Applications of Medical Digital Technologies for Noncommunicable Diseases for Follow-Up during the COVID-19 Pandemic

Background: Noncommunicable chronic diseases (NCDs) are multifaceted, and the health implications of the COVID-19 pandemic are far-reaching, especially for NCDs. Physical distancing and quarantine can lead to the poor management of NCDs because the visual tracking of them has been replaced with medical digital technology, that is, smartphone apps. This study aimed to explore medical digital technology applications for NCDs for follow-up during the COVID-19 pandemic. Methods: The participants in this study were 400 adult patients with NCDs; they were selected by systematic random sampling. A descriptive cross-sectional design was used. The study was conducted in the outpatient department of Yanbu General Hospital and primary-care health centers in Yanbu Al-Baher, Al-Madinah Al-Munawwarah, in the Kingdom of Saudi Arabia. The tools used in this study were a structured questionnaire to collect the sociodemographic characteristics of the patients and their health history, an NCD questionnaire to assess follow-up of the patients during the COVID-19 pandemic, and a medical digital technologies questionnaire to explore the medical digital technology applications. Results: The mean age of the patients was 47.32 ± 14.362 years, and 62.8% of them were female and 372 were male. Of the patients, 69.2% and 57.5% had been diagnosed with diabetes mellitus and hypertension, respectively; 52.4% were followed up monthly, and 29.75% used medical digital technology applications such as Tabeby Online to monitor their health. Furthermore, 71.75% and 75.5% of the patients used the Sehhaty and Tawakkalna medical digital applications, respectively. Overall, 38.7% of the patients were satisfied with using medical digital technology applications used for follow-up during the COVID-19 pandemic. Conclusions: The study concluded that the services that use networks, smartphones, and medical digital technology applications on the Saudi Ministry of Health website and mobile applications to improve the quality of the health-care system, and that provide health services for noncommunicable or communicable diseases, are not effective. This is because the patients lack awareness of these services, with most of the chronic patients being elderly with lower levels of education and computer literacy.


Introduction
The prevalence and impact of noncommunicable diseases (NCDs) are increasing at a remarkable rate and the burden of NCDs remains a global public health challenge, leading to high mortality and morbidity [1,2]. Currently, NCDs such as cardiovascular disease, diabetes, cancer, and chronic lung disease account for approximately 60% of all deaths health-care centers in Yanbu affiliated with the Ministry of Health and using Steven K. Thompson's equation to calculate the sample size as follows: where N = population size (22,610), Z = confidence level at 95% (1.96), d = error proportion (0.05), P = probability (50%), and the result n = sample size (378).

Tools for Data Collection
The data were collected using the following tools: Structured questionnaire: This was developed by the researchers in Arabic and consisted of two parts: The first part dealt with the sociodemographic characteristics of the patients, such as age, gender, occupation, marital status, educational attainment, financial status, and location. The second part was used to collect the health history of the patients, including medical diagnosis related to NCDs, duration of diseases, regular medication, family history, smoking, previous accidents, allergic conditions, duration of sleep, and passive smoking.
NCDs questionnaire: This was designed by the researchers in Arabic to assess the follow-up of patients during the COVID-19 pandemic. The first part of the questionnaire addressed the characteristics of follow-up for the patients (frequency of follow-up, pattern of follow-up, progress of health status during follow-up, desire to visit member of the health team during follow-up, going to follow up with a relative, specified treatment during follow-up, symptoms and signs known to the patient requiring hospital visit, instructions/education given during follow-up, and any change in medication during follow-up). The second part dealt with the methods of follow-up during the COVID-19 pandemic. A reliability test was performed where the Cronbach's alpha value was equal to 0.982.
Medical digital technologies questionnaire: This was designed by the researchers in Arabic to explore the applications of medical digital technologies for the follow-up of NCDs. The first part consisted of three questions about the availability of medical digital technologies for the patients during the COVID-19 pandemic; the second part consisted of nine questions about the use of medical digital technologies applications; the third part consisted of five questions about the services; and the last part consisted of questions about the patients' satisfaction with the use of medical digital technology applications during the COVID-19 pandemic. A reliability test was performed where the Cronbach's alpha value was equal to 0.952.

Fieldwork
The fieldwork was carried out for six months, from March 2021 to August 2021 inclusive. The researchers collected a sample from six primary-care health centers and outpatients in Yanbu General Hospital, each comprising 58 patients selected from the patients list; 1 in every 10 patients was chosen. The sample was chosen during morning shifts. The period of data collection estimated for each patient ranged from ten to fifteen minutes after explaining the purpose of the study by using Google Forms. The data were collected in an Excel spreadsheet to enter into SPSS for data analysis.

Validity and Reliability
Face validity and content validity were used to test validity. Face validity aimed to check the instruments for clarity, relevance, completeness, simplicity, and applicability; minor modifications were made. Content validity testing for all instruments was reviewed by five experts from the academic staff of the Medical-Surgical Nursing Department at the Faculty of Nursing, Ain Shams University, to ensure that the assessment instrument provided stable and consistent results over time. Reliability analysis was established with Cronbach's alpha to determine how closely the items in all the tools were related.

Pilot Study
The pilot study was conducted on five patients in order to check the clarity, relevance, and applicability of the tools and estimate the time required for interviewing a patient. Based on the opinion of a panel of five experts and the results of the pilot study, some statements were omitted or rephrased, and then the final forms were developed. The patients who were included in the pilot study were excluded from the study sample 2.6.4. Data Analysis Data entry and statistical analysis were performed using the SPSS 16.0 statistical software package. Results are presented in terms of frequency and percentage. Table 1 shows that the mean age of the patients was 47.32 ± 14.362 years, with a minimum of 18 years and a maximum of 85 years; two-thirds were females (62.8%) and most were married (70.7%). Regarding occupation, 31.5% were housewives and 27.5% were office workers. Regarding educational attainment, 30.2% were highly qualified; more than two-thirds (71.2%) had sufficient monthly income, and the majority (84%) lived in a city.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.   Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.   Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.

Items. N = 400 %
Smoking ness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-Yes 97 24.2 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-

Previous accidents
City 336 84 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, respectively. However, in the third and fourth quarters, 79.5%, 77%, and 75.2% of patients had specified treatment during follow-up, knew the symptoms and signs that required a hospital visit, and were given instruction and education during follow-up, respectively. Figure 1 shows that less than half (42%) of the patients were following up with their health center and one-third (29.75%) were using medical digital technology applications.    mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-First time 31 7.8 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-Weekly 20 5 City 336 84 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36 Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during follow-up, with 52.4%, 50%, 54.8%, and 57.5%, respectively. In terms of patient health status progress during follow-up, 36.2% and 32.8% improved and maintained progress, re-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up, monthly medication, no follow-up with a relative, and change in medication during fol-  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family. Passive smoking ▪ Exposed 182 45.5 ▪ Not exposed 218 54.5 * Answers are not mutually exclusive. Table 3 shows that more than half of the patients reported monthly follow-up,  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Table 2 shows that almost two-thirds of the patients were diagnosed with diabetes mellitus and hypertension, 69.2% and 57.5%, respectively. Regarding the duration of illness of the patients, 34.5% ranged between 5 and 10 years; most took regular medication, did not smoke, and had no history of accidents, with 81.5%, 75.8%, and 81.5%, respectively. Two-thirds of them had a family history of NCD, did not suffer from allergies, and had enough time to sleep, with 66%, 68.2%, and 63.5%, respectively. More than half (54.5%) of the patients did not live with a smoker within or outside the family.  Figure 2 shows that 67.2% of the patients had smartphones, 34.8% had medical digital technology applications, and 74.2% had an internet service available all the time.       Table 4 shows that more than half (59.8%) of the patients knew about the health application of the Ministry of Health. Telemedicine consultation was used by 29.8% of the patients and 20% admitted that the use of medical digital technology applications kept them from visiting the hospital. Overall, 80.5% of patients were not provided with all the required medical information, 81.8% had no effective interaction with the medical team about the application, 83.2% had not received any notifications about health instructions through the application, 83.5% did not have medical digital technology applications available at all times and places, and 85.5% could not send medical reports about medical digital technology to the doctor in the hospital.   Table 4 shows that more than half (59.8%) of the patients knew about the health application of the Ministry of Health. Telemedicine consultation was used by 29.8% of the patients and 20% admitted that the use of medical digital technology applications kept them from visiting the hospital. Overall, 80.5% of patients were not provided with all the required medical information, 81.8% had no effective interaction with the medical team about the application, 83.2% had not received any notifications about health instructions through the application, 83.5% did not have medical digital technology applications available at all times and places, and 85.5% could not send medical reports about medical digital technology to the doctor in the hospital.  Figure 4 shows that the majority of the patients did not agree on services provided by medical digital technology applications during the COVID-19 pandemic. Overall, 86.5% of the patients did not agree about medical consultations, 86.5% did not agree about booking an appointment for follow-up in the hospital, 89.5% did not agree about activating the dispensing of prescription drugs, 89.5% did not agree about sending orders for medical analyses, and 89.5% did not agree about sending or exchanging medical reports.  Figure 4 shows that the majority of the patients did not agree on services provided by medical digital technology applications during the COVID-19 pandemic. Overall, 86.5% of the patients did not agree about medical consultations, 86.5% did not agree about booking an appointment for follow-up in the hospital, 89.5% did not agree about activating the dispensing of prescription drugs, 89.5% did not agree about sending orders for medical analyses, and 89.5% did not agree about sending or exchanging medical reports.      Figure 5 shows that 38.7% of the patients were satisfied by the use of medical digital technology applications for follow-up during the COVID-19 pandemic.

Discussion
The COVID-19 pandemic is straining health systems and disrupting the delivery of health-care services, especially for older adults and people with chronic diseases [21]. Digital health is a multidisciplinary field of research that is playing a significant role in boosting traditional health services and developing follow-up for NCDs, especially during COVID-19 [22], via the medical health technologies used for COVID-19 analysis and limiting the current outbreaks of COVID-19 [23].
Findings from this study revealed that less than 10% of the patients in the study were 65 years of age or older. This is similar to Reference [24], in which it is mentioned that less than 10% of patients in the study, on the prevalence and determinants of NCDs in Saudi Arabia, were 65 years of age or more. This highlights the possibility that aging patients are not keen on follow-up due to the aging process.
In the present study, female patients represent less than two-thirds of the sample. This finding does not correspond with Reference [25], a study on NCDs in Saudi Arabia. It was found that the presence of NCDs was higher in males compared to females. This might be because most of the participants who agreed to participate in this study were females.
In relation to marital status, the results of this study revealed that more than two-thirds of the patients were married. This finding was supported by Reference [24], in which more than two-thirds of the patients were married. This result might be because the age of the patients in this study was 18 years or more.
Regarding patients' educational attainment, the results of this study revealed that one-quarter of patients were illiterate. This finding was supported by Reference [26], in which one-quarter of Saudi patients with chronic NCDs were illiterate. This finding might be because more than one-third of patients in this study were more than 55 years old, and might not have been concerned with education, or might not have been offered opportunities for further education, in the past.
In the present study, slightly more than 10% of the patients were retired. This finding was supported by Reference [24], in which slightly less than 10% of the patients were retired. This finding might be because less than 10% of the patients in the study were 65 years old or more.
Regarding the area of residence, the findings of this study state that the majority of patients were from the city. This finding does not correspond with Reference [26], in which more than half of patients with NCDs from the south of Saudi Arabia were from rural areas.
Regarding the prevalence of NCDs in Saudi Arabia, more than two-thirds of the patients in this study had diabetes mellitus and more than half had hypertension. This finding does not correspond with Reference [24], in which the prevalence of NCDs in Saudi Arabia was less than one-quarter for hypertension and more than one-tenth for diabetes mellitus. This might be because a large proportion of the patients who participated in this study had diabetes.
The findings of the present study report that two-thirds of patients had a positive family history of NCDs. The same finding was confirmed in another study carried out in Saudi Arabia and given in Reference [27]. The authors of that study confirmed that more than half of the sampled university students in Saudi Arabia had a positive family history of NCDs. This finding might be related to the fact that most NCDs have a hereditary factor.
In this study, the frequency of follow-up was more than one month for more than one-third of the patients. This is compatible with Reference [28], in which more than one-third of the patients with chronic diseases reduced the frequency of hospital visits during the COVID-19 pandemic. This might be related to fear of coronavirus infection.
Regarding progress in health during follow-up, more than 10% of patients in the study had less progress during the COVID-19 pandemic. This finding was consistent with Reference [29], in which less than one-quarter of Saudi patients with chronic disease became worse during the COVID-19 pandemic. This might be because approximately half of the patients in the study did not continue their follow-up during the COVID-19 pandemic.
The current study showed that more than two-thirds of the patients have smart phones, and more than one-third have medical digital technology applications. This result agrees with Reference [30], which reported that the widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between health-care providers. This can increase patients' access to specialist advice and improve patient health outcomes. Reference [31] reported that the smartphone application tools can provide full consultations when patients are advised not to attend in-person consultations due to the COVID-19 pandemic.
The current study showed that three-quarters of patients could use an Internet service with constant availability. This result was consistent with Reference [32], which illustrated that digital solutions may have equity implications for at-risk populations with poor Internet access and poor access to digital technology. Telehealth and digital care technologies can benefit society. This study has implications for medical staff, providing information about the potential of digital technologies to provide support during and after the pandemic [21]. This result indicates that individuals depend on the Internet and smartphones for many things, especially since their use at the present time helps protect them against coronavirus infection.
In the present study, more than one-quarter of patients used digital medical applications during the COVID-19 pandemic. This result is in accordance with Reference [33], which reported that more than one-quarter of patients used a telemedicine facility and took telephonic advice from (private) physicians during the COVID-19 pandemic.
Regarding medical digital technology applications used by patients during the COVID-19 pandemic, more than three-quarters of patients in the current study used Tawakkalna, less than three-quarters used Sehhaty, and more than one-half used Mawid. This result agrees with Reference [34], which reported that the Mawid mobile application can be very effective in delivering health-care services in Saudi Arabia during pandemics. This application is one of the health applications provided by the Ministry of Health [35]. The study states that the use of the Tawakkalna application was proven to be successful in fighting the COVID-19 pandemic in the Kingdom of Saudi Arabia.
The researchers' opinion is that the Ministry of Health provided primary healthcare services during the COVID-19 pandemic for patients. As an example, the infected patients with coronavirus followed up through applications such as Tawakkalna, Sehhaty, Mawid, and Tabaeud. However, other medical digital technology applications are available to monitor NCDs, such as Tabeby online and Seha for medical consultation, but they are less used. This agrees with Reference [36], which concluded that the majority of the patients did not report using any health applications developed by the Saudi Ministry of Health. Reference [37] utilized the newly developed devices designed for home use that facilitated remote monitoring of various physiological parameters relevant to pulmonary disease telemedicine and mobile health technologies. These devices rapidly develop acute care hospital-at-home programs for the treatment of mild-to-moderate cases during the COVID-19 pandemic [38]. The authors of Reference [37] mention that providers working for the adoption of virtual technology for the delivery of medical care may need time to implement changes.
The current study showed that more than half of patients were aware of the health application of the Ministry of Health. This result agrees with Reference [39], which reported that the health-care system is mainly dependent on advanced health technology to cope with the current situation, and it can be a novel tool for improving the health-care system and allowing for better delivery of health-care services during global crises (for example, the COVID-19 pandemic).
The study also showed that less than three-quarters of patients did not use telemedicine consultation, and more than three-quarters did not use medical digital technology applications to prevent hospital visits. This is not in agreement with Reference [39], which reported that technology could be utilized to reduce the burden of both communicable and noncommunicable diseases, as well as to build a patient-centered decision-making health-care system. The majority of patients did not believe that using medical digital technologies provided all of the necessary medical information. There was no effective interaction with the medical team through the application, and no notifications about health instructions through the application were sent. This result disagrees with Reference [40], which reported that eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe the usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health-care professionals, patients, and caregivers are rare. This might be because some patients believe that utilization of medical digital technologies is not enough to follow up on their chronic diseases.
This study showed that the majority of the patients reported that medical digital technology applications were not available at all times and places, and that they could not send medical reports through medical digital technologies to the doctor in the hospital. This result contradicts Reference [32], which stated that contact tracing teams reported that digital data entry and management systems were faster to use than paper systems and possibly less prone to data loss [41]; a digital platform that focuses on providing and curating the information used for self-assessment could help physicians make informed changes more accurately for their own clinical practice and decision making; and availability of patient-related data could help physicians make informed changes more accurately for their own clinical practice and decision making [40]. Health-care professionals have full access to patients' most relevant cross-institutional health record data. This might be because one-quarter of patients in the study were illiterate and approximately another one-quarter could read and write but were not familiar with medical digital technology applications.
The current study shows that most patients do not agree regarding services provided by medical digital technology applications during the COVID-19 pandemic, including medical consultations, booking an appointment for follow-up in the hospital, activating the dispensing of prescription drugs, sending orders for medical analysis, and sending or exchanging medical reports. These results do not correspond with Reference [42], which reported the positive uptake by both health-care providers and patients after the rapid design and implementation of a digital platform and monitoring services during the COVID-19 pandemic for patients with chronic diseases to support primary health-care services. Reference [43] reported that the Ministry of Health has introduced multiple health applications that provide services such as appointment booking and telemedicine since the beginning of the COVID-19 pandemic. However, we agree with Reference [37] that these applications have been integrated into current clinical workflows and electronic medical records.
The findings of this study showed that more than one-third of patient satisfaction was related to the medical digital technology applications for follow-up during the COVID-19 pandemic. The results agree with Ref. [30], which reported little evidence of effects on the participants' health status and well-being, satisfaction, or costs. Reference [42] reported the positive uptake and satisfaction of both health-care providers and patients after the rapid design and implementation of a digital platform.
The researchers' opinion of the results of the current study is that the services for the Internet, smartphone, and medical digital technology applications presented on the Saudi Ministry of Health website and the mobile application improve health system quality and provide health services for noncommunicable or communicable diseases but are not used effectively. This is due to lack of awareness about these services, with chronic patients being older and having lower levels of education and literacy in relation to technology applications. This agrees with Reference [44], which states that digital health and telemedicine solutions, which exploded during the pandemic, may address many inefficiencies and deficiencies in chronic disease management, such as increasing access to care. However, these solutions are not panaceas and are replete with several limitations, such as low uptake, poor engagement, and low long-term use.

Limitations of the Study
This study's main limitation is as follows: many patients, after being selected by systemic random sampling, refused to participate in the study, so the researcher selected the next patient and excluded them from the sampling. Because clinical outpatient departments only work on certain days of the week, the number of subjects chosen from among outpatients was small.

Conclusions
More than one-quarter of the patients in this study used medical digital technology applications. The use of the Tawakkalna and Sehhaty applications was proven to be a successful method in fighting the COVID-19 pandemic in the Kingdom of Saudi Arabia, rather than medical digital technology applications, to follow-up NCDs. Regarding satisfaction, more than one-third of the patients were happy with the services provided by medical digital technology applications for follow-up during the COVID-19 pandemic, so this indicates a need to encourage the use of medical digital technologies.

Recommendation
The study recommends that patients' awareness of medical digital technology applications and understanding of their utilization and services should be increased through educational programs.