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Assessing the implementability of telehealth interventions for self-management support: a realist review

Assessing the implementability of telehealth interventions for self-management support: a realist review
Assessing the implementability of telehealth interventions for self-management support: a realist review
Background
There is a substantial and continually growing literature on the effectiveness and implementation of discrete telehealth interventions for health condition management. However, it is difficult to predict which technologies are likely to work and be used in practice. In this context, identifying the core mechanisms associated with successful telehealth implementation is relevant to consolidating the likely elements for ensuring a priori optimal design and deployment of telehealth interventions for supporting patients with long-term conditions (LTCs).

Methods
We adopted a two-stage realist synthesis approach to identify the core mechanisms underpinning telehealth interventions. In the second stage of the review, we tested inductively and refined our understanding of the mechanisms. We reviewed qualitative papers focused on COPD, heart failure, diabetes, and behaviours and complications associated with these conditions. The review included 15 papers published 2009 to 2014.

Results
Three concepts were identified, which suggested how telehealth worked to engage and support health-related work. Whether or not and how a telehealth intervention enables or limits the possibility for relationships with professionals and/or peers. Telehealth has the potential to reshape and extend existing relationships, acting as a partial substitute for the role of health professionals. The second concept is fit: successful telehealth interventions are those that can be well integrated into everyday life and health care routines and the need to be easy to use, compatible with patients’ existing environment, skills, and capacity, and that do not significantly disrupt patients’ lives and routines. The third concept is visibility: visualisation of symptoms and feedback has the capacity to improve knowledge, motivation, and a sense of empowerment; engage network members; and reinforce positive behaviour change, prompts for action and surveillance.

Conclusions
Upfront consideration should be given to the mechanisms that are most likely to ensure the successful development and implementation of telehealth interventions. These include considerations about whether and how the telehealth intervention enables or limits the possibility for relationships with professionals and peers, how it fits with existing environment and capacities to self-manage, and visibility-enabling-enhanced awareness to self and others.
telehealth, self-management, chronic illness, intervention, mechanisms, implementation
1-25
Vassilev, Ivaylo
d76a5531-4ddc-4eb2-909b-a2a1068f05f3
Rowsell, Alison
058f3917-b556-4eef-a393-4c025a3c4ccb
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
O’Cathain, Alicia
fda66d76-5af9-42dc-bbf8-5f4926b6bfb2
Salisbury, Chris
50e9a5a0-c074-4af8-9b1b-e1e8408aae3c
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Vassilev, Ivaylo
d76a5531-4ddc-4eb2-909b-a2a1068f05f3
Rowsell, Alison
058f3917-b556-4eef-a393-4c025a3c4ccb
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
O’Cathain, Alicia
fda66d76-5af9-42dc-bbf8-5f4926b6bfb2
Salisbury, Chris
50e9a5a0-c074-4af8-9b1b-e1e8408aae3c
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7

Vassilev, Ivaylo, Rowsell, Alison, Pope, Catherine, Kennedy, Anne, O’Cathain, Alicia, Salisbury, Chris and Rogers, Anne (2015) Assessing the implementability of telehealth interventions for self-management support: a realist review. Implementation Science, 10 (1), 1-25. (doi:10.1186/s13012-015-0238-9).

Record type: Article

Abstract

Background
There is a substantial and continually growing literature on the effectiveness and implementation of discrete telehealth interventions for health condition management. However, it is difficult to predict which technologies are likely to work and be used in practice. In this context, identifying the core mechanisms associated with successful telehealth implementation is relevant to consolidating the likely elements for ensuring a priori optimal design and deployment of telehealth interventions for supporting patients with long-term conditions (LTCs).

Methods
We adopted a two-stage realist synthesis approach to identify the core mechanisms underpinning telehealth interventions. In the second stage of the review, we tested inductively and refined our understanding of the mechanisms. We reviewed qualitative papers focused on COPD, heart failure, diabetes, and behaviours and complications associated with these conditions. The review included 15 papers published 2009 to 2014.

Results
Three concepts were identified, which suggested how telehealth worked to engage and support health-related work. Whether or not and how a telehealth intervention enables or limits the possibility for relationships with professionals and/or peers. Telehealth has the potential to reshape and extend existing relationships, acting as a partial substitute for the role of health professionals. The second concept is fit: successful telehealth interventions are those that can be well integrated into everyday life and health care routines and the need to be easy to use, compatible with patients’ existing environment, skills, and capacity, and that do not significantly disrupt patients’ lives and routines. The third concept is visibility: visualisation of symptoms and feedback has the capacity to improve knowledge, motivation, and a sense of empowerment; engage network members; and reinforce positive behaviour change, prompts for action and surveillance.

Conclusions
Upfront consideration should be given to the mechanisms that are most likely to ensure the successful development and implementation of telehealth interventions. These include considerations about whether and how the telehealth intervention enables or limits the possibility for relationships with professionals and peers, how it fits with existing environment and capacities to self-manage, and visibility-enabling-enhanced awareness to self and others.

Text
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More information

Accepted/In Press date: 26 March 2015
e-pub ahead of print date: 24 April 2015
Published date: 2015
Keywords: telehealth, self-management, chronic illness, intervention, mechanisms, implementation
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 378877
URI: http://eprints.soton.ac.uk/id/eprint/378877
PURE UUID: f92dae58-f00d-4ee1-8f88-9e6fb779e177
ORCID for Ivaylo Vassilev: ORCID iD orcid.org/0000-0002-2206-8247
ORCID for Catherine Pope: ORCID iD orcid.org/0000-0002-8935-6702
ORCID for Anne Kennedy: ORCID iD orcid.org/0000-0003-4570-9104

Catalogue record

Date deposited: 16 Jul 2015 13:32
Last modified: 28 Apr 2022 02:09

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Contributors

Author: Ivaylo Vassilev ORCID iD
Author: Alison Rowsell
Author: Catherine Pope ORCID iD
Author: Anne Kennedy ORCID iD
Author: Alicia O’Cathain
Author: Chris Salisbury
Author: Anne Rogers

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