Technologies of Compliance? Telecare technologies and self-management of COPD patients

In current healthcare discourses self-management has been articulated as one of the major aims of telecare technologies for chronic patients. This article investigates what forms of self-management are inscribed during the design of a telecare system for patients with COPD (Chronic Obstructive Pulmonary Diseases) and enacted during its use. Based on an analysis of the design and use of this telecare system, the paper shows that there are important differences between self-management approaches incorporated in the telecare system and the self-management strategies adopted by patients. The telecare equipment was designed in such a way that it incorporated forms of self-management based on compliance. It disciplined patients to adhere to medical treatment and an activity regime rather than involving them in shared decision-making with healthcare professionals. However, the used practices reflected self-management approaches based on collaboration and concordance between healthcare professionals and patients, including integration of their experience based knowledge. Patients domesticated the devices in such a way that they became adjusted to their daily routines and embodied experience with managing their illness.