Study Identifies Key Factors Affecting Patient Willingness to Use eHealth Tools in COPD

Specific factors, such as experience with technology and health literacy, were key drivers of whether a patient with chronic obstructive pulmonary disease (COPD) would benefit or be likely to use eHealth tools to improve self-management skills, investigators concluded.

Motivation, comfortability with technology, and health literacy levels are the key factors influencing whether patients with chronic obstructive pulmonary disease (COPD) were willing to use eHealth self-management tools over time, according to a study published in the Journal of Medical Internet Research.

These factors, “are important to consider when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among individuals with COPD,” noted the investigators.

Self-management strategies have been shown to reduce the need for hospitalization, increase physical activity and physical performance, and improve quality of life of patients with COPD. Strategies can include exercise training, breathing strategies, and techniques for conserving energy during daily activities.

Despite a growing push for self-management strategies to be recommended to patients with COPD, individual and structural barriers prevent a lot of patients from being offered support, suggesting that methods to circumvent limitations are needed.

eHealth tools have been used to educate and monitor patient health and can provide a significant amount of disease-specific information. Although there has been research investigating the effectiveness of eHealth technology, less is known about user behavior over time. This study was the first to examine the factors that impact the utilization of eHealth tools targeted at improving of self-management strategies in patients with COPD over time, according to the authors.

The investigators recruited patients from 5 publicly funded primary health care facilities in Sweden. A total of 23 patients were contacted and 16 chose to participate. Participants were interviewed on their experience with COPD Web, an eHealth web tool for patients with COPD.

All consenting patients were interviewed at 3 months and 7 were interviewed at 12 months. Patients considered to be users tended to have a higher level of communicative and critical health literacy than patients who were considered nonusers or seldom users.

During the analysis, the investigators identified 3 categories of factors influencing whether patients used or did not use the eHealth tool:

  • Ambiguous impact
  • Basic conditions for usage
  • Approaching capacity

For ambiguous impact, non- and seldom users expressed feelings of shame about having COPD prevented them from receiving assistance to manage their disease, leading them to feel that using eHealth tools felt like getting undeserved assistance.

Additionally, some patients felt that they weren’t ill enough to need eHealth tools or preferred using paper and written notes as opposed to online resources. Some non- and seldom users who have had a COPD diagnosis for a long time felt that the educational information presented in the eHealth tool wasn’t helpful because it didn’t provide anything that they didn’t already know.

Users were more likely to have poor health, express interest in learning more about their diagnosis, or feel comfortable with using computer and online resources.

The category addressing experiences regarding basic conditions for usage included remarks about patient frustration with computer issues and lack of compatibility with smartphones.

COPD Web included a pedometer function that was considered by users to be beneficial because it served as a way to prove that they had done something right in regard to improving their physical activity level. However, non- and seldom users reported that the pedometer made them feel stressed, uncomfortable, or that they weren’t doing enough.

The approaching capability category included experiences regarding getting access to COPD-specific education and self-management skills. Users reported that the educational information gave them a sense of hope and that breathing techniques were helpful for traveling purposes.

The investigators said that having a sense of hope was important, “as a person’s belief in his or her ability to manage the disease is a powerful and well-recognized predictor of health-related behavior changes.”

At 12 months, users expressed that they had better insight into their COPD and that they had adopted self-care strategies in their everyday life. They also reported having an easier time using stairs and avoiding minor illnesses that can worsen COPD conditions.

“Our findings highlight that time might be an essential factor when evaluating the potential benefit of eHealth tools aiming at behavioral changes regarding self-management strategies,” wrote the investigators.

The majority of participants were women, leading the investigators to suggest that future studies analyze whether the results would be similar in a population including more male participants.


Marklund S, Tistad M, Lundell S, et al. Experiences and factors affecting usage of an eHealth tool for self-management among people with chronic obstructive pulmonary disease: qualitative study. J Med Internet Res. April 2021;23(4):e25672. doi:10.2196/25672

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