Using technology to manage chronic illness: why patients’ attributional styles matter
Based on an interview with Azadeh Savoli and her article “Examining How Chronically Ill Patients’ Reactions to and Effective Use of Information Technology Can Influence How Well They Self-manage Their Illness,” co-authored by Henri Barki (HEC Montréal) and Guy Paré (HEC Montréal), published in MIS Quarterly, March 2020.
In the midst of the Covid-19 health crisis, it is easy to forget that it is not infectious diseases that pose the greatest threat to humans but chronic diseases. According to the World Health Organization, chronic illnesses such as cardiovascular disease, cancer and diabetes surpass infectious diseases as leading causes of mortality by far. They are also the most prevalent and costly health problems worldwide.
Because these are long-term diseases, self-management — including recognizing symptoms and taking appropriate action, using medications as indicated and interacting with the healthcare system — is important. It is a way to empower patients, helping them make informed decisions about their own health and ultimately improve their well-being. Yet, for example, in the specific case of chronic asthma, which researcher Azadeh Savoli and her coauthors examined in a recent study, less than 40 percent of patients regularly monitor their symptoms and even fewer follow their prescribed action plan when they have acute symptoms.
IT solutions have been proposed as a way to help patients take a more active role in managing chronic illnesses.
Three types of patients
Savoli and her fellow researchers partnered with a McGill University research team that was developing a web-based self-management system for asthma patients. As part of their interaction with the portal, patients would answer a questionnaire at least weekly; the portal would then offer personalized feedback. Alerts were sent to patients under certain conditions, and an email function allowed patients to interact with the nurse case manager, who was monitoring study participants daily.
Using a combination of interviews and data analysis, Savoli and her team recognized three distinct groups of patients: engaged, reliant and autonomous. The engaged patients attributed the cause of their good or bad self-management to themselves. Therefore, they “were active, present and used the system in an efficient way.” Because of their so-called attributional style, they wanted to understand their symptoms to make informed decisions, and overall achieved good results in using the technology.
The reliant patients also liked and used the system regularly but may have had an “overdependence” on it, believing that it was taking care of them. These patients would not often use functions that would allow them to understand their condition better — they simply complied with recommendations. They achieved ineffective or moderately effective usage of the portal, based on the nurse case manager’s assessment of the quality of their self-management.
The autonomous patients felt disengaged from the healthcare system and saw the portal as an irritating, paternalistic imposition. They were most likely to enter incorrect information into the system and were least likely to effectively use the portal.
IT systems: not for everyone?
The study suggests that highly effective use of IT-based self-management systems can be useful to chronic patients by helping them become active, mindful participants in their own care. However, not all patients use and benefit from such systems equally. It may, therefore, be helpful for medical professionals to identify patients’ attributional styles before prescribing an IT system. In this way, they might better select those most likely to benefit or suggest a training program to help educate those with maladaptive patterns that predispose them to failure.
The research Savoli and her coauthors undertook has not only clear health and financial implications, but it also had an unexpected emotional aspect, she reports. “The condition makes [patients] fragile and everything becomes emotional for them,” Savoli said. “Some were crying when they were talking to me. If they could manage their illness, it would hugely affect their quality of life.”
Savoli suggests that medical personnel try to determine patients’ attributional style to better target who will profit from using self-management technology. Those most averse to it might first be introduced to a training program to help them adjust maladaptive perceptions or behavior. For systems designers, Savoli advises that the wording of messaging on health self-management platforms be suggestive rather than prescriptive, and interventions as nonintrusive as possible to avoid offending some patients.
The researchers conducted their study in cooperation with a clinical trial of a web-based self-management portal for asthma patients developed by McGill University’s clinical and health informatics research group. Research methods included in-depth interviews with 32 asthma patients (who used the portal for three to six months), interviews with the nurse case manager about patients’ self-management performance, as well as governmental data on medications prescribed, medications dispensed and patients’ emergency room visits. Data on patients’ weekly usage of portal functionalities was also examined.