Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden.

Frida Jonsson,Anna-Karin Hurtig,Dean B Carson,Isabel Goicolea

doi:10.34172/ijhpm.2021.08

Abstract

Background: Unlike the large body of research that has examined the ‘success’ or ‘failure’ of eHealth in terms of patient and provider perceptions or cost- and clinical effectiveness, the current study teases out ways through which a novel eHealth initiative in rural northern Sweden might result in more distal or systemic beneficial outcomes. More specifically, this paper aims to explore how and under what circumstances the so-called virtual health rooms (VHRs) are expected to improve access to person-centred care and strengthen community health systems, especially for elderly residents of rural areas. Methods: The first phase of the realist evaluation methodology was conducted, involving qualitative interviews with 8 key stakeholders working with eHealth, business development, digitalisation, and process management. Using thematic analysis and following an abductive-retroductive analytical process, an intervention-context-actor-mechanism-outcome(ICAMO) configuration was developed and elicited into an initial programme theory. Results: The findings indicate that a novel eHealth initiative, which provides reliable technologies in a customized facility that connects communities and providers, might improve access to person-centred care and strengthen community health systems for rural populations. This is theorized to occur if mechanisms acting at individual (such as knowledge, skills and trust) and collective (like a common vision and shared responsibilities) levels are triggered in contexts characterised by supportive societal transitions, sufficient organisational readiness and the harnessing of rural cohesiveness and creativity. Conclusion: The elicited initial programme theory describes and explains how a novel eHealth initiative in rural northern Sweden is presumed to operate and under what circumstances. Further testing, refinements and continued gradual building of theory following the realist evaluation methodology is now needed to ascertain if the ‘VHRs’ work as intended, for whom, in what conditions and why.

Highlights

Ageing populations with complex health needs have shifted thinking away from hospital-centric and curative approaches towards flexible and personalized models of care, in high-income countries.[1]
This study suggests that initiatives in eHealth – like the virtual health rooms (VHRs) – might improve access to person-centred care and strengthen community health systems for rural populations if they engender trust and cooperation among actors who have a common vision while sharing responsibilities and resources in mutual dependence
This change has contributed to a rising interest in and concern about the organisation of primary healthcare (PHC) in Sweden more generally, and rural areas in particular, with the system largely struggling in the role of ‘front-line care’ and to manage the increased multi-morbidities of a growing elderly population.[2]

Summary

Introduction

Ageing populations with complex health needs have shifted thinking away from hospital-centric and curative approaches towards flexible and personalized models of care, in high-income countries.[1] This change has contributed to a rising interest in and concern about the organisation of primary healthcare (PHC) in Sweden more generally, and rural areas in particular, with the system largely struggling in the role of ‘front-line care’ and to manage the increased multi-morbidities of a growing elderly population.[2] Based partly on these problems, a large reform has recently been introduced to develop an equitable, accessible and efficient Swedish health system This policy has been focused on strengthening PHC, improving the coordination between provinces and municipalities, promoting access to person-centred solutions and facilitating the integration of medical technologies.[3] while initiatives that use information and communication technologies for health are assumed to make clinical support structures more effective, improve patient-provider connection and increase peoples’ involvement in their care processes, eHealth has yet to show its expected potential in terms of scale, full system deployment and/or effectiveness for health services, especially at the community level.[4]. For example, highlighted the importance of users being ‘digitally literate’[17]; of creating ‘real’ engagement and collaboration between stakeholders[18]; and of ensuring that the interventions become part of formal systems and routine care.[19]

Objectives

Methods

Results

Conclusion