Variation in the feasibility and acceptability of electronic patient-reported outcome measures in patients with inflammatory arthritis

Abstract Objectives Whilst electronic patient-reported outcome measures (ePROMs) can facilitate innovative, holistic care for patients with inflammatory arthritis (IA), their implementation could inadvertently worsen health inequalities. This mixed-methods study aimed to evaluate their feasibility and acceptability in routine care, and how this varied by factors potentially impacting digital inclusion. Methods Patients with IA were invited to complete ePROMs before/at their appointment on an NHS digital platform (“Haywood Arthritis Portal”). A cross-sectional survey and semi-structured interviews were conducted in consenting patients and healthcare professionals (HCPs). Acceptability was evaluated using the Theoretical Framework of Acceptability. Survey responses were summarised descriptively. Statistical tests assessed global acceptability responses in relation to factors associated with digital inclusivity. Interviews were analysed using the Rigorous and Accelerated Data Reduction technique. Quantitative and qualitative findings were triangulated. Results 336 patients/11 HCPs were surveyed; 12 patients/5 HCPs were interviewed. Patient surveys/interviews demonstrated high ePROMs acceptability (89% found ePROMs completely acceptable/acceptable; 89% felt they benefitted care). Acceptability was lower in those that were older (p 0.001), lacked internet access (p = 0.009), and had low general/e-health literacy/digital skills (p 0.001). Largest differences were in those with vs without essential digital skills (93.0% vs 42.9% rating ePROMs acceptable/completely acceptable). Patient/HCP interviews also demonstrated inclusivity concerns. All HCPs considered ePROMs acceptable. Conclusions Whilst using ePROMs is feasible and highly acceptable to patients with IA and HCPs, as acceptability is lower in patients that are older, less health literate, and with lower digital skills/access, these factors require careful consideration in ePROMs implementation to avoid worsening health inequalities.