E.A.L. CHEW1, S.H. TEO1, N.A.B. SURYA AKMAJA1, W.E. TANG1, D.W.L. NG1, H.M. TAN1, C.H. TAM2, G.C.H. KOH2, V.H.Y. TEO1
NHG Polyclinics1, National University of Singapore2
Telehealth’s growing prominence makes it essential to understand how technological mediation alters trust relationships between healthcare providers and patients. The Primary Tech-Enhanced Care – Hypertension (PTEC-HT) pilot recruited patients in Ang Mo Kio Polyclinic to monitor their blood pressure remotely through a home blood pressure machine connected to a mobile gateway. We examined trust in the implementation of the pilot.
The PTEC-HT pilot recruited 121 patients to do remote monitoring of blood pressure over a 12-month period. Interviews with 13 patients and 8 staff in the program were analysed using inductive thematic analysis, paying particular attention to trust between the patient, telehealth technology, healthcare professionals and the healthcare institution.
Four emerging themes showed increased trust: a) Patients felt reassured that “someone is monitoring”, b) patients trusted technology and the telehealth program, c) staff perceived the patient-uploaded data as trustworthy, and d) a better patient-provider partnership arose based on the mutually trusted data. Contrastingly, four themes related to lowered trust: a) Some patients distrusted or felt discomfort with technology, b) staff expressed some concerns about the limitations of remote consultations, c) patients and staff experienced uncertainties regarding various aspects of the program, and d) awareness of institutional risk to the healthcare provider’s reputation.
A dialectical tension exists, with trust-increasing factors pulling against trust-reducing factors. The overall impact on trust seems positive—a closer patient-provider relationship—yet trust-reducing factors also need to be addressed. Strategies to boost trust and reduce uncertainty may support long-term successful implementation and sustainability of the program.