Page 66 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

64 Chapter 3
example by empowering patients to interpret their measurements, instead of providing automatic interpretation from the system as a method to decrease patients’ stress of using the technology [57]. Furthermore, using warm colours rather than bright colours to get a calming effect, and cold colours for a more relaxing effect [58-60].
Limitations and Future Research
To appreciate the study, awareness of its limitation is necessary. First, the study has a relatively small sample size considering the number of factors included in the study. Another limitation is the way of dealing with the ‘not applicable’ ratings. Although items indicated as not applicable by a substantial sub group were excluded in the analyses, others were treated as missing values, but they could have had a different meaning. A third limitation is pre-selection, as the data used in this study were derived from a group of patients that had already agreed to use the SMSS. The high intention at the beginning of the trial to use the system confirms this bias. Besides, among all 36 patients who declined to participate in the randomised controlled trial at first place, 17 patients declined because they expected additional burden and two because they expected no gain of using it, which belonged to the performance expectancy factor. Fourth, the SMSS has different components, such as the medical devices, MNI, and the eLearning modules, and the patients might have held different attitudes towards them. However, their intention to use each of these components and the corresponding influencing factors were not investigated in the questionnaire.
This work can be extended in several directions. First, enlarging the sample size would increase the statistical power, and additional research would also help to mature the model, justifying the use of more sophisticated statistical techniques such as confirmatory factor analysis, or, when including other dependent variables such as observed usage and health indicators, structural equation modelling. Second, interviewing some respondents would provide essential insights in, for example, how they interpreted the items, especially the affect items, and the rational for considering items as not applicable. This could help in the re-formulation of some items. Third, it would be interesting to include patients who would not use the SMSS to understand them as well. Another direction could be to investigate patients’ acceptance of the different components of a SMSS.
Conclusions
This study builds a model to investigate the influencing factors for renal transplant patients to accept a self- management support system. Trust and performance expectancy could explain variation in behavioural intention of using the SMSS, but not beyond the explanation given by patients’ affect towards the system.