An app for treating ulcers – technology does not heal all wounds

What functions does an app need to have in order to provide meaningful support for wound therapy? An interdisciplinary team from Bern University of Applied Sciences (BFH) investigated this question. The project was funded as part of the “Humane Digital Transformation” programme. A needs analysis was carried out based on a human-centred design approach. This involved qualitative, semi-structured interviews with patients and healthcare professionals in order to better understand the context of use of the medical device and identify requirements for an accompanying app. However, the analysis shows that both patients and carers see little added value in integrating an app into therapy.

Healing chronically inflamed wounds – a challenge for older patients

Chronic wound inflammation can occur after an accident or an operation. There are various methods for treating chronically inflamed wounds, with carers adapting their strategies to the patient’s general state of health and the severity of the wound. The treatment method investigated promises to accelerate wound healing through two physical stimulation methods, whereby regular use is important for the success of the therapy. An appropriate device, a certified medical product, is applied to the wound for 16 minutes at a time, two to three times a week for several weeks.

The manufacturer of the device wanted to find out whether an accompanying app would support the documentation and use of the medical device. The app was also intended to facilitate communication between patients, carers and doctors. The aim of the project was to simplify the use of the device, give patients more incentive to use it and improve patient care. Based on a human-centred design approach, our study investigated what content such an app should sensibly offer and what function it can fulfil in interaction with the medical device.

Can an app have a positive influence on the therapy process?

Two wound experts (37 and 58 years old), who have been working with the device for several years, and five patients (age range 66-86 years) took part in the study. All of the patients surveyed suffer from chronically inflamed wounds and were given advice on how to use the device. The questions asked related to their general state of health, use of the device and their relationship with the technology. Data was collected through interviews on site and by telephone, as well as by means of self-administered questionnaires.

The interviews and questionnaires provided valuable insights into the use of the device, the treatment process and the use of technology. Patients and carers are satisfied with the ease of use of the device. It can be used on an outpatient basis or at home. For home use, patients are trained by carers in hospital or by Spitex. The English language of the device and the perceived lengthy treatment time (16 minutes) cause difficulties. However, it was clear from the interviews that the patients surveyed showed little interest or affinity for new technologies. The majority do not own a mobile phone and mainly use television or radio.

As a result, patients see no need for an app. In contrast, the importance of personal contact with care professionals was emphasised for every treatment. The patients surveyed do not want to “leave responsibility for their health to technology”. Since the device is already easy to use, patients do not see any additional benefit in an app.

The carers surveyed were generally more open to new technology. The condition here is that there is a clear benefit and training is provided. However, the carers also did not recognise the purpose or added value of an app to support therapy. They emphasised that the high average age of the patients (over 70 years) made the introduction of an app difficult anyway.

The results from the surveys point in a clear direction: the therapy device is effective and easy to use, the treatment regimen is established. Neither patients nor carers see any significant additional benefit in an app.

Early involvement of stakeholders is essential

The aim of the study was to investigate the potential and role of an app as an accompaniment to therapy. In a participatory process, information was collected on the treatment context both in the setting of the wound consultation and at the patient’s home, as well as on the patient’s state of health and affinity for technology and the carer’s point of view.

Despite the small sample size and the homogeneous group of patients, it became clear that the need for a therapy-supporting app is low. There was positive feedback regarding the handling and effect of the existing therapy device; the improvement in the wound motivates patients to adhere to the therapy and regular checks in hospital ensure the success of the therapy. However, these are also reasons that call into question the potential of a planned app.

It has been shown that the involvement of potential users and professionals is crucial at an early stage of requirements elicitation. Participatory, human-centred designs can be used to show which digital functionalities are useful in a specific use case and can have a supportive effect.

In the specific case of a product that already works intuitively and motivates active use, it was found that additional technological gimmicks are not useful. A target group with little affinity for technology, which also places great value on human contact and closeness, tends to reject such attempts at digitalisation.