Elsevier

Health & Place

Volume 21, May 2013, Pages 140-147
Health & Place

Telehealth as ‘peace of mind’: embodiment, emotions and the home as the primary health space for people with chronic obstructive pulmonary disorder

https://doi.org/10.1016/j.healthplace.2013.01.006Get rights and content

Abstract

A theoretical understanding of why some people with chronic obstructive pulmonary disorder (COPD) experienced ‘peace of mind’ when a new telehealth service was introduced into a community respiratory service (CRS) is presented in this article. This is based on analysis of in-depth, qualitative, situated interviews with COPD patients who were receiving the service. Telehealth brought peace of mind through two mechanisms: legitimising contact with health professionals and increased patient confidence in the management of their condition. When the home is the primary health space, the introduction of telehealth can modify emotional and bodily experiences to an extent that is significant for people with COPD. The process by which technology can provide ‘peace of mind’ to people with long term conditions should be taken into account when designing or commissioning a service.

Highlights

► Situated interviews enable researchers to ask people to show and tell us their (health) spaces. ► For people with COPD, their homes become the primary health space as opposed to the clinic. ► They become physically and emotionally dependent on others and on medical technologies. ► In this context, telehealth does not cause extra disruption in the home and brings ‘peace of mind’. ► Telehealth legitimises contact with health professionals and increases self-confidence.

Introduction

This article explores the experience of people with Chronic Obstructive Pulmonary Disorder (pwCOPD) when a new ‘telehealth’ system was installed in their homes to monitor their health. This particular intervention can be seen as part of a wider trend to move medical technologies from the hospital (and other conventional health spaces) to home (NHS Choices, 2011), changing the meanings associated with and experience of both places. Overall, the intervention was enthusiastically received by the patients, who felt that it gave them ‘peace of mind’. In this article, we unpick the reasons for this, by documenting and explaining how introducing a new medical technology into the home served to mitigate some of the key challenges of living with COPD.

Populations are ageing across the industrialized world. In the UK, life expectancy is now at 78 years for men, and 82 years for women (ONS, 2011). Long term conditions (LTCs) are more prevalent, and we must find more efficient ways to finance healthcare services (Department of Health, 2005, World Health Organisation, 2002, Heller, 2003). Chronic Obstructive Pulmonary Disease (COPD) is a common LTC, affecting one person in seven in the UK (British Lung Foundation, 2012). It is a major cause of morbidity and mortality in the UK and worldwide (Lopez et al., 2006), costing the English National Health Service (NHS) an excess of £800 m per year (Department of Health, 2010). Symptoms include long-term, chesty cough, wheeze, phlegm, breathlessness, anxiety and/ or depression (British Lung Foundation, 2012). COPD is a life-limiting condition with severe physical effects and associated with psychological distress, feelings of loss, dependency on medication, disruption to social and family life, low self esteem (Nicolson and Anderson, 2003), loss of control (Simpson et al., 2009), anxiety and fear of breathlessness (Rozenbaum, 2008). Research on the experience of pwCOPD has identified the deployment of coping strategies such as acceptance (Pols and Willems, 2011), adaptation, and increased reliance on spiritual or religious resources to help manage their condition (Seamark et al., 2004). The experiences of exacerbations, which tend to require hospitalisation, are often distressing and patients have expressed the need for more support from healthcare professionals (HCPs) (Jarrold and Eiser, 2010, Polisena et al., 2010). On the basis of this evidence, there have been calls to improve self care amongst patients to reduce the occurrence of such exacerbations (Barlow et al., 2007, Connolly et al., 2006), such as through telehealth.

Telehealth allows healthcare professionals to monitor patients' health through the use of telecommunications. There have been many ‘promises’ made about the potential of telehealth technologies to improve the quality of care, reduce costs and solve workforce shortages, alongside warnings that telehealth devalues the interpersonal aspects of care (Pols and Willems, 2011). A recent systematic review tentatively suggested that home telehealth could reduce the rate of hospitalisation for patients with COPD, but was limited by the quality of the studies included (Polisena et al., 2010). The European Commission Communication on Telemedicine has highlighted that although there is potential for telehealth to benefit in the management of COPD, further good quality research is needed (Mckinstry et al., 2009).

Small scale pilots (Holt, 2007, Mair et al., 2008, Waddington and Downs, 2005, Horton, 2008) as well as qualitative studies included as part of a small randomised controlled trials (Hibbert et al., 2004, Lyndon and Tyas, 2010, Whitten and Mickus, 2007) have been carried out throughout the UK examining the impact of telehealth in people with COPD, and those managing their care. The mode of telehealth has included video links and telephone monitoring, with either call centres or hospital nursing staff triaging the readings. These studies show a mixed result in terms of benefits to patients and staff. One study highlighted problems in actually recruiting COPD patients to take part on a trial of telecare, as patients were worried about losing face to face contact with clinical staff (Annandale and Lewis, 2011). In other studies, patients have reported generally positive outcomes: telehealth is a good way for them to receive care, gives them continuity of and rapid access to care, helps them have greater peace of mind, improves management of their condition and prevents them from having to go into hospital (Holt, 2007, Horton, 2008, Lyndon and Tyas, 2010, Whitten and Mickus, 2007). However, these studies have tended to remain descriptive, using simple questionnaire data, or relied on staff views of the patient experience to gain an insight into patient views. Research on staff views has shown mixed results: some found that telehealth undermined nurses' core values because it limited their face-to-face contact with patients (Hibbert et al., 2004), or found that staff lacked confidence in the safety of the equipment (Annandale and Lewis, 2011), while others found that the telehealth service helped HCPs to increase their capacity enabling them to focus on acutely ill patients, as well acting as a system to detect early signs of deterioration (Lyndon and Tyas, 2010).

In Sandwell, a deprived borough of the West Midlands, UK, a new telehealth intervention was introduced within a nurse-led community respiratory service (CRS). A brief survey conducted with the telehealth users had indicated high levels of satisfaction with the service (Lauder, 2011). The aim of this study was to document people with COPD's experience and interaction with the technology, in order to understand how they negotiated incorporating telehealth technologies into their everyday life and home space, and to understand why they valued it.

Section snippets

Study design

The central purpose of telehealth is that interventions that have previously been conducted in hospital or other formal healthcare spaces are moved into the home. In medical sociology and geography there has been an explosion of interest in methods to elicit data (in the form of talk) from people in context, usually their neighbourhood contexts, though the use of ‘walking’ or ‘go-along’ interviews (Evans and Jones, 2011, Carpiano, 2009, Jones and Evans, 2012, Jones et al., 2008, Mcdonald, 2005,

Findings

The traditional distinction between the ‘home’ and the ‘clinic’ in terms of their characteristics as ‘health spaces’, that constrain and enable certain types of health practices, is problematized in the context of people living with COPD. This is because pwCOPD often have severely restricted mobility and so spend a large proportion of their time at home, and they are subject to a complex regime of pharmaceuticals and other health technologies, which must be administered throughout the day. We

Discussion

In summary, we explore the experience of current users of the telehealth services (a group who had previously reported high satisfaction of the service) to understand why they valued it. Our main findings were that pwCOPD had transformed their personal living space into a highly technical health space in order to manage their condition and within this context the new medical technology, telehealth, was absorbed relatively unproblematically. The acceptability of the telehealth was reinforced

Conclusions

Overall, our study found that positive experiences of telehealth can be explained because it helped pwCOPD to legitimise contact with their healthcare providers, and increased their confidence in being able to manage their condition, which resulted in greater peace of mind. The use of ‘situated interviewing’ enabled participant accounts to be collected in a way that was participant-led and sensitive to place, because people could show and tell us about their (health) spaces, and the effects of

Acknowledgements

This work was funded by the National Institute for Health Research (NIHR) though the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme. The views expressed in this publication are not necessarily those of the NIHR, the Department of Health, NHS Partner Trusts, University of Birmingham, or the CLAHRC-BBC Management Group. The authors would like to thank Pam Price, Nathan Lauder and Carl Griffin for their input.

References (39)

  • A.D. Lopez

    Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data

    Lancet

    (2006)
  • B. Mckinstry et al.

    Telemedicine for management of patients with COPD?

    Lancet

    (2009)
  • J. Annandale et al.

    Can telehealth help patients with COPD?

    Nursing Times

    (2011)
  • J. Barlow et al.

    A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions

    Journal of Telemedicine and Telecare

    (2007)
  • British Lung Foundation,2012. COPD. British Lung Foundation. Available from:...
  • M. Bury

    Chronic illness as biographical disruption

    Sociology of Health and Illness

    (1982)
  • R. Carpiano

    Come for a walk with me: the “go-along” interview as a novel method for studying the implications of place for health and well-being

    Health and Place

    (2009)
  • Communities and Local Government, 2011. The English Indices of Deprivation 2010. 24th March, Available from:...
  • M.J. Connolly

    Admissions to hospital with exacerbations of chronic obstructive pulmonary disease: effect of age related factors and service organisation

    Thorax

    (2006)
  • Department of Health, 2010. Facts about COPD. Department of Health. 23 February, Available from:...
  • Department of Health, 2005.Independence, well-being and choice: our vision for the future of social care for adults in...
  • J. Evans et al.

    The walking interview: methodology, mobility and place

    Applied Geography

    (2011)
  • Heller, P.S., 2003. Time is ticking away to solve long-term fiscal challenges posed by aging societies, climate change,...
  • D. Hibbert

    Health professionals' responses to the introduction of a home telehealth service

    Journal of Telemedicine and Telecare

    (2004)
  • F. Holt

    Making a difference with a telehealth service

    British Journal of Nursing

    (2007)
  • K. Horton

    The use of telecare for people with chronic obstructive pulmonary disease: implications for management

    Journal of Nursing Management

    (2008)
  • I. Jarrold et al.

    BLF and BTS Ready for home survey of patients admitted to hospital with copd: the hospital experience

    Thorax

    (2010)
  • P. Jones

    Exploring space and place with walking interviews

    Journal of Research Practice

    (2008)
  • P. Jones et al.

    The spatial transcript: analysing mobilities through qualitative gis

    Area

    (2012)
  • Cited by (46)

    • Perceptions of patients with chronic obstructive pulmonary disease towards telemedicine: A qualitative systematic review

      2021, Heart and Lung
      Citation Excerpt :

      One patient said, “no, I'm alright, but if that [telehealth] tells us to ring, we'll ring”.35 The communication is more appropriate and convenient than face-to-face interactions, and it reduced the amount of time spent waiting for treatment and made patients more relaxed.1435 As one patient put it, “you will not be treated like a child”.32

    View all citing articles on Scopus
    View full text