How Patient Work Changes Over Time for People With Multimorbid Type 2 Diabetes: Qualitative Study.

Kathleen Yin,Frances Rapport,Sanjyot Vagholkar,Kenneth W K Ho,Annie Y S Lau,Ann Blandford,Joshua Jung,Enrico Coiera

doi:10.2196/25992

Abstract

BackgroundThe experiences of patients change throughout their illness trajectory and differ according to their medical history, but digital support tools are often designed for one specific moment in time and do not change with the patient as their health state changes. This presents a fragmented support pattern where patients have to move from one app to another as they move between health states, and some subpopulations of patients do not have their needs addressed at all.ObjectiveThis study aims to investigate how patient work evolves over time for those living with type 2 diabetes mellitus and chronic multimorbidity, and explore the implications for digital support system design.MethodsIn total, 26 patients with type 2 diabetes mellitus and chronic multimorbidity were recruited. Each interview was conducted twice, and interviews were transcribed and analyzed according to the Chronic Illness Trajectory Model.ResultsFour unique illness trajectories were identified with different patient work goals and needs: living with stable chronic conditions involves patients seeking to make patient work as routinized and invisible as possible; dealing with cycles of acute or crisis episodes included heavily multimorbid patients who sought support with therapy adherence; responding to unstable changes described patients currently experiencing rapid health changes and increasing patient work intensity; and coming back from crisis focused on patients coping with a loss of normalcy.ConclusionsPatient work changes over time based on the experiences of the individual, and its timing and trajectory need to be considered when designing digital support interventions.International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2018-022163

Highlights

Background and SignificancePatient work is defined as health-related tasks and actions a patient undertakes in their self-management of health conditions [1,2]
We examine how patient work tasks and goals change over the chronic illness trajectory, focusing on multimorbid patients with type 2 diabetes mellitus self-managing in the community
We report our findings on patient work tasks and how they fit into the Chronic Illness Trajectory Model

Summary

Introduction

Background and SignificancePatient work is defined as health-related tasks and actions a patient undertakes in their self-management of health conditions [1,2]. The experiences of patients change throughout their illness trajectory and differ according to their medical history, but digital support tools are often designed for one specific moment in time and do not change with the patient as their health state changes. Results: Four unique illness trajectories were identified with different patient work goals and needs: living with stable chronic conditions involves patients seeking to make patient work as routinized and invisible as possible; dealing with cycles of acute or crisis episodes included heavily multimorbid patients who sought support with therapy adherence; responding to unstable changes described patients currently experiencing rapid health changes and increasing patient work intensity; and coming back from crisis focused on patients coping with a loss of normalcy.

Results

Discussion

Conclusion