances to improve treatment through more integrated and seamless information transmission, from the prevention stage to monitoring patients to postpone the start of disease through managing the chronic condition itself. As a result, patients must be well-educated and actively involved in their own treatment, which necessitates a multidisciplinary approach involving everyone from general practitioners to home caregivers. Mobile technologies are a good alternative for this new systematic perspective of healthcare delivery because of its widespread use, mobility, immediate nature, ease, and context (location). It is easier for patients and doctors to exchange information with the help of these tools, and it’s possible that they will speed up the diagnosing process for those who have been diagnosed with a chronic illness.
Literature Review
Despite the importance of the research cited, the present literature fails to focus on the function of mobile health during patient-caregiver interactions. Studies therefore overlook the fact that empowerment relies on the relationship with the doctor. Consequently, current understanding on how to employ m-health and available data in sessions and if they encourage patient empowerment is lacking. Patient-physician misunderstanding is possible if m-health uses patients in general medical conditions instead of empowering them (Lee et al., 2018). Research is needed to understand how m-health is employed and how it impacts empowerment. When it comes to patient-physician interactions, there is a lack of understanding about the usage of m-health technologies.
Mobile Health Technology
Technology and platforms are covered in the literature on mobile health in chronic illness self-management. Wearables, social networking sites, and smartphone applications are all examples of new technologies. There are two primary groups that look at medical technology: health care providers and patients. As seen through the eyes of a medical expert, mobile health technology makes it possible to deliver medical treatment to patients who live far away. Transferring patient data to healthcare providers and delivering medical services in remote places is possible using m-health. A reduction in the requirement for emergency treatment was observed by Wildenbos et al. (2018). However, the findings of studies on clinical outcomes and costs are not definitive.
M-health technology has several advantages for patients because of the extensive usage of mobile phones and the ability to integrate information from numerous wearable devices. Patients may monitor their symptoms and other health concerns, which can be beneficial in the quest for better health. Various technologies also act as external memory aids for patients, making it easier for them to retain information about their health. Such technologies aid patients’ capability to manage their health and cope with the disease. In addition, m-health makes it possible for patients and medical professionals to exchange information. As a result, patients are better able to self-manage chronic conditions because of their increased knowledge. Studies, on the other hand, have shown issues such as the need to remind patients that they have a chronic illness (Zhu et al., 2022). In addition, patients typically reject adopting technology since m-health is designed without taking their values and requirements into account. A patient-centered solution that enhances the voices of patients is claimed to be the best alternative. Technology that promotes patient empowerment has been described in the literature.
Patient Empowerment and Its Importance
Empowerment indicates that patients can meet their own needs, taking charge of their own care, and making their own decisions about what behaviors and treatments are suitable, all on their own, or at the very least as equal partners. According to a generally accepted perspective on empowerment, patients’ independent perceptions of the condition are crucial to therapy and follow-up. Empowerment is a patient involvement that goes beyond basic compliance by boosting patients’ voices. As a result, the significance of mobile health technology in empowerment of patients is ironically referred to, debated, and assessed in terms of adherence to established quality standards in treatment in many studies of empowerment. As an example, Chen et al. (2022) created an app to assist patients with self-care and daily decision-making using mobile health technology. Empowerment and medical treatment compliance are thought to be part of the answer.
As an analogy, Zhu et al. (2022) looked at how mobile health may be used to empower patients to better comply with their doctors’ orders. This approach encourages a new way of living while also increasing adherence. Through these research studies, the literature demonstrates a contradictory understanding of empowerment. As a result of their improved capacity to adhere to their doctors’ medical recommendations, patients acquire more power. According to this reasoning, it follows that patients’ empowerment is less about their everyday lives and individual experiences with sickness than their adherence to medication regimens. In this view, empowerment remains disease-centered instead of patient-focused, and technology continue to favor a clinician viewpoint.
Empowerment should be patient-centered to enhance the quality of care and patient satisfaction. For m-health to empower patients, Chen et al. (2022) suggest that the technology must be tailored to their preferences. Using patient and clinical perspectives, Scott et al. (2018) developed a technology-facilitated education sector that both helps patients by enhancing their capacity to make decisions and assists health care providers by training patients how to take care of themselves and informing them of scheduled appointments. Patients should have access to an m-health journal that is tailored to meet their own needs and allows them to keep track of their own health data. Such a method might teeter on the contradiction of making patients to better mute their opinions but inadequately assists them with the challenges and complications of living with the condition. Patients’ subjective perceptions of illness should not be minimized to a list of medical terms. It is possible to overlook important parts of people’s life because of their illnesses if patients’ views and expertise are not considered. This is critical because patients’ lifestyle preferences and daily lives are critical to treating chronic conditions; thus, the focus on empowerment as enhancing patients’ voices and empowering them to participate in decisions and treatment is essential.
M-Health Adoption Barriers
Any new technology is motivated in part by what it can accomplish and how it may be used but also by what it cannot. According to research, a user’s satisfaction with mobile devices is swayed by aspects such as socioeconomic and organizational facets.
Social Issues
Technology that reduces face-to-face connection might impact people’s social requirements and lead to a subconscious aversion to new technology. This is an issue if the dismissal of the technology has a detrimental effect on those requirements. Mobile phones, on the other hand, have become an intrinsic component of social norm and are seen as a sign of wealth and social integration in many parts of the population. M-health adoption may benefit from the status-bestowing nature of innovation implementation highlighted by Zhu et al. (2022), in addition to removing the disgrace that might result from more evident health monitoring equipment among certain socioeconomic groups.
For one thing, mobile devices are location independent. Thus, healthcare is not constrained to a single site, such as a hospital or medical practice. For both patients and physicians, access to information is facilitated by this flexibility, resulting in benefits for constant checking of patients’ health problems, interactive consultation, remote/countryside treatment, and quick emergency reactions. Non-critical care may be managed in the community using mobile technology, which reduces the number of hospitalizations, enhances patient well-being, and helps keep expenses under control (Chen et al., 2022). Mobile phones, on the contrary, are typically viewed as invasive devices that may raise workloads by generating circumstances that necessitate rapid replies right away, much like emails. Their intrusion into public areas is also viewed as a concern by others.
As previously stated, the aging population in wealthy countries is a major force in healthcare. By 2051, the elderly population of Wyoming State, for example, will account for 25% of the state’s entire population. Modern medicine has a great deal of success in extending people’ lives by treating episodic ailments (Chen et al., 2022). Poor lifestyle awareness can contribute to the establishment of chronic illnesses in old age, notwithstanding public medical initiatives and efforts to improve knowledge about early wellbeing management measures. The result is a growing pressure for healthcare and improved quality across extended periods. Because of their widespread use, mobile phones provide a platform for health-related marketing campaigns that may be more precisely targeted and reinforced over time using rewards and reminders. M-health projects are encouraged by the prospect of lowering the prevalence of chronic illness through preventative education.
Efficiency and effectiveness are two of the more general types of gains that new technology might bring about. Mobile technology’s widespread use, particularly mobile phones, will significantly influence how healthcare services are delivered as a third general benefit (Zhu et al., 2022). For example, physicians may want to outsource some of their job to intermediaries to reduce their burden and information needs. Security concerns often overshadow social and ethical considerations when it comes to protecting the privacy of medical records.
Technical Problems
Even though concerns about the capture, electronic storage, and transfer of sensitive data, as well as the potential abuse of such data, cannot be disregarded, they are perhaps more imagined than genuine. Biometric and cryptographic, secure and private technologies are being developed in several nations, and wireless security protocols are quickly catching up. Medical practitioners are making more effort to ensure the quality and processing of their obtained data because of the increased concern for safety, quality, and the significance put on timely communication (Zhu et al., 2022). In countries like the United States, which rely heavily on their national data sets, these advances are of relevance. The value of choices and the effectiveness of service implementation and ensuing processes might be greatly enhanced if information can be acquired directly and easily from patients’ cellular phones through suitable examination and management. Mobile phones are accepted because of their simplicity and ease of use when it comes to their primary function: voice communication via the phone.
Disruptive technology is an expertise that first fails to suit the demands of its consumers and then improves in power and usefulness as a result. The primary drawback here is the compactness of the device. Small displays and narrow keypads have so far failed to meet the criteria of portability, which must be solved for general user acceptance. The insufficiency of battery power is still a concern. Battery strength has taken over three decades to grow to the same extent as computing technology, which doubles its power every 18 months (Chen et al., 2022). Additionally, the dependability of phones and tablets does not match healthcare’s mission-critical standards.
Economic Issues
The seeming inexpensive cost of m-health technology is a major selling point. There is no doubt that their expense to the patient is extremely low and their cost-efficiency extremely high. Even while capital and operating expenses are spread across multiple markets and decline drastically as services grow, there is no evidence of this trend slowing down any time soon. It is expected that the development of more inventive and seamless applications will reduce expenses even more as technology advances (Zhu et al., 2022). There will be an increase in demand for value-added items and services because of these consequences, as previously indicated.
High costs of mobile connections in certain countries are still an issue and may limit the use of m-health benefits by some patients, notably those with chronic illnesses and their accompanying financial challenges. With its small populace and minimal rivalry in the telecoms sector, texting is typically chosen to pricey voice calls in Wyoming because of its lack of competitiveness. Regarding chronic disorders, there may be a compromise between mobile expenses and reduced travel costs in the context of frequent visits to medical facilities (Scott et al., 2018). As with telemedicine, patients may get a greater return on their investment than healthcare professionals. Mobile payment mechanisms are also required in nations where cash payment for medical services is more common than in the United States.
Clinical/Organizational Concerns
The acceptance of the technology by patients and healthcare providers is another clinical barrier that m-health faces. When it comes to the distribution of medicine, professionals are a little more conservative than consumers when it comes to new methods of delivering it. Because of the shift in shareholder power brought about by organizational transformation and financial incentives, adoption is likely to spread. Clinicians are concerned about various aspects of chronic illness management, including the possibility of automating data collecting, diagnosis, and clinical decision-making (Zhu et al., 2022). All care group participants must accept the solutions if therapy is to be smooth and cohesive in a multidisciplinary setting. As chronic illness care has a greater influence on under-resourced health systems, these necessities and the accompanying change management difficulties will become more critical.
Methodology
The first step was to conduct a pilot study to learn more about healthcare providers’ perspectives on m-health and to identify potential challenges and possibilities. Semi-structured discussions with the participants were recorded, transcribed, and validated by interviewees as part of the research. Over the course of many months, 18 interviews were held, with each taking around an hour. Caregivers and allied health professionals from across Wyoming’s medical sector were among the interviewees, along with employees of healthcare technology businesses. In the beginning, scholars involved in healthcare informatics contacted each other to identify potential interviews, and the process was broadened via a snowball method.
A grounded theory technique was used to analyze the data. Study participants’ perspectives of the elements that influence long-term m-health adoption in Wyoming were examined. Despite several research demonstrating the feasibility of m-health programs and proof of concept studies, little is known about the main elements that promote or limit adoption and the realization of the advantages that may be gained. Five major themes emerged from the study questions, which served as the foundation for semi-structured interviews. Data analysis was continual and iterative. The transcripts of the interviews and the iterative processing of the data generated subsequent topics.
As a beginning point, the interviewee’s thoughts were elicited on the use of mobile technology for healthcare in Wyoming using framework questions. These questions focused on the advantages of m-health for the interviewees’ industry and their perceptions of its utilization by healthcare workers. M-health’s capacity to help unified care and its application to the progression of chronic condition were discussed in interviews. They were asked to talk about any additional variables that would be significant in an m-health context, including technological challenges.
Location of the Study
Wyoming is a great place to do this kind of research. Despite its small size, it has a tiny but diverse population, with a high degree of cultural integration. A worrisome rise in chronic illness levels has accompanied a rise in the standard of life in most industrialized countries. Information exchange and disclosure via national databanks is well-established in Wyoming’s health system. With a public health network and a commercial sector of about 30 percent of total service, it covers a wide spectrum of healthcare needs. The viability of m-health projects in Wyoming has ramifications for other states in the United States and countries across the world.
Findings and Discussion
The findings are reported and analyzed per the research questions guiding the study. In this way, we may present the findings of the interviews within the framework of the study topics but maintain the holistic viewpoint of preventative to end care. Qualitative research is more suitable to a narrative technique than the standard hypothetico-deductive approach used in information systems (Chen et al., 2022). It was evident that more systematic effort was needed to create mobile health technology, but the participants of the research had focused their thoughts on the prospective applications and uses. However, many operational, technological, and ethical issues needed to be resolved before patients could access their electronic health records (EHRs) from their smartphones or tablets. It was not long before attendees were ready to debate both the positive and negative aspects of m-health as a potential development path.
Advantages and Use of M-Health Technology
Many of the people who were questioned had a wide variety of information about how mobile technology may be used. Short message services (SMS) have been pushed as the backbone of cellular phone services for the current and the foreseeable future because of its simplicity and uniform format for monitoring vital signs and transmitting medical reports for patients with chronic diseases. If the right format or incentives can be established, SMS might be a powerful tool for delivering public healthiness and wellbeing communications in the enhancement of the management of chronic conditions and preventative care. The employment of mobile technology to obtain data in a digital form was viewed as a key achievement in boosting the usefulness of information and its worth in both tactical and analytical judgment by the service providers. For both the benefit of clinicians and patients, data collecting is a continuous and essential part of treating chronic diseases (Chen et al., 2022). Data collecting systems should be as autonomous as feasible from the type of data that they gather in the early phases of development.
In the case of secondary care professionals, mobile technology was particularly important to them in communicating with colleagues and acquire clinical information. Furthermore, one district health board (DHB) has reduced its missed appointment percentage in just two years, and it was found that SMS would help it achieve even further reductions in this metric. Messaging was found to reduce the frequency of missed hospital visits dramatically, while a further influence on patient behavior in terms of enhancing self-management was not noticed by those questioned. Despite the widespread acceptance of the benefits of mobile health apps in the field of public health, little was said about how they may be used by patients themselves. Only one participant talked about the importance of patients providing information to physicians and obtaining important information from secondary medical sources. Similarly, this interviewee was aware of the benefits for elderly and chronically ill residents.
The proper application of mobile health applications was a major topic of discussion. Many people interviewed agreed that the technology needed to produce m-health was already available but that converting the relevant procedures into appropriate apps significantly impedes their more effective deployment. Several instances of this type of work have been cited. Despite the high expenses, web services were projected to be a key factor in the creation of customized applications. As stakeholder information networks become increasingly reliant on ICT, the role of intermediaries in the health industry is expected to rise.
Sustainability Concerns
Many participants responded by emphasizing the need to be able to seamlessly integrate these technologies into any chain of communication or exchange of information, such as in the case of holistic chronic care. M-health was seen as being hindered rather than helped by the instance of a community nurse gathering information from patients or obtaining directives on paperwork and then transferring the evidence or delivering the same instructions online. To eliminate these obstacles, a comprehensive systems or performance management strategy was required.
This comprehensive approach is also related to the consistent requirement for national health sector standards. Interviewees from a variety of backgrounds repeated this sentiment, which is consistent with earlier studies. One participant thought of the Ministry of Health as a mediator who might push health boards toward standardization and harmonization instead of allowing them to come up with their own incompatible solutions. Researchers found that practitioners’ engagement was critical to the sustained use of technology in healthcare, as Chen et al. (2022) reported. With more clinician-led initiatives, Wyoming’s status was considered as encouraging. In the development of sustainability, change management was identified as an important problem. Because of the respondents’ willingness to embrace the necessity for change, a proactive attitude to m-health was seen. Only individuals who had a strong interest in the advancement of m-health initiatives were willing to participate in the study.
Security and Privacy
Those who participated in the study were eager to separate privacy and security. In their opinion, security was not a major concern because the elements that regulate it are mostly operational and technological. There was a strong ethical undercurrent in privacy and permission to use or treatment, but these issues were more theoretical and philosophical. Technology advancements and increased convenience will likely lead to a decrease in oppositions to the use of m-health, but privacy issues remain crucial and online health information advocates should include them into the novel methods of operation (Scott et al., 2018). Intriguingly, clinicians were virtually evenly split on whether they would accept EHRs on mobile devices because of the privacy concern. Some providers were willing to compromise on privacy to allow EHRs to be used, while others insisted that they would not be made available until the security of mobile devices had been improved.
Technology
Interviewees (even those in the technology industry) only briefly touched on technical concerns, even though all respondents typically possessed knowledgeable perspectives on technological issues. In general, they did not comply with the discovery that technology was a barricade to wireless acceptance, but there was consensus that training sessions for all practitioners were needed because of the complexity of the health setting. When it came to mobile devices, the primary problem was their small screen and keypad size. It was the opinion of doctors that users of m-health apps may not be required to enter large quantities of free-field information but instead ought to access options from choose lists to enter information into designated sections.
Keypads are not the major issue; all the respondents pointed out that a mobile phone’s screen is too small and that new technologies like foldable screens are needed before multimedia and web-based services become mainstream. As a healthcare system developer pointed out, it is difficult to get a large enough customer base to have a significant influence on software development time and cost. The development of guidelines and the necessity to migrate applications across numerous procedures and stages is a short-term obstacle, but this is less of a long-term issue given the widespread usage of mobile technology.
Patient Empowerment
The study found that mobile technology has a significant influence on the empowerment of patients. Patients were encouraged to become more active and accountable for their own health care by the ease of access to information, better communication with professionals, and increased convenience. For chronic illness care, the requirement for empowerment of patients is widely documented (Scott et al., 2018). People’s attitudes in this research show that they are aware of how important this issue is. The failure to incorporate the data, not just among DHBs but also involving different sectors, the community, and other specialties, was seen as a major obstacle to full empowerment by those interviewed. The inability to deliver comprehensive solutions soonest possible will be hampered by the slow progress of such integration.
Conclusion and Future Research
Conclusion
While the research was done in Wyoming, its findings may probably be applied to other industrialized countries, and the participants offered an optimistic image of the future of m-health. The advantages and applications of mobile technology were widely acknowledged, and all participants were sure that m-health efforts that improve care delivery would keep growing. Patient empowerment’s potential benefits have been acknowledged and embraced, although it is not clear how this would benefit health services or the management of chronic conditions. Overall, there was a high level of acceptance and acknowledgment of the benefits of mobile health. The primary obstacles to long-term sustainability in chronic illness management were outlined in relation to these difficulties. It is anticipated that progress toward comprehensive, long-term systems of chronic illness management will be difficult, even if m-health services in chronic care emerge alongside other health care services. This is due to numerous factors. Standards and information integration are the most critical issues. Many stakeholders in chronic care necessitate a rigorous examination of the aspects involved, dramatic changes in how data is collected, absorbed, and distributed, and a nationwide strategy for the implementation of mobile health.
A chronically ill patient’s whole network of caretakers is beyond the reach of the health care sector’s current capabilities. However, this does not rule out the possibility of future m-health integration; rather, it means that other challenges must be addressed first. This package includes operational considerations such as privacy issues, in-depth analyses of workflows and procedures, and significant efforts to recognize and alleviate the social and organizational repercussions of change. Even minor and local initiatives like text message reminders for appointments favorably impact attendance numbers. Increasing patient empowerment through m-health advancements may be more beneficial than large-scale programs to implement self-management principles for the chronically sick and their providers. This necessitates thoughtful and rigorous study and the development of products and services that extract best practices and disseminate them to everyone who can put them to use.
Limitations and Future Research
The study’s concentration on healthcare professionals is a major drawback. People who were interviewed have the experience of communicating patient perspectives; nevertheless, more research must include patients directly. While the participants were selected from across the health sector, which lends credence to the conclusions, their generally favorable attitudes imply an enthusiast prejudice that should be tested with a bigger sample. However, the study’s results imply a hopeful future for developments of m-health, in which the hurdles will not be about digitalization but acceptance, such that education, encouragement, and the inevitable advancements with time will lessen their influence on its successful application.
References
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Lee, J. A., Choi, M., Lee, S. A., & Jiang, N. (2018). Effective behavioral intervention strategies using mobile health applications for chronic disease management: A systematic review. BMC Medical Informatics and Decision Making, 18(1), 1-18. Web.
Scott, I. A., Scuffham, P., Gupta, D., Harch, T. M., Borchi, J., & Richards, B. (2018). Going digital: A narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management. Australian Health Review, 44(1), 62-82. Web.
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