Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopaedic Specialist Care: A Co-design study (Preprint)

BACKGROUND The demand for orthopaedic specialist consultation for patients with osteoarthritis (OA) in public hospitals is large and continues to grow. Lengthy wait times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse (CALD) backgrounds who are more likely to rely on public health care. OBJECTIVE The aim of this study was to co-design a digital health intervention for patients with OA who are waiting for an orthopaedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. METHODS The stakeholders involved in the co-design process included the research team, end-users (patients), clinicians, academic experts, senior hospital staff and a research, design and development agency. The iterative co-design process comprised of several key phases, which included the collation and refinement of evidence-based information by the research team with assistance from academic experts. Structured interviews with 16 clinicians (sex: 10 female and six male) and 11 end-users (mean ± SD, age: 64.3 ± 7.2, sex: seven female and four male) of 1-hour duration were completed to understand the needs of the intervention. Weekly workshops were held with key stakeholders throughout the development. A different cohort of 15 end-users examined the feasibility of the study during a 2-week testing period (age: 61.5 ± 9.7, sex: 12 female and three male). The system usability scale (SUS) was utilized as the primary measure of the feasibility of the intervention. RESULTS Seven content modules were developed which were refined over several iterative rounds. Key themes highlighted in the clinician and end-user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio and visual) and access to patient-centered information as early as possible in the healthcare journey. All content was translated to Vietnamese, the most widely spoken language following English in the LGAs included in this study. Patients with hip and knee OA from diverse CALD backgrounds tested its feasibility. A mean score of 82.7 ± 16 was recorded for the SUS placing it in the excellent category for usability. CONCLUSIONS Through the co-design process, we developed an evidence-based, holistic and patient-centered digital health intervention. The intervention has been specifically designed to be used by patients from diverse backgrounds, including those with low health, digital and written literacy levels. The effectiveness of the intervention for improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.