Hege Andreassen

Patients Who Use E-Mediated Communication With Their Doctor: New Constructions of Trust in the Patient-Doctor Relationship

The introduction of information and communication technology (ICT) into the patient-doctor relationship represents a significant change in modern health care. Communication via computers—e-mediated communication—is affecting the context of patient-doctor interaction, touching core elements of the relationship. Based on data from a qualitative study conducted among Norwegian patients who had used ICT to communicate with their doctors, the authors argue that patients’ use of ICT and the element of trust in the patient-doctor relationship influence each other. Furthermore, they contend that patients’ constructions of trust in this relationship can be understood in light of basic mechanisms in modern society. The study sheds light on some potential concerns and benefits as communication technology increasingly is integrated into the patient-doctor relationship.

Use of the internet for health purposes: trends in Norway 2000–2010

AIM The aim of this work is to study the 10 year trends in the use and projected use of internet for health purposes in Norway. This includes more detailed analyses of changes in latter years, current uses, valuation as source of health information, reported effects and projected developments. METHOD Surveys on the use of the internet for health purposes have been conducted in Norway in the years 2000, 2001, 2003, 2005 and 2007. Representative samples were drawn from the population, and interviews were conducted by poll agencies using telephone (CATI). RESULTS Internet use for health purposes in the Norwegian population has increased dramatically over the last 7 years from 19% in 2000 to 67% in 2007. If this trend continues, we estimate that 84% of the Norwegian population will be using internet for health purposes by the year 2010. Reading about health or illness is the most common activity, and the rated importance of the internet as a source of health information is increasing. The internet is also used more for ordering medicines and other health-related products. Forty-four per cent of those having used the internet for health purposes reported having searched for lifestyle-related information, and 40% reported having felt inspired to change health behaviour. CONCLUSIONS The internet is an important source of health information, which is likely to increase in importance in the years to come. This study further underlines the potential of internet use for health promoting purposes, as well as the potential for exacerbating social disparities in health.

Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study

BackgroundTelemedicine may increase accessibility to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), thus enhancing long-term exercise maintenance. We aimed to explore COPD patients’ adherence and experiences in long-term telerehabilitation to understand factors affecting satisfaction and potential for service improvements.MethodsA two-year pilot study with 10 patients with COPD was conducted. The intervention included treadmill exercise training at home and a webpage for telemonitoring and self-management combined with weekly videoconferencing sessions with a physiotherapist. We conducted four separate series of data collection. Adherence was measured in terms of frequency of registrations on the webpage. Factors affecting satisfaction and adherence, together with potential for service improvements, were explored through two semi-structured focus groups and an individual open-ended questionnaire. Qualitative data were analysed by systematic text condensation. User friendliness was measured by the means of a usability questionnaire.ResultsOn average, participants registered 3.0 symptom reports/week in a web-based diary and 1.7 training sessions/week. Adherence rate decreased during the second year. Four major themes regarding factors affecting satisfaction, adherence and potential improvements of the intervention emerged: (i) experienced health benefits; (ii) increased self-efficacy and independence; and (iii) emotional safety due to regular meetings and access to special competence; (iv) maintenance of motivation. Participants were generally highly satisfied with the technical components of the telerehabilitation intervention.ConclusionsLong-term adherence to telerehabilitation in COPD was maintained for a two-year period. Satisfaction was supported by experienced health benefits, self-efficacy, and emotional safety. Maintenance of motivation was a challenge and might have affected long-term adherence. Four key factors of potential improvements in long-term telerehabilitation were identified: (i) adherence to different components of the telerehabilitation intervention is dependent on the level of focus provided by the health personnel involved; (ii) the potential for regularity that lies within the technology should be exploited to avoid relapses after vacation; (iii) motivation might be increased by tailoring individual consultations to support experiences of good health and meet individual goals and motivational strategies; (iv) interactive functionalities or gaming tools might provide peer-support, peer-modelling and enhance motivation.

Survival of the project: A case study of ICT innovation in health care

From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology.

DIFFERENCES AND INEQUALITIES IN HEALTH

The potential for information technologies (ITs) to contribute to a struggle against social inequalities in health is discussed in contemporary policy and research. Expectations are on IT to facilitate access to health expertise and knowledge, and hence result in improved health practices and outcomes for individuals. In this article, the authors argue that this currently dominant understanding of the relation between IT and social inequalities in health is constraining as well as insufficient to explain the persistence of health inequalities in digitalized western societies. Human action is reduced to be about rational choice, and technology is expected to be a passive tool to be employed by implementers and policy-makers. Drawing on case studies from two telemedicine projects in Norway, this analysis combines perspectives from sociology concerned with structural inequalities on the one hand, with science technology studies on the other. It reveals how the practice and performance of IT is tied to the practice and performance of local differences, and this might be important to a discussion of the social distribution of health. Combining these two perspectives allows for an alternative understanding of how IT and social inequalities in health interact.

Nordic eHealth benchmarking

The report presents results of the Nordic eHealth Research Network, a subgroup of the eNordic Council of Ministers Health group. The network defined and collected data for altogether 49 common eHea ...

Using the Internet to Support Exercise and Diet: A Stratified Norwegian Survey.

Background Internet is used for a variety of health related purposes. Use differs and has differential effects on health according to socioeconomic status. Objective We investigated to what extent the Norwegian population use the Internet to support exercise and diet, what kind of services they use, and whether there are social disparities in use. We expected to find differences according to educational attainment. Methods In November 2013 we surveyed a stratified sample of 2196 persons drawn from a Web panel of about 50,000 Norwegians over 15 years of age. The questionnaire included questions about using the Internet, including social network sites (SNS), or mobile apps in relation to exercise or diet, as well as background information about education, body image, and health. The survey email was opened by 1187 respondents (54%). Of these, 89 did not click on the survey hyperlink (declined to participate), while another 70 did not complete the survey. The final sample size is thus 1028 (87% response rate). Compared to the Norwegian census the sample had a slight under-representation of respondents under the age of 30 and with low education. The data was weighted accordingly before analyses. Results Sixty-nine percent of women and 53% of men had read about exercise or diet on the Internet (χ2= 25.6, P<.001). More people with higher education (71%, χ2=19.1, P<.001), reported this. The same gender difference was found for using Internet-based interventions with 20% of women compared to14% of men reporting having used these interventions (χ2=7.9, P= .005), for having posted a status about exercise or diet on Facebook or other SNS (23% vs 12%, χ2=18.8, P<.001), and for having kept an online exercise or diet journal (21% vs 15%, χ2=7.0, P=.008). Evaluations of own physical appearance accounted for some of the gender differences in using online exercise or diet journals. Seven percent of the total sample reported having used electronic communication to ask professionals about exercise or diet, while a few more had discussed online with peers (10%). Asking professionals online was more common amongst those with only primary education (13%, χ2<10.5, P=.005). Conclusions Gender and education are related to how the Internet is used to support health behaviors. We should be aware of the potential role of the Internet in accelerating social disparities in health, and continue to monitor population use. For Internet- and mobile-based interventions to support health behaviors, this study provides information relevant to tailoring of delivery media and components to user.

eHealth Use Among First-Generation Immigrants From Pakistan in the Oslo Area, Norway, With Focus on Diabetes: Survey Protocol

Background A variety of eHealth services are available and commonly used by the general public. eHealth has the potential to engage and empower people with managing their health. The prerequisite is, however, that eHealth services are adapted to the sociocultural heterogeneity of the user base and are available in a language and with contents that fit the users’ preference, skills, and abilities. Pakistani immigrants in the Oslo area, Norway, have a much higher risk of Type-2 diabetes (T2D) than their Norwegian counterparts do. In spite of having access to information and communication technology (ICT) and the Internet, ICT skills in this population are reported to be relatively low. Further, there is insufficient information about their use of and attitudes toward eHealth services, necessitating investigation of this group in particular. Objective This study targets first-generation immigrants from Pakistan living in the Oslo area and examines their use of and attitudes toward eHealth services, specifically: information searches, communication using ICT, and use of ICT for self-management or decision making, all concerning T2D. Methods Due to a high prevalence of low literacy among the target population, we employed questionnaire-based individual interviews. The questionnaire was developed by implementing potentially relevant theoretical constructs (technology acceptance model (TAM) and health belief model (HBM)) as measures. To explore issues around language, culture, and general ICT skills, we also implemented questions that we assume were particularly relevant in the context studied but do not appear in any theoretical frameworks. The questionnaire was revised to reflect results of a pilot study involving 10 participants. We employed culturally sensitive sampling methods to reach informants who could otherwise fail to be included in the survey. Results This paper presents a survey protocol. The data collection is ongoing. The aim is to collect 200 responses in total by March 2016. Conclusions For eHealth to become an influential social innovation, equal access to eHealth services regardless of users’ language, culture, and ICT skills is a prerequisite. Results from this study will be of importance for understanding how people who may not maximally benefit from eHealth services today could be targeted in the future.

Digitized patient - provider interaction: How does it matter? A qualitative meta-synthesis

Sociological interest in the digitization of health has predominantly been studied using qualitative approaches. Research in this field has grown steadily since the late 1990s but to date, no synthesis has been conducted to integrate this now rather comprehensive corpus of data. In this paper we present a meta-ethnography of 15 papers reporting qualitative studies of digitally mediated patient - professional interactions. By dissecting the detailed descriptions of digitized practices in this most basic relationship in health care, we explore how these studies can illuminate important aspects of social relations in contemporary society. Our interpretative synthesis enables us to reassert a sociological view that places changes in social structures and interaction at the core of questions about the digitization of health care. Our synthesis of this literature identifies four key concepts that point at structural processes of change. We argue that when patient-professional interactions are digitized, relations are respatialized, and there are reconnections of relational components. These lead to empirically specific reactions, which can be characterized as reconstitutions and renegotiations of social practices which in turn are related to the reconfiguration of basic social institutions. We propose a new direction for exploring the digitalization of health care to illuminate how digital health is related to contemporary social change.

The Association Between Commonly Investigated User Factors and Various Types of eHealth Use for Self-Care of Type 2 Diabetes: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway

Background Sociodemographic and health-related factors are often investigated for their association with the active use of electronic health (eHealth). The importance of such factors has been found to vary, depending on the purpose or means of eHealth and the target user groups. Pakistanis are one of the biggest immigrant groups in the Oslo area, Norway. Due to an especially high risk of developing type 2 diabetes (T2D) among this population, knowledge about their use of eHealth for T2D self-management and prevention (self-care) will be valuable for both understanding this vulnerable group and for developing effective eHealth services. Objective The aim of this study was to examine how commonly were the nine types of eHealth for T2D self-care being used among our target group, the first-generation Pakistani immigrants living in the Oslo area. The nine types of eHealth use are divided into three broad categories based on their purpose: information seeking, communication, and active self-care. We also aimed to investigate how sociodemographic factors, as well as self-assessment of health status and digital skills are associated with the use of eHealth in this group. Methods A survey was carried out in the form of individual structured interviews from September 2015 to January 2016 (N=176). For this study, dichotomous data about whether or not an informant had used each of the nine types of eHealth in the last 12 months and the total number of positive answers were used as dependent variables in a regression analysis. The independent variables were age, gender, total years of education, digital skills (represented by frequency of asking for help when using information and communication technology [ICT]), and self-assessment of health status. Principal component analyses were applied to make categories of independent variables to avoid multicollinearity. Results Principal component analysis yielded three components: knowledge, comprising total years of education and digital skills; health, comprising age and self-assessment of health status; and gender, as being a female. With the exception of closed conversation with a few specific acquaintances about self-care of T2D (negatively associated, P=.02) and the use of ICT for relevant information-seeking by using search engines (not associated, P=.18), the knowledge component was positively associated with all the other dependent variables. The health component was negatively associated with the use of ICT for closed conversation with a few specific acquaintances about self-care of T2D (P=.01) but not associated with the other dependent variables. Gender component showed no association with any of the dependent variables. Conclusions In our sample, knowledge, as a composite measure of education and digital skills, was found to be the main factor associated with eHealth use regarding T2D self-care. Enhancing digital skills would encourage and support more active use of eHealth for T2D self-care.