How Technology in Care at Home Affects Patient Self-Care and Self-Management: A Scoping Review

The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.

[1]  K. Lorig,et al.  Self-management education: History, definition, outcomes, and mechanisms , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[2]  Kathryn H. Bowles,et al.  Applying Research Evidence to Optimize Telehomecare , 2007, The Journal of cardiovascular nursing.

[3]  S. Zwijsen,et al.  Ethics of using assistive technology in the care for community-dwelling elderly people: An overview of the literature , 2011, Aging & mental health.

[4]  Enrique J. Gómez,et al.  Telemedicine as a tool for intensive management of diabetes: the DIABTel experience , 2002, Comput. Methods Programs Biomed..

[5]  Helen Hoenig,et al.  Does assistive technology substitute for personal assistance among the disabled elderly? , 2003, American journal of public health.

[6]  M. Jaana,et al.  Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. , 2007, Journal of evaluation in clinical practice.

[7]  T. Vontetsianos,et al.  Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: Preliminary results after nine-month follow-up , 2005, Journal of telemedicine and telecare.

[8]  Norma J. Stumbo,et al.  Assistive technology: Impact on education, employment, and independence of individuals with physical disabilities , 2009 .

[9]  Guy Paré,et al.  Review Paper: Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base , 2007, J. Am. Medical Informatics Assoc..

[10]  Dorothy J. Wilson,et al.  Effects of Assistive Technology on Functional Decline in People Aging With a Disability , 2009, Assistive technology : the official journal of RESNA.

[11]  R. Hofmann-Wellenhof,et al.  Pilot study on the acceptance of mobile teledermatology for the home monitoring of high‐need patients with psoriasis , 2012, The Australasian journal of dermatology.

[12]  Louise Laframboise,et al.  A Technological Life Buoy: Patient Perceptions of the Health Buddy , 2009, The Journal of cardiovascular nursing.

[13]  Teaching Self-Management of Diabetes Via Telehomecare , 2002, Home healthcare nurse.

[14]  Rupa S. Valdez,et al.  Technology-enhanced practice for patients with chronic cardiac disease: home implementation and evaluation. , 2010, Heart & lung : the journal of critical care.

[15]  L. Cardozo,et al.  Telemedicine for recently discharged older patients. , 2010, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[16]  B. Riegel,et al.  A Situation-Specific Theory of Heart Failure Self-care , 2008, The Journal of cardiovascular nursing.

[17]  R. Orpwood,et al.  Using Smart Technology in an Enabling Way: A Review of Using Technology to Support Daily Life for a Tenant with Moderate Dementia , 2011 .

[18]  Richard Curry,et al.  Meeting government objectives for telecare in moving from local implementation to mainstream services , 2005, Journal of telemedicine and telecare.

[19]  Elsa Marziali,et al.  E-health program for patients with chronic disease. , 2009, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[20]  K. Dansky,et al.  Is there a business case for telehealth in home health agencies? , 2006, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[21]  J. M. Peeters,et al.  Key factors influencing the implementation success of a home telecare application , 2012, Int. J. Medical Informatics.

[22]  H. Skolnick,et al.  SYMPTOM MONITORING IN CHILDHOOD ASTHMA: A RANDOMIZED CLINICAL TRIAL COMPARING PEAK EXPIRATORY FLOW RATE WITH SYMPTOM MONITERING , 2003, Pediatrics.

[23]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[24]  William C Mann,et al.  The association of home-telehealth use and care coordination with improvement of functional and cognitive functioning in frail elderly men. , 2004, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[25]  A. Rogers,et al.  Integration of devices into long-term condition management: a synthesis of qualitative studies , 2008, Chronic illness.

[26]  C. Wright,et al.  Self-management approaches for people with chronic conditions: a review. , 2002, Patient education and counseling.

[27]  S. Kendall,et al.  Nurses' responses to expert patients: the rhetoric and reality of self-management in long-term conditions: a grounded theory study. , 2006, International journal of nursing studies.

[28]  Jennifer L Pecina,et al.  Telemonitoring increases patient awareness of health and prompts health-related action: initial evaluation of the TELE-ERA study. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[29]  Kathryn H Bowles,et al.  The effect of telehomecare on heart failure self care. , 2010, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[30]  Mindy Benson,et al.  Improving asthma outcomes and self-management behaviors of inner-city children: a randomized trial of the Health Buddy interactive device and an asthma diary. , 2002, Archives of pediatrics & adolescent medicine.

[31]  E. Hui,et al.  Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial , 2006, Journal of telemedicine and telecare.

[32]  N. Kearney,et al.  Results of a UK based pilot study of a mobile phone based advanced symptom management system (ASyMS) in the remote monitoring of chemotherapy related toxicity , 2005 .

[33]  Ching-Kuan Liu,et al.  Development of a home‐based telehealthcare model for improving the effectiveness of the chronic care of stroke patients , 2012, The Kaohsiung journal of medical sciences.

[34]  W. Mann,et al.  Feasibility of Machine-Based Prompting to Assist Persons With Dementia , 2009, Assistive technology : the official journal of RESNA.

[35]  Kathryn Bowles,et al.  Use of telehealth by older adults to manage heart failure. , 2008, Research in gerontological nursing.

[36]  D. Gould,et al.  What are scoping studies? A review of the nursing literature. , 2009, International journal of nursing studies.

[37]  D. Levac,et al.  Scoping studies: advancing the methodology , 2010, Implementation science : IS.

[38]  Maria J Grant,et al.  A typology of reviews: an analysis of 14 review types and associated methodologies. , 2009, Health information and libraries journal.

[39]  MinKyoung Song Diabetes Mellitus and the Importance of Self-care , 2010, The Journal of cardiovascular nursing.

[40]  Margaret Grey,et al.  Processes of self-management in chronic illness. , 2012, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[41]  Joseph Finkelstein,et al.  Home-based physical telerehabilitation in patients with multiple sclerosis: a pilot study. , 2008, Journal of rehabilitation research and development.

[42]  Joseph Finkelstein,et al.  Implementing home telemanagement of congestive heart failure using Xbox gaming platform , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[43]  K. Shea,et al.  Telehomecare communication and self-care in chronic conditions: moving toward a shared understanding. , 2012, Worldviews on evidence-based nursing.

[44]  Guy Paré,et al.  Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[45]  M. Bujnowska-Fedak,et al.  The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[46]  Polly Ryan,et al.  The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes. , 2009, Nursing outlook.

[47]  A. Mihailidis,et al.  The COACH prompting system to assist older adults with dementia through handwashing: An efficacy study , 2008, BMC geriatrics.

[48]  H. Arksey,et al.  Scoping studies: towards a methodological framework , 2005 .