Abstract

Introduction:
Health information technology (HIT) has potential benefits for patient care, patient safety and reduced healthcare costs. For example, telecare (including remote monitoring and a clinical response to changes in measures) is associated with lower mortality, emergency admission rates and primary care contacts in patients with stable chronic obstructive pulmonary disease (COPD). There are seemingly many reasons behind slow uptake of HIT, including those which relate to service users, e.g., patients’ concerns about loss of the ‘human touch’ in care. We aimed to explore factors that might explain use of telecare in older people with multimorbidities.

Methods:
We undertook a qualitative study of patients using telecare in a European randomised controlled trial of telecare for older people with multimorbidity (CHROMED), applying a behavioural model to the data. Interview data from 13 patients were analysed using NVivo and applying the Health Information Technology Acceptance Model (HITAM) as a conceptual framework. This model encompasses eight elements that directly or indirectly influence someone’s attitude towards HIT and its acceptance.

Results:
Most participants (patients) had a positive attitude to using the monitoring devices, their ease of use and the possibilities it generated for their future care. The support from and attitudes of healthcare providers provided extra motivation for patients to use the equipment. Although patients mentioned several facilitators with regard to the usefulness of the equipment (e.g. continuity of information, prevention or early detection, and feeling monitored), some did not perceive an immediate personal benefit. Barriers to the acceptance of HIT included some patients’ heightened focus on their illness when undertaking daily clinical testing, which occasionally increased anxiety. Some patients were also fearful that the technology would replace face-to-face, personal contact with healthcare providers. In addition some patients disliked the lack of interactivity with the equipment or the design of the devices (e.g. finding them too intrusive and bulky). Where patients’ clinical data were visible to them before being transferred electronically, these were often manually recorded onto paper format by patients for their personal records. However, no lifestyle decisions (like contacting the doctor or changing activity levels) were made as a result of collecting these data.

Conclusions:
The HITAM model, constructed on previous behavioural models (e.g. Health Belief Model) has not been previously tested. This study showed that elements of the model were valid, but it did not entirely explain or predict the use of telecare in this study.