Electronic Data Capture of Patient-Report Questionnaire in Patient Management in a Rural Population

Abstract

Background and Objectives:

Electronic data capture may enhance efficiency and patient engagement in preoperative psychosocial evaluations for metabolic and bariatric surgery yet concerns persist about its feasibility in rural populations with historically lower mobile health adoption. This study evaluated the feasibility and acceptability of electronic patient-reported outcomes among metabolic and bariatric surgery patients in a rural setting.

Methods:

In this quality improvement project, 202 patients undergoing presurgical psychosocial evaluation at an academic medical center in rural West Virginia completed a battery of psychological assessments on a clinic-provided tablet. Patients also completed a 9-item questionnaire assessing satisfaction, usability, and perceived impact on provider communication.

Results:

Most patients reported high satisfaction with the tablet-based format (85%), and nearly all (96%) preferred it over paper-and-pencil forms. Usability ratings were strong, with the majority describing the tablet as “very easy” to read (86%), use (84%), and navigate (87%). Notably, 42% reported the tablet encouraged them to discuss eating or mental health concerns with their provider, and 49% indicated it helped them remember prior symptoms. Only 4% preferred paper-and-pencil assessments, and these patients were significantly older.

Conclusion:

Tablet-based electronic patient-reported outcomes collection is a feasible and well-accepted method for presurgical psychosocial evaluations in rural metabolic and bariatric surgery patients. These findings challenge assumptions about digital hesitancy in rural populations and support broader implementation of electronic data capture in bariatric care workflows.

INTRODUCTION

Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity and its associated comorbidities, yet patient outcomes vary widely. To optimize surgical success, the American Society for Metabolic and Bariatric Surgery (ASMBS) recommends presurgical psychosocial assessments that include both clinical interviews and psychosocial testing.¹ Psychosocial testing provides valuable information that may not be fully captured in an interview, aids in diagnosis and treatment planning, and helps assess postsurgical outcomes. The most used psychosocial assessments in MBS rely on patient self-report and are traditionally administered using paper-and-pencil (P&P) methods.²

Electronic data capture presents an alternative approach with potential benefits for both clinicians and patients. Prior research suggests that electronic patient-reported outcomes (ePROs) improve clinical efficiency by enabling immediate data scoring, reducing errors in data entry, and minimizing missing information. Electronic methods may also encourage more honest reporting of sensitive information and facilitate long-term data storage for research and clinical tracking.³ Although the digital divide between urban and rural populations has narrowed in recent years, concerns remain regarding access to reliable internet and comfort with technology in rural settings, which may impact the feasibility of digital health tools in these populations.⁴ One study found that West Virginia residents were 82% less likely to use mobile health (mHealth) applications than the national average, even after adjusting for socioeconomic and demographic factors.⁵ This suggests that rurality, and particularly regional cultural factors, may still influence patient engagement with digital tools despite broader national trends toward increased adoption.

This quality improvement project aimed to evaluate the feasibility and acceptability of electronic data capture for PROs in a rural MBS population. As part of their preoperative psychosocial evaluation, patients completed self-report questionnaires on a tablet rather than using traditional P&P forms. Feasibility was assessed through patient-reported satisfaction and usability ratings. While the COVID-19 pandemic accelerated the nationwide adoption of telehealth and digital health tools, the integration of these technologies into routine behavioral health screening—particularly within rural bariatric surgery programs—remains limited and understudied. This study seeks to address that gap by evaluating how digital assessments function in real-world clinical settings serving rural patients.

MATERIALS AND METHODS

Study Design and Participants

This cross-sectional quality improvement study evaluated the feasibility of electronic data capture for PROs in an MBS population. The study included all patients undergoing presurgical psychosocial evaluation at a large academic medical center in West Virginia. No exclusion criteria were applied. As part of their standard evaluation for surgical readiness, patients were required to complete a presurgical psychosocial assessment conducted by a licensed, doctoral-level psychologist or a supervised predoctoral trainee. This evaluation included a semistructured clinical interview and a battery of self-report measures assessing eating behaviors, depression, and anxiety (Appendix 1). The data were collected via tablet at the time of the office visit for the psychosocial behavioral health evaluation. The participants returned the tablets once the survey was completed. This research received Institutional Review Board approval. Informed consent was obtained from all individual participants included in the study.

Procedure

Patients typically completed self-report measures using P&P forms the day of their behavioral medicine appointment prior to seeing the provider. In this study, tablets replaced the P&P forms for electronic data capture. Patients used the tablet to complete their assessments in the waiting room in the hour preceding their scheduled psychosocial evaluation. After completing the electronic assessments, patients were asked to complete a 9-item feasibility and satisfaction questionnaire assessing their experience using the tablet.

Measures

Patient demographic information, including sex, race, education, age, and body mass index (BMI), was collected. A 9-item questionnaire assessed patients’ experiences using the tablet-based assessment system. The following items were evaluated:

1. Overall satisfaction with tablet use (Likert scale)

2. Willingness to recommend the tablet to other patients (dichotomous scale)

3. Preference for tablet use over P&P forms (dichotomous scale)

4. Comfort of the tablet’s weight (Likert scale)

5. Ease of reading text on the tablet (Likert scale)

6. Ease of responding to questions on the tablet (Likert scale)

7. Ease of navigating the tablet interface using the touchscreen (Likert scale)

8. Whether tablet use encouraged discussion of eating or mental health concerns with the provider (dichotomous scale)

9. Whether tablet use helped patients remember symptoms they had experienced recently (dichotomous scale)

Statistical Analysis

Descriptive statistics were used to summarize patient demographics and responses to feasibility and satisfaction items. Exploratory analyses were conducted to assess whether specific patient characteristics were associated with a preference for P&P forms over tablet-based assessments.

RESULTS

Patient Demographics

Table 1 describes participant demographic data. A total of 202 patients completed the tablet-based testing battery prior to their presurgical psychosocial evaluation. Most participants were female (80.2%) and White (95%), with smaller proportions identifying as Black or African American (4%) or Hispanic/Latino (0.5%). The mean age was 43.54 years (standard deviation [SD] = 10.62), and the mean BMI was 48.07 (SD = 7.15).

Table 1.

Patient Demographics (n = 202)

Question and Responses for Survey Items	Frequency	%
Race/Ethnicity
White	192	95
Hispanic or Latino	1	0.5
Black or African American	8	4
Other (specify)	1	0.5
Total	202	100.0
What is the highest level of education you have completed?
High school not completed	9	4.5
High school graduate/GED	60	29.7
Some college	56	27.7
Associates degree	31	15.3
Bachelor’s degree	29	14.4
Master’s degree or higher	17	8.4
Total	202	100.0
What is your current employment status?
None/unemployed	23	11.4
Part-time (20 hours or less weekly)	9	4.5
Full-time (more than 20 hours weekly)	123	60.9
Disabled	18	8.9
Retired	8	4
Student	3	1.5
Homemaker	18	8.9
Total	202	100.0
What is your marital status?
Single/never married	39	19.3
Married	119	58.9
Divorced	27	13.4
Separated	7	3.5
Widowed	8	4.0
Remarried	2	1.0
Total	202	100.0
What sex were you assigned at birth on your original birth certificate?
Female	162	80.2
Male	40	19.8
Total	202	100.0

Most participants had completed some college or higher (66%). While 28% reported only having some college experience, others had earned associates (15%), bachelor’s (14%), and master’s (8%) degrees. In contrast, 34.2% had a high school education or less, including 29.7% who were high school graduates or had obtained a General Educational Development (GED). Only 4.5% of patients had not completed high school.

Most participants were employed full-time (60%). Marital status varied among participants, with approximately 60% being married, 20% single/never married, and 13% divorced.

Patient Experience with Tablet-Based Assessment

Table 2 illustrates patients’ satisfaction with tablet use. Most participants reported a positive experience using the tablet. Overall, 85% were very satisfied with the tablet-based format, and 92% would recommend it to other patients. Nearly all patients (96%) preferred the tablet over P&P questionnaires.

Table 2.

Patient Responses to Satisfaction/Feasibility Survey Items (n = 202)

Question and Responses for Survey Items	Frequency	%
How easy was it to read the tablet?
Very easy	173	85.6
Somewhat easy	20	9.9
Neither difficult nor easy	5	2.5
Somewhat difficult	4	2.0
Very difficult	0	0
How easy was it to use the Tablet to respond to the questions?
Very easy	169	83.7
Somewhat easy	22	10.9
Neither difficult nor easy	6	3.0
Somewhat difficult	5	2.5
Very difficult	0	0
How easy was it to navigate with the touch screen on the tablet?
Very easy	179	88.6
Somewhat easy	16	7.9
Neither difficult nor easy	4	2.0
Somewhat difficult	1	.05
Very difficult	2	1.0
Was the weight of the tablet comfortable for your use?
Very comfortable	158	78.2
Somewhat comfortable	29	14.4
Neither uncomfortable nor comfortable	7	3.5
Somewhat uncomfortable	7	3.5
Very uncomfortable	1	0.5
In general, how satisfied were you with using the tablet to report your symptoms?
Very satisfied	171	84.7
Somewhat satisfied	19	9.4
Neither dissatisfied nor satisfied	8	4.0
Somewhat dissatisfied	1	0.5
Very dissatisfied	3	1.5
Would you recommend that other patients use the tablet?
Yes	185	91.6
No	3	1.5
I don’t know	14	6.9
Did use of the tablet encourage you to discuss eating or mental health concerns with your doctor that you might otherwise not have discussed?
Yes	84	41.6
No	55	27.2
I don’t know	63	31.2
Did use of the tablet help you to remember symptoms that you have experienced in the past, such as eating in response to stress, depression, or anxiety?
Yes	99	49.0
No	74	36.6
I don’t know	29	14.4
Would you prefer to use paper-and-pencil or a tablet to complete clinic surveys such as these?
Paper-and-pencil	8	4.0
Tablet	192	95.0

Responses to individual feasibility questions demonstrated high ease of use. Most patients found reading from the tablet “very easy” (86%), responding to questions “very easy” (84%), and navigating the touchscreen “very easy” (87%). Additionally, 78% reported the tablet’s weight was “very comfortable.”

Regarding its impact on clinical discussions, 42% of participants reported using the tablet encouraged them to discuss eating or mental health concerns with their provider. Almost half of respondents stated that it helped them remember past symptoms related to eating behaviors or mood.

Exploratory Analysis

Patients who preferred P&P over the tablet (4%, n = 8) were significantly older than those who preferred the tablet (mean age 55 ± 8 vs 43 ± 10, t(195) = 3.35, P = .001). However, there were no significant differences in preference based on sex, race, or education level.

DISCUSSION

This study demonstrates that tablets are a feasible and well-accepted method for collecting PROs in a MBS population. Most patients were highly satisfied with the tablet-based assessments, and nearly all (96%) preferred them over P&P forms. These results suggest that digital assessments can be successfully implemented in presurgical psychosocial evaluations, even in rural populations where mHealth adoption has been historically low.

Previous research suggests that West Virginians use mHealth tools less frequently than other populations. Giacobbi et al found that men in West Virginia were particularly less likely to engage with mHealth.⁵ This study shows that when digital tools are integrated into routine clinical care, patients in this region—including both men and women—are comfortable using them. This finding challenges assumptions about rural patients’ reluctance to use technology and highlights the potential for expanding digital health initiatives in surgical and behavioral health settings.

Tablets As a Tool for Enhancing Clinical Communication

Tablet-based assessments may also improve clinical discussions about mental health. In this study, 42% of patients reported that completing the questionnaire on a tablet encouraged them to discuss eating behaviors and mental health concerns with their provider. Future studies could further explore whether patients would disclose more sensitive information if they were able to complete this battery at home compared to completion in the clinic waiting room ahead of their appointment.

The ASMBS underscores the importance of comprehensive psychosocial assessment in optimizing surgical outcomes. These evaluations are designed to identify disordered eating, unmanaged mental illness, or substance use that could impact postoperative success. According to the ASMBS-International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Guidelines, “The presurgical evaluation process is designed to optimize surgical outcomes and implement interventions that can address disordered eating, severe uncontrolled mental illness, or active substance abuse.”⁶ Our findings suggest that tablet-based data capture may enhance this process by facilitating more open communication about behavioral health concerns, especially in rural populations where access to specialized mental health care is limited.

Providers may have greater satisfaction with the tablet-based method. The ability to review PRO data in advance can allow physicians and psychologists to tailor their interviews and address concerns more effectively.⁷ Electronic data capture also streamlined documentation and improved workflow efficiency.^8–10 By integrating digital assessments into routine care, MBS programs may enhance multidisciplinary communication and ensure that behavioral health providers, surgeons, and dietitians have real-time access to patient-reported data.

Streamlining routine clinical care is essential to maintaining high patient volume and optimizing provider productivity. The integration of electronic data capture has the potential to enhance patient-provider communication, facilitate multidisciplinary collaboration, and improve the overall efficiency of MBS patient management.

Implications for Rural Healthcare and Future Directions

While telehealth adoption has surged in recent years, much of the literature has focused on remote patient monitoring or virtual visits. This study contributes novel insight into the integration of digital self-report tools within the structured, in-person workflow of preoperative psychosocial evaluations. Importantly, our sample represents a rural population, which is often underrepresented in digital health implementation research despite experiencing higher barriers to surgical care access and follow-up.

While this study was conducted in a hybrid setting—electronic assessments completed on tablets during in-person visits—this approach reflects the real-world workflow of many rural clinics where patients travel long distances for care. As such, it offers practical insight into the feasibility of digital tools embedded within traditional clinical encounters. However, this model may not reflect practices at centers that rely on remote or bring-your-own-device (BYOD) strategies. Future research should explore how digital assessments perform in fully remote, at-home contexts to evaluate scalability across more varied clinical models.

These findings suggest that digital PRO collection is a viable option for MBS patients in rural settings. When presented in a structured clinical environment, patients are receptive to digital health tools. Future research should explore whether similar technology can be applied to other surgical populations or chronic disease management programs. Focus should also be given to the applicability of patient’s use of their own mobile device or tablet and how it impacts satisfaction and transmission of data. These studies have been done in urban centers but less attention has been given to these questions in rural populations.¹¹

Limitations

This study has limitations. Although this study focused on a rural patient population, we did not formally assess key contextual variables that may influence digital tool use, such as distance traveled to the clinic, digital literacy, or home internet access. Future studies should evaluate how these factors influence feasibility and satisfaction with electronic assessments.

As a single-center study at an academic medical center, findings may not be generalizable to all rural populations. Additionally, while providers reported improved workflow efficiency, we did not formally assess provider satisfaction. Future research should evaluate the impact of tablet-based assessments on workflow burden, clinical decision-making, and patient outcomes.

Finally, while most patients in our study indicated a preference for tablet-based assessments over P&P forms, this study did not include a direct or randomized comparison between the two formats. Because patients were not blinded to the assessment method or offered a choice at the time of completion, it is possible that satisfaction with P&P assessments may also have been high in a different context. Future studies employing crossover or randomized designs could provide more definitive insights into relative patient preferences.

CONCLUSION

Tablet-based PRO collection is a feasible and well-accepted method for presurgical psychosocial evaluations in MBS patients. Patients reported high satisfaction with the digital format, and providers found that electronic data capture improved workflow and enhanced clinical discussions. These findings support the broader implementation of ePROs in bariatric surgery programs to enhance patient-provider communication and streamline multidisciplinary care. Future research should explore provider satisfaction and the potential for patient-administered assessments on personal devices.

Appendix 1. Description of Patient Surveys

Demographics

Collects basic patient information such as age, gender, race, and socioeconomic status.

Surgery Information

Collects data on the patient’s understanding of and expectations for bariatric surgery.

Binge Eating Scale

Identifies symptoms and severity of binge eating behaviors.

Three Factor Eating Questionnaire

Measures eating behaviors in three key areas: cognitive restraint, emotional eating, and uncontrolled eating.

Brief COPE

Assesses coping mechanisms and strategies used to manage stress.

PROMIS Anxiety

Evaluates anxiety symptoms and their impact on daily functioning.

PROMIS Depression

Measures depressive symptoms and their effect on quality of life.

AUDIT-C

A brief screening tool for detecting alcohol use disorders.

Beck Anxiety Inventory (BAI)

A standardized tool for assessing the severity of anxiety symptoms.

Beck Depression Inventory (BDI)

A widely used questionnaire for measuring the severity of depressive symptoms.