Self-care behaviours and technology utilised during COVID-19
Background: The COVID-19 pandemic has disrupted self-care behaviours among people living with chronic conditions, adding complexities to their daily routines. However, there is limited research on how they self-manage and use technology to bypass these disruptions during the pandemic.
Objective: To investigate changes in self-care behaviours among people living with chronic conditions and their utilisation of technology before and during COVID-19.
Methods: This thesis has two phases: a systematic review and a secondary multi-method analysis of people living with Type 2 diabetes (T2DM) and comorbidities.
• Phase 1 systematically evaluated literature on changes in self-care behaviours and technology utilised during COVID-19 among people with chronic conditions.
• Phase 2 focused on a vulnerable population living in the community during the pandemic (i.e., older people average age of 74, living with T2DM and comorbidities, limited digital literacy, and not easily accessible via online survey methods).
By analysing in-depth data of 15 participants from this vulnerable population (via wearable cameras, interviews, and time use diaries), we compared how their self-care behaviours and use of technology have changed before and during COVID-19. Personas were developed to visualise their daily routines, changes in self-care behaviours, and use of technology during the pandemic, informed by Diabetes Australia Guidelines on self-management and the Substitution, Augmentation, Modification, and Redefinition (SAMR) framework.
Results:
Out of 36 eligible articles, our Phase 1 systematic review has found:
1. Mixed changes in self-care behaviours observed during COVID-19 amongst people with chronic conditions. Examples include:
• Positive: increased medication adherence, maintained glycaemic control, and improved diet control.
• Negative: decline in physical activity, and poor diet control.
2. Telehealth was the most utilised technology, followed by social media, messaging apps, web-based platforms (education and exercise), and web browsing.
Our Phase 2 secondary analysis, focusing on 15 older adults living in the community with T2DM and comorbidities, has identified:
3. Disruptions were observed in diet control, physical activity, medication adherence, monitoring of health status, consultations with health care professionals, and other self-care behaviours. New self-care behaviours were adopted (e.g., wearing masks, leaving groceries to decontaminate).
4. Telehealth was the most frequently used technology. Online platforms were used for ordering groceries, exercise, education, and socialising with family and friends.
5. Other novel uses of technology include attending online yoga, medication ordering app, and remote babysitting (Google Home).
6. Four personas emerged, namely: improved health behaviours, mixed changes in health behaviours, poorer health behaviours, and no significant health changes.
Conclusions: Telehealth has emerged as the silver lining of the pandemic, illustrating how technology can be rapidly adopted. Insights from the two phases will help inform recommendations on new models of care, that consider the needs of population groups with limited digital literacy and address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases.
