The influence of an eHealth intervention for adults with type 2 diabetes on the patient–nurse relationship: a qualitative study

Abstract

BACKGROUND: A constructive patient-nurse relationship is beneficial in self-management support approaches. Research indicates eHealth interventions hold a potential for self-management support for adults with type 2 diabetes. However, eHealth may change the patient-nurse relationship. No studies to date have addressed how eHealth self-management support interventions with written asynchronous communication can influence the relationship between patients and nurses. AIM: The aim of this study was to explore how an eHealth intervention based on the Guided Self-Determination program (eGSD) influences the patient-nurse relationship from the perspective of patients participating and the nurses conducting the intervention. METHODS: A qualitative approach with individual semi-structured interviews was used. Ten patients with type 2 diabetes who completed the eGSD and four nurses who delivered the intervention participated. The data were transcribed verbatim, and qualitative content analysis was used to analyse the text. RESULTS: The findings revealed two themes: 'eGSD facilitates a reciprocal understanding and a flexibility in the relationship' and 'eGSD creates a more fragile relationship', reflecting ambiguous experiences with the eGSD. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The findings indicate that eGSD influences the patient-nurse relationship by facilitating reciprocal understanding and flexibility. Both patients and RNs acknowledged these outcomes as beneficial. Nevertheless, familiar in-person consultations were expressed as integral for the patient-nurse relationship. As written communication in eHealth is a novelty, it demands new knowledge and expertise that RNs must master. Findings from this study may therefore be acknowledged when developing and implementing eHealth interventions. Education programs in written eHealth communication, as well as guidelines and frameworks on how to professionally and effectively conduct eHealth services while maintaining supportive patient-nurse relationships, should be a priority for institutions that educate healthcare personnel, health institutions and other stakeholders.