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Does virtual patient engagement impact adherence?

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With online and mobile health (mHealth) usage embedded in GP and hospital practices, what might the effect be on patient adherence? 

Driven by the pandemic, mHealth technology and online communication platforms have evolved faster than ever predicted. At every point of contact, healthcare professionals (HCPs) have seen the need to become more agile in how they communicate with patients. It has been a steep learning curve for most, with both clinicians and their patients having to upskill and become comfortable with communicating healthcare concerns, responses and diagnoses via online consultations. 

Having made the sizeable leap into this virtual and app-dominant world of interaction, are HCPs able to re-assess how they gather and analyse patient feedback? Furthermore, how can they turn statistics into initiatives that deliver the next level of best practice across all services to ultimately improve patient adherence and resultant outcomes? 

Current research: the role of mHealth literacy 

Current research: the role of mHealth literacy 

Recognised research into the dynamics around online and mHealth communication and patient adherence naturally lags behind changes adopted in healthcare, but one study throws interesting light on the important part that the now well-established online health communities (OHCs) play in patient care. The authors explain: “in terms of practical implications, our findings suggest that physician-patient communication, internet health information-seeking behaviour, and patients’ perceived quality of internet health information are perspectives from which patient adherence can be enhanced by developing patients’ eHealth literacy in OHCs.” 1 

It must be noted that with the universal accessibility of the internet comes variation in the quality and levels of regulation of information. If eHealth literacy is defined as individuals’ ability to “seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem”,2 we must be aware of the inherent variability of the information being appraised. 

The increase of collaboration between healthcare parties is also significant. Healthcare information sites, OHCs and disease-related apps that support management of disease are becoming ever-more sophisticated. Alongside these, integration of online practice management systems, mHealth apps, virtual appointments and email-led patient dialogue can offer patients more involvement in, and control over, their healthcare. 

Unquestionably, the challenge of reaching and improving health outcomes for some patient sectors will remain to be particularly challenging, whether online or in-person. Interestingly, a 2022 survey evaluating mHealth apps for diverse, low-income populations recognised that “as identified by prior studies, multimedia availability, such as videos, helped increase mobile app engagement, particularly for individuals with low literacy levels.”3

The dynamics of tracking virtual patient engagement

Tracking adherence within a more virtual working model raises all the usual questions around social economics, but as fast as the technology is changing, so too are characteristics of the different patient sectors, as they adapt and upskill to advance communication. Much of this patient – or consumer – learning, of course, is driven by householders’ increasing uptake of non healthcare communication applications, information portals and their online purchasing. Having an eye on how consumer brands are capturing audiences can trigger thought processes for healthcare delivery too. 

While general trends are important, establishing tracking criteria aligned with individual practice communications is crucial. Subsequently, some findings within the virtual and mHealth patient experience will still be more definitive than others. Finding out how virtual engagement is impacting the immediate, short-term uptake of advice and treatment protocol across your different patient sectors is an easy fit for a definitive set of statistics. It is also important to seek feedback on the timing of the virtual activity and how it influences specific goals you have set. In contrast, the use of patient narrative and feedback relating to virtual communications and mHealth apps can stimulate more abstract discussions within your professional group. Drilling down further into preferred delivery methods is critical: could new content ideas or collaborative initiatives be introduced? Are you ensuring that the patient’s voice is being heard in a two-way conversation? 

To some extent, tracking virtual healthcare communications means ‘unlearning’ pre-virtual analyses and, to a large extent, creating a new approach, both in the form that feedback is invited and by the wording of the information sought. Significantly, it means re-appraising existing tracking methods in order to optimise existing and developing technologies across all patient sectors. Undoubtedly, with IT organisations keen to build market share we should see more and more built-in tracking capacity within online applications.

Engagement favours digital

Whether through necessity or choice, patients and HCPs alike are beginning to adapt to digital healthcare. As consultations are increasingly provided via various online healthcare advice portals, the availability and uptake of high-quality, user-friendly platforms and technologies (such as remote patient monitoring) is growing; but there may be room for improving patients’ digital literacy, to ensure that mHealth works to improve patient engagement and adherence, rather than diminishing it

References:​​​​​​​1. Lu X, Zhang R. Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study. J Med Internet Res 2021;23(9):e14908 DOI: 10.2196/14908 Accessed online 27 June 2022. Available at
2. Norman, C. D., & Skinner, H. A. eHealth literacy: essential skills for consumer health in a networked world. J Med Internet Res, 8(2):e506.
3. Sharma S, Gergen Barnett K, Maypole J, Grochow Mishuris R. Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study JMIR Form Res 2022;6(2):e29922 Accessed online 28 June 2022. Available at httpst:// DOI: 10.2196/29922s. 
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