JMIR Publications

ABSTRACT

Background:

Chronic diseases often have severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients’ lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, patients’ ability to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening the patients’ voices and enabling patients to assert control over their health and treatment. To support self-management and foster empowerment, mHealth provides cost-efficient means.

Objective:

There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. Our objective is to address this knowledge gap. We investigate how mHealth affects consultations, and how it affects patient empowerment.

Methods:

We rely on data from an ethnographic field study of six children and adolescents diagnosed with juvenile idiopathic arthritis. We analyze six patient-physician consultations and draw on Michel Foucault’s concepts of power and power technology.

Results:

Our results suggest that use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and ‘correct’ their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients’ lives with the disease being ignored, and thus, inadvertently, patients’ voices may be silenced.

Conclusions:

Our results show that concrete uses of mHealth conflict with extant literature on empowerment which emphasizes the importance of strengthening the patients’ voices and enabling patients to take more control of their health and treatment. We contribute to state-of-the-art knowledge by showing that uses of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations.