Navigating the care system : feasibility and acceptability of the use of ICT to support older people with multimorbidity

• Main Author: Vos, Jolien
• Other Authors: Windle, Karen
• Published: University of Lincoln 2017
• Subjects: 362.19897; L510 Health & Welfare
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.721922

Health and social care systems, primarily designed for people with single diseases rather than those with multimorbidity (two or more long-term conditions [LTCs]), are becoming more complex. With increases in the older population, a rise of multimorbidity and greater fragmentation in the care landscape, little is known about how multimorbidity affects the patient’s task to find appropriate care in the right place and at the right time (i.e. care navigation). Difficulties in care navigation have proven to cause delays in access and use of inappropriate services. For older individuals with a number of LTCs, there is an urgent need to support them in appropriately navigating the care system to maximise their health and wellbeing. Using a mixed method design, this study aims to map the personal care network (PCN) of older people (aged 55 years and over) with multimorbidity. It explores the use of Information and Communication Technologies (ICT) to support this patient group in finding their way through the care system. The research involves three stages, addressing the overall question: “Navigating the care system: what is feasible and acceptable with regard to the use of ICT to support older people with multimorbidity?” A scoping review brings together the limited literature on care navigation in older people with multimorbidity and identifies gaps in knowledge. The results demonstrate that navigating the care system is perceived to be a daunting task for many patients. Patients have to learn through experience, rather than being able to rely on systems and actors within the care environment. The gaps in knowledge and practice, identified in the scoping review, are the drivers of the second stage of the study. Stage two investigates from a patients’ perspective, the structure and composition of the PCN surrounding older people with multimorbidity. People and services (actors) involved in the care for this patient group are explored through data from self-administered questionnaires (n=62) and semi-structured interviews (n=7). PCNs are visualised through Social Network Analysis (SNA), detailing those actors involved in the network and their relationship. The application of framework analysis enables a definition of roles and responsibilities within the PCN. Stage three of the study outlines the process of creating data-driven personas for the design of digital PCN navigation support for the study population. This study stands at the intersection of care and ICT. With the expansion of research informing design of ICT for care, this study delivers a number of original contributions to the field. First, the study develops and applies a new conceptual framework: Patient-Centred-Design. Patient-Centred-Design is grounded in and connects three distinguished theories (patient-centred care, patient empowerment and user-centred design). Secondly, the use of innovative methods dictated by this conceptual framework provides valuable additions to the field of SNA by comparing pre and post interview maps of PCNs. Thirdly, this study contributes to health and social care by filling current gaps in care navigation in older people with multimorbidity. Finally, theoretical and practical additions are presented to the field of Human-Computer Interaction through the provision of design requirements.