Designing an IT-Based Self-Monitoring System to Promote Chronic Disease Self-Management Subjective Vitality - From the Perspective of Self-Determination Theory

Abstract

Chronic disease self-management (CDSM) comprises a series of actions in the daily routines, including self-monitoring, medication management, emotion management, maintaining social connection, and lifestyle adjustment. Adhering to these tedious actions on a daily basis is a big challenge for chronic patients. With the rapid development of IT-enabled self-monitoring technologies such as embedded sensors, wearable devices, mobile apps, and data analytics, IT-based self-management (ITSM) systems in the market are increasing. Unfortunately, these technologies manifest limited influences on chronic patients’ self-management vitality and long-term adherence owning to various psychological or behavioral obstacles. To investigate the effective IT designs and the underlying mechanism underlying IT-based self-management systems, this study draws on the perspective of Self-Determination Theory, which explains the antecedents of behavior adherence by differentiating human motivations (i.e., autonomous motivation and controlled motivation), to explain the rationale behind an ITSM system. Specifically, this study proposes three proper interventions of an ITSM system and six specific designs that contribute to the self-management subjective vitality of chronic patients. In addition, this study develops a new construct called personal health record identity and explains its moderating role in the relationships between the proposed IT interventions and self-management subjective vitality based on Self-Determination Theory.

Two waves of surveys were conducted on users of an ITSM system targeting diabetes control to test the research model. A total of 177 valid cases were left after matching the two waves of survey and 147 cases after matching the valid cases with behavioral data (i.e., the frequency of IT-enabled self-monitoring recorded in the ITSM system). Results suggest that only chronic disease self-management autonomous motivation directly contributes to self-management subjective vitality and self-monitoring adherence, whereas the effects of controlled motivation are mediated by autonomous motivation through the internalization mentioned in Self-Determination Theory. Additionally, personal health record identity enhances the relationships between ITSM system interventions and chronic patients’ self-management motivations.

This study has several contributions. Firstly, we build and verify a research model that investigates how an ITSM system promotes IT-enabled self-monitoring adherence whilst ensuring psychological well-being in the context of CDSM. Existing studies on the continuance of an information system either assume the system to be mandatory by an organization or free for a user to continue or discontinue. The present context falls somewhere between mandatory use and voluntary use in that users can decide whether or not to continue but the decision is subjected to health threats or environmental pressure. We enrich the literature on IS continuance by introducing the concept of adherence to IS and confirming the critical role of autonomous motivation in predicting adherence to IS from the perspective of Self-Determination Theory. Our results confirm the positive role of self-management autonomous motivation on subjective vitality and self-monitoring adherence, and the effects of controlled motivation are found to be nonsignificant.

Secondly, the present thesis identifies three ITSM interventions by synthesizing the literature on self-management interventions and health-information technologies (HITs) and then verifies the effects of the three ITSM interventions. On this account, we answered the call for an understanding of a patient-centric ITSM system as well as the mechanisms of how to design such a system to improve patients’ self-management performance (Savoli, Barki, and Paré 2020) by discussing the mediating roles of CDSM autonomous motivation and controlled motivation. Our findings thus provide both theoretical and practical implications with respect to designing an ITSM system to promote chronic patients’ self-management performance.

Finally, we propose the construct of personal health record (PHR) identity to bridge the gap between IT-enabled self-monitoring and preventive CDSM activities. Rothman and Savoley (1997) pointed out that self-monitoring only indirectly contributes to health improvement, whereas preventive health activities directly contribute to health improvement. Thus, a gap exists between IT-enabled self-monitoring and the preventive CDSM tasks suggested by the ITSM system. We argue that a chronic patient’s PHR identity influences an individual’s view of the ITSM system and the perceived locus of causality (PLOC). Accordingly, a high PHR identity means a chronic patient attributes the PHR readings to his or her completion of preventive CDSM tasks. Our hypothesis of the moderating effects of PHR identity on the relationships between ITSM interventions and the two types of motivations is supported by the data. Furthermore, we hypothesize that PHR identity strengthens the positive relationship between controlled motivation and autonomous motivation. Our empirical study also supports this hypothesis. As such, the role of PHR identity in facilitating the internalization of ITSM interventions is confirmed, enriching the health promotion literature by reducing the gap between self-monitoring and preventive CDSM activities through the introduction of IT-enabled self-monitoring technologies.

Date of Award	12 Aug 2022
Original language	English
Awarding Institution	City University of Hong Kong
Supervisor	Kai H. LIM (Supervisor)