Trust in ICT-enabled medical self-management: the case of diabetes

Purpose Trust is an important value for the design and use of information and communication technologies (ICTs) in healthcare. It shapes how ICTs are used by and for people seeking better clinical outcomes as patients, but who have other important interests and goals as individuals. The increasing use of ICTs for self-management fundamentally changes the trust of the patient toward the physician and the practice of medicine. The present article aims to investigate trust in this context, focusing on the point of view of patients with diabetes. Design/methodology/approach A patient-centric approach was followed to develop interview questions and collect and analyze interview data. A total of 20 patients with diabetes were interviewed in the state of Washington. Patients received training and instruction in how to use the diabetes app and were then asked to use the app for one week, after which the patients were then interviewed again and asked about their experiences and expectations using the app and the features they liked or did not like. A coding scheme was developed based on the dimensions predictive/normative trust, and competence/commitment, to describe trust expectations. Findings Trust expectations identified in the interview data relate to values, ideas or concepts that are important to the patients who want to trust technology, information, clinicians, others and themselves to self-manage their chronic conditions and diseases. A total of seven categories of technology features emerged from the interview data. These technological features can be used to build trust between the patients and the trustees. Interview data shows that diabetic patients use these technology features to reaffirm, verify and remember information. Research limitations/implications Future research should investigate trust for other common chronic diseases, such as heart problems, asthma, chronic pain and chronic mental disorders and impairment. Self-trust emerged from the analysis of interview data in this study as an important aspect of a networked technology-enabled self-management system in the case of diabetes. This suggests that patients hold attitudes and beliefs toward their own competence and commitment that are strongly related to the functioning of technology-enabled self-management. Future work in this area should further explore self-trust in technology-enabled self-management of chronic disease to characterize, conceptualize and theorize its role and impact. The growing role of AI in healthcare must be investigated further to design patient-centric applications and features in care systems that will be trusted by the patients. Practical implications The findings of this study can be generalized to other healthcare technology-enabled approaches, contexts, system designs and policies. Chronic diseases and conditions are similar in the lifelong challenges that they impose on patients’ daily lives. Social implications The society will better understand the complications and nuances of managing a chronic disease or condition like diabetes and will not assume or judge that technologies advance and all patients’ problems will go away. One social implication for the patients is that they will be understood and treated as humans not merely a medically diagnosed patient without feelings, families, relationships, needs and fears. Originality/value The paper is the first of its kind to investigate trust in mobile health technologies for patients with chronic diseases based on patient-centric approaches. The findings of the paper inform healthcare providers on the effective use and implementation of technologies in the care and treatment processes and provide insights and recommendations for mobile health app developers and designers.