A positive digital patient experience can improve health and care outcomes, but a positive digital patient experience does not just happen; it refers to understanding, evaluating, and improving the entire patient journey through digital health. Human-centered design is often applied to understand patients’ needs and improve patient experiences when designing digital health solutions. However, human-centered design for digital health is demanding. It often involves multiple stakeholders with different values and requires evidence for implementation. Patient perspectives routinely differ from those of other stakeholders. Even within the same patient group, individual situations are also often different from each other. Yet, it is not always apparent that patients were engaged in the design process and were empowered enough to voice their opinions. Listen to the patients’ voices and uncover their unique needs; designers are expected to speak for patients. This thesis aims to support designers in improving the quality of care in digital health by defining, evaluating, and designing digital patient experiences. This thesis is divided into three parts to achieve this goal.

Part A: defining digital patient experiences
To build a common understanding of digital patient experiences among design, technology, and healthcare communities and to facilitate transdisciplinary knowledge exchange and learning between these different fields for driving digital health innovation, this part contains one chapter and focuses on defining digital patient experiences. In chapter 2, we proposed the term “digital patient experience” as a common phrase to describe the patient experience in digital health and defined “digital patient experience” by synthesizing the reported patient experience or user experience of varied digital health interventions from multiple reviews. Specifically, the concept of the digital patient experience was defined as “the sum of all interactions affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channelling digital health.” In addition, we identified information on influencing factors and summarized them into 9 categories (i.e., patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment). These categories were classified into positive, negative, and double-edged factors based on their positive, negative, or dynamic impacts on digital patient experiences. Furthermore, we uncovered 4 design constructs (i.e., personalized, information, navigation, and visual design) and 3 common design methods (i.e., user-centered design or human-centered design, co-design, and inclusive design) as design considerations for addressing digital patient experiences. Finally, we proposed a framework and 9 design guidelines to help digital health designers and developers improve digital patient experiences throughout the entire design process.

Part B: evaluating digital patient experiences
In the second part, we discussed the importance of evaluating digital patient experiences, developed an evaluation guide to help digital health researchers, designers, and developers further evaluate digital patient experiences, and conducted a case study to evaluate digital patient experiences in a clinical setting. Following the research findings of Chapter 2 on defining the digital patient experience, in Chapter 3, we first identified five typical evaluation objectives and related stakeholder groups. We then described potential evaluation timing considerations in terms of 4 intervention maturity stages and 3 evaluation timings. We also collected knowledge on evaluation indicators of digital patient experiences and grouped them into 3 categories: intervention outputs, patient outcomes, and health care system impact. These were then classified into 9 themes (i.e., intervention functionality, usability, care quality, patient emotional outcomes, perceptual outcomes, capability outcomes, behavioral outcomes, clinical outcomes, and system economic outcomes) and 22 subthemes. Furthermore, we noted a set of common study designs, data collection methods, and instruments, as well as data analysis methods, that can be used or adapted to evaluate digital patient experiences. To facilitate the standard evaluation of digital patient experiences, we recommend 6 directions for further research on digital patient experience evaluation. In Chapter 4, we conducted a prospective observational study to evaluate digital patient experiences of using virtual reality distraction in wound care for pain management. This chapter can be used as an example for guiding digital health designers and developers to evaluate digital patient experiences in clinical settings. It also offers inspiration to improve the design, development, and implementation of the virtual reality distraction in wound care for better digital patient experiences. For example, We found that patients who had high levels of technology acceptance, pain during previous wound care, or previously used VR distraction in wound care were more willing to use VR distraction in wound care. These findings indicate patient behavioral determinants have an influence on their intention to use digital health solutions, which supports our findings in Chapter 2 that patients’ behavioral determinants influence patient perceptions of using digital health. In addition, in Chapter 4, no evidence was found on the effectiveness of virtual reality distraction in significantly reducing pain or anxiety during wound care. Although many studies have indicated the effectiveness of using virtual reality distraction in wound care for pain management, our research results do not support this argument. To avoid ineffective digital health implementation, we encourage more rigorous research on investigating the effectiveness of virtual reality distraction in wound care or how to improve its effectiveness through design. Besides, on average, the digital patient experience and patient satisfaction with using virtual reality distraction in wound care were positive, which reveals that although digital health solutions do not always lead to a significant better health outcome, they can contribute to a better treatment experience, which is also very valuable.

Part C: designing digital patient experiences
In the final part, we focus on guiding the design of digital patient experiences. We investigated the general human-centered design process in digital health and synthesized all research findings to generate a web-based design guide to support the understanding, evaluation, and improvement of digital patient experiences. In chapter 5, we mapped the (re)design and continuous improvement processes in digital health into 8 stages and grouped them into 4 phases: preparation, problem-thinking, problem-solving, and implementation. We also identified 12 challenges and classified them into 4 categories: contextual, practical, managerial, and commercial challenges. Furthermore, we outlined 8 corresponding strategies, recommended by the participating designers, to address each challenge type. Finally, we created a framework including design deliverables, activities, involved stakeholders, design challenges, and related design strategies for each design stage. The framework not only aids designers in understanding the design practices in the healthcare industry but also guides them when managing their digital health design processes towards the improvements of digital patient experiences. In chapter 6, we presented a web-based digital patient experience design guide that synthesized the previous research findings, and we further evaluated the design guide. We show that our digital patient experience design guide was evaluated as usable with good content quality, but that it needs further improvement in providing relevant, detailed, and resourceful content, intuitive and interactive interfaces, as well as simple and ready-to-use templates. We believe these improvement insights are relevant for developing and evaluating design guides in general. In addition, participants reported conflicting tensions in the guide’s design, requiring a balance between specific and general, less and more, as well as fixed and flexible. These tensions reveal the diversity and conflicts in students’ needs for useful and effective design guides. On the one hand, users want design guides to hold relevant, detailed information and content, provide a systematic overview, include complete conceptual explanations, detailed design cases, and integrated design resources, enabling them to use the design guide as a resource library for flexible exploration. On the other hand, they want a design guide to be simple and easy to use, offering concise and clear information with low learning and usage costs, enabling them to effortlessly complete efficient designs. We believe this study serves as an example, inspiring future design researchers to develop and evaluate their own design guides.

In conclusion, this thesis contributes theoretically (via new knowledge) and practically (via the design guide) to facilitate a scientific impact on the definition, evaluation, and design of digital patient experiences from a human-centered design perspective, thus, supporting the improvement of the quality of care in digital health solutions.@en