Digitized patient–provider interaction: How does it matter? A qualitative meta-synthesis

Abstract

Sociological interest in the digitization of health has predominantly been studied using qualitative approaches. Research in this field has grown steadily since the late 1990's but to date, no synthesis has been conducted to integrate this now rather comprehensive corpus of data. In this paper we present a meta-ethnography of 15 papers reporting qualitative studies of digitally mediated patient - professional interactions. By dissecting the detailed descriptions of digitized practices in this most basic relationship in health care, we explore how these studies can illuminate important aspects of social relations in contemporary society. Our interpretative synthesis enables us to reassert a sociological view that places changes in social structures and interaction at the core of questions about the digitization of health care. Our synthesis of this literature identifies four key concepts that point at structural processes of change. We argue that when patient-professional interactions are digitized, relations are respatialized, and there are reconnections of relational components. These lead to empirically specific reactions, which can be characterized as reconstitutions and renegotiations of social practices which in turn are related to the reconfiguration of basic social institutions. We propose a new direction for exploring the digitalization of health care to illuminate how digital health is related to contemporary social change.

Experiences of computer‐based and conventional self‐help interventions for eating disorders: A systematic review and meta‐synthesis of qualitative research

“…The perceived neutrality and distance between the computer and the user supports the need for a nonjudgmental environment which may be particularly pertinent in EDs, given high levels of self‐criticism, shame, guilt and embarrassment found (Frank, ), as well as potentially negative experiences from past help‐seeking attempts. Another unique merit of such interventions is the reconfiguration of treatment time and space, a concept also identified in an earlier meta‐synthesis on digitization and healthcare infrastructure (Andreassen, Dyb, May, Pope, & Warth, ). These authors described how through e‐health, there is a transferal of clinical spaces into domestic spaces.…”

“…These authors described how through e‐health, there is a transferal of clinical spaces into domestic spaces. This could be problematic, especially as this change could make their mental health difficulty more pronounced at home (Andreassen et al, ). For example, in the ED context, the concept of “home” becoming a clinical space is potentially complex, as struggles with food often occur in domestic spaces, such as kitchens and bedrooms.…”

Use of virtual consultations in an orthopaedic rehabilitation setting: how do changes in the work of being a patient influence patient preferences? A systematic review and qualitative synthesis

“…We found that having rehabilitation in the patient's own environment was preferred by some although bringing the clinical space into the patient's home can change the meaning of their home for them. 35 Greenhalgh et al 36 consider, among other things, what is expected of the patient when using new technologies and explains that complex tasks are more likely to lead to non-adoption.…”

Round hole, square peg: social inequalities and the political legitimization of health technology in Norway, a critical discourse analysis

“…This is presented as a means of freeing the individual from using traditional, institutionalized services and empowering (or challenging) users to gain increased control over their own health and activities of daily living. However, this independence from traditional, institutionalized services also increases daily dependence on technological aids, in some cases using the empowerment discourse as a justification for creating entirely new technologically dependent interventions, including replacing activities not traditionally delivered by the health sector (6,7). This type of "personalized," rather than "institutionalized," dependence on technological aids also has the potential to increase individual dependence on the, often commercial, producers of these technologies and the consequences this dependence may promote, as Lupton has also highlighted and discussed in detail (2,46).…”

“…Although technological innovations have proven, in many cases, to be extremely useful and effective, their undisputed development and adoption opens for a myriad of unanticipated, undesirable consequences that threaten to undermine their aggregate social value. Recent research has begun to investigate and document these effects, presenting a complex picture of health technologies (2,3,(5)(6)(7)(8). These consequences are increasingly being recognized as mechanisms that have the potential to (re)produce social inequalities in health (4,(9)(10)(11)(12).…”