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The organising vision for telehealth and telecare: discourse analysis
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OBJECTIVE: To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. DESIGN: Discourse analysis. SAMPLE: 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. METHOD: Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. MAIN FINDINGS: Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. CONCLUSION: Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.
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“The bio-medical discourse prevails within the academic literature addressing technology and aging [30].”
From Ambient Assisted Living Technologies for Aging Well: A Scoping Review (2016) · cites this paper as [30]
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“This discourse emphasizes the impairments of older adults and medicalizes aging as a disease [30].”
From Ambient Assisted Living Technologies for Aging Well: A Scoping Review (2016) · cites this paper as [30]
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“In an analysis of the discourses around technology and health care, Greenhalgh et al. [30] found that “different stakeholders hold different assumptions, values, and world views, talk past each other, and compete for recognition and resources.””
From Ambient Assisted Living Technologies for Aging Well: A Scoping Review (2016) · cites this paper as [30]
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“Policy talk about remote health services was typically technology-focused, depicting these as state-of-the-art, high-quality, efficient, and safe (16).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [16]
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“This imagery resonates strongly with modernist discourseof rationally organised activity made more efficient and delivering happiness through the use of smoothly working technology.146”
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Metadata
- Authors
- Greenhalgh, T., Procter, R., Wherton, J., Sugarhood, P., & Shaw, S.
- Affiliations
- University of London (GB)
- University of Manchester (GB)
- Barts Health NHS Trust (GB)
- Corresponding author
- Greenhalgh, Trisha
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2012
- Volume
- 2
- Issue
- 4
- Pages
- e001574
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC3401833
- OpenAlex
- W2098025845
- Cited by
- 199
- References
- 45
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 20 · 2020: 19 · 2019: 15 · 2018: 20 · 2017: 19 · 2016: 16 · 2015: 14 · 2014: 22 · 2013: 10
- FWCI
- 14.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Open (London South Bank University) (acceptedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by-nc)
- Funders
- Queen Mary University of London
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Geriatrics and Gerontology › Technology Use by Older Adults
- Social Sciences › Health › Social Policies and Healthcare Reform
- Keywords
- telemedicine, telecare, organizational vision, stakeholder perspectives, competing discourses, modernist discourse, humanist discourse, change management, assistive technology, older adults, chronic disease, home automation, commodification of health care, technology implementation
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