An experience-based analysis of barriers to the adoption of tele-monitoring technologies in UK healthcare: a case study on COPD

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Abstract

Background: Telemonitoring (also termed telehealth, telecare, ehealth etc.) is promoted as a way to reduce healthcare costs and promote self-management in long term conditions such as COPD. Research suggests telemonitoring may be useful in COPD management, but barriers remain to its uptake and sustained use. Research has often been limited to testing technologies at a late stage and potential users’ perspectives are not often considered. Aims/objectives: 1. Explore the barriers to using telehealth technologies from a user and potential user perspective: people with COPD (pwCOPD), their informal carers and health professionals (HPs). 2. Understand the challenges of living with and managing COPD to identify how telehealth models should be designed/existing models refined to better meet the needs of (potential) users. Methods: Multiple qualitative methods were used. This included a meta-synthesis of published papers that investigated users’ experience of telehealth in COPD; semi-structured interviews and focus groups with HPs; focus groups and longitudinal interviews with pwCOPD and their informal carers. User involvement consisted of an advisory group (pwCOPD and HPs) that helped guide the research. Transcripts were analysed using a broadly thematic approach. Findings: Meta-synthesis: Findings indicate contradicting consequences of telehealth use. 1. It influenced moral dilemma of help seeking (increased dependency or improved self-care practices). 2. It transformed interactions (increased risk or reassured). 3. It reconfigured work practices (burdened or empowered). HP data: presented three overarching themes: 1. Telehealth was often implemented within a technology centred approach which failed to engage clinicians and did not result in efficiency savings. Recognised that telehealth implementation needed to focus on patient need before technology. 2. Organisational pressures and professional roles impact upon HPs’ perception of telehealth. Telehealth undermined holistic care and threatened professionals’ identity if it focused reductively on biometric monitoring. 3. Telehealth was not considered useful in ‘complex’ patients with high needs and considered more suitable in patients with fewer needs. Identified a need to tailor telehealth to patients’ needs which was consistent with professional values of providing holistic support. PwCOPD and their informal carers’ data: presented three overarching themes. 1. It identified how pwCOPD and their carers lived and responded to unpredictable illness trajectories and highlighted the work they did to manage illness at home. Identified reasons why they failed to seek timely help at times of acute illness: these were numerous and involved experiences of illness trajectory and healthcare. 2. PwCOPD and their carers carried out technical work for routine monitoring and at times of acute illness. Some did not consider technical work to be their responsibility. 3. People with mild illness expressed no felt need for telehealth and considered it a threat to their independence and identity; people with complex illness expressed a felt need for telehealth and perceived it would increase connectedness with clinicians and improve continuity of care. Some felt telehealth was not sophisticated enough to manage their complex illness and respondents did not want telehealth to replace current care. Discussion/conclusion: Patients and HPs hold different views regarding whereabouts in the illness trajectory telehealth would be considered useful. Greater recognition of the work that patients and their informal carers do to manage illness at home is needed to identify when patients need support at different times in their illness trajectory. Findings have implications for wider service support and organisational factors for supporting telehealth use, to identify where it may or may not be suitable. The study highlights a need for tailoring telehealth to patients’ needs (which is more consistent with HPs’ professional values of providing ‘good care’). The findings provide valuable insights to inform telehealth solutions fit for reacting to uncertainty and changing trajectories of need in pwCOPD.

Keyword(s)

Chronic Obstructive Pulmonary Disease (COPD); Telehealth; User perspective; barriers; health professional views; patient and carer views; patient and public involvement; potential user perspective; qualitative research

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