title: Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes.
abstract: Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Rayzel
authors.initials: R
authors.lastname: Shulman
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada. Electronic address: fiona.miller@utoronto.ca.
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Daneman
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D020811:Biomedical Technology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D006291:Health Policy; D006801:Humans; D007332:Insulin Infusion Systems; D007407:Interviews as Topic; D009864:Ontario; D010372:Pediatrics; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research
keywords: Diffusion of innovation; Health policy; Insulin infusion system; Qualitative research; Type 1 diabetes mellitus