User-Centered Feature Requirements in Wearable Digital Health to Support Self-Care Among Stroke Survivors
Abstract
Introduction: Stroke is a major cause of death and disability in Indonesia, leaving many survivors with long-term self-care challenges. Wearable technologies using digital health technology offer potential support. However, the adoption of technology is hindered by usability, accessibility, and cultural barriers. This study explores user-driven feature requirements to inform inclusive and effective digital self-care solutions for stroke survivors
Methods: This explorative qualitative study with a phenomenological approach involved in-depth interviews with 19 stroke survivors conducted between May and August 2024 in Yogyakarta and Bandung. Participants were selected using purposive and snowball sampling and analyzed using thematic analysis. Ethical approval was obtained from the Universitas Aisyiyah Yogyakarta Ethics Committee (No. 3832/KEP-UNISA/VII/2024), and all participants provided informed consent.
Results: A total of 19 stroke survivors (mostly male and aged 45–60) participated in this study, with the majority having lived with stroke for over five years. Two overarching themes emerged. The first, Managing Health and Daily Life, reflected the need for features that assist stroke survivor to navigate their self-care practices. The second, Navigating Technology with Limitations, highlighted emotional and socio-cultural barriers that hinder technology adoption and sustained use among stroke survivors. These findings suggest that effective wearable solutions must integrate practical health management functions with user-centered design, addressing cognitive, emotional, and contextual barriers to long-term use, with implications for inclusive design guidelines and grassroots-based technology policies.
Conclusion: This study gives an understanding of user-centered perspectives in digital health technology by highlighting the practical and emotional aspects of technology use. Future research should incorporate caregiver and healthcare provider perspectives and evaluate prototypes in real-world settings to strengthen inclusive innovation and sustainable adoption.
References
AL?Fayyadh S. Predicting the functional independence during the recovery phase for poststroke patients. Nurs Open. 2019 Jul 11;6(4):1346–53.
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol [Internet]. 2021 Oct [cited 2023 Aug 12];20(10). Available from: https://pubmed.ncbi.nlm.nih.gov/34487721/
Kementerian Kesehatan Republik Indonesia. Laporan Riset Kesehatan Dasar Tahun 2018. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia; 2018.
Sekretariat Direktorat Jenderal Pelayanan Kesehatan. World Stroke Day 2023, Greater Than Stroke, Kenali dan Kendalikan Stroke [Internet]. 2023 [cited 2024 Mar 26]. Available from: https://yankes.kemkes.go.id/read/1443/world-stroke-day-2023-greater-than-stroke-kenali-dan-kendalikan-stroke
Tiwari S, Joshi A, Rai N, Satpathy P. Impact of Stroke on Quality of Life of Stroke Survivors and Their Caregivers: A Qualitative Study from India. J Neurosci Rural Pract. 2021 Sep 22;12(4):680–8.
Cobley CS, Fisher RJ, Chouliara N, Kerr M, Walker MF. A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge services after stroke. Clin Rehabil. 2013 Aug;27(8):750–7.
Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke Survivors’ Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil. 2015 Sep 1;96(9):1698-1708.e10.
Johnson VL, Apps L, Hadjiconstantinou M, Carey ME, Kreit E, Mullis R, et al. The development of a self-management intervention for stroke survivors – My Life After Stroke (MLAS). Disabil Rehabil. 2023 Jan 16;45(2):226–34.
World Health Organization. Self-care for health and well-being [Internet]. 2024 [cited 2024 Sep 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/self-care-health-interventions
Fryer CE, Luker JA, McDonnell MN, Hillier SL. Self management programmes for quality of life in people with stroke. Cochrane Database Syst Rev [Internet]. 2016 [cited 2023 Aug 8];(8). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010442.pub2/full
Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, et al. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PloS One. 2018;13(2):e0192533.
Wang W, Pucciarelli G, Mei Y, Zhang Z, Vellone E. The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study. Health Expect. 2023;26(6):2325–39.
Venkatesh V. Determinants of Perceived Ease of Use: Integrating Control, Intrinsic Motivation, and Emotion into the Technology Acceptance Model. Inf Syst Res. 2000;11(4):342–65.
Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Q. 1989;13(3):319–40.
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016 Jun;47(6):e98–169.
Byrne S, Kotze B, Ramos F, Casties A, Harris A. Using a mobile health device to manage severe mental illness in the community: What is the potential and what are the challenges? Aust N Z J Psychiatry. 2020 Oct 1;54(10):964–9.
Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int. 2021;2:100117.
Gokalp H, De Folter J, Verma V, Fursse J, Jones R, Clarke M. Integrated Telehealth and Telecare for Monitoring Frail Elderly with Chronic Disease. Telemed E-Health. 2018 Dec;24(12):940–57.
Panday BC. Monitoring in Thoracic Surgery. In: Sood J, Sharma S, editors. Clinical Thoracic Anesthesia [Internet]. Singapore: Springer; 2020 [cited 2023 May 8]. p. 99–109. Available from: https://doi.org/10.1007/978-981-15-0746-5_8
Wu JM, Chen HS, Chen HH, Cheng BW, Huang CW, Chung MH. Enhancing patient self-management after a first stroke: An application of the wearable devices and the health management platform. Disabil Health J. 2023 Jan 1;16(1):101392.
Kheirollahzadeh M, Sarvghadi P, Bani Hani J, Azizkhani S, Monnin C, Choukou MA. Digital Health Technologies to Support At-Home Recovery of People with Stroke: A Scoping Review. Appl Sci. 2025 Jan;15(10):5335.
Wall C, Hetherington V, Godfrey A. Beyond the clinic: the rise of wearables and smartphones in decentralising healthcare. Npj Digit Med. 2023 Nov 25;6(1):1–3.
Haji Mukhti MI, Ibrahim MI, Tengku Ismail TA, Nadal IP, Kamalakannan S, Kinra S, et al. Exploring the Need for Mobile Application in Stroke Management by Informal Caregivers: A Qualitative Study. Int J Environ Res Public Health. 2022;19(19).
Fischer AK, Mühlbacher AC. Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment. JMIR Res Protoc. 2023 Aug 10;12:e46056.
Yen PY, Bakken S. Review of health information technology usability study methodologies. J Am Med Inform Assoc JAMIA. 2012;19(3):413–22.
Van Manen M. Phenomenology of practice: meaning-giving methods in phenomenological research and writing. Walnut Creek, California: Left Coast Press; 2014. 412 p. (Developing qualitative inquiry).
Fiordelli M. Transitioning Perspectives in Digital Health Through Phenomenology Integration. J Med Internet Res. 2024 Oct 23;26(1):e62691.
Guest G, Bunce A, Johnson L. How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods. 2006 Feb 1;18(1):59–82.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Chen Y, Yuan J, Shi L, Zhou J, Wang H, Li C, et al. Understanding the Role of Technology Anxiety in the Adoption of Digital Health Technologies (DHTs) by Older Adults with Chronic Diseases in Shanghai: An Extension of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model. Healthcare. 2024 Jan;12(14):1421.
Lobo EH, Frølich A, Kensing F, Rasmussen LJ, Livingston PM, Grundy J, et al. mHealth applications to support caregiver needs and engagement during stroke recovery: A content review. Res Nurs Health. 2021;44(1):213–25.
Kerr A, Smith M, Reid L, Baillie L. Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study. JMIR Rehabil Assist Technol. 2018 Aug 17;5(2):e15.
Wen X, Li Y, Zhang Q, Yao Z, Gao X, Sun Z, et al. Enhancing long-term adherence in elderly stroke rehabilitation through a digital health approach based on multimodal feedback and personalized intervention. Sci Rep. 2025 Apr 23;15(1):14190.
Chandrasekaran R, Katthula V, Moustakas E. Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey. J Med Internet Res. 2020 Oct 16;22(10):e22443.
Arini M, Primastuti HI. Literature Review: Telemedicine Implementation in Developing Countries. In: Proceedings of Ninth International Congress on Information and Communication Technology [Internet]. Springer, Singapore; 2024 [cited 2025 Aug 15]. p. 505–14. Available from: https://link.springer.com/chapter/10.1007/978-981-97-3559-4_41
Cao W, Kadir AA, Wang Y, Wang J, Dai B, Zheng Y, et al. Description of apps targeting stroke patients: A review of apps store. Digit Health. 2023 Jan 1;9:20552076231181473.
Piran P, Thomas J, Kunnakkat S, Pandey A, Gilles N, Weingast S, et al. Medical Mobile Applications for Stroke Survivors and Caregivers. J Stroke Cerebrovasc Dis. 2019 Nov 1;28(11):104318.
Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, et al. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2018 Jul 19;2018(7):CD006732.
Hong W. Advances and Opportunities of Mobile Health in the Postpandemic Era: Smartphonization of Wearable Devices and Wearable Deviceization of Smartphones. JMIR MHealth UHealth. 2024 Jan 22;12(1):e48803.
Krichen M. Anomalies Detection Through Smartphone Sensors: A Review. IEEE Sens J. 2021 Jan 26;21:1.
Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A’Court C, et al. Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res. 2017 Nov 1;19(11):e8775.
McCool J, Dobson R, Muinga N, Paton C, Pagliari C, Agawal S, et al. Factors influencing the sustainability of digital health interventions in low-resource settings: Lessons from five countries. J Glob Health. 10(2):020396.
Agbeyangi A, Suleman H. Advances and Challenges in Low-Resource-Environment Software Systems: A Survey. Informatics. 2024 Dec;11(4):90.
Naderbagi A, Loblay V, Zahed IUM, Ekambareshwar M, Poulsen A, Song YJC, et al. Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review. J Med Internet Res. 2024 Jul 9;26(1):e55130.
Busse TS, Nitsche J, Kernebeck S, Jux C, Weitz J, Ehlers JP, et al. Approaches to Improvement of Digital Health Literacy (eHL) in the Context of Person-Centered Care. Int J Environ Res Public Health. 2022 Jul 7;19(14):8309.
Sharma RS, Mokhtar IA, Ghista DN, Nazir A, Khan SZ. Digital literacies as policy catalysts of social innovation and socio-economic transformation: Interpretive analysis from Singapore and the UAE. Sustain Soc Dev. 2023 Aug 24;1(1):2167.
Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, et al. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med. 2023 Sep 18;6:161.
Liu Y, Lu X, Zhao G, Li C, Shi J. Adoption of mobile health services using the unified theory of acceptance and use of technology model: Self-efficacy and privacy concerns. Front Psychol [Internet]. 2022 Aug 11 [cited 2025 Aug 15];13. Available from: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.944976/full
Hadi A. Bridging Indonesia’s Digital Divide: Rural-Urban Linkages? J Ilmu Sos Dan Ilmu Polit. 2018 Sep 5;22(1):17–33.
Utoyo DB. Empowering Rural Communities through Digital Literacy: An Empirical Study of Former Women Migrant Workers in Panjer Village, Kebumen - Indonesia. In Atlantis Press; 2025 [cited 2025 Aug 15]. p. 378–90. Available from: https://www.atlantis-press.com/proceedings/icispe-24/126012981
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