Stakeholder Perspectives on the Development of a Virtual Clinic for Diabetes Care: Qualitative Study

Abstract

Background The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based “virtual clinic,” which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users.Objective The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management.Methods Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized.Results Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described.Conclusions Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study.

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

“…106 Stakeholders believed that younger diabetic patients or those comfortable with technology would more likely benefit from virtual clinics. 107 It was suggested that adults with low literacy levels could benefit from e-health interventions, although concerns were also expressed around oversimplified interventions being perceived as too basic 108 or that patients might be misunderstood and unable to express themselves adequately in relation to computerised CBT. 98 Online CBT was perceived as particularly beneficial for patients familiar with computers.…”

“…Internet programmes may require some level of basic training and web-based interventions were more accessible to patients who were familiar or comfortable with using the internet. 98,107 Less computer-literate users expressed concerns over being misunderstood 105 and older people reported fear. 105 Evidence of fit with daily life…”

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

“…With improved availability of internet technologies virtual clinics may offer a technology-supported alternative to members of a group being present in person. 139 In addition, the relatively good performance of automated telephone disease management systems as a comparator for group clinics suggests that, for some patients at least, support might be offered via such technologies. 77,78 These weekly, rotating automated (prerecorded) telephone calls take between 6 and 12 minutes to complete with any 'out of range' responses triggering a personal call back by a nurse manager.…”

The patient perspective on the use of information and communication technologies and e-health in rehabilitation

“…Moreover, Vankatesh's Unified Theory of Acceptance and Use of Technology (UTAUT) explains current performance and use behaviour explain a large proportion of the variance in the intention to use a new technology [22,23]. In addition, a few studies identified patients' preferences for e-health in rehabilitation by using a qualitative research design [7,24,25]. These studies found that patients with cancer and diabetes were willing to use ICT in (rehabilitation) care for self-monitoring of symptoms, web-based physical exercise programs [7], communication with peers [24,25] and access to their health record [7].…”

“…In addition, a few studies identified patients' preferences for e-health in rehabilitation by using a qualitative research design [7,24,25]. These studies found that patients with cancer and diabetes were willing to use ICT in (rehabilitation) care for self-monitoring of symptoms, web-based physical exercise programs [7], communication with peers [24,25] and access to their health record [7]. However, a lack of studies with a quantitative design impaired generalization of results and so far it is unclear what usage preferences are for other patient groups in rehabilitation care.…”