Determinants of acceptance of patients with heart failure and their informal caregivers regarding an interactive decision-making system: a qualitative study.

Abstract

Heart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that influence the acceptance of patients and their informal caregivers regarding a patient-oriented digital decision-making solution-a <i>doctor-at-home</i> system. We applied a semistructured design using an interview guide that was based on a theoretical framework influenced by established acceptance theories. The interviews were analysed using a content analysis. A multicentred study in four European countries. We interviewed 49 patients and 33 of their informal caregivers. Most of the patients were male (76%) and aged between 60 and 69 years (43%). Informal caregivers were mostly female (85%). The majority of patients (55%) suffered from heart failure with mild symptoms. Four main categories emerged from the data: <i>needs and expectations, preferences regarding the care process, perceived risk</i> and <i>trust</i>. Participants expressed clear wishes and expectations regarding a <i>doctor-at-home</i>, especially the need for reassurance and support in the management of heart failure. They were receptive to changes to the current healthcare processes. However, <i>trust</i> was identified as an important basis for acceptance and use. Finally, <i>perceived risk</i> for decision-making errors is a crucial topic in need of attention. Patients and informal caregivers see clear benefits of digitalisation in healthcare. They perceive that an interactive decision-making system for patients could empower and enable effective self-care. Our results provide important insights for development processes of patient-centred decision-making systems by identifying facilitators and barriers for acceptance. Further research is needed, especially regarding the influence and mitigation of patients and informal caregivers' perceived risks.