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A qualitative analysis of remote patient monitoring: how a paradox mindset can support balancing emotional tensions in the design of healthcare technologies

Zoe Jonassen, Katharine Lawrence, Batia Mishan Wiesenfeld, Stefan Feuerriegel, Devin Mann

TL;DR

This work performs the first qualitative study to explore the emotional needs of diverse patients around RPM, and identifies emotional needs that lead to four emotional tensions within and across stakeholder groups when applying an equity focus to the design and implementation of RPM technologies.

Abstract

Remote patient monitoring (RPM) is the use of digital technologies to improve patient care at a distance. However, current RPM solutions are often biased toward tech-savvy patients. To foster health equity, researchers have studied how to address the socio-economic and cognitive needs of diverse patient groups, but their emotional needs have remained largely neglected. We perform the first qualitative study to explore the emotional needs of diverse patients around RPM. Specifically, we conduct a thematic analysis of 18 interviews and 4 focus groups at a large US healthcare organization. We identify emotional needs that lead to four emotional tensions within and across stakeholder groups when applying an equity focus to the design and implementation of RPM technologies. The four emotional tensions are making diverse patients feel: (i) heard vs. exploited; (ii) seen vs. deprioritized for efficiency; (iii) empowered vs. anxious; and (iv) cared for vs. detached from care. To manage these emotional tensions across stakeholders, we develop design recommendations informed by a paradox mindset (i.e., "both-and" rather than "and-or" strategies).

A qualitative analysis of remote patient monitoring: how a paradox mindset can support balancing emotional tensions in the design of healthcare technologies

TL;DR

This work performs the first qualitative study to explore the emotional needs of diverse patients around RPM, and identifies emotional needs that lead to four emotional tensions within and across stakeholder groups when applying an equity focus to the design and implementation of RPM technologies.

Abstract

Remote patient monitoring (RPM) is the use of digital technologies to improve patient care at a distance. However, current RPM solutions are often biased toward tech-savvy patients. To foster health equity, researchers have studied how to address the socio-economic and cognitive needs of diverse patient groups, but their emotional needs have remained largely neglected. We perform the first qualitative study to explore the emotional needs of diverse patients around RPM. Specifically, we conduct a thematic analysis of 18 interviews and 4 focus groups at a large US healthcare organization. We identify emotional needs that lead to four emotional tensions within and across stakeholder groups when applying an equity focus to the design and implementation of RPM technologies. The four emotional tensions are making diverse patients feel: (i) heard vs. exploited; (ii) seen vs. deprioritized for efficiency; (iii) empowered vs. anxious; and (iv) cared for vs. detached from care. To manage these emotional tensions across stakeholders, we develop design recommendations informed by a paradox mindset (i.e., "both-and" rather than "and-or" strategies).

Paper Structure

This paper contains 30 sections, 4 figures, 1 table.

Table of Contents

  1. Introduction
  2. Related Work
  3. Promoting Health Equity with RPM
  4. Needs of Diverse Patients Groups Using RPM
  5. Human-Centered Design Approaches to Understand Emotional Needs Around Digital Health Technologies
  6. Method
  7. Overview of Research Approach
  8. Study Context
  9. Healthorg Approach to Designing and Implementing RPM Technologies
  10. Data Collection
  11. Retrospective interviews
  12. Prospective focus groups
  13. Real-time observations
  14. Data Analysis
  15. Ethical Considerations
  16. ...and 15 more sections

Figures (4)

  • Figure 1: Illustration of step-wise analysis process of the data
  • Figure 2: Design and implementation process of RPM at Healthorg. Circle in the middle represents the emotional needs of diverse patients. Double arrows show emotional tensions that emerged in the design and implementation of RPM when addressing diverse patients’ emotional needs and other stakeholders’ demands.
  • Figure 3: Mentioning of emotional needs and tensions per stakeholder, split into the four stakeholder groups. T1 to T4 represent the four tensions. The pluses and minuses behind the T's indicate whether a need was met versus unmet. For example, all four designers mentioned that diverse patients felt seen (T2$+$), while only one of them mentioned that patient efficiency needs were prioritized (T2$-$).
  • Figure 4: Frequency of emotional needs and tensions mentioned per stakeholder group. For example, patient focus groups mentioned T4$-$ a total of 28 times.