Exploration of Digital Health Technologies

Table 3. Results of the independent samples t-tests for differences between users and non-users of a telemonitoring app (CWZ & ZU hospitals, Netherlands 2024).

Variable	Users		Non-users		Test statistics	P²
Variable	M	SD	M	SD	Test statistics	P²
Age (years)	67.87	7.71	68.16	9.12	t(187) = 0.235	0.815
Hospital admissions	1.57	0.90	1.41	0.86	t(187) = –1.200	0.232
Exacerbations	2.42	1.17	2.25	1.16	t(188) = –0.947	0.345
CCQ	3.33	0.86	3.57	1.12	t(120.955) = 1.591	0.114
Symptoms¹	3.42	0.92	3.90	1.37	t(110.239) = 2.617	0.010
Functional state	3.67	1.10	3.66	1.27	t(189) = –0.072	0.943
Mental state	2.44	1.56	2.74	1.33	t(189) = 1.338	0.183
Health literacy	4.31	0.76	4.06	0.92	t(184) = –2.033	0.043
Digital literacy	3.62	0.75	3.17	0.78	t(188) = –3.976	< 0.001
Support	8.06	1.66	7.70	1.67	t(185) = –1.432	0.154
Self-efficacy	4.59	0.64	4.15	1.06	t(125) = –1.892	0.061
Social influence	3.56	0.98	2.95	1.05	t(180) = –3.929	< 0.001
Infrastructure	2.45	1.20	2.26	1.22	t(179) = –0.984	0.326
Performance expectancy	4.41	0.58	3.77	0.83	t(124) = –2.933	0.004
Cosmopolitan system¹	4.09	0.93	3.68	1.26	t(110.410) = –2.331	0.022
Confidentiality¹	3.98	0.84	3.63	1.21	t(105.709) = –2.108	0.037
Norms and values¹	3.86	0.91	3.12	1.30	t(106.625) = –4.142	< 0.001
Read-aloud function 30.1	2.29	1.23	2.74	3.88	t(179) = 1.126	0.262
Easy language 30.2	3.64	1.18	3.27	1.33	t(182) = –1.966	0.051
Imagery 30.3	3.04	1.18	2.85	1.23	t(178) = –1.048	0.296
Personalization 30.4	3.35	1.24	3.41	1.11	t(177) = 0.329	0.743
Login 30.9	3.68	1.18	3.43	1.33	t(179) = –1.275	0.204
Different languages¹ 30.10	1.88	1.26	1.64	1.06	t(158.428) = –1.346	0.180
Ease of use¹ 30.5	4.06	0.97	3.78	1.18	t(118.880) = –1.659	0.100
Scientific validity¹	4.15	0.92	3.74	1.28	t(107.814) = –2.328	0.022

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¹ A non-equality test was used as the assumption of homogeneity of variances was violated, as assessed by Levene’s test for equality of variances. ² A p-value < 0.01 is considered significant to correct for multiple testing.

Supplementary materials

The supplementary materials for this article are available at: https://www.explorationpub.com/uploads/Article/file/1011101_sup_1.pdf.

Declarations

Acknowledgments

This study was registered in OSF (https://doi.org/10.17605/OSF.IO/SW6C4).

Author contributions

TH: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing—original draft. LL: Conceptualization, Methodology, Supervision, Writing—review & editing. DD: Supervision, Writing—review & editing. PP: Resources, Data curation, Writing—review & editing. AvV: Resources, Data curation, Writing—review & editing. MdK: Resources, Data curation, Writing—review & editing. SO: Methodology, Writing—review & editing. CB: Conceptualization, Methodology, Project administration, Supervision, Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

TH, LL, DD, CB, PP, MdK, AvV and SO declare that there is no conflict of interest with respect to the research, authorship, and/or publication of this article. DD is one of the founders of Luscii Healthtech B.V. which develops and distributes the telemonitoring app Thuismeten. However, as this study focuses on the empirical factors that explain (intention to) use telemonitoring apps, DD was involved in this study as a professor at the faculty of Management Sciences at the Open Universiteit rather than as founder of LUSCII Healthtech B.V. Findings were honestly presented and were not influenced by DD’s interference.

Ethical approval

Ethics approval was obtained on October 25th, 2023 from the Medical Ethics Committee of the Zuyderland Medical Center (METC-Z) in the Netherlands (METCZ20230088). All procedures were conducted in accordance with the ethical standards of the 2013 Declaration of Helsinki.

Consent to participate

Informed consent to participate in the study was obtained from all participants.

Consent to publication

Not applicable.

Availability of data and materials

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

Funding

No funding was received for this research.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Yao R, Zhang W, Evans R, Cao G, Rui T, Shen L. Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review. J Med Internet Res. 2022;24:e34144. [DOI] [PubMed] [PMC]

van der Burg JM, Aziz NA, Kaptein MC, Breteler MJ, Janssen JH, van Vliet L, et al. Long-term effects of telemonitoring on healthcare usage in patients with heart failure or COPD. Clin eHealth. 2020;3:40–8. [DOI]

Wu R, Calligan M, Son T, Rakhra H, de Lara E, Mariakakis A, et al. Impressions and Perceptions of a Smartphone and Smartwatch Self-Management Tool for Patients With COPD: A Qualitative Study. COPD: J Chronic Obstr Pulm Dis. 2024;21:2277158. [DOI] [PubMed]

Watson JS, Jordan RE, Gardiner L, Adab P, Jolly K. A Systematic Review of the Effectiveness of Interventions to Promote Referral; Adherence; and Uptake of Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease. Int J Chronic Obstr Pulm Dis. 2023;18:1637–54. [DOI] [PubMed] [PMC]

Chronic obstructive pulmonary disease (COPD) [Internet]. World Health Organization; c2026 [cited 2024 Apr 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

Fromer L, Cooper CB. A review of the GOLD guidelines for the diagnosis and treatment of patients with COPD. Int J Clin Pract. 2008;62:1219–36. [DOI] [PubMed]

Yang F, Wang Y, Yang C, Hu H, Xiong Z. Mobile health applications in self-management of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of their efficacy. BMC Pulm Med. 2018;18:147. [DOI] [PubMed] [PMC]

Korpershoek YJG, Vervoort SCJM, Trappenburg JCA, Schuurmans MJ. Perceptions of patients with chronic obstructive pulmonary disease and their health care providers towards using mHealth for self-management of exacerbations: a qualitative study. BMC Health Serv Res. 2018;18:757. [DOI] [PubMed] [PMC]

Gezondheidsvaardigheden en laaggeletterdheid [Internet]. Pharos; [cited 2024 May 6]. Available from: https://www.pharos.nl/infosheets/laaggeletterdheid-en-beperkte-gezondheidsvaardigheden/

10.

Naranjo-Rojas A, Perula-de-Torres LÁ, Molina-Recio G. Patients, caregivers, and healthcare professionals’ needs when designing the content of a mobile application for the clinical monitoring of patients with chronic obstructive pulmonary disease and home oxygen therapy: A user-centered design. Internet Interv. 2022;29:100552. [DOI] [PubMed] [PMC]

11.

Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48:177–87. [DOI] [PubMed]

12.

Keij B, Versluis A, Alblas EE, Keuper JJ, van Tuyl LH D, van der Vaart R. E-healthmonitor 2023. Stand van zaken digitale zorg. RIVM. 2024. [DOI]

13.

Medical Device Regulation (MDR) [Internet]. European Union; [cited 2025 Jan 27]. Available from: https://eur-lex.europa.eu/legal-content/NL/TXT/?uri=CELEX:32017R0745

14.

Ramachandran HJ, Oh JL, Cheong YK, Jiang Y, Teo JYC, Seah CWA, et al. Barriers and facilitators to the adoption of digital health interventions for COPD management: A scoping review. Heart Lung. 2023;59:117–27. [DOI] [PubMed]

15.

Eigen regie over ziekte en zorg: ervaringen van mensen met een chronische longziekte [Internet]. Nivel; [cited 2024 Apr 25]. Available from: https://www.nivel.nl/nl/publicatie/eigen-regie-over-ziekte-en-zorg-ervaringen-van-mensen-met-een-chronische-longziekte

16.

Li W, Liu W, Liu S, Li J, Wang W, Li K. Perceptions of patients with chronic obstructive pulmonary disease towards telemedicine: A qualitative systematic review. Heart Lung. 2021;50:675–84. [DOI] [PubMed]

17.

Venkatesh V, Thong JYL, Xu X. Consumer Acceptance and Use of Information Technology: Extending the Unified Theory of Acceptance and Use of Technology1. MIS Q. 2012;36:157–78. [DOI]

18.

Venkatesh V, Morris MG, Davis GB, Davis FD. User Acceptance of Information Technology: Toward A Unified View1. MIS Q. 2003;27:425–78. [DOI]

19.

Fishbein M, Ajzen I. Predicting and changing behavior. New York: Psychology Press; 2009. [DOI]

20.

HLS19 International Report on the methodology, results and recommendations [Internet]; c2021 [cited 2024 May 22]. Available from: https://m-pohl.net/Int_Report_methdology_results_recommendations

21.

Willems AEM, Heijmans M, Brabers AEM, Rademakers J. Gezondheidsvaardigheden in Nederland: factsheet cijfers 2021 [Internet]. Utrecht: NIVEL; c2022 [cited 2024 May 22]. Available from: https://nivel.nl/sites/default/files/bestanden/1004162.pdf

22.

Van Deursen A. Trendrapport digitale inclusie: kerncijfers en beleidsaanbevelingen [Internet]. Enschede: University of Twente; c2023 [cited 2024 Feb 27]. Available from: https://www.utwente.nl/nl/centrumdigitaleinclusie/nieuws/2023/11/1237417/trendrapport-digitale-inclusie-kerncijfers-en-beleidsaanbevelingen

23.

Hengst TM, Lechner L, Dohmen D, Bolman CA. The facilitators and barriers of mHealth adoption and use among people with a low socio-economic position: A scoping review. DIGIT HEALTH. 2023;9:20552076231198702. [DOI] [PubMed] [PMC]

24.

Al-Dhahir I, Reijnders T, Faber JS, van den Berg-Emons RJ, Janssen VR, Kraaijenhagen RA, et al. The Barriers and Facilitators of eHealth-Based Lifestyle Intervention Programs for People With a Low Socioeconomic Status: Scoping Review. J Med Internet Res. 2022;24:e34229. [DOI] [PubMed] [PMC]

25.

Lenferink A, Brusse-Keizer MGJ, van der Palen J, Effing TW. Personalizing Self-Management Interventions in COPD – Looking Beyond One-Size-Fits-All. Int J Chronic Obstr Pulm Dis. 2025;20:65–8. [DOI] [PubMed] [PMC]

26.

Soper D. A-priori sample size calculator for multiple regression [Internet]. [cited 2024 Feb 29]. Available from: https://www.danielsoper.com/statcalc/calculator.aspx?id=1

27.

Luscii. COPD [Internet]. c2018-2025 Luscii healthtech B.V.; [cited 2025 Nov 11]. Available from: https://luscii.com/en/library/copd

28.

van der Molen T. Clinical COPD Questionnaire [Internet]. c1999 [cited 2025 Sep 23]. Available from: https://meetinstrumentenzorg.nl/instrumenten/clinical-copd-questionnaire/

29.

Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, et al. Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population. J Gen Intern Med. 2008;23:561–6. [DOI] [PubMed] [PMC]

30.

IBM Corp. IBM SPSS Statistics for Windows. Version 29.0.2.0. Armonk. 2023.

31.

Bol N, Helberger N, Weert JCM. Differences in mobile health app use: A source of new digital inequalities? Inf Soc. 2018;34:183–93. [DOI]

32.

Scheibe M, Lang C, Druschke D, Arnold K, Luntz E, Schmitt J, et al. Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study. JMIR Hum Factors. 2021;8:e27156. [DOI] [PubMed] [PMC]

33.

Pung A, Fletcher SL, Gunn JM. Mobile App Use by Primary Care Patients to Manage Their Depressive Symptoms: Qualitative Study. J Med Internet Res. 2018;20:e10035. [DOI] [PubMed] [PMC]

34.

Alkureishi MA, Choo ZY, Rahman A, Ho K, Benning-Shorb J, Lenti G, et al. Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions. JMIR Hum Factors. 2021;8:e33364. [DOI] [PubMed] [PMC]

35.

Parker R, Kreps GL. Library outreach: overcoming health literacy challenges. J Med Libr Assoc. 2005;93:S81-5. [PubMed] [PMC]

36.

Integraal Zorgakkoord: ‘Samen werken aan gezonde zorg’ [Internet]. The Hague: Ministry of Health Welfare and Sport; c2022 [cited 2024 May 22]. Available from: https://www.rijksoverheid.nl/documenten/rapporten/2022/09/16/integraal-zorgakkoord-samen-werken-aan-gezonde-zorg