Perceptions on use of home telemonitoring in patients with long term conditions \u2013 concordance with the Health Information Technology Acceptance Model: a qualitative collective case study

Jo B Middlemass,Jolien Vos,A Niroshan Siriwardena

doi:10.1186/s12911-017-0486-5

Abstract

BackgroundHealth information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED).MethodsAn instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data.ResultsParticipants included 21 patients aged between 60–99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced.ConclusionsHITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors need to be considered.Trial registrationClinicalTrials.gov Identifier: NCT01960907 October 9 2013 (retrospectively registered) Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED). Start date October 2012, end date March 2016. Date of enrolment of the first participant was February 2013.

Highlights

Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services
There is some evidence that HIT home monitoring may be effective in reducing disease exacerbations [5, 6] with a consequential reduction in hospitalisations in patients with LTCs including Chronic Obstructive Pulmonary Disease (COPD) [1, 5, 6] and Chronic Heart Failure (CHF) [3], and diminished costs mainly due to reduced hospitalisations [1]
Aim of this study By exploring patients’ perceptions and experiences of using telemonitoring equipment in their homes and comparing our findings with the Health Information Technology Acceptance Model (HITAM), we aimed to apply the HITAM to home telemonitoring in older patients with LTCs in order to test the model and to see whether it could be used to help increase the adoption of HIT in this age group

Summary

Introduction

Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Health information technology (HIT) commonly known as telemonitoring, telehealth or telemedicine is a form of non-invasive, remote, home monitoring of patients’ clinical signs and symptoms [1] used to improve the care and management of people with chronic LTCs, many of whom are aged over 60 years. There is some evidence that HIT home monitoring may be effective in reducing disease exacerbations [5, 6] with a consequential reduction in hospitalisations in patients with LTCs including COPD [1, 5, 6] and CHF [3], and diminished costs mainly due to reduced hospitalisations [1]. Patients’ concerns in previous studies include a preference for face-to-face health professional contact rather than HIT [11, 14, 15]

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