Tackling the digital divide: Exploring the impact of ICT on managing heart conditions in a deprived area

Abstract

Background: Cognitive Muscular TherapyTM (CMT) is an integrated behavioural intervention developed for knee osteoarthritis. CMT teaches patients to reconceptualise the condition, integrates muscle biofeedback and aims to reduce muscle overactivity, both in response to pain and during daily activities. This nested qualitative study explored patient and physiotherapist perspectives and experiences of CMT.Methods: Five physiotherapists were trained to follow a well-defined protocol and then delivered CMT to at least two patients with knee osteoarthritis. Each patient received seven individual clinical sessions and was provided with access to online learning materials incorporating animated videos. Semi-structured interviews took place after delivery/completion of the intervention and data were analysed at the patient and physiotherapist level.Results: Five physiotherapists and five patients were interviewed. All described a process of changing beliefs throughout their engagement with CMT. A framework with three phases was developed to organise the data according to how osteoarthritis was conceptualised and how this changed throughout their interactions with CMT. Firstly, was an identification of pain beliefs to be challenged and recognition of how current beliefs can misalign with daily experiences. Secondly was a process of challenging and changing beliefs, validated through new experiences. Finally, there was an embedding of changed beliefs into self-management to continue with activities. Conclusion:This study identified a range of psychological changes which occur during exposure to CMT. These changes enabled patients to reconceptualise their condition, develop a new understanding of their body, understand psychological processes, and make sense of their knee pain.

Enabling healthy choices: is ICT the highway to health improvement?

“…This project addressed an important gap in the literature on e-health and is one of the few of its kind to distribute home computers and free Internet access among an older group of heart patients in a deprived area. Past research has tended to focus on the use of the Internet for health information among those who already have a computer while less is known about the impact on health behaviour change among older populations in a deprived area (Diaz et al, 2002;Lindsay et al, 2007). Further, there are few randomized controlled trials assessing the impact of online health portals on behaviour change.…”

“…Yet health promotion through the Internet may be particularly valuable to groups vulnerable to poor health who are isolated by chronic illness and live in deprived areas. Little is known about Internet use for health purposes among such groups, because few of them have access to it (Lai et al, 2004;Lindsay et al, 2007). Thus, the realistic potential of Internet access for this purpose is yet to be assessed (Kleinke, 2000).…”

“…Using the Internet for health promotion might provide people with the opportunity to exchange information, share illness experiences and promote a sense of shared strength among group participants (Bliss et al, 1998;Lindsay et al, 2007). In general, communication over the Internet is at least as important as fi nding information there for home users, especially for older age groups.…”

“…They seek to develop patients' quality of life and skills to work in partnership with health professionals (Department of Health, 2001;Wilson, 2001). In principle, expert patients should make less and better use of health professionals' time, have less severe symptoms, more confi dence, resourcefulness and self-effi cacy (Tattersall, 2002;Wheeler, 2003;Shaw and Baker, 2004;Lindsay et al, 2007). An 'expert patient' agenda is based on patients having quality information, good knowledge-processing skills and appropriate social networks.…”

Chronic Disease Management for Recently Homeless Veterans

“…Veterans in HUD-VASH live in dispersed community apartments where they may have limited social support and transportation access. As health information technologies (HIT) can offer in-home health education and disease promotion, 8 we aimed to apply and test an existing VA HIT program that provides care management for Veterans in HUD-VASH.…”