Why end-users matter: Tailoring to the needs of patients and healthcare professionals Implementation of digital health technologies in practice

Digital health technologies (DHTs) are often promoted as solutions to relieve pressure on healthcare systems, yet implementation remains difficult. A core barrier lies in the frequent mismatch between technology design and the needs of end-users, resulting in poor adoption and disrupted workflows. This thesis investigates how involving healthcare professionals (HCPs) and patients early in the design and implementation process can improve usability, satisfaction, and long-term use. Unlike much of the current research, which treats patients and professionals as uniform groups, this work emphasizes their diverse experiences, digital literacy, and capabilities.
The thesis pursued four objectives: (1) identifying barriers and facilitators of DHT implementation from both patient and HCP perspectives, (2) exploring usability evaluation methods in home settings, (3) developing and validating a patient questionnaire tailored to different literacy levels, and (4) examining the impact of DHTs on patient-HCP interactions.
Part I shows that implementation of DHTs depends on recognizing barriers such as unfamiliarity, patient anxiety, and loss of communication, while facilitators include enhanced communication and tailoring to patient needs. HCPs stressed that technology should complement rather than replace in-person care. Part II highlights the need for inclusive usability evaluations, leading to the development of the Experienced Usability and Satisfaction with Self-monitoring in the Home Setting (GEMS) questionnaire, which proved valid and reliable across a nephrology patient population. Part III focuses on how digital tools alter communication, responsibilities, and trust in the patient-HCP relationship.
Overall, the thesis demonstrates that tailoring DHTs to end-users’ diverse needs is essential for effective, sustainable implementation in healthcare practice.