Qualitative evaluation of the digital Coaching Health App Implementation Partnership (CHAMP)

Aims:

To evaluate the COPD digital Coaching Health App Implementation Partnership (CHAMP) project with focus on the rollout of the myCOPD app in the BNSSG area and the role of health champions in improving implementation and use.

Phase 1 aimed to understand health professional and patient barriers and facilitators of engaging with the myCOPD app to improve
implementation. Phase 2 aimed to explore stakeholders experience of the digital health champion role in order to create and recommend future implementation resources.

Methods:

In phase one, 14 semi-structured interviews were conducted with two clinical champions (CCs), two digital health champions (DHCs), five COPD patients, three consultants, one policymaker, and one commercial stakeholder. Questions were asked to elicit information on their experiences of referring and using the myCOPD app. Data were organised into a Table of Changes to identify recommendations to enhance the roll-out and ongoing implementation.

For phase two, nine semi-structured interviews were conducted with two DHCs, three CCs, three COPD patients, and one clinician to understand stakeholders’ views on what was needed for sustainable implementation of the myCOPD app and health champions. Data were organised into a Table of Changes and an inductive thematic analysis was employed to analyse the data from phase two. A co-design approach was taken to synthesise the data with ongoing stakeholder involvement. Data and suggestions for changes to the implementation plan were presented iteratively to a group of CCs, DHCs, patients and the rest of the project team and then refined based on their feedback.

Results:

In phase one, a ‘referrer guide’ laying out three quick steps for app referral was created as a solution to address some of the modifiable concerns that arose in the phase one Table of Changes. Alongside this, we provide a set of recommendations for ongoing implementation. In phase two, four themes were developed from the thematic analysis. 1) Definition and boundaries of the digital health champion role. 2) Importance of personalised clinical contact. 3) Judgements on appropriateness of referring the app from healthcare professionals. 4) A desire for consistency in communication. These were subsequently mapped onto the theoretical domain framework where knowledge, social influences, beliefs about capabilities, and environmental context and resources featured most prominently in the successful implementation of the myCOPD app.

Conclusion:

The data indicates that the use of DHCs and CCs addressed common barriers to patient engagement and uptake of digital tools. Firstly, the one-to-one contact between DHC and patient is beneficial in that it is responsive to patient concerns regarding new technology. Secondly, the ability to provide a demonstration on how to use digital tools facilitates patients’ learning. Finally, the action-planning inherent in the act of helping patients choose which myCOPD tiles to focus on and scheduled phone calls increasing engagement. In terms of how DHCs and CCs have experienced the programme, the data highlights that it is important to CCs and DHCs that they are doing the right thing facilitated with consistent guidance that ultimately provides clear benefit to the patients. This combined with the flexibility to make their own judgements and the importance of having one-to-one clinical contact with patients indicates that creating and maintaining those conditions in the CHAMP project is integral for its success.