Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives.
Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives.
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DOI：
10.2196/29916
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发表时间：
2021-12-08
影响因子：
2.2
通讯作者：
Mohankumar R
中科院分区：
文献类型：
--
作者：
Breland JY;Agha K;Mohankumar R
用于体重管理的移动的健康（mHealth）干预措施可以产生与面对面治疗相当的减肥结果。然而，关于在现实世界中实施这些治疗的信息很少。这项工作的目的是回答两个实施的研究问题有关的mHealth体重管理：（1）什么是障碍和促进mHealth采用（初始使用）和参与（继续使用）？以及（2）患者对移动健康用于体重管理的适当性（即，感知的适合性、相关性或兼容性）的信念是什么？我们进行了半结构化的采访与肥胖患者在一个单一的设施，在一个综合的医疗保健系统（退伍军人健康管理局）。所有参与者都被推荐到一个新的移动健康计划，其中包括获得现场教练。我们对访谈进行了快速定性分析，以确定与采用、参与和适当使用mHealth进行体重管理相关的主题。我们采访了24名退伍军人，其中7人使用移动健康计划。几乎所有受试者年龄≥45岁，三分之二为白色。快速分析确定了三个主题：（1）通过促进问责制，但导致未达到目标的人感到内疚，教练既促进又阻止了mHealth的采用和参与;（2）关于治疗交付模式，可用性和治疗内容的偏好是mHealth适当性和采用的障碍，包括对亲自护理的偏好和对自我监测的厌恶;（3）一次邀请不足以促进新的移动健康计划的采用。主题与参与者的年龄、种族或民族无关。在一项评估一组中年和老年人在现实世界中使用mHealth的研究中，我们发现，尽管可以通过现场教练免费使用mHealth，但大多数人都没有完成注册过程。我们的研究结果表明，实施mHealth体重管理需要不止一个信息会话。研究结果还表明，关注教练关系以及用户的生活和目标如何随着时间的推移而变化，可能是促进参与和改善健康的重要途径。大多数参与者认为mHealth适合体重管理，但有些人更喜欢亲自护理。因此，保证公平护理的最佳方法是确保实现相同行为健康目标的多种途径。退伍军人健康管理局的患者可以选择使用mHealth进行体重管理，但也可以参加团体体重管理计划或单次营养课程或使用健身设施。美国的卫生保健政策不允许大多数人获得这种机会;然而，扩大行为体重管理的机会是确保所有人健康的一个重要长期目标。
Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all.