Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework.
Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework.
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DOI：
10.2196/31037
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发表时间：
2021-11-15
影响因子：
5
通讯作者：
Hogan TP
中科院分区：
文献类型：
--
作者：
Yakovchenko V;McInnes DK;Petrakis BA;Gillespie C;Lipschitz JM;McCullough MB;Richardson L;Vetter B;Hogan TP
退伍军人健康管理局(VHA)正在部署自动短信系统(ATS)来支持患者自我管理。我们在不采用、放弃、扩大、传播和可持续(NASSS)框架的指导下，对影响ATS在全国推广的因素进行了定性评估，旨在支持对新技术的评估。对33名工作人员和38名早期采用ATS的患者进行了半结构化访谈。使用先验码和基于NASSS的紧急编码，采用演绎和归纳法对数据进行分析。我们确定了NASSS领域的主题：(1)条件：ATS被认为与一系列患者的需求相关；然而，对患者适宜性的感知是由短信经验和临床复杂性而不是潜在的好处来指导的。(2)技术：ATS的入职存在困难，工作人员对将患者生成的数据纳入护理计划有不同的意见。(3)价值：供给侧价值取决于安非他明类药物的灵活性及其对工作人员工作量的影响，而需求侧价值取决于患者对安非他明类药物的心理和行为影响的看法。(4)采用者：工作人员角色和职责的有限明确性给将ATS纳入临床流程带来了挑战。(5)组织：工作人员愿意尝试ATS；但是，领导支持和诊所准备的观念阻碍了使用。(6)更广泛的系统：工作人员专注于加强ATS与电子病历的互操作性。(7)随着时间的推移嵌入和适应：ATS的多功能性、患者和工作人员的需求以及更广泛的社会对交流健康信息的偏好的变化相互作用，促进了ATS的实施。VHA的新ATS有可能进一步吸引患者并扩大VHA护理的覆盖范围；然而，患者和工作人员需要额外的支持才能采用、实施和维持ATS。NASSS强调了ATS如何更好地嵌入到当前的实践中，哪些患者可能从其功能中受益最大，以及ATS消息的哪些方面与自我管理最相关。ClinicalTrials.gov NCT03898349；https://clinicaltrials.gov/ct2/show/NCT03898349
The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349
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影响因子：
7.4
作者：
James HM;Papoutsi C;Wherton J;Greenhalgh T;Shaw SE
通讯作者：
Shaw SE
DOI：
10.1089/tmj.2008.0099
发表时间：
2009-04-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
--
作者：
Krishna, Santosh;Boren, Suzanne Austin;Balas, E. Andrew
通讯作者：
Balas, E. Andrew
影响因子：
20.8
作者：
Hall AK;Cole-Lewis H;Bernhardt JM
通讯作者：
Bernhardt JM
影响因子：
3.2
作者：
Foreman, Kalee F.;Stockl, Karen M.;Curtis, Bradford S.
通讯作者：
Curtis, Bradford S.
影响因子：
2.8
作者：
Junod Perron N;Dao MD;Righini NC;Humair JP;Broers B;Narring F;Haller DM;Gaspoz JM
通讯作者：
Gaspoz JM