Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study

Objectives The aim of this study, which was embedded into the ASPIRED randomised controlled trial (ISRCTN10278811), was to explore patient and healthcare professional usability and acceptability of an enhanced (14-day) ambulatory ECG monitoring patch to manage and facilitate discharge of emergency d...

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Main Authors: Matthew James Reed, Coral L Hanson, Lis Neubeck, Caroline Blackstock, Ellise Clarke, Alice Pearsons
Format: Article
Language:English
Published: BMJ Publishing Group 2025-04-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/15/4/e095927.full
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author Matthew James Reed
Coral L Hanson
Lis Neubeck
Caroline Blackstock
Ellise Clarke
Alice Pearsons
author_facet Matthew James Reed
Coral L Hanson
Lis Neubeck
Caroline Blackstock
Ellise Clarke
Alice Pearsons
author_sort Matthew James Reed
collection DOAJ
description Objectives The aim of this study, which was embedded into the ASPIRED randomised controlled trial (ISRCTN10278811), was to explore patient and healthcare professional usability and acceptability of an enhanced (14-day) ambulatory ECG monitoring patch to manage and facilitate discharge of emergency department patients with unexplained syncope.Design A qualitative study using semistructured interviews. Data were analysed using thematic analysis and mapped using the theoretical framework of acceptability.Participants A sample of 20 syncope patients recruited to the ASPIRED RCT and 10 healthcare professionals who had a direct care provider and clinical decision role for syncope patients (eg, consultants, junior doctors, advanced nurse practitioners, advanced care practitioners, emergency nurse practitioners and physician associates) were recruited from four hospitals (two in England and two in Scotland) between February 2023 and January 2024.Results Three overarching themes developed that mapped to six of the seven constructs within the theoretical framework of acceptability. The themes were: (1) Efficacy: Patients and healthcare professionals felt that the remote intervention would increase patient reassurance. Healthcare professionals perceived the intervention would improve clinical care pathways by overcoming delays for Holter monitors, but that a standard protocol would be required to ensure appropriate intervention use. (2) Burden: Patients considered that the device was non-obstructive and easy to use. However, healthcare professionals noted that although attaching the device was simple, there would be associated time and resource costs (eg, documentation). (3) Communication and education: Comprehensive verbal and written information were considered necessary to ensure that the intervention was usable by, and acceptable to, patients. Healthcare professionals suggested additional training would be required. Additionally, they considered that feedback from patient monitoring would reinforce their decision-making and improve healthcare professionals’ self-efficacy to use the device appropriately.Conclusions An immediate, enhanced (14-day) ambulatory ECG monitoring patch was positively received by patients and offered healthcare professionals an acceptable route for monitoring emergency department patients with unexplained syncope. However, future use should be controlled using standardised pathways to prevent inappropriate use.Trial registration number ISRCTN10278811.
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spelling doaj-art-aa94fb71702c4b5397e2bf07c2d52edf2025-08-20T02:16:49ZengBMJ Publishing GroupBMJ Open2044-60552025-04-0115410.1136/bmjopen-2024-095927Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative studyMatthew James Reed0Coral L Hanson1Lis Neubeck2Caroline Blackstock3Ellise Clarke4Alice Pearsons5Acute Care Edinburgh (ACE), Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Cardiovascular Health, Edinburgh Napier University, School of Health and Social Care, Edinburgh, UKCentre for Cardiovascular Health, Edinburgh Napier University, School of Health and Social Care, Edinburgh, UKEmergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UKEmergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UKCentre for Cardiovascular Health, Edinburgh Napier University, School of Health and Social Care, Edinburgh, UKObjectives The aim of this study, which was embedded into the ASPIRED randomised controlled trial (ISRCTN10278811), was to explore patient and healthcare professional usability and acceptability of an enhanced (14-day) ambulatory ECG monitoring patch to manage and facilitate discharge of emergency department patients with unexplained syncope.Design A qualitative study using semistructured interviews. Data were analysed using thematic analysis and mapped using the theoretical framework of acceptability.Participants A sample of 20 syncope patients recruited to the ASPIRED RCT and 10 healthcare professionals who had a direct care provider and clinical decision role for syncope patients (eg, consultants, junior doctors, advanced nurse practitioners, advanced care practitioners, emergency nurse practitioners and physician associates) were recruited from four hospitals (two in England and two in Scotland) between February 2023 and January 2024.Results Three overarching themes developed that mapped to six of the seven constructs within the theoretical framework of acceptability. The themes were: (1) Efficacy: Patients and healthcare professionals felt that the remote intervention would increase patient reassurance. Healthcare professionals perceived the intervention would improve clinical care pathways by overcoming delays for Holter monitors, but that a standard protocol would be required to ensure appropriate intervention use. (2) Burden: Patients considered that the device was non-obstructive and easy to use. However, healthcare professionals noted that although attaching the device was simple, there would be associated time and resource costs (eg, documentation). (3) Communication and education: Comprehensive verbal and written information were considered necessary to ensure that the intervention was usable by, and acceptable to, patients. Healthcare professionals suggested additional training would be required. Additionally, they considered that feedback from patient monitoring would reinforce their decision-making and improve healthcare professionals’ self-efficacy to use the device appropriately.Conclusions An immediate, enhanced (14-day) ambulatory ECG monitoring patch was positively received by patients and offered healthcare professionals an acceptable route for monitoring emergency department patients with unexplained syncope. However, future use should be controlled using standardised pathways to prevent inappropriate use.Trial registration number ISRCTN10278811.https://bmjopen.bmj.com/content/15/4/e095927.full
spellingShingle Matthew James Reed
Coral L Hanson
Lis Neubeck
Caroline Blackstock
Ellise Clarke
Alice Pearsons
Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study
BMJ Open
title Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study
title_full Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study
title_fullStr Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study
title_full_unstemmed Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study
title_short Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study
title_sort usability and acceptability of ambulatory monitoring in undiagnosed syncope insights from the aspired q qualitative study
url https://bmjopen.bmj.com/content/15/4/e095927.full
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