Flagship 7: Adaptive mHealth Pulmonary Rehabilitation

Summary

This project is about the development and evaluation of a personalised adaptive mHealth programme for people with Chronic Obstructive Pulmonary Disease (COPD), sometimes referred to as emphysema or chronic bronchitis. We aim to weave current best practice for pulmonary rehabilitation, wearable devices, existing data and mobile technology into an adaptive learning programme to support people with COPD. The long-term goal is a programme for COPD patients that can maximise wellbeing and reduce avoidable use of health services.

Team

Principal Investigators

University of Auckland

AUT

Associate Investigators

University of Auckland

  • Gayl Humphrey
  • Rosie Dobson
  • Jim Warren
  • Ian Warren
  • Koray Atalag

AUT

  • Julie ReeveNicola Jepsen

Waitemata DHB

  • Tamzin Brott
  • Kelly Bohot

Counties Manukau DHB

  • Jeff Garret

Our work

Formative research has been along several different tracks

- Engagement with clinicians for a greater understanding of current Pulmonary Rehabilitation programmes and who attends these has been undertaken. There has also been a review of other research and developments in this area, and contact made with other researchers and companies working in this area in New Zealand as well as internationally.

- Cross-sectional survey of people with chronic respiratory disorders (n=30) through Waitemata and Counties-Manukau DHBs (37% Maori or Pacific). High level findings include:

  • 23% were unsure of their diagnosis
  • 23% had started but not completed a PR programme due to location, transport, timing, being hospitalised
  • 10% did not attend a PR programme due to transport and other commitments
  • 20% felt they had not been offered PR
  • 87% had access to a mobile phone (3/4 were smartphones and 60% of them had access to the internet all of the time)
  • 77% had access to the internet at home
  • 77% liked the idea of a mobile PR programme due to no need to travel, cost reduction, being able to access wherever/whenever, not feeling embarrassed and able to involve family
  • Those who didn’t like it said that technology was too difficult, didn’t have internet, wanted the social aspect of PR or preferred to go to the hospital
  • 79% said they would wear a sensor, 76% wanted the programme to be lined with their health information record

- Indepth patient interviews were conducted by a medical anthropologist (n=9) using ethnographic methods. This found that patients don’t always identify with or understand their condition. There are many factors involved including environmental, isolation, stigma, personalisation, and vulnerability. The recommendations are that a multimodal approach in conjunction with PR may support patients and allow them to choose the complexity and level of support required.

- Key stakeholder interviews (n=8) were conducted with physiotherapists, nurse specialists, consultant physician, general practitioner and health psychologist. All were supportive of mPR but there were many considerations including:

  • 3 models possible: as an alternative to inperson PR, as maintenance following PR, and in combination with PR
  • Features that would be appropriate and inappropriate for mPR were suggested
  • Need to consider health literacy and technology literacy
  • Patient safety and clinician monitoring
  • How to foster the social aspect and personal touch

- Sensors and wearables in chronic respiratory illness – a review and recommendations has been completed as a student project

- Integration with existing health information and IT systems – a review and recommendations has been completed as a student project

Next Steps

- Multidisciplinary and multiorganisational workshops have been held to design a minimal prototype for initial testing, as well as the features that would be desirable in a future full product

- This prototype is currently being designed in terms of content as well as technology

- The team is planning for testing with approximately 20 people with chronic respiratory disorders as well as their whanau/caregivers

Collaborators

Current collaborators

  • University of Auckland
  • AUT
  • Waitemata DHB
  • Counties Manukau DHB

Publications


mPR poster presented at the Ministry of Health’s Longterm Conditions Conference