Hans van den Heuvel

and proportionality of burden and benefits. Regarding the delegation of responsibilities, our study showed that users are able to bear the responsibility for measuring their own blood pressure, but they did not feel able to bear the responsibility of interpreting their own data. Clinicians play an important role in the responsible use and implementation of these technologies. This indicates that careful consideration is required regarding which tasks and responsibilities can be delegated to technology (instead of face-to-face care) and which can be delegated to patients (instead of the health care professionals) without compromising safety or quality of care. Digital technologies, including mHealth, are not a stand-alone solution in the clinical context and need to be supplemented with clinical expertise. With regard to the influence on patient autonomy, our study has supported evidence that patients can become more familiar with their own body and disease symptoms and are able to use this information in adjusting their behavior or to deliberate with physicians. It is important to recognize that supporting and respecting patient autonomy are not completely in their own hands. Health care professionals involved in blended care play a crucial role. Not only will health care professionals have to recognize and respect wishes of autonomous persons but will also have to navigate between the standardized way of measuring, supported by digital technology, while still being able to personalize the analysis and interpretations to the interests and needs of a specific patient. Lastly, while mHealth technologies have several benefits, such as accessibility of information for both patients and health care professionals, less frequent hospital visits, and better understanding of one’s own conditions, these benefits need to outweigh the burden of using these technologies (eg, time investment, user friendliness). Overall, our participants were very positive and satisfied with the mHealth technology, but the interview participants who felt their blood pressure was stable because of prescribed medication argued that the burden of measuring every day became somewhat disproportionate. Less frequent measurements may be a way to balance the burden and benefits for these groups. It also indicates that high levels of satisfaction with this blended care approach might be specific to the high-risk population that was selected for this approach. For the high-risk population, there is much to gain in terms of both health outcomes and time investment, but the balance may tip differently for medium-risk to low- risk groups. Strengths and Limitations This is a mixed-methods study that benefits from reducing weaknesses inherent to both methods; it expands understanding, while also being comprehensive. Approximately half of the total users of the mHealth technology filled out the validated questionnaires. The sample of interviewees was representative of the participants of the questionnaires in terms of age, BMI, education level, and underlying conditions (Table 1). The findings of the survey and interviews were supplementary and helped to better understandwhat and for which reasons the mHealth tool was appreciated, which can inform future mHealth health interventions. Our results must be interpreted in the context of the following limitations. Selection bias CHAPTER 7 116