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      Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

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          Abstract

          Background

          Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts.

          Methods

          PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results.

          Results

          Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health En Gagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature.

          Conclusion

          This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them.

          Systematic review registration

          International Prospective Register of Systematic Reviews CRD42015029846

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12911-016-0359-3) contains supplementary material, which is available to authorized users.

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          Most cited references56

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          Qualitative data analysis for applied policy research

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              Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide.

              Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
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                Author and article information

                Contributors
                s.oconnor.1@research.gla.ac.uk , siobhan.oconnor@manchester.ac.uk
                peter.hanlon@nhs.net
                Kate.ODonnell@glasgow.ac.uk
                sonia.garcia@york.ac.uk
                julie.glanville@york.ac.uk
                +44 0141 330 8330 , Frances.Mair@glasgow.ac.uk , Francses.Mair@glasgow.ac.uk
                Journal
                BMC Med Inform Decis Mak
                BMC Med Inform Decis Mak
                BMC Medical Informatics and Decision Making
                BioMed Central (London )
                1472-6947
                15 September 2016
                15 September 2016
                2016
                : 16
                Affiliations
                [1 ]General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
                [2 ]School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
                [3 ]York Health Economics Consortium Ltd, York, UK
                Article
                359
                10.1186/s12911-016-0359-3
                5024516
                27630020
                790f0d8e-cd73-4fda-b4cc-41cc66c1bf2b
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000396, Technology Strategy Board;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Bioinformatics & Computational biology
                digital health,ehealth,electronic health records,telemedicine,mobile applications,mhealth,engagement,recruitment,barrier,facilitator

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