Incompatible Images: Asthmatics' Non-Use of an E-Health System for Asthma Self-Management

Incompatible Images: Asthmatics' Non-Use of an E-Health System for Asthma Self-Management

Michel J. Sassene (Roskilde University, Denmark)
Copyright: © 2009 |Pages: 15
DOI: 10.4018/978-1-60566-016-5.ch014
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This chapter investigates asthmatics’ reasons for not adopting an e-health system for asthma selfmanagement. An understanding of these reasons is particularly relevant, because clinical evidence indicates that, if used, such systems lead to better asthma management. The investigated asthma system is, however, based on a taken-for-granted image of asthmatics as, per se, striving to be symptom-free. This image is incompatible with interviewed asthmatics’ day-to-day performances of their asthma, and renders invisible (a) that their asthma performances emphasize an economy of good passages and of feeling capable, (b) that they achieve the objective of feeling capable in quite different ways, and (c) that feeling capable does not per se equal being symptom-free all the time. To attain long-term use of self-management systems and other patient-centred e-health systems, such systems must acknowledge and link into the manifold performances that comprise users’ ways of living with their disease.
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Asthma, diabetes, and other chronic diseases cannot be cured. This positions these diseases at the periphery of common conceptions of diseases and their treatment. First, whereas healthcare professionals can diagnose chronic diseases and make plans for their treatment, the actual treatment, which is thus management, must to a large extent be performed by the patients themselves (Newman, Steed, & Mulligan, 2004). Second, many chronic diseases are in part caused by what can broadly be termed patients’ life styles, and the management of these diseases involves as a core element comprehensive changes or restrictions in patients’ habits and day-to-day lives (Butler, Rollnick, & Stott, 1996; GINA, 2005). Third, even brief failures to comply with proper management of the diseases may lead to symptoms or an irreversible worsening of the patient’s condition. For many chronic diseases, patient-centred e-health systems are therefore seen as a way of supporting patients’ self-management of their disease, primarily by providing information not otherwise available and by extending the communication between patients and healthcare professionals beyond infrequent, face-to-face consultations (Ball & Lillis, 2001; Safran, 2003).

This chapter analyses an e-health system for asthmatics. For reasons of anonymity, the system will be referred to as AWeb, and the company developing it as ACorp. Though asthma is a condition asthmatics have to live with, the risks of symptoms can be minimized by taking the right amount of medication. It is, however, no simple task to determine the correct amount of medication, because this depends on various risk factors, which may change dynamically and be hard to foresee. To accommodate the difficulties with dosing medication, asthmatics’ self-management of their medication is considered a cornerstone in asthma treatment (Gibson, Powell, Coughlan, Wilson, Abramson, Haywood, Bauman, Hensley, & Walters, 2002; GINA, 2005). AWeb provides tools for asthmatics to manage their asthma themselves. Nevertheless, in spite of the utility of AWeb and considerable marketing by ACorp the system never attained widespread use and was discontinued after five years. To inform other initiatives toward providing e-health support for self-management of chronic diseases, we provide two accounts of the relations between asthmatics and their asthma:

  • The system’s image of the user: How does AWeb set up a way for asthmatics to think about their asthma?

  • The self-image of asthmatics: How do asthmatics perform their asthma on a day-to-day basis?

The aim of our analysis is to elaborate and contrast these two images. We do not take asthmatics’ non-use of AWeb as a rejection of self-management initiatives, but rather seek to inform future initiatives by attempting to explain why AWeb was not taken up by the targeted users.

Previous work on e-health systems for self-management of asthma has suggested several reasons for asthmatics’ low uptake of such systems (Anhøj & Nielsen, 2004; Nielsen, 2005). The suggested reasons include inexperience with the Internet and computers, a latency time between starting to use a system and realizing the benefits of using it, and unpredictable interactions between the system and asthmatics’ everyday lives. A limitation of this previous work is, however, that reasons for non-use have been derived from studies of asthmatics that—admittedly, to varying extents—are users of e-health systems for self-management of asthma. In the present chapter, we extend previous work by turning to non-users for input to an understanding of what “went wrong” in the AWeb project. Such an understanding is particularly relevant because a clinical test shows that, if used, Web-based asthma monitoring leads to better asthma management (in terms of symptoms suffered, lung function, and so forth) compared to monitoring by asthma specialists or general practitioners (Rasmussen, Phanareth, Nolte, & Backer, 2005).

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List of Reviewers
Table of Contents
Joseph Tan
E. Vance Wilson
Chapter 1
Juanita Dawson, Bengisu Tulu, Thomas A. Horan
This chapter provides a conceptual foundation by exploring the existing literature on traditional healthcare, patient-centered healthcare, and the... Sample PDF
Towards Patient-Centered Care: The Role of E-Health in Enabling Patient Access to Health Information
Chapter 2
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This chapter introduces a series of techniques and tools useful for developing patient-centered e-health. As information technology (IT) is... Sample PDF
Patient-Centered E-Health Design
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Jan-Are K. Johnsen
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Connecting with Ourselves and Others Online: Psychological Aspects of Online Health Communication
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Ebrahim Randeree
An increasing focus on e-health and a governmental push to improve healthcare quality while giving patients more control of their health data have... Sample PDF
Personal Health Records: Patients in Control
Chapter 5
Elaine A. Blechman
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Disability Determinations and Personal Health Records
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E-Health Marketing  (pages 70-80)
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E-Health Marketing
Chapter 7
Olli P. Järvinen
This chapter introduces the privacy management framework as a means of studying patient-centered e-health. The chapter raises some important issues... Sample PDF
Privacy Management of Patient-Centered E-Health
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Richard Klein
Patient-centered e-health (PCEH) offerings see the emergence of divergent, new third parties, through initiatives, including (a) medical content... Sample PDF
Trust in Patient-Centered E-Health
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John Powell, Natalie Armstrong
This chapter deals with the principles and practice of patient and public involvement in e-health research, and discusses some of the issues raised.... Sample PDF
Involving Patients and the Public in E-Health Research
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Stefano Forti, Barbara Purin, Claudio Eccher
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Using Interaction Design to Improve Usability of a PHR User Interface Based on Visual Elements
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Jiao Ma
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Ann L. Fruhling
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Perceptions of E-Health in Rural Communities
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Elizabeth Cummings, Stephen Chau, Paul Turner
This chapter explores how in developing patient-centred e-health systems it is possible to accommodate heterogeneous characteristics of end-users... Sample PDF
Assessing a Patient-Centered E-Health Approach to Chronic Disease Self-Management
Chapter 14
Michel J. Sassene
This chapter investigates asthmatics’ reasons for not adopting an e-health system for asthma selfmanagement. An understanding of these reasons is... Sample PDF
Incompatible Images: Asthmatics' Non-Use of an E-Health System for Asthma Self-Management
Chapter 15
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