Heart failure patients' perspectives on future preventive remote care: insights from a qualitative co-constructing stories interview study

Abstract Introduction Although remote patient management (RPM) shows promise for improving chronic heart failure (HF) management, preventing re-admissions and improving quality of life and health behaviours, its effectiveness depends heavily on technology acceptance and patient engagement. Patients are often involved only after systems are developed and implemented, limiting the opportunity to align design choices with their requirements for adoption. By exploring patients’ expectations, motivations, and concerns about the future of RPM through participatory design methods, this study generated insights into their vision of remote care and provided guidance for tailoring patient-facing aspects of these systems. Methods Patients with HF using RPM were recruited from a single Dutch hospital to participate in individual, semi-structured interviews of one hour each. A co-constructing stories approach was employed, inviting participants to imagine future scenarios of remote care. Guided by narrative prompts about potential developments in RPM, participants were encouraged to envision and discuss how such technologies might shape their daily experiences. Notetaking during the interviews was supplemented with sketching to facilitate immediate reflection and to create a shared reference point for discussion. (Figure 1) The combined visual and textual data were analysed using Annotated Visual Analysis (Figure 2) to identify overarching themes. Results Six patients were interviewed, producing 8.5 hours of audio and 18 A3 sketch notes. Several key themes emerged: Actionability, reflecting patients’ desire to take more responsibility for their own health through RPM, valuing feedback and small prompts that support self-management and healthy behaviour even on days without alerts; Invasiveness, perceived as a potential barrier to adoption, was considered more manageable when accompanied by clear explanations from healthcare professionals and when perceived as proportional to the severity of the monitored disease; Adaptability and Integration, highlighting the need for RPM to extend support beyond remote monitoring and to remain useful in daily life, including outside the home; and Caregiver contact, where patients stressed that human interaction is irreplaceable, with the empathy of care providers playing a key role in fostering trust in the system and confidence in their health. Conclusion Engaging patients with HF early in the design process through participatory methods provided valuable insights into their vision for future RPM. Patients emphasised that RPM should be actionable, minimally invasive, adaptable to daily life, and complemented by meaningful human contact. They expressed a desire to take more responsibility for their own health, highlighting the importance of systems that empower self-management while providing appropriate guidance and support. These findings can guide more human-centred, effective RPM designs for HF care.Co-constructing stories and sketchingFor image description, please refer to the figure legend and surrounding text. Sketch, reflection, theme analysis (AVA)For image description, please refer to the figure legend and surrounding text.