Introduction
Long-term health conditions, including hypertension, diabetes, cardiovascular diseases, and respiratory ailments, are recognized as principal factors contributing to global mortality and morbidity, creating increasing strain on healthcare systems, and resulting in financial challenges owing to ongoing treatment requirements. This challenge is particularly evident in nations such as Saudi Arabia, where the prevalence of chronic conditions continues to rise, presenting significant challenges to the healthcare infrastructure.1,2
As these conditions become increasingly common, healthcare systems are placing greater emphasis on enabling patients to play an active role in managing their conditions. Healthcare professionals view self-management as a crucial element of chronic care. Individuals with long-term health conditions must make daily decisions in order to manage their health. Self-management necessitates that patients actively handle their treatment regimens, symptoms, psychosocial and physical consequences, and lifestyle modifications.3
However, achieving optimal self-management behavior presents significant challenges and requires considerable patient effort. Previous studies have demonstrated that individuals with chronic conditions encounter numerous obstacles to active self-management,4,5 including difficulties with weight control, maintenance of regular exercise routines, depression, pain, fatigue, poor communication with doctors, and insufficient family support.
The digital health (eHealth) technologies that individuals with chronic conditions can employ in their homes are anticipated to play a significant role in supporting self-management. eHealth encompasses a broad spectrum of technological innovations in the health care sector. It is described as “an emerging field at the intersection of medical informatics, public health, and business, referring to health services and information delivered or enhanced through the internet and related technologies.6
Various eHealth technologies provide support for people with chronic self-management. For instance, electronic coaching and monitoring apps assist with dietary choices, exercise routines, weight management by offering personalized feedback and motivation as well as artificial intelligence (AI)-based tools.7–10 These tools also help individuals manage their depression and anxiety. Furthermore, electronic communication tools enable effective interaction between patients and healthcare professionals.11–13 Home monitoring systems for chronic conditions generate accurate data, promote patients, affect their behaviors and attitudes, and enhance medical outcomes.14 Furthermore, AI-powered tools—such as intelligent decision support systems and Chabot’s—provide customized recommendations depending on personal health data and actively control their health issues.15 Recent reviews indicate that digital health shows promise in supporting the self-management of chronic conditions.10,11,16,17
Nevertheless, eHealth often fails to be successfully integrated into daily care routines.18,19 One primary reason for this is non-adoption by individuals. The reported justifications for non-use and withdrawal include a lack of further advantages from digital health solutions, the belief that conventional healthcare is adequate,18,20–22 technical challenges with the equipment, and the association of digital health with increased dependency and poor health status.22
An additional challenge is that eHealth frequently lacks personalization for individual patients or relevant cultures.19,21,23 Before implementing new digital health technologies, it is essential to consider how patients currently control their condition and adapt their lifestyles according to their chronic illness. Research has established that self-management activities are partially condition-specific and general.24 Individuals with neurological or diabetes conditions perceived more daily self-management activities than those with other long-term diseases such as chronic obstructive pulmonary disease (COPD) or cardiovascular disease. The perception of the compatibility between daily regimes and digital health solutions is crucial for successful adoption and utilization.19,21
Before digital health can be effectively implemented, it is vital to include potential users in order to understand their requirements and needs. User-centered design is commonly employed to involve patients in digital health design and development.25,26 Most studies have utilized a user-centered design to enhance the usability and functionality of digital health technology. However, little attention has been devoted to the preliminary stages of development and design.27 A fundamental question emerges: Which components of self-management do individuals with long-term conditions require further support? If they require help, are they genuinely able to utilize digital health solutions?
Although addressing patients’ needs and preferences could positively influence the acceptance and successful implementation of digital health in self-management,20,22 potential users have rarely been consulted and involved during development.28,29
Moreover, while digital health is receiving increasing prioritization and promotion globally, there has been limited research exploring chronic patients’ views, expectations, and needs towards these technologies.13,25 Although eHealth is increasingly used in chronic disease management, there remains a lack of qualitative research that captures patients lived experiences, condition-specific needs, and digital readiness across a range of chronic illnesses. Most existing studies focus on an individual condition or general attitudes, rather than exploring comparisons in cross-condition and nuanced patient perspectives, or they often uses quantitative or mixed methods evaluating clinical outcomes or effectiveness.30
While eHealth is increasingly promoted for chronic disease management, Still missing is qualitative research spanning several chronic diseases that reflects patients’ lived experiences, condition-specific requirements, and digital readiness.21 Rather than investigating cross-condition comparisons and complex patient viewpoints, most current investigations concentrate on a single condition or general attitudes.15 Additionally, although some qualitative work has begun to examine digital engagement among people with specific conditions like COPD or diabetes, these studies often highlight persistent barriers such as low digital literacy and lack of trust in digital tools without highlighting the differences between various chronic conditions.15 This disparity points to a pressing need for more inclusive, patient-informed studies that take into account different chronic illness experiences in the creation of eHealth solutions—including digital tracking tools, developing artificial intelligence technologies, and related innovations—as well as patients’ readiness to utilize them, so offering a thorough knowledge over a broader spectrum of common chronic diseases.
This gap is more evident in the Saudi context or wider gulf region, where recent investigations have evaluated potential users from the general population or individuals with specific chronic conditions (such as diabetes) regarding digital health in managing their particular chronic condition, primarily through closed-ended questionnaires, without examining patients’ needs and requirements for support in self-managing their conditions or highlighting the differences between various chronic conditions.31–37
Therefore, it is crucial to address this gap by examining this emerging topic to explore the expectations, viewpoints, and requirements of individuals living with long-term health conditions regarding areas of self-management where they desire further support and their attitudes towards eHealth for self-management.
The primary aim of this investigation was to explore the opinions, expectations, and needs of individuals with long-term health conditions, and examine possible variations regarding areas of self-management where they desire further support, and their views towards digital health for self-management. Additionally, this study aimed to understand individuals’ willingness to use digital health technologies. To examine possible variations and differences among patient groups, individuals with 1) diabetes, 2) hypertension, 3) COPD and 4) cardiovascular conditions were included. These patient groups were selected because they represent major chronic condition types worldwide38 and within Saudi Arabia,1,2 and these groups may find eHealth to be useful for self-management.
This investigation provides novel insights into how digital health can be tailored to address the unique challenges faced by patients with hypertension, COPD, diabetes, or cardiovascular diseases within this cultural context. It also contributes to the limited research on chronic condition management through digital health in Saudi Arabia, providing a more comprehensive understanding of patient-centered digital health interventions in this context.
Materials and Methods
Recruitment and Design
An exploratory qualitative study was conducted to understand the expectations, viewpoints, and requirements of individuals needing support with the self-management of long-term health conditions, and their views towards digital health for self-management purposes. This was accomplished by focus groups of patients with chronic conditions. The informed consent was obtained from the study participants prior to study commencement.
Participants
This qualitative investigation was conducted in Riyadh, Saudi Arabia, which is the capital city of Saudi Arabia, and its largest population center. Convenience sampling was employed to recruit patients (n = 37) at the two primary care centers using flyers. Ethical approval for this study was obtained from the ethics committee of the Saudi Ministry of Health in Riyadh, Saudi Arabia (approval number 21–518E).
The inclusion criteria required participants to be over 18 years old and diagnosed with one of the following chronic illnesses: cardiovascular disease, diabetes, hypertension, or COPD. The exclusion criteria included cognitive impairment, severe psychiatric illness, or insufficient Arabic language proficiency, leading to an inability to comprehend the research information.
Interested individuals received an information letter, then completed a consent form, and a questionnaire. The questionnaire gathered background information, including age, type of chronic condition, experience of using care technology (such as searching for information about their condition online, utilizing a remote coach, or utilizing a self-tracking system), and level of difficulty they experienced in using care technology.21
The objective was to arrange two focus-group discussions for each condition. Focus groups were scheduled when a minimum of five to six individuals with similar chronic illnesses agreed to participate.
A researcher (TA) asked patients to arrange suitable dates and times for the focus groups. The focus groups were conducted in the primary care center where the participants were recruited.
Procedure
The focus groups were facilitated by the TA and the assistant moderator (research assistant).
Following an introduction regarding the aim and procedure, the following themes were explored: 1) the influence of the chronic condition on participants’ routines; 2) their views, requirements, and experience regarding self-management; and 3) their expectations, perceptions, and requirements regarding, and readiness to utilize, digital health for self-management support.
Concerning the final theme, three distinct types of digital health applications were discussed: 1) self-tracking tools enabling individuals to track their health status, receive reminders, and share these with their healthcare professionals online; 2) remote coaches offering advice and information about conditions or lifestyles; and 3) online communication apps, such as phone or video consultation.
During the discussion, participants were initially asked about their experience of using technologies or the internet for health purposes and their awareness of other digital health technologies. The various eHealth technologies mentioned by the participants are discussed below. The moderator introduced additional possibilities to ensure that the three types of digital health technology received similar discussion time between each focus group. The moderator’s role involved briefly introducing themes, encouraging participants to share their thoughts, and asking follow-up questions to clarify their opinions. Each focus group lasted approximately 60–90 minutes and was audio-recorded; the assistant moderator documented the written field notes.
Data Analysis
The focus group interviews were conducted in Arabic and transcribed word for word, and the transcripts were verified against audio recordings. Initially, the researchers independently analyzed the transcripts from each condition group (diabetes, COPD, hypertension, and cardiovascular disease). A content analysis method39 was employed to code the data because of the exploratory nature of the focus-group structure. The researchers verified the agreement between the variation codes of the initial four transcripts to ensure coding consistency. The primary researcher then applied this coding framework to the remaining four focus-group transcripts. Emerging codes were then incorporated if required. Subsequently, both researchers grouped the codes and consented to the themes and sub-themes of the coding framework, and any discrepancies were resolved by consensus. NVivo version 10 was used to code the transcripts. To ensure the integrity of the research data, coding was conducted in Arabic. Quotations reported within the results were translated first into English and then back-translated into Arabic to ensure the accuracy and trustworthiness of the translated data.
Results
Participant Characteristics
Forty-six participants participated in this study, with an average age of 63.48 years (range, 44–82 years), as shown in Table 1. Of these, 55.3% were male. Two focus groups were created for each condition: hypertension (n = 6 and n = 6), diabetes (n = 7 and n = 6), COPD (n = 6 and n = 5), and cardiovascular conditions (n = 5 and n = 5).
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Table 1 Participants Characteristics
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Participants with COPD reported visiting their doctors once to twice a year. The majority had early to mid-stage COPD, with one patient experiencing COPD GOLD (Global Initiative on Obstructive Lung Disease) stage IV, resulting in pulmonologist consultations five times per year. Physiotherapy treatment had been received by three participants. All participants were on oral medication once or twice daily (eg, tablets and/or inhalers). Phone consultations had been experienced by only one participant; the other participants had never used eHealth technologies.
Patients with diabetes visited their doctors between two and four times annually. Nine participants took only oral medications and four used insulin injections. Four participants had experience with chat communication with healthcare professionals. One patient used a diabetes monitor app to record and track blood glucose values and remind them to take medication. Another participant had previously utilized a diabetes health coach where he could input his blood glucose measurements to receive recommendations.
Patients with hypertension visited their doctors between two and four times annually. All 12 participants only took oral medications. Two participants had experience in chatting with healthcare professionals. One patient used a hypertension monitor app to record and track blood pressure values and remind them to take medication. Another patient with hypertension reported that she had used a food diary.
Patients with cardiovascular conditions visited their doctors between two and three times annually. Two patients visited a cardiologist annually. Five patients reported cholesterol levels and high blood pressure. Three patients reported having either a stent in place or having undergone angioplasty. All the participants used oral medications. One patient had experience of phone consultation with a healthcare professional.
Themes
Analysis of the study focus groups resulted in three main themes: views, needs, and expectations toward self-management; requirements and experience of using eHealth services; and factors affecting eHealth, as shown in Table 2.
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Table 2 Overview of the Study Findings (Theme and Sub-Themes)
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Themes Identified
Views, Needs, and Expectations Toward Self-Management
Knowledge and Awareness
Most participants, excluding those with COPD, had sufficient information about their condition. However, some patients with hypertension and diabetes had knowledge gaps regarding the condition risks and their impact on self-management. Patients with COPD lacked fundamental information regarding their condition and management.
Participants reported receiving information primarily from doctors, brochures, and the internet. However, some expressed concerns regarding online information reliability and noted that detailed medical information occasionally caused unnecessary anxiety.
I had some information about the diseases; nowadays you can get information from everywhere; discussing with doctor, nurse or even my relatives, available broachers and even the internet, but sometimes when I read information on the internet I get shocked whether the information is medically correct or not Hypertension
Being aware of the disease risks may help to be active in managing diabetes more; trying to eat more healthy food, having healthy lifestyle …etc. to avoid any future consequences Diabetes
Adherence and Medication Management
Different patterns have emerged for medication management across conditions. Most participants described medication use as a daily routine, although many reported difficulties with initial adherence. Patients with diabetes, who regularly monitored their blood glucose levels, appeared to be more active in medication management, adjusting doses as required.
Participants with mild COPD and hypertension reported ongoing challenges with medication adherence, frequently due to a perceived lack of effect or absence of symptoms. A small number of patients discontinued their medication without consulting healthcare providers. Patients with cardiovascular disease generally demonstrate strong medication adherence, motivated by an understanding of the serious implications of non-compliance.
Various medication-management strategies have been proposed. Some utilized pillboxes, while others employed technology, such as mobile phone alarms or medication reminder applications. One participant living with diabetes had previously used a diabetes coach in which he could enter his blood glaucous readings, where he could receive recommendations. Although he reported that this app might be beneficial for those with variable blood glucose values, he no longer used it, as it was not working well.
I attempted to use a mobile phone alarm to remind me to take the medication, it proved very helpful Cardiovascular
I employed a beneficial application recommended by my friend where I could establish a reminder not only for medication but also for measuring blood glucose and also I can share the data to receive an advice whether I increase the medication does? But Diabetes
Monitoring and Managing Related Symptoms
Requirements and expectations regarding symptom management varied considerably among patient groups.
Patients with COPD express diverse views on home-based oxygen saturation and lung function monitoring. Some valued home monitoring tools for the early detection of worsening symptoms and the prevention of complications. They demonstrated positive attitudes towards healthcare professionals with remote access to their data for timely intervention and medication adjustments.
Monitoring my lung function individually at home is really helpful in checking my health and catching any problem early COPD
If my data available and my doctor can see online, he can let me know in case I need a check-up. COPD
One COPD sufferer said he looked for an Arabic mobile app connected to COPD in app stores but came up empty.
I looked for a COPD app in Arabic but found none. While there are many in English, I don’t know which one is the most relevant or appropriate for me. COPD
Another participant recounted utilizing an AI-based tool (ChatGPT) to track their respiration levels. While some users welcomed the individualized insights, others expressed worries about the tool’s reliability.
I entered my breathing level into ChatGPT, and it gave genuine comments. I was surprised by how it provided me tailored insights.actual comments about my situation COPD
We’re still a bit afraid it might not be accurate all the time—it’s helpful, but it’s not a doctor. COPD
This highlights the growing potential of AI applications beyond simple tracking. While many patients traditionally rely on monitoring tools, AI systems like ChatGPT are now capable of analyzing patient data, offering real-time feedback, and providing actionable recommendations. Such tools can assist in recognizing early signs of deterioration, giving patients confidence in their ability to manage COPD symptoms independently while fostering communication with their healthcare providers.
Patients with diabetes and hypertension reported that doctors encouraged regular monitoring of their blood glucose and blood pressure. Most studies have attempted frequent measurements, either daily or weekly, or based on condition stability. Only a small number of patients measured their blood glucose and blood pressure when experiencing unwellness, such as fatigue, and then took medications based on these readings. Some patients with diabetes maintained their paper records during consultation visits. Some patients with hypertension and diabetes expressed uncertainty regarding the appropriate responses to abnormal measurements.
I monitor my blood sugar frequently and wrote it in a paper, as doctor advised me, to take it in my appointment Diabetes
Monitoring my blood pressure data assists me in keeping everything on track, but If I see my blood pressor abnormal I do not know exactly what I should do Hypertension
Two patients (one each with diabetes and hypertension) reported using applications for recording measurements and appreciating features, such as graphical and tabular data presentation. Some patients with hypertension have suggested enhancing applications with explanatory text along with color-coded feedback for measurement deviations. Most patients with diabetes and hypertension suggest that the option to automatically send and share blood measurements to the healthcare professional would be helpful, as the care team then has real-time available data and could respond to it if that data deviates from the norm. They also reported potential advantages of tracking and sharing blood data values with healthcare professionals. Though some users appreciated the tracking capabilities in their monitoring apps for tracking their condition and spotting trends, others pointed out that the new AI-based apps might offer more advantages including real-time pattern detection, early alerts for glycaemic events like hypoglycemia or hyperglycemia, and personalized insulin dose recommendations. These features enabled them to more proactively and confidently control their condition. Some users also underlined that such tools can help doctors communicate with them, particularly when it is challenging to obtain an early appointment.
The hypertension management app I use is very useful. I can track overview of my blood pressure data in table Hypertension
The app would be more beneficial if it sending my measurement data automatically to the doctor and my daily data available to them, so he [the doctor] intervenes when something wrong Diabetes
Though I occasionally require more thorough or tailored advice, such as when I should raise my dose or forecast when my blood pressure will worsen and what I should do, I have tracked my blood pressure using an app. Hypertension
The AI app does so much more; I used to only monitor my blood sugar with an app. Even before I see it, it examines my data and alerts me if my sugar could go too high or low. It also advises me on actions to take, such as modifying my insulin or eating something. It’s like having a smart assistant cooperating with my doctor to help me control my diabetes. Diabetes
Some individuals with cardiovascular disease felt that their condition had a minimal impact on their lives and reported few complaints due to minimal symptoms. Consequently, they might not perceive home monitoring as beneficial and may find routine health checks with doctors or nurses at health centers that are satisfactory for managing their condition. Two patients expressed that while home monitoring increased their awareness of their condition, it also generated more negative emotions.
We don’t feel like patients at all because I rarely have any issues and it did not impact my everyday routine Cardiovascular
Monitoring thing at home also would make me more conscious of my condition make me feeling uncomfortable Cardiovascular
I don’t see any reason to monitor things at home. I am satisfied with my appointments with the doctors. Cardiovascular
Healthy Lifestyle
Participants across all groups acknowledged receiving warnings regarding lifestyle modifications upon diagnosis, although many admitted an initial lack of awareness about risks and consequences that deterred changes. They emphasized the role of healthcare professionals in raising awareness about lifestyle modifications to prevent complications.
Smoking cessation was particularly discussed in the hypertension and COPD groups, with participants acknowledging difficulties despite understanding their health benefits. Exercise was discussed across all groups, with cardiovascular, diabetes, and hypertension patients noting its benefits, whereas COPD patients reported reduced activity due to breathlessness. Many expressed uncertainty regarding appropriate exercise types and durations, particularly in individuals with cardiovascular conditions and COPD, suggesting the need for medical guidance and tracking tools.
I know being active help me to control my cholesterol and strength my heart muscle so I want to be active bur sometimes I said may be running is not suitable for you Cardiovascular
There are some obstacles affecting doing exercise regularly including not knowing which most suitable exercise, hot weather, lack of motivation Hypertension
Nutrition and diet were especially significant in patients with diabetes and hypertension, who noted immediate effects on blood glucose and pressure levels. One patient with hypertension mentioned that she used a food diary app, but this app was not specifically designed for Saudi people; therefore, she stopped using it. One patient with diabetes noted that although calorie-tracking applications exist, they are not tailored to specific chronic conditions. Diet management challenges include a lack of awareness of condition risks, social pressure, busy lifestyles, and forgetfulness. Another diabetic participant said that an AI-powered software provided a better tailored experience; the app adjusted to users’ daily habits and health behavior over time. Key lifestyle variables including particular meals, exercise, and even device faults could be found by it, therefore enabling the system to provide timely and customized feedback on his glaucous level. This degree of customization helped users feel more supported in their self-management initiatives, hence enabling them to make educated decisions and keep better control of their condition with more confidence and safety.
Yes, I agree that a healthy diet helps manage my diabetes. For example, I noticed that when I eat sweet food, my blood sugar goes up” Diabetes
I think a healthy lifestyle isn’t that important for my heart condition; medication is what really matters.” Cardiovascular
We [patients with heart diseases] get information from our doctor, brochures.etc, but we may need more encouragement to live healthier, like reminders to exercise. Cardiovascular
“Having the drive to actually make changes is what’s really important.” Cardiovascular
“I had used a food diary app but I realized the app does not fit because it did not have the ingredients I used to eat” Hypertension
“I read about an AI app it seems it learns about me over time—it knows my habits, like when I eat or exercise, and even spots if something’s wrong with my device. It gives me tips that fit my lifestyle, not just general advice. I feel like it helps me make better choices and stay safer every day.” Diabetess
Cardiovascular patients generally view dietary changes as less critical than medication. Most participants seemed to have no interest in employing an online coach to encourage and motivate them to adopt a healthy lifestyle, such as an online coach assisting with quitting smoking. Intrinsic motivation to live a healthy life is generally considered important, with health information available from brochures, healthcare professionals, and the internet.
Psychological Consequences
All participants reported an initial shock and difficulty accepting their chronic condition. Patients with diabetes and COPD expressed anxiety regarding symptom management and uncertainty regarding appropriate responses. Patients with hypertension are worried about their asymptomatic condition, which leads to frequent monitoring. Cardiovascular patients were particularly worried about life expectancy implications and showed a higher tendency toward depression. Patients with COPD experience breathlessness, particularly frightening and stress.
“At the beginning, I couldn’t believe I had this condition. I thought I was too young to get it and said it was because of eating high-calorie food, like too much sweet and rice. I wondered how my life would change.” Diabetes
“In my diabetes, sometimes I feel dizzy or my BG is low, and I do not know exactly what I should do; do I eat sugar, do I rest, or do I need to take my medication?” Diabetes
“As someone with heart disease, I feel like I will die soon, which makes me even sadder.” Cardiovascular
“Getting breathless is really scary. I am stressed when I can’t breathe or when I cannot do deep breathing very well… it would be good if letting us know what is the right steps in how to breath well” COPD
While many recognized the value of health monitoring applications, some noted that these tools could increase anxiety, particularly when tailored recommendations for managing readings are lacking.
“I use apps based on what they do [their functions]. Some apps can make me more anxious by showing my BG as very low or high without giving specific helpful advice for managing my disease.” Diabetes
Social Support
Participants across groups valued support from friends and relatives, particularly those with similar conditions, finding comfort in shared experiences and advice. Some regularly sought assistance from their children for various health-related tasks. However, some preferred discussing health matters exclusively with health care professionals. Few participants noted using applications to connect with others sharing their condition, although the Arabic language options were limited.
“Talking with others who have the same disease and discussing our struggles, experiences, and goals makes me feel comforted, understood, and less alone” COPD
“I usually contact my son to help me when I feel my blood pressure is high, book an appointment, or even bring medication from the pharmacy.” Hypertension
“I used an app to connect with others from different countries to discuss our difficulties, medications, and experiences. However, there is no app available for Arabic speakers. Diabetes
Current and Expected Communication with Doctors
Participants reported satisfactory regular access to doctors and the ability to arrange follow-up appointments through the Ministry of Health (MOH) application. However, patients with cardiovascular disease and COPD experience difficulties in accessing specialists between scheduled visits. They suggested that enhanced communication options such as online video consultations could better address their needs. Participants emphasized the importance of considering elderly individuals’ needs when designing these tools. Particularly for chronic disease management, some attendees recommended using technology developments—including artificial intelligence tools—to supplement the doctor’s function by providing tailored alerts, early warnings about symptom changes, and unambiguous, practical advice. Particularly for patients with chronic diseases, this would assist to close the gap between visits and guarantee prompt actions.
“I can usually reach my doctor by booking appointments through the MOH app, but sometimes I can’t get a quick appoint ……. Online Chat or video consultations would be a big solution to help me get answers and discuss my needs sooner.” Cardiovascular
“The app driven by artificial intelligence can interpret my health data. It offers recommendations on what to do next and early alerts when something might change—like my blood sugar, blood pressure, or even my respiration levels. Especially when getting an appointment is difficult, it’s like having a smart assistant working with my doctor to help me remain in charge of my health; I would feel more supported between appointments.” Diabetes
Participants reported that regular apps mainly served as symptom trackers and required manual input, offering little real-time support or guidance. In contrast, AI-powered eHealth tools provided personalized alerts, early warnings about symptom changes, and actionable recommendations like when to use inhalers or perform breathing exercises. The addition of AI chatbots also offered emotional support and 24/7 assistance, helping users feel less alone. Overall, AI tools transformed COPD management from passive recording to active, intelligent self-care.
Requirements and Experience of Usage eHealth Services
Most participants began utilizing digital health tools such as telephone consultations during the COVID-19 pandemic. Initially, elderly individuals struggled and resisted using these tools. However, many gradually adapted and found certain digital health services, such as electronic prescriptions, helpful in managing their care. They expressed willingness to continue using these services after the pandemic for tasks, such as appointment booking.
“During COVID-19, we had to use phone consultations because in-person visits weren’t possible. I found it easier and more useful than going in person” Hypertension
“but dealing with technology can be challenging, so I ask my child for help with things like ordering medication and booking appointments.” COPD
The majority across all groups recognized digital health’s potential in supporting self-management but emphasized that it should complement rather than replace in-person care. COPD and cardiovascular patients in particular note that certain conditions require physical examination that cannot be accomplished through video consultation alone.
“I did not prefer to do all my consultation online, I think it is difficult if my disease can be examined remotely via video … there is still important to see doctors in person and discuss the condition with him/her.” Cardiovascular
“ Electronic services are good for supporting regular hospital care and self-manage my disease but shouldn’t replace it. I still think seeing a doctor in person is important.” Diabetes
Most patients suggested implementing digital health services, while allowing users’ choices for adoption. Some worried that making such tools optional might lead to resistance from those averse to change, given rapid technological development. A few patients with cardiovascular disease expressed concerns about the potential negative consequences of inconsistent tool usage.
“Not all participants have the same interest to use technology so it would be great if patients have the choice if he can use it or not …… I am afraid if this tool is compulsory and I was not adhered with it what will happen for me.” Cardiovascular
“To encourage patients to use it, we need to tell them about the short-term and long-term benefits and advantages.” Diabetes
“I know some patients don’t like change and prefer their usual routines, so it’s important to support them in using technology and then help convince them of its benefits.” Hypertension
“Giving patients choice and getting more advantages in using eHealth services will may increase it’s adoptions.” COPD
Expected Benefits of Using eHealth
The participants noted that the expected benefits depended on the specific services offered, such as improved appointment access, reduced waiting times, and easier specialist access. Patients with hypertension and diabetes anticipated the benefits of active self-management including daily reminders, monitoring support, and educational information. Patients with COPD suggest that these tools would be most beneficial if they enhance their disease understanding and coping strategies. Conversely, several diabetes and hypertension sufferers said that while normal eHealth tools are helpful, they are more passive than AI driven eHealth tools, such as apps. By providing, for example, glucose Trend Prediction and…
“I used to simply record my blood sugar on a regular app, but that didn’t much enable me to grasp what was happening. It truly tells me when my levels might go high or low after switching to the AI-based app; it looks at my historical readings and recommends what I can do. For instance, it highlighted something I had never seen before: my blood sugar usually rises after lunch on weekdays. It feels like carrying a tiny doctor in my pocket.” Diabetes
“Current electronic services make it easier to see doctors. For example, I can book an available appointment via the app and then meet the doctor right away, without long waits. I also receive a message letting me know when I can pick up my medications, so I don’t have to ask the pharmacist for re-prescription.” Diabetes
“Access to my health information is easy through the app. It tells me if my blood pressure is normal and reminds me to take my medication.” Hypertension
“Access to educational information is very easy through the app I downloaded. I can learn more about my conditions[COPD] and more.” COPD
Factors Affecting eHealth Use
Most participants emphasized the need for simple, clear navigation, and minimal required actions, particularly for those unfamiliar with technology. Elderly users often report difficulties with small text sizes, unclear layouts, and technical problems that sometimes require family assistance.
“As we get older, we might find it hard to use, even if we can read and write. Sometimes, I need to ask my son for help to enter medication names and dose because the size is very tiny small to read or write.” Hypertension
“Many things need to be considered to make the service easy to use, like font size, background color.etc.” Cardiovascular.
“Easy navigation between screens is crucial to avoid confusion” Diabetes
“I am not used to use technology so it is very important this tool to be easy to use” COPD
Some participants discussed the importance of involving potential users in digital health service design in order to ensure alignment with their needs and preferences. Users with previous application experience preferred both manual and automatic data-entry options.
“It’s important to think about what users need before setting up these services or tools. Ask them what they want the service to do, how it should work, and details like colors and design” Cardiovascular
“I prefer the tool to include only the essential features and leave out the ones that aren’t needed.” Hypertension
“Having both manual and automatic data entry options via linked devices to make the process easier., like in some apps I’ve used, makes the tool easier to use.” Diabetes
Most patients expressed minimal concerns about privacy when using MOH services, although some high-profile individuals preferred the assurance of data security. Many reported being unaware of available services or proper usage methods, suggesting the need for awareness campaigns through various media channels. They recommended providing training (in person or online), written instructions, and technical support to overcome barriers to adoption.
“I don’t mind sharing my information as long as it’s used to support my care” COPD
“I’m not worried because the information entered is not sensitive.” Hypertension
“I am very careful about sharing my health information because as you know I am well-known person. I never put my confidence on apps or websites because it may share with others” Diabetes
“It’s helpful to let patients know about available services because we often only find out about them suddenly through receptionists or doctors.” Hypertension
“if the digital services are promoted via different method via twitter or snapchat or on TV patients can become aware of it”. COPD
“Training patients or giving them instructions on how to use the services will definitely help and encourage us to use them.” Diabetes
“Providing 24-hour technical support can resolve any issues and make it easier for more people to use the service.” Cardiovascular
The present research indicates a general willingness to engage with digital health, and shows support for new systems that utilize emergent technologies such as AI to improve the user experience. However, another key finding of this study is that attitudes towards eHealth varied across the four patient groups, suggesting that policy-makers may need to develop tailored solutions to suit different chronic conditions. The results also highlight the relative lack of eHealth self-management systems targeted at specific chronic conditions, and/or tailored to a Saudi context, eg food tracking apps tailored toward Saudi people and/or Arabic-language communication apps. This suggests that the creation or commissioning of new eHealth systems tailored toward these unique patient groups and/or to the Saudi population specifically should be key policy goals.
Discussion
This qualitative investigation revealed notable differences and similarities between patient groups regarding viewpoints, expectations, and requirements for self-management and digital health support. Generally, diabetes and hypertension patients recognized more viewpoints and potential advantages regarding self-management areas and showed the greatest willingness to utilize digital health, followed by COPD patients and then cardiovascular patients. All groups attempted to maintain health and reported similar general requirements for digital health, while identifying key usage factors. Participants emphasized that digital health adoption should be patient-driven rather than healthcare professional-mandated and should supplement rather than replace personal care.
Although digital health adoption has been extensively researched, this study offers a fresh viewpoint by investigating the particular views of Saudi Arabia’s chronic condition patients in a location witnessing fast digital change in healthcare. The Saudi healthcare system is a public-sector body, which delivers treatment to the majority of chronic disease patients in the country.2,31,36 By investigating culturally specific obstacles and enablers affecting digital health self-management among patients of the Saudi healthcare system, the study offers valuable insights to inform national policy on eHealth and chronic disease, and which could also be useful to other nations with comparable healthcare systems. Furthermore, our results draw attention to specific patient issues, including trust in digital platforms, accessibility issues, or policy-related aspects, which have been underexplored in current research. This work is useful outside a local context since it offers a wider knowledge of how eHealth uptake is shaped by contextual elements by contrasting these findings with outside studies.
The self-management techniques presented in this study were broadly aligned with those identified in previous studies.3,40 Generally, more viewpoints were discussed regarding medication management, educational information, symptom management, lifestyle, and communication than regarding social support and the management of psychological consequences. Participants attempted to adopt different self-management strategies and techniques to stay healthy, such as self-monitoring blood data, lung function, and exercise. However, they discussed less about managing the psychological effects inherent in living with a long-term health disease, although stress was identified as affecting the adoption of self-management strategies. This may reflect that self-management approaches primarily focus on behavioral and medical management, with less emphasis on helping patients manage the emotional effects of chronic diseases,21 despite stress and anxiety being common barriers to effective self-management. Moreover, the healthcare system and cultural differences may influence self-management approaches.33
The variations among individuals with hypertension, diabetes, COPD, and cardiovascular conditions in terms of requirements, opinions, and expectations in relation to self-management and digital health may be related to variations in symptoms, treatment, and level of control among condition groups. Most individuals with diabetes and some participants with hypertension were already aware of the self-tracking apps for monitoring blood pressure and glucose levels. Additionally, these patients reported that adopting a healthy lifestyle and adherence to medication directly influenced their health. However, patients with hypertension often forget medications because they are asymptomatic. Some diabetics and hypertensive people also said they liked AI-powered tools since they understood the particular qualities such technology provide, including help in deciding the right medication dose and forecasting possible blood pressure or glucose level increases. Therefore, these patients might perceive their condition as more controllable through their behavior, potentially increasing interest in digital health for self-management if it supports measurement recording and activity tracking, and provides medication and exercise reminders—paired with artificial intelligence-based solutions, these might improve patient involvement with eHealth systems and assist long-term disease control.7,41
In contrast, patients with cardiovascular disease reported few complaints and had a minimal impact on their daily life. Many perceived no need for digital health monitoring as regular health checks were sufficient, although they preferred tools to track and determine suitable exercises. Patients with COPD expressed more psychological and physical consequences, frequently mentioning declining health status and diminished life enjoyment, and wondering about future disease progression. This may indicate a sense of diminished control over their illness, requiring more support in knowledge enhancement and breathing technique instruction through active videos.42 A study in Netherland backs this up by showing that the sensation of having less control over their sickness could reduce the extra benefit of employing eHealth for self-management assistance.21 Furthermore, language obstacles and/or low eHealth knowledge made digital health solutions for COPD management less available to Arabic-speaking users. Research indicates that Arabic-speaking immigrants in Sweden struggle to use digital health technologies43 although Arabic is a widely-spoken language in the Middle East.37 This highlights the significance of recognizing local language and social traditions Apart from the eHealth tool dependability in the implementation of eHealth interventions among chronic illnesses, particularly COPD and hypertension.31,37,44,45
Furthermore, while not the main emphasis of this research, certain individuals in this study showed curiosity about how artificial intelligence (AI) might assist chronic condition management, especially via applications like personalized recommendations, health monitoring, and early alerts, where is mentioned by Bijun Wang et al, 2023.30 This implies increasing patient awareness and willingness to digital instruments augmented by artificial intelligence.46 Though AI has promise in chronic condition self-management,7,15,41 a recent review found that many studies remain in the early stages, including algorithm development and feasibility testing, and there is little understanding of how people with chronic conditions view AI’s role in their care.47 To fully realize AI’s potential in this field, especially across different chronic illness populations,7,15,41 it is vital to investigate patient expectations, trust, and worries about AI-driven solutions as eHealth systems15,48 become more integrated.
Perceived usefulness and ease of use emerged as primary factors affecting users’ willingness to use technology, which is consistent with widely used technology acceptance models.49,50 Patients in this study, especially those with diabetes and hypertension, expected more benefits from such tools in supporting self-management, influenced by some patients’ previous experiences with condition-specific applications. As different groups of patients demonstrate varying needs and requirements in relation to further self-management support, tailoring digital health tools to specific patient groups would likely increase expected benefits. Cultural differences also played a key role in the self-management approach. Participants in this study with diabetes and hypertension said that lack of current dietary food tools for their particular regional meals and a need for culturally specific tools and recommended that advantages of AI-based tools could support such features to adapt a healthy daily routine, helping users manage their condition more confidently and effectively. Therefore, offering culturally appropriate eHealth tools with AI features detecting needs, such as regional meal dishes or culturally relevant dietary recommendations, could significantly increase acceptance and use and manage their condition more confidently and effectively.7,41,51
Participants in eHealth services also highlight the significance of support from family and friends in influencing their involvement with these services. Especially for individuals less confident with technology, social support offered both emotional motivation and practical assistance. Close social circles’ participation seemed to increase users’ confidence in the services and support their planned use.52,53 Particularly relevant in collectivist societies, such as in many Arab countries, where interpersonal relationships significantly affect individual behavior,32,33 these results correspond with earlier studies indicating that family and peer support may be vital in health-related decision-making and technology adoption.50,54
The patients’ interest in self-management support appears to be influenced by their perceived control over their disease, which is known as the health locus of control. Research has indicated that individuals with a higher sense of internal control may be more inclined to engage in self-management actions and techniques.2 Further studies should explore the relationship between patients’ perceived control and their willingness to adopt self-management technologies. Many participants expressed anxiety about taking measurements and uncertainty regarding the interpretation of abnormal results, highlighting the need for healthcare professionals to provide clear guidance on using digital health tools and understanding their outcomes.
The study results emphasized the importance of offering patients’ choices in digital health adoption and clearly explained the implementation benefits. Patients wanted more control over their health despite the more prescriptive character of the Saudi healthcare system, reflecting global trends in patient-centered care.2,26,27 In a system that is usually more structured, this preference complicates the application of eHealth technologies.2
These results underline the importance of incorporating more flexibility and patient choice in the Saudi healthcare system—especially with regard to artificial intelligence tools—to more closely fit patients’ needs and expectations.2 Users reported few privacy concerns regarding digital health tools but stressed the importance of training and technical support in familiarizing users with tools and overcoming usability issues to enhance acceptance.33 This aligns with previous evidence indicating that diverse users can engage with digital health tools given appropriate training and support.33
Strengths and Limitations
The strength of this study is that it is the first that focus on various chronic illness experiences of self-management and patients’ readiness to use digital health in the context of Saudi Arabia and the larger Gulf Region, providing a thorough knowledge of their opinions, needs, and interests, across a more broad spectrum of common chronic diseases. The qualitative methodology also allowed participants to answer and show their need to use their own feelings and opinions in depth rather than select predetermined options.55 The study design, involving eight focus groups, each comprising participants with the same chronic condition, enabled more focused and in-depth discussions on condition-specific experiences, needs, and challenges. However, some limitations have to be considered. First, the generalizability of this study is limited by its focus on a Saudi context and the use of a convenience sample, which may have favored participants more comfortable with technology—potentially excluding those with lower digital literacy, such as individuals with COPD. While most participants had some Internet familiarity, this factor may have influenced their willingness to adopt digital health services,56 as research suggests that computer and Internet proficiency significantly affects technology acceptance.54 Still, the results underline the impact of cultural and contextual elements on digital health uptake and offer insightful analysis for more general eHealth projects. Future studies should investigate comparable patient views in various healthcare settings, hence enabling cross-country comparisons to confirm and broaden these results.
Conclusions
This investigation revealed differences in requirements and expectations among patient groups regarding self-management and eHealth support, indicating that digital health and its implementation should be customized for specific individual groups. While those with cardiovascular diseases had the least interest, those with COPD came next in openness to using eHealth technologies behind diabetics and hypertensives. Participants therefore predicted gains and advantages from eHealth, and perceived disease controllability was crucial in determining their willingness to use digital health for self-management purposes. Clear information about eHealth possibilities, usage, and implementation rationale is crucial for encouraging its adoption in primary care settings. However, it is important to acknowledge that not every patient wishes to use digital healthcare services. To improve uptake, involving patients in digital health tool design is essential to ensure that tools meet their needs and preferences, and address usage factors. This patient-centered approach can help create more effective and widely accepted digital health solutions.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ministry of Health (MOH) approval number 21-518E).
Data Sharing Statement
The data presented in this study are not publicly available due to ethical restrictions. However, they are available from the corresponding author upon reasonable request.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Acknowledgments
The author would like to acknowledge the assistant researcher (Dr. Musaad Alhumaid) for their invaluable support and assistance with data analysis. The author extends their appreciation for participating in this study.
Funding
The authors acknowledge funding from the King Saud University, Deanship of Scientific Research. This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosure
The author declares no conflict of interest.
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