Patient Experiences of Diabetes eHealth

Patient Experiences of Diabetes eHealth

Peggy Gregory (School of Computing, Engineering & Physical Sciences, University of Central Lancashire, Preston, UK), Paula Byrne (Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK) and Mark Gabbay (Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK)
DOI: 10.4018/ijskd.2014010101


The authors report results from a qualitative study designed to investigate patients' use and perceptions of a diabetes eHealth system. 38 patients at a primary care practice in Northern England used a system for six months and were interviewed three times. Facilities provided were access to information; blood glucose upload and sharing; target setting; and communication with health practitioners and other patients. Results showed a variety of ‘frequency of use' and ‘features used' patterns, including non-use. Barriers included difficulty accepting diabetes, technical problems, and health or personal problems; facilitators included a positive approach to diabetes, being an established home computer user and having no additional health or personal problems. A model is presented showing how the system crosses the boundary between self-management and support seeking. The authors theorise that the system created boundary objects that take on different meanings for the actors that use them; these need to be meaningful, acceptable and engaging if the system is to be used. The authors conclude that eHealth systems would be improved by using iterative co-design and evaluation techniques to enable the capture of heterogeneous and unanticipated system use.
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Background And Significance

The increasing incidence of chronic diseases such as diabetes is a global phenomenon that poses severe challenges for health and healthcare systems. ICT has been widely seen as an efficient and cost-effective option for supporting clinical management for this growing problem (Gaikwad & J., 2009; May, Finch, Mair, & Mort, 2005). The widespread ownership of mobile phones and home computers amongst populations in many countries (Fox, 2005) provides a basis for the development of new approaches to chronic disease management

Diabetes has been of particular interest for those looking to develop eHealth technology because aspects of the disease, such as blood glucose readings and insulin doses, require regular measurement. Also, patients with diabetes need to embed health management activities into their daily lives, and these activities typically occur outside clinical settings (Aschner, Horton, Leiter, Munro, & Skyler, 2010; Jarvis, Skinner, Carey, & Davies, 2010). Technology that can be used by patients in their daily lives can potentially deliver support at the point of need.

Over the last decade increasing interest has been shown in the potential of developing patient-focussed technology for use on home computers or mobile phones. A number of different approaches have been taken such as: providing communication between patients and clinical practitioners, data sharing, providing educational material, and patient forums. Most empirical studies into the use of this technology focus on assessing measurable health outcomes, usually changes to HbA1c (the glycated haemoglobin test that measures the amount of glucose carried by red blood cells, which is used to indicate blood glucose levels for the previous two to three months), but also blood pressure, cholesterol, and dietary behaviour. The literature is inconclusive on the health benefits that ensue from using IT-based systems. Some studies report significant improvements (Bond et al., 2007; Kwon et al., 2004; Ralston et al., 2009), and others do not (Farmer et al., 2005; Jennings, Powell, Armstrong, Sturt, & Dale, 2009; Ladyzynski & Wojcicki, 2007).

However, patient-focussed diabetes eHealth systems are complex, multi-faceted interventions that are difficult to design, control and assess. Replication of assessment is not easy, as it is hard to quantify, describe and control all elements of a study (Campbell et al., 2000; Craig et al., 2008). Health professionals usually define criteria for success, but successful outcomes depend on patient engagement. The patient population is heterogeneous and growing, hence their needs will not be uniform. Given these difficulties, there is a need for studies to explore how and why patients use eHealth technologies in home environments. However, only a small body of qualitative studies have looked at participant experiences of home-based technology for diabetes patients (Gammon et al., 2005; Goldberg, Ralston, Hirsch, Hoath, & Ahmed, 2003; Ralston, Revere, Robins, & Goldberg, 2004), and this study aims to contribute to this body of work.

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