Crossing Boundaries: Patients’ Experiences of using a Diabetes eHealth System

Abstract

This thesis is concerned with exploring patients’ experiences of using a diabetes eHealth system. The context of the study is the growth of interest in eHealth systems that focus on patient needs, alongside increasing home computer use and the rising incidence of chronic diseases, such as diabetes. I aim in this thesis to make a novel contribution to knowledge about how eHealth technology is experienced by patients with diabetes. The study takes the form of a qualitative enquiry into the use of a diabetes eHealth system by a group of patients and their healthcare practitioners at a primary care general practice in Northern England. Using symbolic interactionism as a methodological perspective and taking elements from grounded theory the study produces a theoretical framework based on a thematic analysis of participants’ descriptions of their experiences of using the eHealth system.
A diabetes eHealth system was designed and built for the study, and 38 patients were recruited from a single GP practice using purposive sampling. Participants used the system for six months and were interviewed at the beginning, middle and end of the study period. Issues of surveillance, automation, endorsement and interaction influenced use and experiences of the system. Results from the study indicate that participants use and perceive the eHealth system as part of their diabetes management experience. My thesis is that the eHealth system is a boundary structure through which boundary objects, such as electronically formatted blood glucose readings, are created and shared across different social worlds. The eHealth system crosses the boundary between two spheres of an individual’s diabetes management experience, the personal sphere of self-management, and the external sphere of seeking and receiving support from medical experts and others with diabetes. The co-location of these two spheres exposes participants to scrutiny but also opens up new possibilities for collaboration and learning.