title: Assessing the implementability of telehealth interventions for self-management support: a realist review.
abstract: BACKGROUND
  There is a substantial and continually growing literature on the effectiveness and implementation of discrete telehealth interventions for health condition management. However, it is difficult to predict which technologies are likely to work and be used in practice. In this context, identifying the core mechanisms associated with successful telehealth implementation is relevant to consolidating the likely elements for ensuring a priori optimal design and deployment of telehealth interventions for supporting patients with long-term conditions (LTCs).
  
  
  METHODS
  We adopted a two-stage realist synthesis approach to identify the core mechanisms underpinning telehealth interventions. In the second stage of the review, we tested inductively and refined our understanding of the mechanisms. We reviewed qualitative papers focused on COPD, heart failure, diabetes, and behaviours and complications associated with these conditions. The review included 15 papers published 2009 to 2014.
  
  
  RESULTS
  Three concepts were identified, which suggested how telehealth worked to engage and support health-related work. Whether or not and how a telehealth intervention enables or limits the possibility for relationships with professionals and/or peers. Telehealth has the potential to reshape and extend existing relationships, acting as a partial substitute for the role of health professionals. The second concept is fit: successful telehealth interventions are those that can be well integrated into everyday life and health care routines and the need to be easy to use, compatible with patients' existing environment, skills, and capacity, and that do not significantly disrupt patients' lives and routines. The third concept is visibility: visualisation of symptoms and feedback has the capacity to improve knowledge, motivation, and a sense of empowerment; engage network members; and reinforce positive behaviour change, prompts for action and surveillance.
  
  
  CONCLUSIONS
  Upfront consideration should be given to the mechanisms that are most likely to ensure the successful development and implementation of telehealth interventions. These include considerations about whether and how the telehealth intervention enables or limits the possibility for relationships with professionals and peers, how it fits with existing environment and capacities to self-manage, and visibility-enabling-enhanced awareness to self and others.
authors.affiliation: Faculty of Health Sciences, University of Southampton, Building 67, University Road, Highfield, Southampton, SO17 1BJ, UK. I.I.Vassilev@soton.ac.uk.
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.affiliation: University of Southampton, Building 44, Highfield Campus, Highfield, Southampton, SO17 1BJ, UK. A.C.O'Callaghan@soton.ac.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Rowsell
authors.affiliation: Faculty of Health Sciences, University of Southampton, Building 67, University Road, Highfield, Southampton, SO17 1BJ, UK. C.J.Pope@soton.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pope
authors.affiliation: Faculty of Health Sciences, University of Southampton, Building 67, University Road, Highfield, Southampton, SO17 1BJ, UK. A.Kennedy@soton.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Health Services Research Section, Medical Care Research Unit, ScHARR, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK. A.OCathain@sheffield.ac.uk.
authors.forename: Alicia
authors.initials: A
authors.lastname: O'Cathain
authors.affiliation: , Office Room 1.01b, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. c.salisbury@bristol.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.affiliation: Faculty of Health Sciences, University of Southampton, Building 67, University Road, Highfield, Southampton, SO17 1BJ, UK. A.E.Rogers@soton.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D055317:Evidence-Based Practice; D015438:Health Behavior; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007398:Interpersonal Relations; D008962:Models, Theoretical; D020380:Needs Assessment; D011369:Professional-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012648:Self Care / Q000379:methods*; D017216:Telemedicine / Q000458:organization & administration*