Socio-cultural and ethical aspects

1. Socio-cultural and ethical aspects Anne G. Ekeland Berlin, 05.05. 2010

2. Key issues ”Socio-cultural and ethicalaspects” Outcomes and topics in thisdomain Outcomes in MAST Examplesofoutcome in theexistingliterature - Key points for decidingoutcomes and istruments in evaluationresearchontelemedicineapplications

3. socio-cultural and ethical • Social • formal and informal ways of regulating behavior and interaction between people in societies, for instance rights and obligation, social classes or hierarchies • institutions established for the purpose, such as the marketplace, the law, prisons, schools, digital communities? • Cultural • Belonging to, or approving a set of rules of what is relevant, right, wrong, good and bad, often institutionalised • Ethical • Questions of what is harmful and not

4. Outcomes and measures Outcomes in this domain are complex, and not easy to define and assess Outcomes are difficult to measure objectively because they often imply subjective meaning, as in patient perspectives

5. Outcomes in MAST • Changes in the patient’s role in major life areas • Patients’ relatives and others’ understanding of the telemedicine application • Societal, political context and changes. Will the application influence the general model for the delivery of healthcare services if deployed? • Changes in responsibility. Are the patients and/or relatives capable of handling the responsibility? • Gender issues. Has the service any consequences on the position of gender

6. Lit. review: outcome found effective • Health service use as an outcome • Interventions that are found to be effective in reducing health service use include: • vital signs monitoring at home with telephone follow-up by nurses • computerized asthma patient education programs • home monitoring of diabetes patients

7. Lit. review: Outcome with knowledge gaps • Access issues Needs more study In the case of dermatology, wound care and ophthalmology • Combinations of technical, ethical, legal, clinical, economical and organisational implications and challenges Require further study in smart homes • Spiritual care A review of studies on this found little systematic research in this area

8. Outcome where new research is needed • Gender differences in computer-mediated communications A review that identified relating to on-line support groups for people with cancer, cautioned that studies on this topic are limited and heterogeneous The authors suggested that this issue needs to be considered by those designing interventions of this kind to understand different patterns of use for future developments

9. Key issues in decidingoutcomes • Politcal/administrative – for decision making • Promotional – to encourage use • Scholarly – examining the structure, function and impact to improve the scientific field • Pragmatic – to improve the resources and learn from mistakes • Ethical – to make sure it does not harm patients • Societal/cultural: economies, organisations, cultural groups… • Medicolegal – to exercise judgement before use and avoid product liability

10. To investigate outcomes… • Recognize a range ofapproaches • Useknowledge from differentdisciplines: • Statistics, • measurementtheory, • medicine, • psychology, • Sociology • anthropology, • Adapttheevaluationstudy to theresourcesavailable and integratewith system design • Use reliable (measurement) tools for: atitudes, workprocesses, outcome

11. Questions? Thanks and contacts