Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden

Document Type : Original Article

Authors

1 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden

2 Arctic Research Centre (Arcum), Umeå University, Umeå, Sweden

3 School of Business and Law, CQUniversity, Rockhampton, QLD, Australia

Abstract

Background
Unlike the large body of research that has examined the ‘success’ or ‘failure’ of eHealth in terms of patient and provider perceptions or cost- and clinical effectiveness, the current study teases out ways through which a novel eHealth initiative in rural northern Sweden might result in more distal or systemic beneficial outcomes. More specifically, this paper aims to explore how and under what circumstances the so-called virtual health rooms (VHRs) are expected to improve access to person-centred care and strengthen community health systems, especially for elderly residents of rural areas.
 
Methods
The first phase of the realist evaluation methodology was conducted, involving qualitative interviews with 8 key stakeholders working with eHealth, business development, digitalisation, and process management. Using thematic analysis and following an abductive-retroductive analytical process, an intervention-context-actor-mechanism-outcome (ICAMO) configuration was developed and elicited into an initial programme theory.
 
Results
The findings indicate that a novel eHealth initiative, which provides reliable technologies in a customized facility that connects communities and providers, might improve access to person-centred care and strengthen community health systems for rural populations. This is theorized to occur if mechanisms acting at individual (such as knowledge, skills and trust) and collective (like a common vision and shared responsibilities) levels are triggered in contexts characterised by supportive societal transitions, sufficient organisational readiness and the harnessing of rural cohesiveness and creativity.
 
Conclusion
The elicited initial programme theory describes and explains how a novel eHealth initiative in rural northern Sweden is presumed to operate and under what circumstances. Further testing, refinements and continued gradual building of theory following the realist evaluation methodology is now needed to ascertain if the ‘VHRs’ work as intended, for whom, in what conditions and why.

Keywords


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Articles in Press, Corrected Proof
Available Online from 09 February 2021
  • Receive Date: 07 July 2020
  • Revise Date: 27 January 2021
  • Accept Date: 30 January 2021