ICTs for the medical profession: an application in chronic care

In health care, information and communication technologies (ICTs) are being used more and more frequently as a way of improving the provision of care. The devices that are marketed for this purpose include web and mobile applications, telephone, decision-making aids, and telemedicine tools (Wootton 2012; Nicolini 2011; Ekeland et al. 2012). However, their uses in many cases are limited to data transfer and information exchange between physicians and patients. Moreover, the technological instruments marketed to patients as aids for a better management of their health have usually been designed to be used at home and are not meant to be integrated within the program proposed to patients by the health care system. This makes it difficult for clinicians to exploit the potential of these instruments for better care or integrate them in their daily practice. Positive Technology, a recent field of research developed in the area of Positive Psychology, focuses on technological tools aimed at individuals’ increased wellness, strength and resilience (Riva 2014; Wiederhold et al. 2013). Existing Positive Technologies are classified according to their objectives: hedonic (mood-altering devices); eudaimonic (systems designed to support individuals in reaching engaging and self-actualizing experiences); and social/interpersonal (technologies that seek to improve the connectedness between individuals, groups, and organizations) (Botella et al. 2012). In our contribution, we focus on the eudaimonic dimension, discussing in particular ICT applications aimed at supporting chronic patients’ engagement and self-management of their disease. More specifically, we present the design of an application for the enhancement of diabetes patients’ critical decision making and motivation. On a theoretical level, the application is based on the notion of dialogue types, which has been developed within the field of Argumentation Theory (Walton, Toniolo and Norman 2014; Bigi 2014a). A preliminary analysis of a sample of chronic care consultations based on this theoretical framework has allowed the definition of criteria for the assessment of the quality of decision-making in this kind of consultations (Bigi, Macagno, Mayweg-Paus, submitted). The most relevant result of this analysis is the close correlation between the amount of information sharing sequences regarding patients’ personal life and the quality of the recommendations by clinicians. It has also been noticed that the more doctor and patient share information on the patient’s lifestyle and beliefs, the more detailed the deliberation sequences become. These results indicate that a potential area for intervention is to strengthen the ability for patients to provide data regarding their life and management of the disease. The application we are designing is intended as an instrument to be used together by doctor and patient, thus strengthening first of all the relationship and alliance between the two. Among its functions there is also a more systematic collection of information regarding the self-management of the disease and a strengthening of the interpretive effort that is required to patients in order to achieve self-management (Bigi 2014b). The application is being finalized and a prototype will be ready by the end of the year. Its usability and effectiveness will be then tested on a group of 60 patients for 12 months in at least two public health care facilities in Italy.