Preliminary interviews with HCPs revealed that the survey would have to provide participants with a definition of ‘Novel Healthcare Technology’ and that the technology should be presented alongside its proposed application (i.e., the medical condition). HCPs highlighted that at present there is a lack of standard procedure through which patients are introduced to NHTs and there is a need to identify and adequately train the key people involved in this process. This information was used to shape the survey and incorporate additional questions around respondents’ views on how NHTs should be introduced to future patients.
Sample
A total of 1,450 people responded to the survey. Median time taken to complete the survey was 15.60 minutes (range: 4.77 mins to 1958.5 minutes). Respondents were based across the United Kingdom, though most were from London (13.2%) and the South East England (13.9%).
Mean age of participants was 46.4 years (SD: 17.13) and 50.6% were female. The majority of respondents were British White (80.1%) and the overall distribution of the sample paralleled population data on ethnicity collected by the Office of National Statistics (ONS, 2011). Most respondents were in active paid work (56.4%), 32.1% held a University degree, and IMD score was evenly spread across quantiles. Respondents mainly rated their general health as ‘Good’ (57.2%), and only 3.5% indicated ‘Bad’ or ‘Very Bad’. 63.9% of participants indicated they had no health condition, with most participants who reported a health condition classifying it as ‘long-term illness, disease or condition’ (14.4%). (Supplementary Material 2 for details).
Knowledge and use of NHTs
Overall, a large majority of participants indicated they were frequent users of technology in their everyday life (82.6%), though only 9.4% reported that novel technologies were being used for management of their health. Of respondents who had previously used NHTs (n = 225), most made use of these technologies every few months (25.3%) or once every few years (27.1%).
Regarding the NHT case studies included in the survey, Table 2 displays participants’ previous understanding of how the actual technology works. Self-reported knowledge on laser-based and microwave-based technology primarily ranged between ‘some understanding’ to ‘never heard of them’, while responses were more diverse for mobile app and virtual reality technology. Yet, awareness of the use of these technologies in healthcare was highest for mobile apps (66%), followed by laser-based technology (63.8%), microwave technology (28%) and lastly virtual reality (18.3%).
Table 2: Previous awareness or use of the NHTs included in the survey case studies
Item
|
Category
|
Laser-based tool for early diagnosis
|
Virtual reality to support self-management
|
Continuous glucose monitoring using microwave signals
|
Mobile app for patient reported monitoring
|
|
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
|
|
|
|
|
|
|
|
|
|
How much do you understand?
|
Never heard of them
|
437
|
30.1
|
196
|
13.5
|
609
|
42.0
|
317
|
21.9
|
Have heard but don't understand
|
411
|
28.3
|
246
|
17.0
|
322
|
22.2
|
157
|
10.8
|
Have some understanding
|
499
|
34.4
|
601
|
41.4
|
343
|
23.7
|
395
|
27.2
|
Understand quite well
|
85
|
5.9
|
306
|
21.1
|
138
|
9.5
|
333
|
23.0
|
Understand and could explain to others.
|
18
|
1.2
|
101
|
7.0
|
38
|
2.6
|
248
|
17.1
|
|
|
|
|
|
|
|
|
|
|
Are you aware of use in healthcare?
|
Yes
|
925
|
63.8
|
266
|
18.3
|
406
|
28.0
|
957
|
66.0
|
No
|
525
|
36.2
|
1184
|
81.7
|
1044
|
72.0
|
493
|
34.0
|
Acceptability of NHTs in future care
After reading information about the NHTs and the proposed health application, including associated benefits and risks, median acceptance score provided by respondents was 2.0 for virtual reality to support self-management (Interquartile Range (IQR): 1.3-3.0) and continuous glucose monitoring using microwave signals (IQR: 1.3-2.3), and 1.7 for laser-based technology for early diagnosis (IQR: 1.3-2.0) and mobile app for patient reported monitoring (IQR: 1.0-2.0). Agreement scores ranged between 1 “Strongly Agree” to 5 “Strongly disagree”. Table 3 for details.
Acceptability according to individual characteristics
Using cross tabulation, several patterns were detected in acceptance according to respondent characteristics. Increasing age was linked with an increased willingness to adopt laser-based technology for early diagnosis and a mobile app for patient reported monitoring (Figure 1). Age had no effect on acceptance scores for the other NHTs. Presence of a self-reported condition followed a similar pattern, having a positive effect on acceptance in the case studies depicting laser-based technology and mobile apps, but not the other NHTs (Figure 2). A gender difference was only found in acceptance of mobile apps for patient reported monitoring, being slightly elevated in females (median: 1.3; IQR: 1.0-2.0) compared to males (median: 1.7; IQR: 1.0-2.0). Agreement ratings towards the mobile apps were also closer to “Strongly Agree” for those aware of the use of these apps in healthcare (median: 1.3; IQR: 1.0-2.0) compared to those not aware (median: 2.0; IQR: 1.0-2.3). These patterns were not observed for the other NHTs (Supplementary Material 3).
As shown in Figure 3, being a frequent user of technology in everyday life impacted acceptability of all NHTs except for continuous glucose monitoring using microwave signals. Respondents’ self-reported understanding on how the various NHTs work was also linked to acceptability. Across all NHTs, those responders with a self-reported higher baseline understanding (i.e., “Understand and could explain to others”) about how the technology worked were more likely to “Strongly Agree” to their use when compared to other responders. (Figure 4).
No patterns were observed in acceptability in relation to ethnicity, IMD quintile, education, self-reported general health, and self-reported experience with NHTs for health management (Supplementary Material 3).
Reluctance to accept
When querying reluctance to accept the NHTs after providing information, risks and benefits of each NHT and its proposed application, differences were found between case studies in the reasons for expressing hesitation (Table 3). Between 10% (virtual reality) and 27% (mobile app) of respondents did not know why they were unwilling to accept the technology after reading the information provided. Overall, participants wanted more information about the NHTs, expressed concerns regarding the risks and safety of using the NHTs, and wanted more scientific and clinical evidence before they would be willing to accept them as part of their care.
Table 3. Reasons (frequency of mention) for not accepting the NHTs as part of their care. Bold denotes most frequent reason provided.
Item
|
Category
|
Laser-based tool for early diagnosis
|
Virtual reality to support self-management
|
Continuous glucose monitoring using microwave signals
|
Mobile app for patient reported monitoring
|
|
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
If you would still not use the technology, why not?
|
Don't know
|
62
|
18%
|
58
|
10%
|
87
|
15%
|
70
|
27%
|
|
|
|
|
|
|
|
|
|
Provided a reason:
|
|
|
|
|
|
|
|
|
More info
|
61
|
18%
|
106
|
18%
|
60
|
11%
|
56
|
21%
|
Safety
|
46
|
13%
|
67
|
12%
|
138
|
25%
|
1
|
0%
|
Evidence
|
28
|
8%
|
67
|
12%
|
67
|
12%
|
1
|
0%
|
Risks
|
71
|
21%
|
23
|
4%
|
52
|
9%
|
6
|
2%
|
Long term
|
11
|
3%
|
2
|
0%
|
88
|
16%
|
0
|
0%
|
Side Effects
|
18
|
5%
|
47
|
8%
|
29
|
5%
|
1
|
0%
|
Other
|
7
|
2%
|
60
|
10%
|
2
|
0%
|
11
|
4%
|
Test Technology
|
0
|
0%
|
45
|
8%
|
20
|
4%
|
1
|
0%
|
Privacy
|
0
|
0%
|
1
|
0%
|
1
|
0%
|
60
|
23%
|
Trust
|
3
|
1%
|
27
|
5%
|
5
|
1%
|
10
|
4%
|
Cost
|
12
|
3%
|
25
|
4%
|
3
|
1%
|
3
|
1%
|
HCP info
|
15
|
4%
|
13
|
2%
|
9
|
2%
|
4
|
2%
|
Individual risk
|
9
|
3%
|
13
|
2%
|
1
|
0%
|
6
|
2%
|
Access
|
0
|
0%
|
4
|
1%
|
0
|
0%
|
24
|
9%
|
Adjunct
|
0
|
0%
|
17
|
3%
|
0
|
0%
|
3
|
1%
|
Intrusive
|
0
|
0%
|
0
|
0%
|
0
|
0%
|
6
|
2%
|
For the laser-based technology, the most common concern was the risk attached to undergoing surgery. Respondents questioned whether “benefits would outweigh the risks” (P622), the “risk associated when not used properly” (P1400), and “risk of localised damage” (P1435). Respondents therefore also requested more detailed information on the procedure, effectiveness, and risks involved.
The most frequent concern expressed by participants regarding the use of virtual reality to support self-management was the need of additional information about the technology and how it worked. Some respondents struggled to see the benefits of using the NHT, or the added value to more traditional approaches to diabetes management, “I don't understand what is involved, the time commitment, why it is better than me just eating less and exercising more or the evidence of efficacy” (P764). Respondents expressed wanting more evidence regarding its effectiveness and implementation. Concerns were also raised about safety, with participants being weary of the possibility of feeling “nauseous”, “sick”, “dizziness” and “disorientated” when using virtual reality. Consequently, the opportunity to test this technology played a more important role in the decision-making around acceptability: “I would base my final decision on the results of a demonstration and further information” (P308)
Similarly, reluctance to accept continuous glucose monitoring using microwave signals was primarily attributable to perceived safety and the long-term effects. Participants expressed particular concern about the impact of microwaves on health. However, respondents also demonstrated that evidence would be an important factor in their decision-making: “I would like more research done first to show me it’s safe” (P518)
In the use of mobile apps for patient reported monitoring, concerns about privacy were the most frequently reported reason for non-acceptance, which were not present with the other NHTs. Respondents expressed “reservations about data security” (P207), “privacy concerns over who would have access to the information” (P881) and “using of personal information without acknowledgement” (P1386). Again, respondents indicated that more information would need to be provided before they would accept this NHT (%): “I would use it if someone took time to explain it fully to me” (P291)
Approaches to introduce NHTs to patients
Across all NHTs, most participants (range 53.6% to 65%) preferred receiving information about the NHT verbally, with respondents wanting the information to come from a healthcare specalist or a general practitioner (see Table 4). The second most preferred form of receiving information was via a webpage across all NHTs except virtual reality, where providing information via a visual demonstration was selected to a similar degree to having a verbal conversation about the NHT.
Table 4. Method and ideal person to introduce a NHT to future patients.
|
Item
|
Category
|
Laser-based tool for early diagnosis
|
Laser-based tool for early diagnosis
|
Virtual reality to support self-management
|
Continuous glucose monitoring using microwave signals
|
|
|
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
How would you like to receive information? (Can select multiple options)
|
Verbal conversation
|
845
|
58.3
|
777
|
53.6
|
942
|
65.0
|
868
|
59.9
|
|
Website
|
640
|
44.1
|
591
|
40.8
|
631
|
43.5
|
705
|
48.6
|
|
Visual demonstration
|
505
|
34.8
|
725
|
50.0
|
606
|
41.8
|
597
|
41.2
|
|
Leaflet
|
518
|
35.7
|
421
|
29.0
|
492
|
33.9
|
470
|
32.4
|
|
Other
|
28
|
1.9
|
31
|
2.1
|
23
|
1.6
|
25
|
1.7
|
|
|
|
|
|
|
|
|
|
|
Who should first tell you about this healthcare technology?
|
Health professional
|
791
|
54.6
|
723
|
49.9
|
551
|
38.0
|
564
|
38.9
|
|
General practitioner
|
482
|
33.2
|
482
|
33.2
|
535
|
36.9
|
558
|
38.5
|
|
Healthcare specialist
|
81
|
5.6
|
71
|
4.9
|
177
|
12.2
|
126
|
8.7
|
|
Other
|
70
|
4.8
|
120
|
8.3
|
65
|
4.5
|
107
|
7.4
|
|
Family/Friend
|
55
|
3.8
|
38
|
2.6
|
56
|
3.9
|
77
|
5.3
|
|
Don’t know
|
47
|
3.2
|
65
|
4.5
|
52
|
3.6
|
44
|
3.0
|
|
Nurse
|
0
|
0.0
|
0
|
0.0
|
102
|
7.0
|
86
|
5.9
|
|
N/A
|
32
|
2.2
|
31
|
2.1
|
55
|
3.8
|
63
|
4.3
|
|
Website
|
20
|
1.4
|
21
|
1.4
|
8
|
0.6
|
25
|
1.7
|
|
Pharmacist
|
0
|
0.0
|
0
|
0.0
|
2
|
0.1
|
6
|
0.4
|
|
Researcher
|
0
|
0.0
|
0
|
0.0
|
2
|
0.1
|
0
|
0.0
|
|
Physiotherapist
|
0
|
0.0
|
0
|
0.0
|
0
|
0.0
|
1
|
0.1
|