Stakeholder Perspectives on the Development of a Virtual Clinic for Diabetes Care

Natalie Armstrong
Warwick Medical School, University of Warwick

*Hilary Hearnshaw
Warwick Medical School, University of Warwick

*John Powell
Warwick Medical School, University of Warwick

*Jeremy Dale
Warwick Medical School, University of Warwick

Topic: Patient portals
Track: Research
Type: Oral presentation

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     Slides: Not Available
     Last modified: June 28, 2006
     Presentation date: 10/16/2006 12:00 PM in RYH Tudor 8
     (View Schedule)

Abstract
Background: The development of the internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. Diabetes is one such condition and internet-based interventions may be particularly appropriate for use with young people, 20% of whom fail to attend routine appointments at clinic. There is considerable research evidence that internet-based health interventions have been successful in reaching and working with young people; for example in smoking cessation [1], eating-disorder prevention [2] and cystic fibrosis [3]. In addition, a report of a small study which pilot-tested the feasibility of allowing patients with type 2 diabetes to co-manage their condition from home showed proof of concept for internet-based co-management of diabetes for adults [4]. This paper reports on the development of an internet-based 'Virtual Clinic' as an innovative way to help people with diabetes manage their condition. The Virtual Clinic allows a person with diabetes to communicate with their healthcare providers, find information about their condition, and share information and support with other users. It is enhanced by being based on the behavioural theory of self-efficacy from psychology [5].

Objective: To present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important and feasible characteristics of such a system.

Methods:
1. 3 focus groups with people with diabetes recruited through a local diabetes clinic
2. 5 qualitative interviews with health care professionals from the clinic (3 doctors, 2 nurses)
3. E-mail consensus gathering with those using internet-based systems for other chronic conditions (asthma, epilepsy, ME, mental health)
4. Workshop to gather expert consensus on the use of IT to improve the care of young people with diabetes

Results: Stakeholder groups identified the following important characteristics of an internet-based Virtual Clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes which uses these principles, and which is based on self-efficacy theory, is described.

Conclusions: Involvement of stakeholders is a vital early stage in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs.

References
1. Woodruff SI, Edwards CC, Conway TL, Elliott SP. Pilot test of an internet virtual world chat room for rural teen smokers. Journal of Adolescent Health 2001;29:p239-243
2. Zabinksi MF, Wilfley DE, Pung MA, Winzelberg AJ, Eldredge K, Taylor, CB. An interactive internet-based intervention for women at risk of eating disorders: a pilot study. International Journal of Eating Disorders 2001;30:p129-137
3. Johnson KB, Ravert RD, and Everton A. Hopkins Teen Central: assessment of an internet-based support system for children with cystic fibrosis. Paediatrics 2001;107(24)
4. Goldberg HI, Ralston JD, Hirsch IB, Hoath JI, Ahmed KI. Using an internet co-management module to improve the quality of chronic disease care. Joint Commission Journal on Quality and Safety 2003;29(9):p443-451
5. Bandura A. Self-efficacy theory: toward a unifying theory of behaviour change. Psychological Review 1977;84(2):p.191-215