Technologies of compliance? Telecare technologies and self-management of chronic patients

Telecare technologies are instruments that enable care at a distance via the use of information and communication technologies (ICTs). One of the aims of telecare technologies is to support self-management strategies of chronic patients. However, the ways in which self-management is articulated in the design and use of these new technologies is largely unaddressed. Thes thesis focuses on how telecare technologies participate in enabling and/or constraining self-management practices of chronic patients by questioning what forms of self-management are inscribed and enacted in design and use practices of a contemporary telecare technology for COPD patients. The research illustrates that telecare technologies participate differently in enabling and/or constraining self-management practices for chronic patients. Some patients develop adequate practices in living with their disease with the incorporation of a compliant form of self-management in the telecare technology, while others thrive better with a telecare system that supports a more autonomous form of self-management. In order to develop a successful and morally acceptable tool to enable care at a distance the thesis therefore suggests incorporating flexible scripts supporting various forms of self-management into the design of telecare technologies, including the integration of experience based knowledge of patients. Moreover, the telecare technology should provide sufficient means for communication, education and shared decision making. To support this goal the approach of Constructive Technology Assessment (CTA) is applied and guidelines for anticipating future care in scenario based design (SBD) are developed.