Table 3.

Summary of the lessons learned from implementation of digital health interventions.

Challenge and description				Examples
Technology-related challenges
	Usability issues
		Participants’ physical, functional, and sensory function	Low vision Hand tremor
		Patients’ and providers’ lack of technical skills and experience	Forgetting log-in information or not remembering to charge the device Accidentally disabling device features Low technology comfort
		Device-related technical issues	Internet connectivity issues Software updates affecting function Immaturity of the prototype
		Fit and compatibility issues	Poor fit with patients’ or providers’ routine Device incompatible with older devices Not integrated into organization’s electronic documentation system Identifying provider functions rather than their roles may enable the technology to accommodate differences among jurisdictions and changing scopes of practice
	Technology content and function
		Patient-facing content	Hypertext links were distracting and confusing Language too technical Offensive tone and complexity of the wording Symptom-reporting questions too specific or broad caused misunderstanding
		Expectations of patient-initiated provider contact	Not all participants were confident about the appropriate circumstances in which to contact the provider
		Device notifications	Excessive alerts caused “alert fatigue” and resulted in less attention being paid to the alert or ignoring it altogether
Technology-related opportunities
	Technology function and features
		Enhancing functionality	Address and improve multiple components of the transition process
		Accessibility, adaptations, and customization	Low-vision adaptations Adapt for participants with low technological literacy and no social support Self-directed apps Use of personal devices when possible and compatibility across multiple data and operating systems Provision of the device when participants do not have access to a personal device
		Training	Technical setup Training on technology use Engage caregivers in the intervention when possible
		Fit with workflows, workloads, and buy-in	Participants, family, caregivers, and providers should inform the technology design and how technology could be integrated into the day-to-day practices of all stakeholders Accounting for providers’ ethical, legal, and professional responsibilities
Research process–related challenges
	Data collection
		Recruitment and retention challenges	Lack of interest High attrition
		Small sample size	Unable to explore the relationship between participants’ profiles, participants’ adherence and compliance to intervention or conduct subgroup analyses
		Sampling bias	Homogenous samples Inclusion limited to those with technology comfort or access
		Missing data	Impacting reliability of intervention results
		Outcome measures	Outcome measures such as rehospitalization and survival may not be sufficiently sensitive to determine intervention impact Single-blinded evaluator could introduce measurement error
		Interventions across settings or institutions	Cross-setting coordination challenges
Research process–related opportunities
	Data collection
		Recruitment considerations	Video of 10-to-15–minute duration describing the intervention (potential benefits and utility) during recruitment to reduce apprehension Consideration of low compliance rates within sample size calculations Comparing the characteristics of participants with those of individuals who declined can indicate selection bias and affect the intervention’s generalizability and acceptability
		Outcomes	Careful consideration of outcome measures (eg, objective or subjective) and end points
		Missing data	Begin intervention during hospitalization Schedule follow-ups during routine patient visits to minimize data lost during follow-up