The Importance of Patient Expectations in Digital Health Products

With the rise of digital health products proposing to streamline the access to health care, it is paramount to understand and set clear patient expectations from the beginning. Businesses seem to sometimes skip this step. However, when there is misalignment between the product offering and the user’s expectation, at best it causes frustration and confusion and at worst, disillusionment with the product, resulting in decreased engagement, adherence and usage.

What is ‘patients’ expectations’

There are many definitions of patients’ expectations from existing literature. For the sake of this piece, we define it as the patient’s belief of results occurring from taking action for their health. Patient expectations can be further broken down into three categories: 1. personal health outcomes, 2. individual clinicians, and 3. the healthcare system, where health outcomes are the most important.¹ Patients recognize that their expectations of health outcomes are separate from those of clinical staff and the larger healthcare system.¹

Most digital health products aim to enhance the patient experience by streamlining processes, whether by digitally monitoring biometrics (eg fitness wearables), satisfying requirements before/ after clinical visits (eg digital lab results) or by replacing in-person care entirely (eg virtual care apps), to name a few examples. A debate can be had about whether this places health tech in an expectation category not entirely separate from clinical staff, or rather as its own fourth category, still within the healthcare system. Either way, the digitization of healthcare suggests the need to view these products as having patient expectations to meet. For example, whereby there are expectations about clinicians being approachable and professional, there are expectations about health tech being easy to use for the intended purpose.

In a critical review of patients’ expectations by Laferton et. al, the notion of personal expectations are broken down further, into generalized, behavior, treatment, timeline and outcome expectations. This piece will focus on behavior and treatment expectations. Laferton argues that behavior-related expectations consists of the belief of one’s own capability in taking an action (self-efficacy) and the belief that said action will lead to a desired outcome (behavior outcome). A patient who believes they are able to regularly exercise will not start doing so unless they expect regular exercise will make them healthier. Treatment expectations consist of expectations of the treatment process and outcome.

Illustration of the integrative model of patients’ expectations by Laferton, et al.

For a deeper understanding of how patients’ expectations can be conceptualized, I recommend reading the paper.

Why is this important

With this cursory overview of the different concepts of patients’ expectations, we can draw a link between meeting these expectations and the success of a health tech product.

First, considering Laferton’s conceptualization (self-efficacy, behavior outcome, treatment process and treatment outcome), making sure to address each of these points clearly in product sets the patient up for success. By stating the intended outcome of the product while making it as user friendly as possible supports patients’ ‘behavior expectations’. Similarly, by educating the patient on the process of using the product in supports their ‘treatment expectations’. When patients are set up for success, they are more likely to have a positive experience with the product.

This brings us to the second point. Expectations are inextricably tied to satisfaction — “patients with unmet expectations may never complain to the physician directly but instead they just will not return for ongoing and follow-up care”.³ Similarly, a health app that falls short of patient expectations may not get deleted or receive a scathing review but will most likely see decreased usage, to be lost in the sea of installed but forgotten apps (which is not terrible if one’s business success metrics are downloads per months and nothing else, but it’s not great either). Second, expectations link directly to value. Patients want to achieve their health goals; they don’t want to repeatedly open a website or app. We must recognize that any health tech is but a means to an end, and never an end in and of itself. Patients will only (repeatedly) use a product if they expect the product to bring them closer to their goal.

Check out this at-home vision exam case study for learnings on how to influence patient expectations.

Sources

1. El-Haddad C, Hegazi I, Hu W. Understanding Patient Expectations of Health Care: A Qualitative Study. Journal of Patient Experience. 2020;7(6):1724–1731. doi:10.1177/2374373520921692
2. Laferton JA, Kube T, Salzmann S, Auer CJ, Shedden-Mora MC. Patients’ Expectations Regarding Medical Treatment: A Critical Review of Concepts and Their Assessment. Front Psychol. 2017 Feb 21;8:233. doi: 10.3389/fpsyg.2017.00233. PMID: 28270786; PMCID: PMC5318458.
3. Lateef F. Patient expectations and the paradigm shift of care in emergency medicine. J Emerg Trauma Shock. 2011 Apr;4(2):163–7. doi: 10.4103/0974–2700.82199. PMID: 21769199; PMCID: PMC3132352.