1. Socio-cultural and ethical aspects Anne G. Ekeland Berlin, 05.05. 2010

2. Key issues 16/10/20152 1.”Socio-cultural and ethical aspects” 2.Outcomes and topics in this domain 3.Outcomes in MAST 4.Examples of outcome in the existing literature - 5.Key points for deciding outcomes and istruments in evaluation research on telemedicine applications

3. socio-cultural and ethical 16/10/20153 Social formal and informal ways of regulating behavior and interaction between people in societies, for instance rights and obligation, social classes or hierarchies institutions established for the purpose, such as the marketplace, the law, prisons, schools, digital communities? Cultural Belonging to, or approving a set of rules of what is relevant, right, wrong, good and bad, often institutionalised Ethical Questions of what is harmful and not

4. Outcomes and measures 16/10/20154 1.Outcomes in this domain are complex, and not easy to define and assess 2.Outcomes are difficult to measure objectively because they often imply subjective meaning, as in patient perspectives

5. Outcomes in MAST Changes in the patient’s role in major life areas Patients’ relatives and others’ understanding of the telemedicine application Societal, political context and changes. Will the application influence the general model for the delivery of healthcare services if deployed? Changes in responsibility. Are the patients and/or relatives capable of handling the responsibility? Gender issues. Has the service any consequences on the position of gender 16/10/20155

6. Lit. review: outcome found effective 16/10/20156 Health service use as an outcome Interventions that are found to be effective in reducing health service use include: vital signs monitoring at home with telephone follow-up by nurses computerized asthma patient education programs home monitoring of diabetes patients

7. Lit. review: Outcome with knowledge gaps Access issues Needs more study In the case of dermatology, wound care and ophthalmology Combinations of technical, ethical, legal, clinical, economical and organisational implications and challenges Require further study in smart homes Spiritual care A review of studies on this found little systematic research in this area 16/10/20157

8. Outcome where new research is needed Gender differences in computer-mediated communications A review that identified relating to on-line support groups for people with cancer, cautioned that studies on this topic are limited and heterogeneous The authors suggested that this issue needs to be considered by those designing interventions of this kind to understand different patterns of use for future developments 16/10/20158

9. Key issues in deciding outcomes Politcal/administrative – for decision making Promotional – to encourage use Scholarly – examining the structure, function and impact to improve the scientific field Pragmatic – to improve the resources and learn from mistakes Ethical – to make sure it does not harm patients Societal/cultural: economies, organisations, cultural groups… Medicolegal – to exercise judgement before use and avoid product liability 16/10/20159

10. To investigate outcomes… 1.Recognize a range of approaches 2.Use knowledge from different disciplines: – Statistics, – measurement theory, – medicine, – psychology, – Sociology – anthropology, 3.Adapt the evaluation study to the resources available and integrate with system design 4.Use reliable (measurement) tools for: atitudes, work processes, outcome 16/10/201510

11. Questions? Thanks and contacts