Journal of Qualitative Research in Health Sciences

Document Type : Original Article


1 Student Research Committee, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Anesthesiology, Fellowship of Critical Care, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Health Management and Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran

4 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran



Background: Intensive care unit stays are associated with numerous complications. These complications can be reduced with timely and appropriate medical services. Mobile applications can provide these services without geographical limitations. Accordingly, the present study aimed to evaluate the statements by the intensive care staff and care team of intensive care survivors on the necessary functionality for designing a mobile-based system for monitoring and following up on patients discharged from intensive care.
Methods: This prospective study involved interviews with specialists that provided care to patients after discharge (including nurses, physicians, physiotherapists, speech therapists, psychologists, and nutritionists). The first interviewees were selected from the specialists in Kerman, Iran and then, the selection of the participants proceeded with the snowball sampling method. Interviews were transcribed and analyzed based on content analysis. Codes were extracted and categorized into three levels of abstraction using MAXQDA software.
Results: Four general categories emerged from the interview analysis: 1) Training, 2) Consultation, 3) Electronic health records (EHRs), and 4) Care team. The interviewees mentioned items such as nursing and physiotherapy training (training category), physician and psychological consultation (consultation category), nurses (care team category), and side reports (EHRs category).
Conclusion: This study presented healthcare professionals’ opinions and statements regarding the requirements for developing a mobile-based intensive care follow-up system. User input is essential to design a scalable and efficient system. Provider input can create a system with all the necessary features. The results can be used to adjust insurance regulations, provide the necessary infrastructure, and train care teams.


Ali Afraz (Google Scholar) (PubMed)

Mehdi Ahmadinejad (Google Scholar) (PubMed)

Reza Khajouei (Google Scholar) (PubMed)

Yousef Shaabani (Google Scholar) (PubMed)

Yunes Jahani (Google Scholar) (PubMed)


  1. References

    1. Society of Critical Care Medicine (SCCM). Critical Care Statistics [Internet]. SCCM. Available from: Accessed January 1, 2022.
    2. NHS Digital. Hospital Admitted Patient Care Activity 2020-21 [Internet]. Leeds, England: NHS Digital; 2021. Available from: Accessed January 1, 2022.
    3. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med. 2014;42(3):625-31. doi: 1097/ccm.0000000000000026.
    4. Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med. 2014;2(5):369-79. doi: 1016/s2213-2600(14)70051-7.
    5. Pandharipande PP, Girard TD, Ely EW. Long-term cognitive impairment after critical illness. N Engl J Med. 2014;370(2):185-6. doi: 1056/NEJMc1313886.
    6. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293-304. doi: 1056/NEJMoa1011802.
    7. Huggins EL, Bloom SL, Stollings JL, Camp M, Sevin CM, Jackson JC. A clinic model: post-intensive care syndrome and post-intensive care syndrome-family. AACN Adv Crit Care. 2016;27(2):204-11. doi: 4037/aacnacc2016611.
    8. Kuehn BM. Clinics aim to improve post-ICU recovery. JAMA. 2019;321(11):1036-8. doi: 1001/jama.2019.0420.
    9. Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev. 2018;11(11):CD012701. doi: 1002/14651858.CD012701.pub2.
    10. Lasiter S, Oles SK, Mundell J, London S, Khan B. Critical care follow-up clinics: a scoping review of interventions and outcomes. Clin Nurse Spec. 2016;30(4):227-37. doi: 1097/nur.0000000000000219.
    11. Samuelson KA, Corrigan I. A nurse-led intensive care after-care programme - development, experiences and preliminary evaluation. Nurs Crit Care. 2009;14(5):254-63. doi: 1111/j.1478-5153.2009.00336.x.
    12. Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, et al. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009;339:b3723. doi: 1136/bmj.b3723.
    13. Jones C, Hall S, Jackson S. Benchmarking a nurse-led ICU counselling initiative. Nurs Times. 2008;104(38):32-4.
    14. Jónasdóttir RJ, Jones C, Sigurdsson GH, Jónsdóttir H. Structured nurse-led follow-up for patients after discharge from the intensive care unit: prospective quasi-experimental study. J Adv Nurs. 2018;74(3):709-23. doi: 1111/jan.13485.
    15. Chan S, Li L, Torous J, Gratzer D, Yellowlees PM. Review of use of asynchronous technologies incorporated in mental health care. Curr Psychiatry Rep. 2018;20(10):85. doi: 1007/s11920-018-0954-3.
    16. Atallah N, Khalifa M, El Metwally A, Househ M. The prevalence and usage of mobile health applications among mental health patients in Saudi Arabia. Comput Methods Programs Biomed. 2018;156:163-8. doi: 1016/j.cmpb.2017.12.002.
    17. Yousaf K, Mehmood Z, Awan IA, Saba T, Alharbey R, Qadah T, et al. A comprehensive study of mobile-health based assistive technology for the healthcare of dementia and Alzheimer’s disease (AD). Health Care Manag Sci. 2020;23(2):287-309. doi: 1007/s10729-019-09486-0.
    18. van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Lessons learnt during the implementation of a web-based triage tool for Dutch intensive care follow-up clinics. BMJ Open. 2018;8(9):e021249. doi: 1136/bmjopen-2017-021249.
    19. Ranjbar H, Borhani F, Abbaszadeh A. Information technology application in medicine and nursing. J Qual Res Health Sci. 2010;9(1):61-7. [Persian].
    20. O’Dea S. U.S. Smartphone Market – Statistics & Facts. Statista; 2021. Available from: Accessed January 4, 2022.
    21. Kichloo A, Albosta M, Dettloff K, Wani F, El-Amir Z, Singh J, et al. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Fam Med Community Health. 2020;8(3):e000530. doi: 1136/fmch-2020-000530.
    22. Chellaiyan VG, Nirupama AY, Taneja N. Telemedicine in India: where do we stand? J Family Med Prim Care. 2019;8(6):1872-6. doi: 4103/jfmpc.jfmpc_264_19.
    23. Poncette AS, Spies C, Mosch L, Schieler M, Weber-Carstens S, Krampe H, et al. Clinical requirements of future patient monitoring in the intensive care unit: qualitative study. JMIR Med Inform. 2019;7(2):e13064. doi: 2196/13064.
    24. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-51. doi: 1097/acm.0000000000000388.
    25. Krippendorff K. Content Analysis: An Introduction to its Methodology. SAGE Publications; 2018.
    26. Hajalizadeh A, Ahmadinejad M, Dehghan M, Arab M. The educational needs of family of patients discharged from the intensive care units: the viewpoints of nurses and the patients’ families. Crit Care Res Pract. 2021;2021:9956023. doi: 1155/2021/9956023.
    27. Hajalizadeh A, Ahmadinejad M, Dehghan M, Arab M. Informational needs of the families of patients discharged from intensive care units: a case of Iran. Int Q Community Health Educ. 2021;41(4):379-86. doi: 1177/0272684x20972641.
    28. Sadeghi R, Mortaz Hejri S, Shakibazadeh E, Rahimi Foroushani A, Heshmati H. Barriers of health education in Iran’s health system: a qualitative study. J Qual Res Health Sci. 2020;8(3):300-17. [Persian].
    29. Egerod I, Modrykamien AM. ICU follow-up clinics: a new frontier in inter-professional collaborative practice. Respir Care. 2012;57(9):1532. doi: 4187/respcare.02007.
    30. Siegel J, Edwards E, Mooney L, Smith C, Peel JB, Dole A, et al. A feasibility pilot using a mobile personal health assistant (PHA) app to assist stroke patient and caregiver communication after hospital discharge. Mhealth. 2016;2:31. doi: 21037/mhealth.2016.08.02.
    31. Sevin CM, Bloom SL, Jackson JC, Wang L, Ely EW, Stollings JL. Comprehensive care of ICU survivors: development and implementation of an ICU recovery center. J Crit Care. 2018;46:141-8. doi: 1016/j.jcrc.2018.02.011.
    32. Engström A, Söderberg S. Critical care nurses’ experiences of follow-up visits to an ICU. J Clin Nurs. 2010;19(19-20):2925-32. doi: 1111/j.1365-2702.2009.03162.x.
    33. Engström A, Andersson S, Söderberg S. Re-visiting the ICU: experiences of follow-up visits to an ICU after discharge: a qualitative study. Intensive Crit Care Nurs. 2008;24(4):233-41. doi: 1016/j.iccn.2008.03.002.
    34. Byaruhanga J, Atorkey P, McLaughlin M, Brown A, Byrnes E, Paul C, et al. Effectiveness of individual real-time video counseling on smoking, nutrition, alcohol, physical activity, and obesity health risks: systematic review. J Med Internet Res. 2020;22(9):e18621. doi: 2196/18621.
    35. Arena R, Williams M, Forman DE, Cahalin LP, Coke L, Myers J, et al. Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings: a science advisory from the American Heart Association. Circulation. 2012;125(10):1321-9. doi: 1161/CIR.0b013e318246b1e5.
    36. Odell M. Patient- and relative-activated critical care outreach: a 7-year service review. Br J Nurs. 2019;28(2):116-21. doi: 12968/bjon.2019.28.2.116.
    37. Williams TA, Leslie G, Finn J, Brearley L, Asthifa M, Hay B, et al. Clinical effectiveness of a critical care nursing outreach service in facilitating discharge from the intensive care unit. Am J Crit Care. 2010;19(5):e63-72. doi: 4037/ajcc2010965.
    38. Odell M, Gerber K, Gager M. Call 4 Concern: patient and relative activated critical care outreach. Br J Nurs. 2010;19(22):1390-5. doi: 12968/bjon.2010.19.22.1390.
    39. Schandl AR, Brattström OR, Svensson-Raskh A, Hellgren EM, Falkenhav MD, Sackey PV. Screening and treatment of problems after intensive care: a descriptive study of multidisciplinary follow-up. Intensive Crit Care Nurs. 2011;27(2):94-101. doi: 1016/j.iccn.2011.01.006.
    40. Shayganmehr A, Malekzadeh G, Trojanowski M. Investigating the role of using electronic health record (EHR) in physician-patient relationship: a qualitative study. J Qual Res Health Sci. 2022;11(1):50-7. doi: 22062/jqr.2021.195426.1019.
    41. Sockolow PS, Liao C, Chittams JL, Bowles KH. Evaluating the impact of electronic health records on nurse clinical process at two community health sites. Ni 2012 (2012). 2012;2012:381.
    42. Jensen JF, Egerod I, Bestle MH, Christensen DF, Elklit A, Hansen RL, et al. A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study. Intensive Care Med. 2016;42(11):1733-43. doi: 1007/s00134-016-4522-1.
    43. Schmidt K, Worrack S, Von Korff M, Davydow D, Brunkhorst F, Ehlert U, et al. Effect of a primary care management intervention on mental health-related quality of life among survivors of sepsis: a randomized clinical trial. JAMA. 2016;315(24):2703-11. doi: 1001/jama.2016.7207.
    44. Schandl A, Bottai M, Hellgren E, Sundin Ö, Sackey P. Gender differences in psychological morbidity and treatment in intensive care survivors--a cohort study. Crit Care. 2012;16(3):R80. doi: 1186/cc11338.
    45. Rehabilitation After Critical Illness [Internet]. London: National Institute for Health and Clinical Excellence (NICE); 2009. National Institute for Health and Care Excellence: Guidelines. Available from: Accessed January 9, 2022.
    46. Low LL, Vasanwala FF, Ng LB, Chen C, Lee KH, Tan SY. Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study. BMC Health Serv Res. 2015;15:100. doi: 1186/s12913-015-0750-2.