Background/Purpose: Early access to specialized rheumatological care is under increasing pressure. Many countries are currently confronted with a relative shortage of practicing rheumatologists, while recent shifts in the management strategies of rheumatoid arthritis (RA) have made ambulatory care more labor intensive. These developments have prompted the exploration of innovative care models for RA, including the use of mobile health (mhealth) applications, such as mobile apps and wearables. Mhealth applications could facilitate the monitoring of disease activity in between clinic visits and thus offer opportunities to provide personalized care for RA patients at the right time. This could potentially result in a significant reduction in the number of unnecessary clinic visits and reduce waiting times for an appointment. In Belgium, mhealth applications have only sparsely been integrated in routine care for RA patients. Little is known about their applicability in Belgian rheumatology care. The aim of this study was to gain more insight in possible barriers and facilitators of mhealth applications for the ambulatory care for RA patients, according to different stakeholders.

Methods: We performed a qualitative study with focus group interviews. Focus groups were organized with the following stakeholders: nurses specialized in the care of patients with RA, patients with RA and rheumatologists. The qualitative analysis guide of Leuven (QUAGOL) was used to analyze the data obtained during the focus groups by 3 researchers (MVDP, RVM, DDC). 

Results: In total, 2 focus groups with nurses (n=16), 2 with patients (n=17) and 2 with rheumatologists (n=19) took place. Due to the Covid-19 pandemic, 1 focus group with patients was cancelled, and 1 with rheumatologists was performed online.

Most stakeholders expressed some form of familiarity with mhealth applications. However, reluctance of seeing these applications as a care innovation was observed. Especially rheumatologists underlined such applications were suitable for only a subgroup of patients. Some stakeholders feared the complexity of mhealth applications and doubted the added benefit versus a face-to-face visit. However, the evolution towards mhealth applications was expressed as inevitable in modern society. Mhealth tools were viewed as complementary to routine care. Especially rheumatologists underlined their role as experts of RA care, fearing to be replaced by mhealth techniques. Expectations of such an application were high. An ideal tool was said to aggregate as much practical, clinical and educational aspects for a patient as possible and to incorporate easy access for all stakeholders to stimulate application use while ensuring privacy.

Conclusion: Although stakeholders expressed doubts towards mhealth applications in daily practice, many saw this evolution as inevitable. Therefore, it would be wise to develop an app integrating the viewpoints of all parties involved in the care of patients with RA to ensure implementation in practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-ideal-mhealth-application-for-rheumatoid-arthritis-qualitative-findings-from-stakeholder-focus-groups/