“In my age, we didn’t have the computers”: Using a complexity lens to understand uptake of diabetes eHealth innovations into primary care—A qualitative study

Abstract

Background Shared decision-making is a central component of person-centred care and can be facilitated with the use of patient decision aids (PtDA). Barriers and facilitators to shared decision-making and PtDA use have been identified, yet integration of PtDAs into clinical care is limited. We sought to understand why, using the concepts of complexity science. Methods We conducted 60-minute in-depth interviews with patients with diabetes, primary care physicians, nurses and dietitians who had participated in a randomized controlled trial examining the impact of MyDiabetesPlan (an online goal-setting PtDA). Relying on a qualitative description approach, we used a semi-structured interview guide to explore participants’ experiences with using MyDiabetesPlan and how it was integrated into the clinical encounter and clinical care. Audiotapes were transcribed verbatim, then coded independently by two analysts. Findings 17 interviews were conducted (5 physicians, 3 nurses, 2 dietitians, 7 patients). Two themes were developed: (1) MyDiabetesPlan appeared to empower patients by providing tailored patient-important information which engaged them in decision-making and self-care. Patients’ use of MyDiabetesPlan was however impacted by their competing medical conditions, other life priorities and socioeconomic context. (2) MyDiabetesPlan emphasized to clinicians a patient-centred approach that helped patients assume greater ownership for their care. Clinicians’ use of MyDiabetesPlan was impacted by pre-existing clinical tools/workplans, workflow, technical issues, clinic administrative logistics and support, and time. How clinicians adapted to these barriers influenced the degree to which MyDiabetesPlan was integrated into care. Conclusions A complexity lens (that considers relationships between multiple components of a complex system) may yield additional insights to optimize integration of PtDA into clinical care. A complexity lens recognizes that shared decision-making does not occur in the vacuum of a clinical dyad (patient and clinician), and will enable us to develop a family of interventions that address the whole process, rather than individual components. Trial registration ClinicalTrials.gov NCT02379078.

Application of complexity theory in health and social care research: a scoping review

“…Implications encompassed changes in clinical practice delivery such as huddles, 23 recommendations for motivational interviewing 45 and social work practice guidelines for dealing with families with complex needs. 55 From a policy perspective, recommendations included complexity-informed processes for the implementation of local drugs policy 35 and complexity-compatible policies regarding integrated healthcare. 37 Implications for future research were typically in relation to the phenomenon being investigated and reflection on their own methodological limitations, for example, Gear and colleagues 25 note the need for more diversity in the samples regarding intimate partner violence in a primary care setting while another study promoted the use of social network analysis and ethnographic approaches to explore the shifts in interactions following the implementation of a simulation tool within a healthcare CAS.…”

A bibliometric analysis on global eHealth

“… 47 eHealth literacy was significantly correlated with patients’ online information behavior, doctor-patient relationship, patients’ compliance and health outcomes. 48 eHealth tools and eHealth interventions had played an important role in the prevention, diagnosis and treatment of many chronic diseases, such as obesity, 49 rheumatic disease, 50 hypertension, 51 depression, 52 diabetes, 53 cancer patients, 54 psychosis 55 and so on. The population involved included the elderly, 56 adults 57 and children.…”

Usability of Telehealth Systems for Noncommunicable Diseases in Primary Care From the COVID-19 Pandemic Onward: Systematic Review

“…"In my age, we didn't have the computers": Using a complexity lens to understand uptake of diabetes eHealth innovations into primary care-A qualitative study [41] The authors argue that the main barrier to the implementation of telehealth was acceptance by health professionals. They also argue that the lack of support from information technology technicians would be a barrier.…”

“…Mobile-based and cloud-based system for self-management of people with type 2 diabetes: Development and usability evaluation [47] All sampled studies were published in 2021 [37][38][39][40][41][42][43][44][45][46][47]. Eight of the sampled studies were conducted in high-income countries, including Australia (n=2) [39,42], Canada (n=1) [41], the United States (n=2) [37,46], Norway (n=1) [38], Portugal (n=1) [40], and Saudi Arabia (n=1) [45]. Three of the sampled studies were conducted in middle-income countries, including Brazil (n=2) [43,44] and Iran (n=1) [47].…”

“…1 was a quasiexperimental study [44], and 1 was a multisite trial [42]. Furthermore, 7 studies addressed diabetes [38,39,41,43,[45][46][47], 1 addressed diabetes and hypertension [44], and 3 addressed chronic diseases [37,40,42]. All studies focused on primary care.…”