Page 160 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 7
and the content of feedback (i.e. green, orange or red traffic light with corresponding advice). More experienced patients seem to prefer a factual interface, showing only measurement history, medical information and the current advice, over a guided style, that provides more support for interpretation and an avatar showing empathy to address emotional needs. This preference became especially apparent in case of a green traffic light, indicating that a patients’ condition was stable. Apart from these general findings, much diversity in preferences was observed. This argues for an interface design that can be tailored to the preferences of an individual patient. However, as these studies also showed that patients often do not use the option to adapt the interface, a default setting based on level of experience and potentially even content of feedback is recommended[33].
The effect of self-monitoring on experienced empowerment and self-efficacy
Self-monitoring has previously been shown to result in an increased sense of the ability to care for oneself, often termed patient empowerment and self-efficacy [9, 13, 34]. The World Health Organization defines empowerment as ‘a process through which people gain greater control over decisions and actions affecting their health’[35]. Self-efficacy is defined as ‘one's belief in one's ability to succeed in specific situations or accomplish a task’ [36]. During the RCT (described in chapter 5), the Partners in Health questionnaire was used to measure level of self-management behavior, including items that reflect both empowerment and self-efficacy. We expected self-management behaviour to increase more in the self-monitoring population, but both the intervention and control group had high levels of self-management behaviour at baseline already which further increased over time. Although this finding is not in line with our hypothesis, it does make sense that the level of self-management behaviour increased in both groups. Patients in the control group did not have access to the creatinine measurements, but they did engage in self-monitoring blood pressure, which is part of standard care after kidney transplantation.
Doctors’ acceptance of the SMSS
For a successful implementation of a new SMSS, it is also highly important that the concerning system is accepted by the other users: the doctors. During the RCT, 70% of the doctors (n=15) treating kidney transplant patients had logged on to the SMSS in less than half of their total number of appointments. Three doctors had never visited the SMSS although having had multiple (telephonic) consults. Results from the interviews with pilot participants that were held in an early phase of the project (described in chapter 2) also indicated that doctors generally paid little attention to the self-measured creatinine data. These findings do, however, need to be placed within the right perspective. The pilot study took