Patient acceptance

Research team

From the University of Sheffield and the University of Manchester

Sarah Gorst
Chris Armitage
Lizzie Coates

Aims

The aim of this workstream was to understand the key barriers and facilitators of patient acceptance of telehealth, and identify the key factors that predict sustained usage of the technology.

Methods

A systematic review of the barriers and facilitators of telehealth acceptance by patients with COPD and CHF was completed. This fed into primary qualitative interviews with 40 patients (and 12 carers) regarding their acceptance and experience of telehealth.

Following this, a patient acceptance questionnaire was developed and refined via the ‘think aloud’ technique in interviews with current telehealth users, and then a two wave survey of patients (263 in wave 1 and 152 in wave 2) was completed across six health service sites in order to identify the key predictors of telehealth acceptance.

Key messages

Home telehealth can provide considerable benefits to people with heart failure and chronic obstructive pulmonary disease, yet evidence suggests that 32% of patients refuse telehealth and 20% abandon it. Identifying the factors that affect whether or not patients take up and continue using telehealth is therefore crucial to the goal of mainstreaming telehealth.

Some patients believe that using telehealth would be unnecessary; therefore it would be useful for healthcare professionals to ensure that patients who are being offered telehealth understand why they are being asked to use it and the benefits it can provide.

Longstanding technical problems can lead patients to question the benefits of telehealth and may lead patients to abandon usage. However, these problems could be minimised by patients having access to well-designed, patient focused telehealth equipment and also good technical support. This would mean that any problems can be quickly resolved, resulting in purely minimal issues for patients, which is consequently likely to facilitate sustained use of telehealth.
A preference for in-person care has been identified as being one of the main barriers to patient acceptance of telehealth. Patients anticipate that using telehealth would result in fewer in-person visits from clinicians.

It may be useful for healthcare providers to offer telehealth to patients at an earlier stage than it is currently offered, before they become accustomed to in-person visits. However, clinicians should also be aware that telehealth is not ideal for all patients and some may never want to use telehealth or be well enough to do so.

Increased access to healthcare services is a key driver of patients’ satisfaction with telehealth. It may be beneficial for clinicians to inform patients that using telehealth would not involve them having to manage their health condition alone, nor would it diminish the contact they have with their healthcare provider, but rather it would lead to more regular and frequent contact. However, some patients will have a preference for in-person care, as a result of the social support provided by nurses.
The majority of patients report better health management as a main benefit of telehealth use. Patients report improvements in self-management as a result of using telehealth, due to having a greater responsibility for their own health. They also report improvements in their health knowledge due to the frequent provision of health status information, which helps them to learn about their health condition.

However, not all patients experience these improvements, particularly those who live alone, and previous research has found self-care to be relatively greater amongst patients who live with others.

It might be useful for healthcare professionals to emphasise the use of telehealth as a tool for self-monitoring to patients considering using telehealth. This recommendation is consistent with both theory and evidence, which show that people who are actively involved in the self-monitoring of their health condition experience improvements in self-management.
Patients deem peace of mind to be a great benefit of using telehealth, as it reduces worry and enables them to feel safer. This finding supports previous research, which has also found that patients felt reassured by having someone ‘watching over them’, and so they report a sense of security in being monitored by telehealth daily. Communicating the potential for peace of mind, to uncertain patients, might be useful in promoting uptake and encouraging usage.
It is possible to develop a tool designed to measure predictors of patient motivation to use telehealth, which has face validity. A telehealth acceptance questionnaire was developed and modified and is now a validated measure, which can be used as a tool by healthcare professionals to assess motivation to use telehealth amongst current users, with the aim of identifying those patients who are likely to abandon telehealth.

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