Digital Health in General Practice: User Experience, Virtual Visits, and Cardiovascular Prevention

Digital tools are sometimes introduced in primary care with little end user involvement and without sufficient evaluation, which may decrease usefulness.Therefore, this thesis project analyzed the end user experience and effects of different digital tools in primary care in southern Sweden.The overarching aim was to contribute to increased patient benefit of digitalization.Paper 1 explored primary care physicians' experience of digital health through qualitative content analysis of free-text questionnaire responses.A barrier to use was the loss of face-to-face patient contact.There were concerns regarding risks for patient harm and an increased workload due to a rising number of patient access routes and a deficient technological infrastructure.Paper 2 studied one of the new patient access routes -text-based virtual visits to public primary care.The patients were comparably young, and the most common group of diagnoses was skin conditions.Most patients did not require subsequent face-to-face health care contact, and of those who did the majority remained in primary care.Paper 3 explored the patient experience of a digital intervention in the form of health-promoting text messages to primary care patients with hypertension.Participant interviews were analyzed using systematic text condensation.We concluded that the text messages were perceived as useful reminders, but that increased individualization could facilitate lifestyle change.Paper 4 analyzed the effects on lifestyle of health-promoting text messages.Compared to the group that was randomized to treatment as usual, the text message group reported decreased alcohol use and increased physical activity.The overall conclusion is that staff and patients should be included early in the development of new digital tools, that the effects on health equity of virtual visits need to be considered, and that a simple intervention such as health-promoting text messages can be effective but may be further improved by increased patient involvement.