Socio-cultural and ethical aspects

Anne G. Ekeland

Berlin, 05.05. 2010

Key issues

04/20/23 2

1. ”Socio-cultural and ethical aspects” 2. Outcomes and topics in this domain 3. Outcomes in MAST 4. Examples of outcome in the existing literature - 5. Key points for deciding outcomes and istruments

in evaluation research on telemedicine applications

socio-cultural and ethical

04/20/23 3

•Social •formal and informal ways of regulating behavior and interaction between people in societies, for instance rights and obligation, social classes or hierarchies•institutions established for the purpose, such as the marketplace, the law, prisons, schools, digital communities?

•Cultural•Belonging to, or approving a set of rules of what is relevant, right, wrong, good and bad, often institutionalised

•Ethical•Questions of what is harmful and not

Outcomes and measures

04/20/23 4

1. Outcomes in this domain are complex, and not easy to define and assess

2. Outcomes are difficult to measure objectively because they often imply subjective meaning, as in patient perspectives

Outcomes in MAST

• Changes in the patient’s role in major life areas• Patients’ relatives and others’ understanding of

the telemedicine application• Societal, political context and changes. Will the

application influence the general model for the delivery of healthcare services if deployed?

• Changes in responsibility. Are the patients and/or relatives capable of handling the responsibility?

• Gender issues. Has the service any consequences on the position of gender

04/20/23 5

Lit. review: outcome found effective

04/20/23 6

•Health service use as an outcome

Interventions that are found to be effective in reducing health service use include:

• vital signs monitoring at home with telephone follow-up by nurses• computerized asthma patient education programs • home monitoring of diabetes patients

Lit. review: Outcome with knowledge gaps

• Access issuesNeeds more study In the case of dermatology,

wound care and ophthalmology• Combinations of technical, ethical, legal, clinical,

economical and organisational implications and challenges

Require further study in smart homes• Spiritual care A review of studies on this found little systematic

research in this area

04/20/23 7

Outcome where new research is needed

• Gender differences in computer-mediated communications

A review that identified relating to on-line support groups for people with cancer, cautioned that studies on this topic are limited and heterogeneous

The authors suggested that this issue needs to be considered by those designing interventions of this kind to understand different patterns of use for future developments

04/20/23 8

Key issues in deciding outcomes

• Politcal/administrative – for decision making• Promotional – to encourage use• Scholarly – examining the structure, function and

impact to improve the scientific field• Pragmatic – to improve the resources and learn

from mistakes• Ethical – to make sure it does not harm patients• Societal/cultural: economies, organisations,

cultural groups…• Medicolegal – to exercise judgement before use

and avoid product liability

04/20/23 9

To investigate outcomes…

1. Recognize a range of approaches2. Use knowledge from different disciplines:

– Statistics, – measurement theory, – medicine, – psychology, – Sociology – anthropology,

3. Adapt the evaluation study to the resources available and integrate with system design

4. Use reliable (measurement) tools for: atitudes, work processes, outcome

04/20/23 10

Questions?

Thanks and contacts