Table 1 Characteristics of the qualitative studies included in meta-synthesis

Baron 2017

United Kingdom [20]

- 26 participants

- Adults (age not specified)

- Gender not specified for Qualitative data

- English speaking Adults with T1DM/T2DM (HbA1c > 7.5%)

- Mixed methods study

- Semi-structured interview.

- Thematic Analysis

Mobile-phone based home telehealth (MTH) – transmitted diabetes related data (BG and BP readings, time since last meal, level of physical activity performed, insulin dose, weight) to MTH nurse for feedback.

1. Increased awareness

2. Increased motivation

3. Influence on diabetes self-care (reported to have increased the most in patients)

4. Perceived sense of security

1.

- Level of diabetes control

- Factors influencing diabetes control

2.

- MTH is a motivational tool/personal challenge

3.

- Increased monitoring of blood glucose

- Dietary changes

- Improved insulin intake and adjustments

4.

- Someone there to monitor my clinical readings and prevent complications

Beran 2018

United States [21]

- 27 participants – 23 patients, 4 pharmacists

- Age not specified

- Uncontrolled BP 140/90, Completed 54 month outcome research clinic

- Mixed methods study

- Patient Focus Groups and Pharmacist semi-structured interviews

- Grounded theory Analysis

Home BP monitors that stored and transmitted BP data to a secure website

1. Strong patient/pharmacist relationship

2. Individualised treatment plans

3. Communication among clinical staff (Insufficient communication with clinician)

4. frequent phone contact with pharmacist.

NA

Buis 2020

United States [19]

- 15 participants − 13 patients, 1 pharmacist 1 physician

Patients:

- 18–65

- 53.3% Male, 46.7% Female

- English speakers, possess smartphone compatible, uncontrolled HTN > 140/90 mmHg, under care at recruiting clinic taking at least 1 antihypertensive medication.

Stakeholders:

- Purposive sampling of individuals affiliated with BPTrack program or healthcare providers for enrolled patients

- Mixed methods study

- Patient surveys and Patient interviews and Stakeholder semi-structured Interviews

- Thematic Analysis

2 different mobile applications (one for patient, one for clinical pharmacist). Together allowed real-time electronic home blood pressure monitoring and medication adherence tracking.

1. Feasibility

2. Acceptability

3. Preliminary Effectiveness

4. Healthcare Utilisation

1.

- Participant utilisation of BPTrack

- Participant perceptions of Feasibility

- Stakeholder Perceptions of Feasibility

2.

- Participant perceptions of Acceptability

- Stakeholder perceptions of acceptability

3.

- Effect of BPTrack on Blood Pressure and Medication Adherence

- Participant Perceptions of Effectiveness

- Stakeholder Perceptions of Effectiveness

Grant 2019

England [22]

- 23 patients, 2 carers, 15 Healthcare professionals

- Patients, carers, and HCPs employed in practices based in West Midlands taking part in TASMINH4 RCT

Patients:

- > 35

- 78.2% male 21.7% Female

- Uncontrolled HTN < 140/90 mmHg

- Qualitative Study, Interviews (type not stated)

- Hamilton’s rapid analysis approach

Patients send BP readings via SMS text-based telemonitoring service. Patients alerted to contact their surgery in the light of very high or low readings, web page interpreted readings and graphically displayed BP readings.

1. Acceptability

2. Managing Data

3. Communication

4. Integrating self-monitoring in HTN management

N/A

Hanley 2015

United Kingdom [23]

- 23 patients, purposively sampled, 10 professionals (4 GPs and 6 nurses)

- Mean age 60 years (age of inclusion not included)

- 70% Male, 30% Female

- Inclusion criteria not included

- At least 1 professional from each practice

- Qualitative study, Semi-structured interviews

- Thematic analysis

Home BP, BG, weight monitoring - transmitted to a remote secure server which could be viewed by HCP and patient.

1. Contextual factors

2. Communication

3. Telemonitoring as support for managing the condition

4. The ‘fit’ of telemonitoring with personal lifestyles and professional practice

1.

- Living with T2DM

- Usual care

- Preferred management options

- Trialling

2. N/A

3.

- Supporting self-care

- Supporting treatment changes

4. N/A

Lee 2018

England [25]

- 10 patients

- > 18

- 49–77

- 80% Female, 20% Male

- formal T2DM diagnosis, Received/receiving telehealth care for T2DM,

- fluent English, able to provide informed consent for study

- Qualitative Semi-structured interviews

- Phenomenological analysis

Recruited participants who have received or receiving telehealth care for T2DM

1. Technology consideration

2. Service perceptions

3. Empowerment

1.

- Initial perception of using technology for self-management

- Telehealth usability concerns

2.

- Sense of security and comfort

- Easy and convenience access to healthcare services

- Privacy concerns

- Continuity of care

3.

- Patient education

- Supporting self-care with telehealth system’s health trend analysis

Lee 2019

Malaysia [24]

- 48 participants

- 18–75

- 56% Females, 44% Males

- Diagnosed with T2DM for at least 6 months (HbA1c 7.5-11%), regular access to internet, Randomised into intervention arms of IDEAS study

- Non-probability sampling method

- Qualitative study

- Semi-structured interview within focus groups

- Thematic Analysis

Home monitoring of BG – transmitted to participant’s mobile phone to a remote secure server.

1. Generational differences

2. Independence and convenience

3. Sharing of health data and privacy

4. Concerns and challenges

N/A

Nissen 2017

Denmark [26]

- 14 participants

- 55–83

- 57.1% Female, 42.9% Male

- selected from RCT net-COPD project group on a principle of maximum variation

- Stable patients from outpatient clinic with severe and very severe COPD and at high risk of exacerbation

- Qualitative study, Semi-structured interviews

- manifest and latent content analysis-

Tablet computer with web camera and microphone and measurement equipment (spirometer, pulse oximeter, scales). Readings submitted by patients to a call centre at patients local hospital and automatically categorised and prioritised. If red/yellow, patient would be contacted.

1. Sense of security and control

2. Knowing your disease

3. Virtues of the virtual consultation

1.

- Keeping track

- The lifeline

2. N/A

3. N/A

Pekmezaris 2020

United States [27]

Pilot study Patients:

- 12 participants

- Age/gender not specified

- Latin-X/Hispanic

- T2DM receiving care form outpatient clinics in the New York Metropolitan area

Community Advisory Board Members

- 23 participants

- H/L patients with T2DM, non-professional caregivers, disparity experts, clinicians, patient advocates and payor and health policy representatives

- Qualitative study

- Focus groups and Semi structured interviews

- Thematic Analysis

Tablet which provides patient with: (1) basic daily vital signs monitoring and facilitates nurse recognition of high BG. (2) weekly telemonitoring face-to-face video chat between patient and nurse. (3) culturally congruent educational videos concerning their condition

Community advisory board and stakeholder focus groups

1. Technology acceptance

2. Tablet interface

3. Video review

4. Consent Process concerns

Feedback from pilot study participants

Adaptations implemented as a result of stakeholder feedback

1. Changed to the patient-facing tablet screens

2. Changes to study procedures

1. N/A

2.

Theatre testing:

- Presentation of the information

- Language use

- Irrelevant information

Community Advisory Board focus group:

- Screen or verbiage changes

- Desire for more training on using tablet

- Video feedback

3.

- Repetition of information

- Presentation of information

- Language choice

- Cultural incongruence

- Personal connection with actors

4. N/A