Academic journal article Journal of the Association for Information Systems

The Clinical Impact of eHealth on the Self-Management of Diabetes: A Double Adoption Perspective

Academic journal article Journal of the Association for Information Systems

The Clinical Impact of eHealth on the Self-Management of Diabetes: A Double Adoption Perspective

Article excerpt


The development, adoption, and acceptance of eHealth systems that change and improve patient self-care have been promising, but the results have been mixed and the work mostly atheoretical. In this paper, we respond to this opportunity by developing and assessing an eHealth system for newly diagnosed type 2 diabetes patients. Study participants used the eHealth system for a 12-month period after diagnosis in an attempt to acquire an understanding about their diabetes, develop self-care activities (e.g., blood glucose testing), and improve their biomedical outcomes. Drawing upon theories and methods from information systems and upon the Precede-Proceed model of health promotion planning, we explored the double adoption of eHealth technology and its antecedents, self-care practices and their antecedents, and improvements in biomedical outcomes important to long-term diabetes health. Path model results indicate important implications for information systems, eHealth, and health promotion practice and research, which are discussed.

Keywords: Adoption, IT Use, ehealth, Internet, Diabetes, Education, Attitudes, Behavior, Health Outcomes.

1. Introduction

The development, adoption, and acceptance of eHealth systems in changing and improving clinician and patient practices in coordinating self-care have been both promising and difficult. Wickrmasinghe, Geisler, and Schaffer (2005) suggest that many eHealth system implementations may address "complex challenges in trying to deliver cost-effective, high-value, accessible healthcare" (p. 294), but these systems also face numerous problems and the health care sector appears "slow to embrace new business techniques and technologies" (p. 294).

In terms of promises, the trends in the global use of the Internet suggest that patients may be both ready and capable of using eHealth systems for improving their care. Eng (2001) defines eHealth as the use of emerging information and communications technology, especially the Internet, to improve or enable health provision and to facilitate the improvement of individual health. According to the Pew Foundation (as cited in Madden and Fox, 2006), approximately 80 percent of Internet users access health information online, and this information influences their health care decisions and interactions with health care providers.

In response, various attempts to build and adopt information systems (IS) have been aimed at taking advantage of this growing Internet connectivity and use through "eHealth." A number of eHealth systems focusing on education have been accepted and rapidly adopted by health organizations, health care providers, and patients because of perceived cost savings, convenience, and access to information from remote locations (Dawson, 2002). Until recently, studies have shown little difference between eHealth treatment groups and traditional face-to-face control groups in terms of health outcomes (Azar & Gabbay, 2009). This lack of difference combined with the related resource utilization benefit and the increased reach of these systems provide evidence that these technologies are useful. However, the theoretical pathways from eHealth systems use to health-related behaviors, and from the behaviors to health outcomes, have remained largely under studied at both group and individual levels. Therefore, the goals of this study are to highlight what factors affect eHealth use, how eHealth use affects the antecedents of self-care behaviors in chronic disease education and management, and how changes in self-care behaviors affect biomedical outcomes.

IS research has much to offer the theoretical and analytical areas outlined above. Santhanam, Sasidharan, and Webster (2008) specifically state that "IS researchers, with their multidisciplinary focus and ability to integrate social and cognitive processes with technology affordances, are uniquely qualified to study TML [technology-mediated learning]" (p. …

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