Background
Methods
Phase one: discourse analysis and comparison of THLs with the available guidance
Source/Leaflet | Leaflet title | Organisation |
---|---|---|
THL1 | Supporting your independence and wellbeing with telehealth and telecare | NHS- 3million lives project |
THL2 | Telehealth- Information for patients and carers | NHS- Wandsworth Clinical Commissioning Group |
THL3 | Telehealth- ‘A new way to support your health care at home’. | NHS- Wales |
THL4 | Would you like to take control of your condition? | NHS- South West Yorkshire Partnership NHS Foundation Trust and Bassetlaw Clinical Commissioning Group |
THL5 | Telehealth Patient Information Leaflet. | NHS- Sunderland Teaching Primary Care Trust. |
THL6 | Telehealth in Bournemouth, Poole and Dorset. | NHS Bournemouth and Poole and NHS Dorset. |
THL7 | Telehealth- Supporting you to live more safely at home | Involve Yorkshire and Humber |
THL8 | Managing Long-Term Conditions- Patients Choice | NHS- East London NHS Foundation Trust |
THL9 | Telehealth monitoring | NHS- Bristol Community Health |
Patient guide | ||
THL10 | The Long Term Conditions Psychological Support Service | NHS- Northamptonshire Healthcare NHS Foundation Trust |
Patient Information Leaflet | ||
THL11 | The Human Touch | NHS- Kent Community Health NHS Trust. |
Transforming Community Services in Kent. | ||
THL12 | Telehealth | Medvivo |
Aiding healthy independence | Integrating Health and Care |
Phase two: semi-structured interviews
Patients characteristics | Number of participants (out of n = 14) | |
---|---|---|
Age group | 21–30 years | 4 |
31–40 years | 1 | |
41–50 years | 1 | |
51–60 years | 2 | |
61–70 years | 2 | |
71–80 years | 3 | |
81–90 years | 1 | |
Gender | Male | 9 |
Female | 5 | |
Diseases/Illnesses | Type 1 diabetes | 3 |
Type 2 diabetes | 1 | |
Type 2 diabetes and hypertension | 4 | |
Type 1 diabetes, high blood pressure and kidney transplant | 1 | |
Asthma and other conditions | 4 | |
COPD & hypertension | 1 |
Ethical consideration
Results
Discourse analysis and comparison with THL guidance
Theme | Guidance criteria | No of Leaflet(s) matching the criteria |
---|---|---|
• Knowledge | • What is telehealth? | • 8 (THL1, THL2, THL3, THL5, THL6, THL7, THL9, THL12) |
• How does telehealth work? | • 8 (THL1, THL2, THL3, THL5, THL6, THL7, THL9, THL12) | |
• Outcomes | • What will be done about the results? | • 6 (THL1, THL2, THL3, THL5, THL7, THL9) |
• Reassurance | • Technology and equipment (ease of use): reassure patients that they do not need to be computer or technology experts. | • 7 (THL2, THL3, THL4, THL5, THL6, THL7, THL9) |
• Support regarding technical problems. | • 5 (THL2, THL3, THL6, THL9, THL12) | |
• Confidentiality: state it directly and clarify who gets to see patients monitoring results | • 2 (THL3, THL5) | |
• Costs: mention that the service is free for the patient. | • 7 (THL3, THL4, THL5, THL6, THL7, THL9, THL10) | |
• Benefits | • What are the benefits of telehealth? | • 9 (THL1, THL2, THL3, THL4, THL6, THL7, THL8, THL9, THL11) |
• Choice | • State that the service is not a substitute for the traditional face-to-face consultations and patients still have the choice of seeing their HCPs when required. Telehealth is an extra service and not a substitute for emergency services. | • 6 (THL2, THL3, THL5, THL6, THL7, THL8) |
• Previous Experience | • Patients positive quotes about telehealth These quotes provide a source of effective communication of patients’ good experience with telehealth services and consequently will encourage other potential service users. | • 4 (THL2, THL4, THL7, THL9) |
• Further Information | • Who to contact for further information about the service in general: there will be somebody to help/ guide the user to understand e.g.: HCP or someone at end of phone. | • 10 (THL1, THL2, THL3, THL4, THL5, THL6, THL7, THL8 THL10, THL11) |
• Information availability in other languages/formats. | • 3 (THL2, THL5, THL7) | |
• Appearance | • Visual Presentation using pictures, not only words. Recommended: Variety of pictures to be included most importantly pictures of how the kit works; patients using the kits at home: images showing different ages, ethnicity and gender of people using the kit. | • 8 (THL2, THL3, THL5, THL6, THL7, THL8, THL9, THL12) |
Leaflet | Number of criteria met by each leaflet (n = out of 13) | Percentage of criteria met by each leaflet |
---|---|---|
THL1 | 5 | 38% |
THL2 | 11 | 85% |
THL3 | 11 | 85% |
THL4 | 5 | 38% |
THL5 | 10 | 77% |
THL6 | 9 | 69% |
THL7 | 11 | 85% |
THL8 | 4 | 31% |
THL9 | 9 | 69% |
THL10 | 2 | 15% |
THL11 | 2 | 15% |
THL12 | 4 | 31% |
Depiction of telehealth service
Portrayed description of the telehealth service | Leaflets |
---|---|
Small unit | THL1 |
New, user-friendly system | THL2 |
A home hub | THL3 |
A special piece of equipment | THL4 |
A small monitor | THL5 |
The homepod | THL6 |
A small pieces of equipment | THL7 |
Using a small hand held device | THL9 |
The Human Touch | THL11 |
Remote health monitoring | THL12 |
Outcome of using telehealth services
“Your readings are sent automatically to a response centre where any abnormal readings are identified. If this happens your GP or healthcare professional will be informed and make contact with you to take any necessary action.” [THL2]
Reassurance about telehealth in the leaflets
“The equipment is easy to use and you will not need any specific technical skills to operate it.” [THL6].
“Your information is confidential and will only be seen by the telehealth monitoring team” [THL5]
Portrayed message regarding the cost of the telehealth service | Leaflets |
---|---|
“The information will be sent by a telephone to a secure computer… These telephone calls will not cost you anything as they use an 0800 freephone number.”
| THL3 |
“The service is led by a dedicated team of nurses, it’s totally free ….”
| THL4 |
“The monitor will use your existing telephone line and the information is sent using a free phone number so there will be no call charges.”
| THL5 |
“The equipment will be provided free of charge… and will be maintained again free of charge”.
| THL6 |
“It is free….”
| THL7, THL10 |
Telehealth is part of the ongoing support you will receive from your healthcare team and there is no cost for using it.”
| THL9 |
Benefits of telehealth
“Telehealth has helped thousands of patients with similar conditions across the UK and we believe this is a great step forward to help you stay at home, stay healthy and self-manage your condition so you have fewer unplanned hospital admissions” [THL6]
Patients’ choices in using telehealth
Portrayed message addressing patients’ choice in the telehealth service | Leaflets |
---|---|
“A telehealth system is not a substitute for making contact with a health care professional if someone feels unwell. Appropriate advice must be sought at the earliest opportunity”.
| THL2 |
“It is important to remember that Telehealth does not replace emergency or normal GP services”.
| THL3 |
“However, this does not give an immediate alert and you should call your usual emergency contact if you feel unwell.”
| THL5 |
“You should be aware that this does not need to be a permanent arrangement and you are able to stop using the equipment when you feel the time is right. You can discuss this with your healthcare professional.”
| THL6 |
’Telehealth is not an emergency service or a replacement for visiting health professionals”.
| THL7 |
“Please remember that our telehealth service is not itself an emergency rather than it aims to help you understand how best to manage your condition”
| THL8 |
Patients’ positive experiences
“Telehealth has been great. I know when I’m becoming unwell and feel very supported”. [Diabetes patient- THL2]
Contact for further information
Appearance of the leaflets
Semi-structured interviews
Telehealth perceived as a means for regular health monitoring/checks
“Enables doctors to monitor you with you just being at home …” (Patient 1)
Simple alternative terminologies to telehealth
“To be honest, I don’t think many people understand the word telehealth, whereas if you use something that is more familiar, will actually make feel like they need it. For example, it’s an emergency, you know in the hospital when you feel it’s an emergency. So they may see it as home monitoring rather than what it really is, which to see from afar whether or not they are deteriorating”. (Patient 1)
Essential information within THLs
“ It should be made very clear that it’s free…..You know some people need very clear cut words to say it is actually free and for installation they are coming to do this and that, with clear instructions”. (Patient 2)
“Reassurance to patients that professionals will teach or instruct them on how to use the equipment”. (Patient 4)
“More description using simple words to aid understanding of readers with second language”. (Patient 9)
Perceived limitations of telehealth
“Not sure where your information is going to and who would have access to them…” (Patient 12)
“Firstly, technology can breakdown….” (Patient 3)
“I suppose becoming too reliant on it, you know like every second you are not sure of something, may be your blood pressure you want to strap it around your arm. I don’t think this is healthy” (Patient 6)
Textual and pictorial presentation preferred for THLs
“The design of the leaflet using both text and pictures would be a good idea because some people are good readers and some like pictures”. (Patient 2)
“Better with both pictures and texts.” (Patient 4)
“A combination of both pictures and texts is mostly preferred.” (Patient 8)