Table 2 Patient-oriented barriers and facilitators to patient-to-provider messaging implementation
TDF Domaina | COM-B Domain | Theme—Barriers | Theme—Facilitators |
|---|---|---|---|
Skills | Physical Capability | • Patients may lack manual dexterity, visual acuity, or reflexes to use a mobile device to communicate | • None identified |
Knowledge | Psychological Capability | • Patient literacy level | • Message content (with detailed information regarding patient care, that uses graphical data) can improve patient knowledge |
Behavioural regulation | Psychological Capability | • None identified | • Virtual messaging systems providing rapid feedback (automated via the device or by a provider) allow patients to make timely modifications to their management |
Memory, Attention, and Decision Processes | Psychological Capability | • Simple errors when writing a message may result in ambiguity and inaccurate content | • Having a written record aids recall • Increased access to healthcare providers can assist patients in decision-making • Easier to remember and communicate health questions in writing (no distractions like when speaking to their provider) |
Social or professional role and identity | Reflective Motivation | • Blurring of the boundaries in the relationshipb | • Levelling out of power imbalances • Patients now have a role as “agenda setters” resulting in greater autonomy and empowerment |
Beliefs about capabilities | Reflective Motivation | • Asynchronous nature makes building a trusting relationship difficultb • When providers make grammatical mistakes in their messaging, it reduces patient confidence in their capabilities as clinicians | • Patients feel empowered to ask questions they would not have otherwise felt comfortable asking • Increased access to healthcare provider improves patient-provider relationshipb • Informal nature of messaging can strengthen patient-provider relationshipb |
Beliefs about consequences | Reflective Motivation | • Privacy and confidentiality with sharing information via technology • Some patients fear their message will be misunderstood by their clinician • Patients feel they are not receiving adequate care if their provider does not use the gathered data to provide tailored feedback or if responses are too general • Virtual messaging not appropriate to receive information on urgent issues • Unable to communicate using visual cues making it difficult to recognize misunderstandings | • Belief that virtual messaging can allow for more detailed informational exchanges • Communicating virtually increases access and convenience (i.e., can send/receive messages at any time and refer back to them when needed; reach isolated or stigmatized populations) • Improves patient access to information • Patients no longer feel like a burden to providers, wasting their time • Patients and caregivers feel more connected to, and looked after by the provider • Ability to share data and receive advice from home reduces travel to clinic visits • Increased feelings of personal connection • Increased connection decreases psychological distress among caregivers |
Intentions | Reflective Motivation | • Patients not motivated to use messaging (do not want to engage in manual data entry) • Patients may feel that technology is too intrusive | • None identified |
Optimism | Reflective Motivation | • Lack of confidence with technology among patients and/or caregivers | • None identified |
Reinforcement | Automatic Motivation | • None identified | • Message content (reminders and motivational messages to reinforce behaviours are preferred by some patients) • Having “virtual physician” who is with you all the time (even asynchronously) can increase accountability |
Emotion | Automatic Motivation | • None identified | • Patients don't feel as though they are a burden to their provider, wasting their providers time with irrelevant questions, or otherwise stressing their provider |
Environmental context and resources | Physical Opportunity | • Lack of time • Lack of resources (i.e., infrastructure, equipment, access to internet or mobile phones) • Affordability of technology • Physical set-up for mobile devices (small text, small buttons, narrow scroll bars) • Technical issues with devices | • Provision of informational resources which can be sent and read at any time • No tight time constraints to share information (compared to in-person visits) |
Social influences | Social Opportunity | • None identified | • Increased access to healthcare provider improves patient-provider relationshipb • Informal nature of messaging can strengthen patient-provider relationshipb |