Involving patients in learning practices on pain management in telehealth

Involving patients in learning practices on pain management in Telehealth
by
Anette Lykke Hindhede, UCSF, Center for Health Research, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark;Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Vibeke Harms Andersen, Department of Culture and Learning. Aalborg University, Copenhagen, Denmark.

Across the developed world, including the Nordic countries, health policies encourage patients to take greater responsibility for their healthcare (Armstrong 2014). Patient participation involves being engaged in the planning of care and exchanging knowledge, setting own goals and carrying out self-management activities. As for digital health technologies, they also increasingly reconstitute patients as rational and reflexive agents that weigh up available knowledge, make choices about their healthcare needs, and competently engage in the digital management of their health (Lupton 2014). However, patients may find themselves in a precarious situation with the responsibilities delegated to them.
In this paper, we focus on how patients learn new practices of understanding and handling a mobile application (app) for pain management. The app offers surgical patients opportunities to participate in the production of pain-related knowledge post-surgery. With the app, they are asked to report e.g. pain intensity, pain location, pain quality, and pain’s impacts on daily life directly into the e-health platform of the hospitals.
Based on the writings of Kemmis et al (2013), we understand learning as a process of initiation into new practices, that are related to other practices in ´practice ecologies´. These practice ecologies enable or constrain what happens in practices of learning. In the project, we conduct observation of the formal teaching sessions pre-surgery at hospitals, where patients learn to manage the app - or in Kemmis’ terms are being ‘stirred into practice’. More precisely, we focus on the way in which various patients position and locate themselves in relation to other patients and to the healthcare professionals in patterns of doings, sayings and relatings and how ´practice architectures´ support and provide resources for these practices. This is followed by interviews with the patients one-week post-surgery, where we inquire their new practices with the pain app and their new role as co-creators of health-related data and how traces of previous experiences are being taken up in new practices after discharge.
This knowledge contributes to the Nordic educational research in how patients learn to become ‘digitally engaged’ in their own medical care practices. Moreover, it adds to the use of practice theory in new educational contexts. In particular, our research provides new insight into the way in which patient education practices may or may not create affordances that enable them to be “translated” or “transferred” into new sites (such as patients homes) where they can be integrated with rather than competing with other practices.

References
Armstrong, D. (2014). Actors, patients and agency: a recent history. Sociology of health & illness, 36(2), 163-174.
Kemmis, S., Wilkinson, J., Edwards-Groves, C., Hardy, I., Grootenboer, P., & Bristol, L. (2013). Changing practices, changing education. Springer Science & Business Media.
Lupton, D. (2014). Digital sociology. Routledge.