Facilitators and barriers of behavioral intention and use of telemonitoring apps among Chronic Obstructive Pulmonary Disease patients

Abstract

Aim: Telemonitoring apps are increasingly prescribed as part of self-management for patients with Chronic Obstructive Pulmonary Disease (COPD), yet patients still make minimal use of these apps. This research investigates explanatory factors associated with the behavioral intention to use and actual use of COPD telemonitoring apps among users and non-users.

Methods: A cross-sectional study was conducted among 200 COPD patients from two Dutch hospitals. Eligible participants (≥ 18 years, diagnosed with COPD, ≥ 2 outpatient pulmonology visits in 2023) were identified through the electronic health record and invited by mail. Participants completed a self-administered questionnaire assessing demographics, disease severity, literacy, facilitating conditions, and app-related factors, based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), the Technology Acceptance Model (TAM), and the Reasoned Action Approach (RAA). Behavioral intention was analyzed using hierarchical multiple regression, and use was analyzed using binomial logistic regression.

Results: Intention was explained by performance expectancy (coefficient = 0.760, p ≤ 0.001), self-efficacy (coefficient = 0.207, p = 0.009), and alignment with personal norms and values (coefficient = 0.163, p = 0.006). Use was explained by self-efficacy (OR = 1.992, p = 0.023), social influence (OR = 1.642, p = 0.039), personalization (OR = 0.628, p = 0.039), and intention to use (OR = 3.459, p ≤ 0.001). App users showed significantly higher digital literacy, performance expectancy, and fewer symptoms compared to non-users. Users also experienced significantly higher importance of social influence and alignment with norms and values than non-users. Demographic variables and disease severity were no significant predictors of behavioral intention and use.

Conclusions: Optimizing the app and the supportive role of the healthcare professional, enhancing digital and health literacy, and hybrid care ensures that patients can benefit from both traditional care and the advantages of remote monitoring.

Keywords

good health and well-being / Chronic Obstructive Pulmonary Disease / COPD / telemonitoring / mHealth / technology adoption

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