Abstract
Background: Chronic constipation affects 15% of adults, impacting quality of life and burdening healthcare systems with frequent and costly visits. Despite effective treatments, constipation management is often neglected. We need innovative digital solutions that reduce suffering and improve healthcare cost-effectiveness by enabling better self-management of constipation.
Approach: We developed the Constipation Care Guide (CCG), an app-based digital patient education programme designed to improve self-management skills in chronic constipation. Inspired by the UK Medical Research Council (MRC) framework, it was part of a large research project. We developed the CCG using a person-centred, evidence-based approach that prioritised the patient experience. Stakeholders were involved from the outset.
Early interviews with patients highlighted themes for the CCG, including lifestyle changes, understanding symptoms and treatment options. Workshops with general practitioners (GP) and gastroenterology staff refined these themes. A literature review of mHealth and national treatment guidelines focused on evidence of interventions and national treatment guidelines. The CCG was tested in four phases: by professionals, in workshops with clinicians and with patients. Participants assessed usability, functionality and potential for clinical integration. We are now exploring patient journeys to gain a deeper understanding of the interplay between patient’s daily living, the digital health solution and clinicians. The feedback will guide improvements to the CCG.
Results: The CCG is offered via the digital platform Emento, that ensures security and data privacy, with the CCG conforming to national clinical standards. It requires patients to use a smartphone or tablet with internet access. The content, which is delivered through videos, texts, and reminders, progresses in two phases over eight weeks, to promote engagement and supporting self-management. While the guide's design enables widespread, adaptive use, there may be limitations for patients who lack digital skills. To mitigate challenges from lack of digital skills and ensure usability, introductory materials and training have been developed for both patients and clinicians.
Implications: Despite the consequences of constipation, there is little time for this large patient group in all parts of the healthcare system. It is therefore important to find alternative ways of supplementing what is available. The project will refine and scale a digital education programme to help patients manage their own health. By increasing knowledge of how to use digital tools to empower patients, we can reduce healthcare costs and improve patient outcomes, creating a pathway to better health. The CCG will be evaluated through a randomised controlled pragmatic trial comparing the effectiveness of the CCG with traditional primary and hospital care. Future analyses will further focus on the use of apps and examine factors such as health literacy and socio-economic status. We expect CCG to be accepted and be effective for patients seen in both hospital and GP settings, to improve quality of life and constipation symptoms, and to reduce the use of health care services.