Does telehealth promote self-care? A qualitative study examining the experience of older people using telehealth for long-term condition management

Introduction: Telehealth and other technology enabled care services are increasingly aligned with policies promoting self-care and independence in older age, yet there is little evidence that telehealth actually increases self-care behaviour. In fact, emerging evidence suggests that people with long-term health conditions can become fixated on monitoring their health, and dependent on the contact with healthcare staff that telehealth facilitates. Aim: This paper examines the role of telehealth in promoting self-care among people with a longterm health condition. This study is part of a wider research programme, MALT (Overcoming the Barriers to Mainstreaming Assisted Living Technologies), which aims to identify the barriers to and facilitators of delivering telehealth at scale. Methods: Thematic analysis of semi-structured qualitative interviews with 40 older people (12 carers contributing), who were using telehealth as part of their condition management. All participants had a diagnosis of chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF), and had accessed telehealth via a community nurse. Interview data were analysed for emerging themes as well as a priori themes drawn from existing research and conceptual literature about self-care. Results: Managing telehealth in the home was a key theme within the data, with patients adapting their routines and environment to undertake the tasks of monitoring, following up technical issues with equipment, and working in partnership with their nurse in responding to telehealth alerts. The study also found evidence of more informed decision-making among patients as a result of closely monitoring their symptoms with telehealth, which helped to facilitate an increased understanding of their condition, including how to identify and respond to triggers and exacerbations. As a result, patients reported greater confidence in their ability to manage their condition. However, confidence was also derived from the reassurance of knowing that their nurse would respond to a worsening of their symptoms regardless of their own actions. In fact, for many patients, telehealth and the community nurse were viewed as a single entity, and being able to depend on their nurse for support was identified as a key benefit of using telehealth. Conclusions: Telehealth promotes self-care and at the same time encourages dependence. This model of supported self-care was welcomed by people with COPD and CHF, many of whom found it an on-going challenge to be able to predict and detect potential exacerbations and deterioration. Having access to a system that enables people, with the support of a healthcare professional, to better manage the unpredictable nature of their health condition and prevent avoidable hospital admissions as a result, is therefore an important and valued component of long-term condition management.