REASONING ABOUT DIABETES AND ITS RELATIONSHIP TO THE USE OF TELECOMMUNICATION TECHNOLOGY BY PATIENTS AND PHYSICIANS

Health care is moving toward a team effort, with patients as partners. This requires effective communication between physicians and patients , who have different understandings of health and illness. These under standings in turn guide their decisions about management of health and illness. With the introduction of home-based technology, which provid es an efficient way for doctors and patients to communicate, the quest ion of the effectiveness of the decisions being made must be addressed . In this study, we assess the conceptualizations of health and illnes s related to diabetes and the relationship to the use of communication technology by patients and physicians. Methods: The subjects were int erviewed using a semi-structured questionnaire and were then asked to enter information into a telephone-based telecommunications system. Da ta were audiotaped, transcribed, and analyzed to characterize models o f health and illness and for the factors that influence the decision m aking about diabetes management. Interactions with the system were the n examined relative to these findings. Results: Patients used lay conc epts in providing explanations of their illness, whereas physicians us ed biomedical concepts. Use of these differing concepts influenced the use of telecommunication technology, with more errors in the communic ation of information being made by patients than by physicians. Examin ation of the organization of information required by the system showed it to be incongruent with the way patients normally reason, but in ag reement with the way physicians reason. The paper discusses the implic ations of these findings for: (a) the nature of evidence used by patie nts and physicians; and (b) the design of technology to maximize effec tive doctor-patient communication. (C) 1998 Elsevier Science Ireland L td. All rights reserved.