Table 3 Quotes according to themes and subthemes in meta-synthesis
From: Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis
Theme | Subthemes and quotes |
|---|---|
Improved Care | Increased self-care • “I get quite annoyed with myself when I see the reading go up, so I start investigating what have I been doing that’s done that” [20] • “It created an awareness within me to really pay attention to my diet, my salt intake, the types of food and, and become more involved with my overall health” [19] • “the minute I see my blood sugar high I definitely don’t eat anything” [23] • “I have to eat the right thing; I have to do this and that. It gives you the motivation to do the right thing…” [25] • “I went on the Net and found out everything I could about COPD” [26] Increased sense of security • “This is my health. Somebody is helping me to do it.” [20] • “You know at least, if something happens, you know that somebody is monitoring” [20] • “They’re looking after me” [22] • “I’m less anxious because I know someone’s always there on the other end” [25] • “This gives a feeling of security, and when you feel secure, you don’t hyperventilate” [26] Individualized treatment plan Positive • “[The pharmacist] was able to make some adjustments, and we were able to delete some medication and increase some medication and get everything to a nice manageable level.” [19] • “They need that close monitoring. They need someone to ask questions to who can really take the time and listen to them and really work with them to modify the regimen that suits them best” [21] • “His treatment is going to change quicker than it would have done normally” [23] • ‘This made it possible to initiate relevant treatment quickly’ [26] • “I was getting monthly readings and so that’s more intense follow-up” [22] Negative • “it’s not really going to change what we’ll do… I’ll change the medication based on the next HbA1c result” [23] • “we’ll… start throwing too many meds without having an adequate follow-up.” [19] |
Communication | Communication between patient & healthcare professional Positive • “the pharmacist could see and take the time to look at readings…it made the biggest difference in the whole world” [21] • “I think what helped most was the instant feedback they got” [21] • “I do think they feel a lot more confident in partnership with the clinician, so I think it’s actually enhanced the doctor–patient relationship” [22] • ‘They further reported that the close contact with their nurses led to more honest answers and made it generally easier to talk about their health.’ [26] Negative • “The only thing that I do get a little bit peeved about is sometimes when they don’t get back to me.” [25] • “Dr. [name] has only been in touch once” [23] Communication among Clinical staff • “There is always a lack of communication between different characters…” [25] • “The Telehealth team’s trying to do one thing, and the doctors and matrons are doing something totally different. That’s the problem. They’re not really working together” [25] • “the doctor was -he was saying ‘well, am I taking care of your blood pressure, or is the pharmacist?’ He wasn’t even aware that I was part of this study, which might be a little bit of a weakness” [21] |
Technology Feasibility & Acceptability | Convenience & Acceptability Positive • “It’s fantastic. I love it. It’s just so easy to access it quick…it’s just really useful” [22] • “Telehealth is much easier. Whereas you’re phoning a doctor you’ve got to wait, God knows how long!” [25] • “it stops me having to physically go so often to the doctors’ surgery and I would have thought it would save a lot of time on the nursing/doctor side.” [23] • “It’s so much easier we do not have to come to the clinic and can stay at home.” [24] • “if patients are able to see what their readings are in the house and keeping an eye on their weight and looking after their blood pressure…inevitably they will have better controlled diabetes…the time will free up for us.” [23] • “It’s become more personal with this screen … I think it’s an assembly line when you are at the respiratory outpatient clinic” [26] Negative • “I don’t know that I could take my blood pressure 3 times… every morning, and 3 times every night, for the rest of my life…” [19] • “I may be moved and get upset and perhaps cry a little, and I haven’t done that yet in these video consultations. But I know I would if I was sitting opposite and talking with her” [26] Technology feasibility Positive • “I say it is so easy to do once you get into the swing of it” [25] • “For me it’s not difficult … just need to teach (me) that’s all.” [24] • “I had no problems with the program” [19] Negative • “You have to train people from the most basic components of it if we’re going to be successful” [27] • “The… phone would unsync from the blood pressure. (Um-hm) And it would take several tries. Even though it said it paired, it did not pair.” [19] • “it didn’t have any cultural connection, like for my mom.” [27] • “it seems like it was an English translation into Spanish as opposed to a transcultural” [27] • “I already know to take my blood pressure medicine at the same time every day. So the repetitiveness of it just got annoying.” [19] • “Some- times, it would flash all through the day for the same question, which I’ve already answered the first time around…” [25] • “I worry that if they have to type in their readings, that they’re gonna put… you know, wrong numbers.” [19] Barriers of rural areas • “…whether you live in a village where (I feel) it will be very difficult… because (in) certain villages you don’t have (Internet) line” [24] |
Intervention Concerns | Privacy and Security of personal data • “The only thing is, potentially, the confidentiality, if you’re texting back on the phone, as to who could potentially read it…if you were wanting to make some changes … you shouldn’t be doing it over a text anyway.” [22] • “I don’t like all my details like that for everybody to be monitoring. You don’t know who is at the other side….”. [25] • “what I am afraid of is (that the use of telemonitoring may) sometimes (cause) conflicts because it feels like you are being monitored by others.” [24] Generational Differences • ‘younger participants were more inclined to learn and use new technologies’ [24] • “It has to be very simplistic, especially for our older patients.” [19] • “there are a lot of not elderly but more retired people and perhaps less confident at using mobile phones and texting is perhaps a younger population.” [22] • “I’m old (and) I need to write (the results) down. Anyway, as long as someone shows me how to do it, I can do it.” [24] |