Article Text

TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation
  1. Chris Salisbury1,
  2. Clare Thomas1,
  3. Alicia O'Cathain2,
  4. Anne Rogers3,
  5. Catherine Pope3,
  6. Lucy Yardley4,
  7. Sandra Hollinghurst1,
  8. Tom Fahey5,
  9. Glyn Lewis6,
  10. Shirley Large7,
  11. Louisa Edwards1,
  12. Alison Rowsell4,
  13. Julia Segar8,
  14. Simon Brownsell2,
  15. Alan A Montgomery9
  1. 1University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Bristol, UK
  2. 2University of Sheffield, Medical Care Research Unit, School of Health and Related Research (ScHARR), Sheffield, UK
  3. 3University of Southampton, School of Health Sciences, Southampton, UK
  4. 4University of Southampton, Centre for Applications of Health Psychology, Southampton, UK
  5. 5Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Medical School, Dublin 2, Ireland
  6. 6Division of Psychiatry, University College London, London, UK
  7. 7NHS Direct, Hampshire, UK
  8. 8The University of Manchester, Centre for Primary Care, Institute of Population Health, Manchester, UK
  9. 9Nottingham Clinical Trials Unit, University of Nottingham, Nottingham Health Science Partners, Nottingham, UK
  1. Correspondence to Professor Chris Salisbury; c.salisbury{at}


Objective To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression.

Design The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients’ and health professionals’ experience of telehealth; a quantitative survey of patients’ interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention (‘Healthlines’) was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations.

Setting Primary care.

Results The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care.

Conclusions A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions. It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to patients and providers, and cost-effective.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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