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

## TL;DR

Electronic patient-reported outcome measures are generally accepted in inflammatory arthritis care but may be less accessible for older or less digitally skilled patients.

## Contribution

This study evaluates how factors like age and digital skills affect the acceptability of ePROMs in inflammatory arthritis care.

## Key findings

- 89% of patients found ePROMs completely acceptable or acceptable.
- Acceptability was significantly lower in older patients and those with low digital skills.
- Healthcare professionals found ePROMs acceptable, but expressed inclusivity concerns.

## Abstract

While 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.

Patients with IA were invited to complete ePROMs before/at their appointment on a National Health Service 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.

A total of 336 patients and 11 HCPs were surveyed; 12 patients and 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 who were older (P < 0.001), lacked internet access (P = 0.009) and had low general/e-health literacy/digital skills (P < 0.001). The largest differences were in those with vs without essential digital skills (93.0% vs 42.9% rating ePROMs acceptable/completely acceptable). Patient and HCP interviews also demonstrated inclusivity concerns. All HCPs considered ePROMs acceptable.

While using ePROMs is feasible and highly acceptable to patients with IA and HCPs, acceptability is lower in patients who are older, less health literate and with lower digital skills/access. These factors require careful consideration in ePROMs implementation to avoid worsening health inequalities.