Page 49 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint
P. 49

 INTRODUCTION
Patient Acceptance of a Self-Management Support System 47
Chronic kidney disease (CKD) is regarded as a major public health problem [1]. In the last stage of this disease, referred to as end-stage renal disease (ESRD), the preferred treatment is renal transplantation. Mortality rates for these patients are less than half compared to patients receiving dialysis treatment [2]. In addition, patients gain more freedom and energy from a successful kidney transplantation than from dialysis [3]. After kidney transplantation, however, patients need to adhere to a strict medication regimen and are followed-up frequently to monitor for signs of graft dysfunction or comorbidities. Kidney transplant patients are therefore still considered to have a chronic disease.
Self-management, the process of managing symptoms, treatment, physical and psychosocial consequences by patients themselves in daily life, has been proposed to be useful when dealing with chronic illness [4]. Self-management support systems (SMSSs) can help to increase the level of self-management [5]. These systems aim at empowering patients by giving them more control of their care process and daily activities and thereby increasing their autonomy [5].
SMSSs have already been successfully used in the health domain to support healthy behaviours, and reports indicate that people are capable of using them. Examples include an internet-based diabetes self- management and support system [6], and systems to manage physical activities [7-9], fruit and vegetables consumption [8], and medication intake [9].
Need For a Specific Model
Besides users’ capability, their willingness, i.e. acceptance of using a SMSS, is also important. Several theories and models have been proposed to explain users’ acceptance of information technology (IT) or information systems. These theories explore the underlying factors of users’ acceptance, so that designers and organisations can anticipate on them to improve system acceptance. Both generic and specific models have been developed. The theory of reasoned action (TRA) [10], the theory of planned behaviour (TPB) [11], and the technology acceptance model (TAM) [12] are generic models formulated to apply across domains. Specific models, which are often derived from generic models, have been formulated for specific domains, such as models for Internet commerce [13, 14], online gaming [15], and mobile commerce [16].
In the area of health informatics and chronic diseases, understanding the acceptance of a SMSS could benefit from a specific model with its own unique set of factors and values, as the use of the technology may influence patients’ health and lives: people may be more concerned and reserved to use an SMSS. For example, interviews with diabetic patients about a SMSS for their insulin therapy showed that emotional aspects were important, such as being embarrassed to inject insulin in public or fear of hypoglycaemia when
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