@Article{info:doi/10.2196/60343,
author="Holmen, Heidi
and Holm, Are Martin
and Falk, Ragnhild S{\o}rum
and Kilv{\ae}r, Thomas Karsten
and Ljosaa, Tone Marte
and Ekholdt, Christopher
and Fosse, Erik",
title="A Digital Outpatient Service With a Mobile App for Tailored Care and Health Literacy in Adults With Long-Term Health Service Needs: Multicenter Nonrandomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="28",
volume="27",
pages="e60343",
keywords="outpatient; digital solution; mobile health; mHealth; remote monitoring; health literacy; self-monitoring; patient-reported outcome measures; cancer; complex pain; epilepsy; interstitial lung disease",
abstract="Background: Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear. Objective: This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care. Methods: We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use. Results: Overall, 162 patients were recruited, 55 (34{\%}) in the control arm and 107 (66{\%}) in the intervention arm, with a 17.3{\%} attrition rate after 6 months. There was no statistically significant difference in the primary outcome, ``understanding health information well enough to know what to do,'' between the arms at 6 months (mean difference --0.05, 95{\%} CI --0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (--0.15, 95{\%} CI --0.30 to --0.00; P=.048) and understanding health information well enough to know what to do (--0.17, 95{\%} CI --0.34 to --0.00; P=.03), as well as both physical (--3.29, 95{\%} CI --5.62 to --0.96; P=.006) and mental HRQoL (--3.08, 95{\%} CI --5.64 to --0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm. Conclusions: This study explored digital outpatient care. Although no statistical differences were observed in patients' health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care. Trial Registration: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869 International Registered Report Identifier (IRRID): RR2-10.2196/46649 ",
issn="1438-8871",
doi="10.2196/60343",
url="https://www.jmir.org/2025/1/e60343",
url="https://doi.org/10.2196/60343"
}