Abstract

The problem
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 many reasons for
poor 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.

The approach
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, 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. The HITAM model, constructed on previous behavioural models
(e.g. Health Belief Model) has not been previously tested in this setting.

Findings
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 facetoface,
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. Decisions about contacting the
doctor or changing physical activity levels were reported to be unaffected as a result
of collecting these data.

Consequences
This study showed that elements of the HITAM were valid, but it did not entirely
explain the impact of telecare. Based on our findings, we present some suggestions
for additional factors to HITAM that help understand the acceptance of HIT in older
adults with chronic conditions. A modified HITAM is presented based on our findings
which showed that psychosocial threats were as important as threats of deterioration
of patients' chronic conditions.