2.1. Known postoperative needs and challenges for angioplasty patients

Existing studies indicate that inadequate pain management and lack of emotional support contribute to chronic pain, anxiety, and depression, leading to poor health outcomes (Reference Ibrahim, Ali and EldrinyIbrahim et al., 2022). Patients also need long-term adherence to medication and lifestyle changes to prevent restenosis and improve survival rates (Reference Astin, Closs, Lenachan, Hunter and PriestleyAstin et al., 2008). However, low-income patients face additional socioeconomic barriers, including financial constraints, limited health literacy, transportation challenges, and inadequate follow-up care (Reference Rathore, Masoudi, Wang, Curtis, Foody, Havranek and KrumholzRathore et al., 2006).

A major concern is medication adherence, as high out-of-pocket costs for essential medications such as antiplatelet therapy and statins often lead to non-compliance, increasing the risk of complications and hospital readmissions (Reference Kripalani, Yao and HaynesKripalani et al., 2007). Similarly, dietary modifications crucial for cardiac health are difficult to maintain due to financial limitations and poor access to nutritious food options in low-income communities.

Cardiac rehabilitation programs are essential for reducing future cardiac events and improving recovery. However, low-income patients are significantly less likely to participate due to financial constraints, lack of awareness, and geographic barriers (Reference Clark, Hartling, Vandermeer and McAlisterClark et al., 2005). Many rely on government or charitable healthcare services, which often provide inconsistent post-procedure monitoring and preventive care.

Caregivers are vital to angioplasty patients' recovery, influencing medication adherence and lifestyle changes. However, their needs are often overlooked. Low-income caregivers face heightened challenges due to financial strain, limited health knowledge, and lack of support, impacting both their well-being and patient outcomes (Reference Vashistha, Poulose, Choudhari, Kaur and MohanVashistha et al., 2019).

2.2. Research gap in existing studies

While extensive research has explored post-angioplasty challenges, most studies focus on the general patient population rather than low-income individuals. Additionally, research on low-income cardiovascular patients often includes broader heart disease populations rather than angioplasty-specific challenges. As a result, there is no dedicated literature examining the unique needs and barriers faced by low-income angioplasty patients and their caregivers. This study explores post-angioplasty challenges for low-income patients and caregivers, identifying key pain points to inform user-centered digital health solutions.

2.3. Qualitative approaches to identifying barriers in healthcare

Qualitative research employs various data analysis methods to identify needs, challenges, and barriers in healthcare. Grounded Theory (Reference Glaser and StraussGlaser & Strauss, 2017) helps develop theories from data but is time-intensive for applied healthcare studies (Walker & Myrick, 2006). Phenomenological Analysis (Reference Smith and OsbornSmith & Osborn, 2004) captures lived experiences but may not address broader systemic challenges. Content Analysis (Reference EloElo & Kyngäs, 2008) systematically quantifies qualitative data but often lacks depth. Framework Analysis (Reference Gale, Heath, Cameron, Rashid and RedwoodGale et al., 2013) offers structure for policy research but can be rigid. In contrast, Thematic Analysis (Reference Braun and ClarkeBraun & Clarke, 2006) provides flexibility and depth, making it ideal for exploring barriers in post-angioplasty care while allowing practical application in healthcare design solutions.

2.4. Digital health solutions for post-angioplasty care

The integration of digital health solutions has emerged as a promising approach to address the complex needs of angioplasty patients and caregivers. Digital therapeutics have shown significant improvements in patient outcomes by enhancing engagement, adherence, and self-management (Srinivasan, 2023). Studies highlight that digital platforms can improve clinical parameters such as blood pressure and heart rate following cardiac events (Srinivasan, 2023). These innovations hold potential for reducing disparities in post-angioplasty care, particularly for low-income patients with limited access to healthcare facilities.

3.1. Qualitative study

This qualitative study utilized an ethnographic approach to explore angioplasty patients' and their caregivers' needs and preferences during the postoperative recovery phase. Data collection methods included contextual inquiries in the angioplasty setting at two public hospitals, as well as semi-structured interviews with patients and caregivers in India.

3.2. Participant selection

Participants were selected based on specific criteria to ensure relevance. Included were angioplasty patients from public hospitals, their accompanying caregivers, and individuals aged 18+ from low-income backgrounds. Patients with cognitive impairments affecting consent or communication were excluded. The study involved 10 patients and 21 caregivers, with their characteristics detailed in Tables 1 and 2.

Table 1.

Demographics of patients

Table 2.

Demographics of caregivers

3.3. Data collection

Data were collected through semi-structured interviews and contextual inquiries to explore the postoperative experiences of angioplasty patients and their caregivers. Interviews lasted 45–60 minutes, and informed consent was obtained from all participants. The interview guide was developed based on a literature review of postoperative recovery, caregiver burden, and patient-centered care. Key themes such as pain management, emotional support, medication adherence, and caregiver challenges shaped the interview structure. Open-ended questions encouraged detailed responses, with follow-up prompts used for deeper exploration. The interview guide was tailored for patients and caregivers to reflect their unique experiences. Patients were first interviewed in the presence of their caregivers for emotional support, followed by separate caregiver interviews. Patient interviews focused on recovery, support systems, and medication adherence, while caregiver interviews explored their responsibilities, emotional challenges, and interactions with healthcare providers.

Contextual inquiries were conducted over a week in angioplasty wards at two public hospitals, lasting 2–3 hours per session. Observations focused on patient-caregiver interactions, emotional responses, and environmental factors affecting recovery. A structured template documented key aspects such as communication with healthcare staff, caregiver support dynamics, and accessibility barriers.

Interviews were conducted in Hindi and transcribed into English. Twelve interviews were recorded, while for others, detailed notes were taken due to patient preferences. Key observations from contextual inquiries were documented using sticky notes for reference. This combined approach provided in-depth qualitative insights into the postoperative needs of low-income patients.

3.4. Data analysis

The collected data from semi-structured interviews and contextual inquiries were analyzed using thematic analysis, following the six-phase framework proposed by Braun and Clarke (Reference Braun and Clarke2006). This qualitative approach allowed for identifying patterns within the data, capturing the lived experiences of low-income angioplasty patients and their caregivers.

An inductive approach was used, allowing themes to emerge directly from the data rather than being shaped by preconceived hypotheses. Data from patients and caregivers were analyzed separately to ensure their unique perspectives were fully captured. Each transcript was coded individually, followed by a comparative analysis to identify shared and contrasting experiences.

The analysis process began with familiarization, where interview recordings were transcribed verbatim, and notes from contextual inquiries were compiled. These transcripts were read multiple times to gain a deep understanding of the content. Initial coding was conducted by identifying meaningful data segments and assigning descriptive labels. For instance, a patient expressing concern about their future health was coded under “Fear of Recurrence.” After generating initial codes, related codes were grouped into broader themes. For example, concerns about heart health, uncertainty about future complications, and anxiety regarding lifestyle changes were categorized under “Emotional Anxiety.” The themes were then reviewed and refined to ensure they accurately represented participants' experiences. Adjustments were made where necessary to capture nuances in their narratives. Each theme was clearly defined and named to maintain clarity and alignment with research objectives.

For example, a patient stated, “I worry about the possibility of heart attacks and overall health.” This was initially coded as “Fear of Recurrence.” As similar concerns emerged across multiple participants, this code evolved into a sub-theme of “Emotional Anxiety.” Further connections were found between Uncertainty about Future Health and Lack of Emotional Support, leading to the overarching theme of “Unmet Emotional Needs.” This broader theme encapsulated the significant psychological burden experienced by both patients and caregivers during recovery. The final themes provided a comprehensive understanding of the physical, informational, and emotional challenges faced by participants. This analysis offered valuable insights for designing interventions that address their specific needs, ensuring a more supportive and effective post-angioplasty recovery process.

4.1. Informational needs

The findings related to informational needs highlight significant challenges faced by angioplasty patients and their caregivers in accessing reliable health information. Many participants reported relying on non-medical sources, such as social media and anecdotal advice, which often led to misconceptions about postoperative care. The need for clear guidelines on do's and don'ts during recovery emerged as a critical theme, with patients expressing a desire for tailored advice on lifestyle modifications, symptom management, and medication adherence. Furthermore, the importance of effective communication with healthcare providers was emphasized, as patients sought immediate access to clarify doubts and receive credible information. Table 3 presents a brief overview of the specific informational needs.

Table 3.

Informational needs of participants post angioplasty

4.2. Physical needs

The findings regarding physical needs reveal the multifaceted challenges that patients encounter during the postoperative recovery phase. Pain management emerged as a prominent concern, with many patients struggling to find effective relief without becoming dependent on pain medications. Additionally, adherence to complex medication regimens proved difficult for some participants, highlighting the need for simplified management tools and reminders. Lifestyle modifications, including dietary changes and increased physical activity, were also identified as significant challenges. Table 4 summarizes the detailed physical needs of the patients.

Table 4.

Physical needs of participants post angioplasty

4.3. Emotional needs

The emotional needs identified in the study highlight the psychological challenges faced by angioplasty patients and their caregivers during recovery. Many participants reported feelings of isolation and anxiety related to their health status, particularly concerning the fear of future cardiovascular events. Participants expressed a strong desire for community support and reassurance from healthcare providers to alleviate their fears and enhance their emotional well-being. These findings suggest that integrating emotional support resources into post-angioplasty care is essential for fostering resilience and improving overall recovery experiences for both patients and caregivers. Table 5 presents a detailed breakdown of the emotional needs expressed by participants.

Table 5.

Emotional needs of participants post angioplasty

5.1. Addressing the unique needs of low-income angioplasty patients

Our study highlights the unique challenges faced by low-income angioplasty patients, a group often overlooked in digital health interventions. While all patients require medical information, emotional support, and lifestyle guidance, financial and logistical barriers shape how these needs manifest for low-income individuals. Unlike higher-income patients who can directly consult cardiologists, low-income patients in government hospitals rely on lengthy in-person visits, delaying critical guidance.

Medication adherence is also impacted by affordability, with some patients discontinuing treatment prematurely or opting for cheaper, unverified alternatives, increasing health risks. Additionally, emotional support is deeply tied to family networks, as low-income patients lack access to professional psychological support. These distinct challenges call for a tailored digital health intervention that provides curated, credible, and accessible medical information, structured recovery guidance, and emotional support tools. By addressing these gaps, such solutions can improve adherence, reduce misinformation, and enhance post-angioplasty care for underserved populations.

5.2. Application of results: design opportunities for digital care applications

The insights gained from patient and caregiver interviews underscore the necessity for a tailored digital platform that provides relevant and personalized information. The identified informational needs highlight several key areas where a digital solution can make a significant impact.

5.2.1. Addressing misinformation through an AI-based health platform

Our study found that many patients rely on non-medical sources due to limited healthcare access and financial constraints. This often leads to misinformation, confusion, and harmful self-management practices.

Design opportunity

How might we provide credible, accessible, and personalized health information on lifestyle changes, symptom management, medication adherence, and diet?

We propose an AI-driven platform that provides personalized health insights by considering a patient’s medical history, preferences, cultural background, and financial constraints. It offers symptom-based guidance, ensuring timely, reliable feedback aligned with medical guidelines. Additionally, culturally and budget-friendly dietary recommendations enhance accessibility. By leveraging AI, this solution reduces misinformation and empowers patients with tailored, credible health support.

5.2.2. Reducing anxiety through AI-driven symptom tracking

Our study highlights significant anxiety among patients regarding symptom interpretation. Many participants expressed uncertainty about when to seek medical attention, leading to unnecessary worry or delayed care.

Design opportunity

How might we enable patients and caregivers to track symptoms, receive real-time feedback, and distinguish between typical post-operative experiences and potential complications?

We propose an AI-powered chatbot as the first point of contact for symptom assessment, using evidence-based protocols to provide self-care guidance and flag emergencies. Visual aids like charts and graphs help patients track symptom trends, enhancing their understanding and control. This approach reduces anxiety, improves condition awareness, and ensures appropriate healthcare utilization.

5.3. Designing digital platforms to address physical recovery needs

Our findings reveal significant physical challenges faced by patients during recovery, including pain management issues and adherence to lifestyle changes. The identified Physical needs highlight several key areas where a digital solution can make a significant impact.

5.3.1. Managing post-angioplasty pain without over-reliance on painkillers

Our study found that patients experience significant pain after angioplasty, making it challenging to manage without becoming dependent on painkillers.

Design opportunity

How might we help patients manage post-angioplasty pain effectively while reducing reliance on pain medication?

To address this, we propose a digital support system for non-pharmacological pain management, offering guided relaxation techniques, breathing exercises, and physiotherapy-based movements. A personalized pain tracker enables patients to log pain levels and receive tailored relief suggestions. Educational resources on heat therapy, lifestyle adjustments, and gradual activity resumption empower patients to manage pain effectively, promoting safer recovery while reducing reliance on medication.

5.3.2. Addressing discomfort and physical limitations after angioplasty

Our study found that many patients experience discomfort at the catheter insertion site or face physical limitations that hinder their recovery.

Design opportunity

How might we help patients manage post-procedure discomfort and overcome physical limitations for a smoother recovery?

To address this, we propose a guided recovery support system that provides educational content on proper wound care, safe movement techniques, and gradual activity resumption to help patients regain confidence in their recovery. Additionally, integrating gentle, doctor-approved rehabilitation exercises and posture guidelines can aid in preventing complications and promoting long-term well-being.

5.4. Implications for future research

The study's findings, specifically the documented informational, physical, and emotional needs of low-income angioplasty patients and their caregivers (Results file, Tables 3-5), offer several concrete implications for the design research community engaged in developing digital health interventions.

• Given the diversity of information sources impacting decision-making, design research must move beyond traditional user-centered approaches towards participatory design methods. Specifically, engaging patients and caregivers as co-designers is critical. Conducting co-design workshops where patients and caregivers directly contribute to the design of platform features.

• Given that patients often rely on non-medical sources for information, (“Diverse Information Sources Impact Decision-Making”), design research must focus on establishing credibility and trust within the digital intervention. This translates to co-designing the information architecture and content with patients and caregivers.

• Addressing uncertainty and fear about recovery, research should explore the effectiveness of integrating peer-to-peer support systems, moderated Q&A sessions with healthcare providers, and personalized reassurance messaging into digital health platforms.

• Recognizing the feelings of isolation and uncertainty experienced by patients and caregivers, design research should explore methods for creating a sense of community and reassurance within the digital intervention.