172 Summary and Discussion The clinical impact of the medical applications is not solely dependent on the specific features they offer but also relies on patient engagement. This is linked to factors such as the context and phase of care during which the application is provided, the patient’s digital literacy, and overall usability and technical stability.10 The connection that patients experience with their treating healthcare provider may be essential for patient engagement.11 Although digital literacy had no significant effect on the outcomes in both clinical evaluations, it should be noted that this could be influenced by a potential selection bias in the study population. However, an upcoming qualitative analysis of the facilitators and barriers to the uptake of the Stoma App showed that some patients faced challenges related to logging in, remembering credentials, and resetting passwords, thereby highlighting the impact of digital (il)literacy on application usage. Other patients reported that using the application enhanced the feeling of being a patient instead of resuming their normal daily life. This self-stigmatisation could pose a significant barrier for continued application use after surgery. Digital literacy Addressing digital literacy is crucial as the digitisation of healthcare information and accessibility is accelerating. Patients with low digital literacy may exhibit hesitancy to use medical applications. Many patients may still be unaware of the potential benefits or may simply not be used to access medical information through applications. Therefore, proactive efforts are required to empower patients to benefit from medical applications.12 Digital literacy should be a focus point for healthcare organizations, engaging in comprehensive counselling to educate patients on the benefits of medical application, and providing support to facilitate their usage. Clinical implementation Despite conducting a thorough predevelopment assessment of the perspectives and needs of the target group, along with a pilot testing phase for the mobile application, true utilization and clinical evaluation are bound to yield valuable new insights. Certain functionalities of the application may be redundant, while others may require adaptation or even inclusion. These insights will prove essential for further refinement of the application to ensure optimal functionality and effectiveness. Both clinical evaluations showed variations in patient recruitment and integration of the mobile application into the standard care pathway across the medical centres. Healthcare providers play a key role in implementing medical applications. It is essential to advocate the application as an information source, integrated into normal preoperative counselling. The pivotal role played by treating healthcare providers was highlighted in the upcoming qualitative analysis. Those with a positive attitude toward the application are more likely to incorporate the application in their working routine, actively advocating its use. Notably,
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