Abstract

People living with a long term condition (LTC), such as diabetes or rheumatoid arthritis have to learn to live with their health problem and to manage the consequences. Not managing is not an option – what varies is the degree to which self-management improves or harms overall health and wellbeing. Corbin and Strauss have defined three tasks for patients with an LTC: medical management; emotional management; and role management. Medical management includes adopting healthy behaviours such as healthy eating, physical activity, working with health care professionals and taking medication as prescribed. Less well recognised, but equally challenging, are managing the emotional reactions of having a long term condition, including anger, despair, shame and guilt; and the changes to one's role, or biographical narrative. For many people a diagnosis of a serious illness fundamentally alters their perceptions of their essential self, and their role in life.

Digital health interventions (DHI) have significant potential for helping people undertake these three tasks. DHI are interventions which are delivered digitally, e.g. over the web to a PC, tablet or phone, or via an app. They can combine information with interactive components such as decision support, emotional support and behaviour change support, and often deliver treatments that have previously been offered face to face, such as cognitive behavioural therapy, mindfulness training, or medication changes according to pre-defined algorithms responding to self-monitoring data entered by patients. The use of video, audio and graphics can make complex information accessible and comprehensible to people with low literacy, or poor language skills. Software programming allows information and responses to be tailored to each individual, reflecting specific needs.

In this talk I will explain how DHI can help patients with the complex tasks of self-management, providing examples of available interventions. I will also summarise the research evidence on their uptake, acceptability and effectiveness.