Chronic illness, self-management and technology: type 1 diabetes patients’ views of the use of technology to communicate with health professionals about their disease

Annmarie Ruston,¹ Alison Smith,¹ Bernard Fernando<sup>2

1</sup>Centre for Health and Social Care Research, Faculty of Health and Social Care, Canterbury Christ Church University, Chatham Maritime, United Kingdom; ²Thames Avenue Surgery, Rainham, United Kingdom

Purpose: Diabetes represents one of the greatest health challenges facing the UK. Telehealth is seen to have the potential to revolutionize health care provision by improving access for patients with chronic disease, reducing health care costs, and improving efficiency. There have been many trials of telehealth in the UK but these have typically failed to become part of routine health care, particularly for diabetics. Program design and implementation has not been grounded in an understanding about the ways in which patients manage their disease and perceive these new technologies. This study addresses this gap by gaining an understanding of the perceptions of patients with type 1 diabetes about how telehealth could be used as part of their health care.
Patients and methods: Thirty-two people with type 1 diabetes were recruited from a database of insulin pump users, and in-depth telephone interviews were undertaken, tape recorded, and transcribed. Analysis was conducted using a constant comparative approach.
Results: Although respondents used technology as part of their diabetes self-management, they considered that the use of telehealth, as part of their health care, was potentially of limited value. Three themes emerged from their discourses: (1) a need to be in control of their disease themselves and a lack of trust of health care professionals in this process; (2) the belief that the National Health Service routine IT systems were unable to support telehealth; and (3) the belief that face-to-face communication was vital in providing them with high-quality care.
Conclusion: Telehealth is considered to be revolutionizing health care and shifting power between patients and health professionals; however, evidence of its effectiveness in delivering improved outcomes for diabetes is limited. The findings presented here suggest that there is a need to understand the context of patients' self-management and their perceptions of their role in telehealth if it is to be successful.

Keywords: patient knowledge, telehealth, self-management, diabetes care, information technology