Why do so many patients drop out of eHealth self-management support?
A recently-published joint study in Norway, investigated why 12 patients with Type 2 Diabetes quickly left a programme of 4 e-consultations intended to support their self-management with eHealth.
Interviews with the patients identified 4 common barriers:
- Usability issues
- Confusing or irrelevant content
- Impact on patients’ time
- Lack of face to face support.
What do we know about why so many patients drop out?
In the battle to gain clinician and patient acceptance of eHealth solutions, it can be hard to address. There are challenges of getting patients to:
- Firstly, sign up to eHealth solutions, such as self-management support
- Secondly, stick with the support.
A joint study team in Norway, felt that although high drop off rates are well-documented in eHealth, there is less insight into why patients leave. In theory, it should be routine to gather feedback from patients who withdraw from eHealth interventions, or to conduct `exit’ interviews. In practice, though, there still appears to be relatively little qualitative data in public.
So, when 13 of out 18 patients quickly dropped out of an eHealth intervention intended to promote self-management in Type 2 Diabetes, the study team carried out telephone interviews with 12 of the patients who left.
They uncovered 4 main reasons for leaving.
Barrier 1: Usability issues
Although it is hardly surprising to find “frustrating technology” amongst the reasons why people exited the eHealth programme very quickly, it is a stark reminder that thorough testing with users before launch is key.
As well as basic functionality problems, the eHealth activity expected patients to download, print and fill in long PDF forms for their e-Consultations.
“There was just too much trouble with it…In the end I just gave up trying.” – Patient
Barrier 2: Confusing or irrelevant content
The eHealth intervention focused on a very specific type way of supporting self-management – Guided Self-Determination counselling – and only 5 of the original 18 patients stuck with it through all 4 e-consultations.
After an initial introductory consultation, 3 people dropped out, and another 6 after trying the first e-consultation. The study concluded that people perceived the “content as irrelevant and incomprehensible.”
“I started losing interest. I wondered: What do you want here? What method is this? I did not understand the purpose of the form.”
Barrier 3: Impact on patients’ time
A combination of usability issues, and the scale and depth of the materials, meant that patients saw the eHealth intervention as time-consuming. The study concluded that patients wanted to choose “other activities and perspectives, and found the structure and schedule of the e-Consultations were hard to fit in.
“I am quite busy…So that going online and having to spend much time there…It took too much of my time”
Barrier 4: Lack of face to face support
Although the nurse introduced the eHealth support, and gave written feedback on anything submitted by the patients, the study found that participants still preferred “face to face encounters”.
“I think it is a lot better to sit and talk with her (the nurse) right in front of me…if there is a misunderstanding, we can ask.”
Balancing technology with human relationships
So, the study team concluded that:
- “To maintain motivation, our study points to the importance of combining eHealth with regular face to face consultations.”
- “It seems important to facilitate more user-friendly but high security eHealth technology” – Department of Health Studies, University of Stavanger, Stavanger, Norway, Stavanger University Hospital, Stavanger, Norway, 3Centre for Evidence-based Practice, Western Norway University of Applied Sciences, Bergen, Norway
Download the recently published study.