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Background: Digital remote monitoring is highlighted as a digital solution for better community-based and personalised management of people with Rheumatoid Arthritis (RA) in the NHS and internationally [1,2]. The Remote Monitoring of Rheumatoid Arthritis (REMORA) system enables people living with RA and their clinicians to monitor changes in disease activity and capture symptoms that may otherwise be missed. Patients enter symptom data via a smartphone app, which is integrated into electronic health records (EHRs). This holds transformative potential to improve clinical decision-making, patient experience, disease activity, and symptom burden. However, uptake of remote monitoring is not distributed evenly across patient groups and evidence regarding the views and experiences of those who do not engage is limited. The REMORA2 programme (2021-26) is currently evaluating the effectiveness, health economics and implementation of the REMORA system using mixed methods [3]. Here, we report findings from interviews with people who could not or chose not to use the intervention within the REMORA2 study, following final analysis of interview data.
Objectives: To explore barriers to app-based remote monitoring among patients who declined participation or who consented but did not subsequently engage with the REMORA system.
Methods: Qualitative semi-structured interviews (n=32) were conducted with patients who were invited to, but declined to participate (n=17), or who were allocated to remote monitoring but did not start tracking on the REMORA system (n=15). The study received ethical approval, and all participants provided informed consent. Interviews were audio-recorded, transcribed verbatim and analysed thematically by three members of the team, including one patient partner investigator. Themes were refined through discussion with the wider study team and patient research partners members.
Results: Participant characteristics were as follows: mean age was 61.8 years (range 24-82); female (n=23) and male (n=9); White British ethnicity (n=18), from ethnic minority groups (n=9), White Irish (n=4) or ethnicity not recorded (n=1).
Table 1 summarises identified barriers across four themes, with illustrative quotes:
Themes of identified barriers to app-based remote monitoring
| Theme summary | Illustrative quote |
|---|---|
| Problems with timing of approach – for example, during periods of symptom relapse, onset of comorbidities, or changes in family members’ health. | ‘Too many appointments at themoment and my head just feels like it’s too full of everything else … I don’t think I could cope with symptom tracking at the moment.’ |
| Incongruence between symptom tracking and existing perspectives on illness and self-management – for example, where remote monitoring posed a constant reminder of illness. | ‘I try to put [my illness] to the back of my mind and just get on with life. … that’s how I cope with it … So, writing it down every day on an app just didn’t appeal to me at all.’ |
| Perceived benefits balanced against problems of remote monitoring – including perceived time costs of initial set-up and daily symptom tracking, or misunderstanding of the potential personal benefits. | ‘I thought I’d have to put a lot of time into downloading the app and getting set up and, because of my work pressures, that freaked me out a bit.’ |
| Technology-related barriers – including limited access, skill, confidence and motivation to use technology for disease management, often with limited support from family networks. |
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Conclusions: These findings provide insight into the barriers patients face when invited to use remote monitoring technologies. Future efforts should focus on addressing technology-related barriers while clearly articulating benefits that align with patients’ approaches to self-management. Supporting patients’ networks (e.g. family members and community organisations) through targeted resources may facilitate adoption, improve digital inclusion, and, in the longer term, support more equitable impacts of remote monitoring solutions.
REFERENCES: [1] NHS England. Fit for the future: 10 Year Health Plan for England. 2025.
[2] De Thurah et al. EULAR points to consider for remote care in rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases. 2022;81:1065-1071.
[3] Van der Veer et al. Remote monitoring of rheumatoid arthritis (REMORA): study protocol for a stepped wedge cluster randomized trial and process evaluation of an integrated symptom tracking intervention. Trials. 2024;25:683.
Acknowledgments: NIL.
Disclosure of Interests: None declared.