Experiences of Older Adults and Caregivers With Home Telemonitoring for Heart Failure in Canada: Qualitative Study

Home telemonitoring programs are increasingly used to support older adults living with chronic conditions such as heart failure (HF). While these interventions show promise for improving health outcomes and reducing care burden, their effectiveness depends largely on how patients and caregivers integrate digital technologies into everyday life and care relationships. However, relatively few studies have examined these experiences using conceptual frameworks that capture both functional and relational dimensions of care.

This study aimed to explore the experiences of older adults and their informal caregivers participating in a home telemonitoring program for HF. Drawing on the Person-Based Approach and the Person-Centered Practice frameworks, we examined how participants engaged with both the technofunctional and relational aspects of the intervention.

We conducted a qualitative study involving 34 patients, 28 informal caregivers, and 20 nurses across 3 primary care organizations in Quebec, Canada. The 6-month intervention included 4 connected devices used by patients (smartwatch, Bluetooth-enabled scale, voice-activated tablet, and a smart pill dispenser [xPill; Domedic]) and a mobile app for caregivers, complemented by remote nursing follow-up. Nurses reviewed patient data through a clinical dashboard at least once daily during weekday daytime shifts. Data were collected through semistructured interviews and field notes and analyzed using directed content analysis.

Participants' experiences revealed both enabling and constraining factors across 2 key dimensions. Technofunctional engagement was shaped by digital literacy, emotional responses to the technology, alignment with daily routines, and access to technical or caregiver support. Relational aspects of care were influenced by perceived professional presence, opportunities for communication and shared decision-making, and the degree of emotional reassurance provided by remote monitoring. While many participants reported increased confidence and a sense of being supported, others experienced frustration, fatigue, or disengagement when the system disrupted routines or when feedback from clinicians was perceived as limited.

Engagement with home telemonitoring technologies among older adults depends not only on usability but also on the relational context in which these technologies are embedded. Combining technofunctional and relational perspectives provides a more comprehensive understanding of how telemonitoring interventions are experienced and highlights the importance of personalized support, reliable technology, and sustained clinical engagement to promote meaningful adoption.