Assessing the implementability of health and telehealth interventions for self management support: a realist synthesis in a European context

Vassilev, I., Pope, C., Rogers, A. and Kennedy, A. (2014) Assessing the implementability of health and telehealth interventions for self management support: a realist synthesis in a European context. Medicine 2.0: World Congress on Social Media, Mobile Apps, Internet/Web 2.0, Malaga, Spain (2014), Malaga, Spain.

Abstract

Background: telehealth and ehealth resources are frequently and increasingly seen as providing resources for supporting people with long-term conditions in domestic and community settings. However, despite an abundance of trials and systematic reviews the evidence for the effective implementation of tele-health for managing LTCs remains inconclusive. There is also insufficient understanding of the mechanisms through which tele-health interventions work; how they get embedded into everyday practice; and how they become viable aspects of systems of support which facilitate and are capable of providing self -management support. As part of a European project FP7 we aimed to identify the mechanisms relevant to exploring the systems of support for people with a long term condition.

Objective: we hypothesised that the adoption of telehealth interventions for long term conditions can be assessed in terms of likely implementation which related to three key concepts. These are relationships and realtionality :the extent to which relationships provide support (professional, peer, clinical and social ) for behaviour change and opportunities for professional feedback which reinforces positive or required behaviour change, fit (the extent to which a telehealth intervention can be integrated within personal everyday life and health care routines), and visibility (the extent to which a telehealth intervention increases the visibility of symptoms or health problems to self or others).

Methods: we searched PubMed and Web of Science for qualitative papers about telehealth, telecare, ehealth or mhealth published between February 2009 and February 2014. The searches were restricted to diabetes, heart failure, and COPD. The final set included 21 papers for review. We used a realist synthesis in analysing the data (Pawson 2009), where the process of synthesizing evidence is an iterative rather than a linear process and is understood as developing a more insightful and generalizable ways of understanding the phenomenon.

Results: the three concepts offer a robust assessment framework for telehealth interventions. Specifically we found that interventions which enable connections and contact between patients and professionals can facilitate support and reinforcement necessary for behaviour change. Where telehealth interventions limit or remove the relationship between patients and professional, other opportunities to support and reinforce behaviour may be necessary. Interventions are also more likely to be adopted if the technology used is comparatively simple, easy to access and use. We report findings which show that Simple technologies tend to work as well or better than more complex ones. Technologies that provided visible monitoring have both positive and negative impacts on implementation. Visibility had a positive impact through providing enabling feedback, reinforcing positive or required behaviour change, and by providing incentives, reminders and behaviour prompts for action. On the other hand, it could also be negative by inducing negative feelings (e.g. fear) regarding surveillance, stigma and punishment.

Conclusions: the implementation of telehealth interventions is most likely to be successful if it is focused on the priorities and structure of people’s everyday lives

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Contributors

Author: I. Vassilev

Author: C. Pope

Author: A. Kennedy

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