The present study is observational and aims to evaluate the PROMBot service in managing patients' hypertension, simplify the follow-up process, and empower patients to actively participate in their own care.
In the last two decades, research and development (R\&D) efforts in remote patient monitoring (RPM) technologies have primarily focused on the technical challenges of providing care in unconventional settings. Several pilot initiatives have emerged, ranging from chronic disease management to episodic care, such as post-surgical follow-ups, to leverage the advantages of RPM. These benefits include improving the continuity of outpatient care, enabling more informed health decision-making, anticipating complications, and reducing costs. For instance, in the context of post-surgical follow-up, RPM has demonstrated significant potential in reducing severe complications and increasing patient safety during the critical period following hospital discharge. By enabling healthcare professionals to continuously monitor clinical indicators and patient-reported outcome measures (PROMs), RPM plays a vital role in ensuring effective surveillance. A systematic review highlights evidence that chatbots could be effective tools for increasing physical activity, fruit and vegetable consumption, and improving sleep duration and quality. In a recent study, users of a chatbot for hypertensive patients demonstrated greater knowledge and skills in blood pressure (BP) monitoring and slightly better accuracy in BP measurements. However, there is still little research on implementation studies. After the COVID-19 pandemic, there was an increase in demand for RPM-based services due to postponed surgeries and the shift from in-person to remote care. As a result, ongoing pilot initiatives increased without sufficient planning. This lack of time and resources poses risks to both accessibility and care quality. Research is needed to explore the characteristics of different RPM systems that drive high-value RPM services. Existing literature consistently emphasizes three key components for an effective RPM system: care team organization and technology utilization. Therefore, the use of participatory action research (PAR) methodologies, which actively involve clinical teams in the research process, is essential to ensure that the technological solutions developed and implemented align with users' needs and preferences, thereby maximizing their adoption. The PROMBot was created using a PAR approach, incorporating feedback from various stakeholders, including healthcare professionals, software developers, and researchers. This collaborative effort allowed for the suggestion, testing, and evaluation of the platform's functionalities, ensuring both effectiveness and usability. By adopting a PAR approach, the development and implementation of the PROMBot platform addressed real-world challenges and requirements associated with implementing digital health services. This study will last for 6 months and aims to evaluate the PROMBot service The implementation of the PROMBot platform in CUF's services serves two primary purposes: 1) to help CUF design and assess various remote follow-up interventions, and 2) to explore different use cases for the application of PROMBot By leveraging PROMBot, patients will have the ability to conveniently record their health parameters and symptoms daily Additionally, the platform will provide a user-friendly digital interface that supports care teams throughout the follow-up process. This study is an observational study that will contribute to the exploration of different use cases for the implementation of innovative patient-centered systems, potentially positioning the patient monitoring service as a model to be followed by other clinical departments, both nationally and internationally By using technology and remote monitoring, this study aims to enhance patient care and set new standards for remote follow-up in the context of CUF, improving outcomes and promoting patient-centered healthcare practices. The specific objectives of this study are: 1. To obtain a more continuous blood pressure history to personalize healthcare 2. To provide information to healthcare professionals about the knowledge acquired by the patient regarding the behavior to adopt 3. To evaluate improvements in participants' health-related knowledge and behaviors, such as salt consumption, physical exercise practices, medication adherence, and preparation of healthy meals 4. To study patient engagement levels with the chatbot and assess treatment adherence throughout the program 5. To evaluate the ease of use and perception of usefulness of the chatbot by participants.
Study Type
OBSERVATIONAL
Enrollment
24
CUF
Lisbon, Lisbon District, Portugal
Semi-structured interview
The semi-structured interviews will be conducted by the research team and aim to gather participants' reactions and experiences with the chatbot. The questions included in the interview are: 1. Do you consider PROMBot easy to use? 2. Do you consider PROMBot useful? Please answer yes or no. 3. Which types of messages from PROMBot were the most useful for you? 4. What improvements would you suggest for PROMBot? 5. Was interacting with PROMBot enjoyable? 6. Would you like to continue using PROMBot to record your blood pressure values? Why? Please briefly justify your reasons for wanting to continue or not. 7. Would you like to continue using PROMBot to receive medication reminders? Why? Please briefly justify your reasons for wanting to continue or not. 8. Would you like to continue using PROMBot to receive tips on healthy habits? Why? Please briefly justify your reasons for wanting to continue or not.
Time frame: After interacting with the chatboot, which took place over 12 weeks.
Engagement
The level of patient engagement will be measured by calculating a proxy based on the number of messages sent to the chatbot.
Time frame: After interacting with the chatboot, which took place over 12 weeks.
Treatment Adherence
The level of treatment adherence will be measured by calculating a proxy based on the number of messages sent following blood pressure measurements by the patient.
Time frame: After interacting with the chatboot, which took place over 12 weeks.
Health Literacy
During the program, patients will be assessed on their knowledge of health literacy content related to hypertension in the following areas (self-reported): Health Literacy Knowledge Assessment on Hypertension Topics: Salt Consumption; Engagement in Physical Exercise. The questions will be multiple choice, with one correct answer for each question.
Time frame: After interacting with the chatboot, which took place over 12 weeks.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Intra-Individual Effects
To evaluate the intra-individual effect of using PROMBot, participants will be invited to respond to four questions before and one week after the program to assess salt consumption habits, frequency of blood pressure measurement, and physical activity: Question 1: In the past week, how many days did you engage in physical exercise or any physical activity for 30 minutes or more? Possible response: 0 - None, 1 - 1 day, 2 - 2 days, 3 - 3 days, 4 - 4 days, 5 - 5 days, 6 - 6 days, 7 - 7 days. Question 2: In the past week, how many days did you record your blood pressure? Possible response: 0 - None, 1 - 1 day, 2 - 2 days, 3 - 3 days, 4 - 4 days, 5 - 5 days, 6 - 6 days, 7 - 7 days. The minimum value on this scale is 0 and the maximum value is 7. A higher score means a better result.
Time frame: After interacting with the chatboot, which took place over 12 weeks.
Intra-Individual Effects
To evaluate the intra-individual effect of using PROMBot, participants will be invited to respond to four questions before and one week after the program to assess salt consumption habits, frequency of blood pressure measurement, and physical activity: Question 3: In the past week, how often did you add salt to your food? Possible response (Likert scale): 1 - Never or almost never, 2 - Sometimes, 3 - Most of the time, 4 - Always. The minimum value on this scale is 0 and the maximum value is 4. A higher score means a worse result.
Time frame: After interacting with the chatboot, which took place over 12 weeks.
Intra-Individual Effects
To evaluate the intra-individual effect of using PROMBot, participants will be invited to respond to four questions before and one week after the program to assess salt consumption habits, frequency of blood pressure measurement, and physical activity: Question 4: In the past week, how often did you take your blood pressure medication as prescribed by your doctor? Possible response: 1 - Never, 2 - Rarely, 3 - Sometimes, 4 - Always. The minimum value on this scale is 0 and the maximum value is 4. A higher score means a better result.
Time frame: After interacting with the chatboot, which took place over 12 weeks.