Mapping the Evolution of a Digital Health Programme towards Innovation in Primary Care: Living It Up

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The problem

- Longer life expectancy has resulted in a growing population placing an unprecedented demand on existing services such as healthcare. A consequence of this demographic shift is the increased prevalence of chronic diseases, the leading cause of 38 million deaths worldwide [1]. The UK government has set out to tackle this problem by joining-up services by 2018 to provide the best continuity of care for patients designed to meet their needs and fit for the future. The focus within primary care is on prevention, supported self-management and patient-centred care. The launch of an innovative eHealth project ‘Living It Up' (LiU) in Scotland (£10.375m) was specifically set up to align with policy in order to revolutionize how health and social care is perceived, delivered and managed [2]. This study examines the service re-design journey and the factors that promoted or inhibited the implementation process of this innovative, national digital self-management programme.

The approach

- We conducted (N=16) participant observation sessions, (N=28) stakeholder interviews and collected a series of documentary evidence (N=45). We synthesised the data using the Normalisation Process Theory (NPT) as the underpinning theoretical framework for our study [3]. NPT is a social theory of change which we used in order to 1) identify barriers and facilitators to eHealth service implementation at scale and 2) interpret ‘how' novel eHealth services become integrated embedded and sustained within the fabric of our day-to-day routines.


- Findings from the LiU Project (June 2012 - May 2015), highlighted implementation barriers such as limited resources and capacity, delay from health professionals buying in, psychological barriers, the difficulty of operating in an overly ‘target driven' setting and the challenge of achieving good communication within a multi-stakeholder environment. Positive factors included a move towards embedding and sustaining ‘change' within existing pathways