"You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions.
BACKGROUND
Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as "quantified self" advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population.


OBJECTIVE
Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data?


METHODS
We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached.


RESULTS
Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients' self-tracked data.


CONCLUSIONS
Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered "illness work" connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their "illness work" more efficiently and effectively.
Weill Cornell Medical College, Department of Healthcare Policy and Research, Division of Health Informatics, New York, NY, United States. jsa7002@med.cornell.edu.
Jessica S
http://orcid.org/0000-0002-3859-9130
JS
Ancker
Holly O
http://orcid.org/0000-0003-4192-0682
HO
Witteman
Baria
http://orcid.org/0000-0001-6594-9733
B
Hafeez
Thierry
http://orcid.org/0000-0003-2182-7835
T
Provencher
Mary
http://orcid.org/0000-0003-1561-1317
M
Van de Graaf
Esther
http://orcid.org/0000-0002-8143-1325
E
Wei
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D059350:Chronic Pain / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D054626:Consumer Health Information; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D055991:Health Records, Personal; D006331:Heart Diseases / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D036301:Qualitative Research; D012648:Self Care
chronic disease; consumer health information; health knowledge, attitudes, practices; medical informatics; self-care