Socio-cultural and
ethical aspects
Anne G. Ekeland
Berlin, 05.05. 2010
Key issues
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”Socio-cultural and ethical aspects”
Outcomes and topics in this domain
Outcomes in MAST
Examples of outcome in the existing literature Key points for deciding outcomes and istruments in
evaluation research on telemedicine applications
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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
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Outcomes and
measures
1. Outcomes in this domain are complex, and
not easy to define and assess
2. Outcomes are difficult to measure objectively
because they often imply subjective
meaning, as in patient perspectives
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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
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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
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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
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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
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Key issues in deciding
outcomes
• 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
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To investigate outcomes…
1. Recognize a range of approaches
2. Use knowledge from different disciplines:
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Statistics,
measurement theory,
medicine,
psychology,
Sociology
anthropology,
3. Adapt the evaluation study to the resources
available and integrate with system design
4. Use reliable (measurement) tools for: atitudes, work
processes, outcome
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Questions?
Thanks and contacts