Table 1

Summary of different discourses in telehealth and telecare

ModernistHumanistPolitical economyChange management
Philosophical positionInstrumental rationalityPhenomenologyCritical theoryPragmatism
What is considered to be of value?Efficiency, cost-effectiveness, rational solutions, technological progress, business successFeelings, experiences, relationships, reciprocitiesEmancipation, reduction in oppression/dominationAdoption, assimilation into business-as-usual, sustainability
Usual unit of analysisTechnology (product)Person, technology-in-useInterest group/conflict situationService model, organisational routine
Methodological approachExperimentalNaturalisticHistoricalNaturalistic
Preferred research designRandomised controlled trial (hypothesis-driven, deductive), emphasis on size and scale and production of generalisable truthsEthnography, in-depth interview, focus group (qualitative, inductive), emphasis on understanding the individual's perspectiveCase study (qualitative, inductive), emphasis on surfacing and challenging power strugglesCase study (qualitative or mixed-method, inductive), emphasis on explaining barriers to change
What is viewed as ‘research evidence’?Effect size, metrics (eg, mortality rates, admission/readmission rates), ‘proof of concept’Authentic, plausible account of lived experience and the meaning of technology from users' perspectiveContextualised account of power strugglesContextualised account of change (or lack of change)
Assumed characteristics of technologiesAutomated, ‘smart’/‘intelligent’, sophisticated (eg, robotic), ubiquitous, seamlessly connected, failure-free, agentic (ie, does things)Potentially stigmatising or constraining, prone to failure, needing human input to work effectively. May be low-tech for example, recycled everyday objectsBenefits inflated by marketing and commodification by an industry biased towards high-tech, ‘innovative’ productsFocus on technology-in-use. Hence, same technology will have different utility in different systems and contexts
Metaphor for technology developmentDeveloping and implementing technological solutionsUser-centred design or redesignManipulation of the marketCreating opportunities for system redesign
Metaphor for technology useDeployment, choice, empowerment, compensation for human deficitsBeing-in-the-world, technology ready-to-handCommodificationAcceptance, adoption
Assumption of what people will use telehealth/telecare technologies for‘Self-monitoring’—sending biometric data to health professionalsCommunicating with friends/family, maintaining autonomy, leisure activityMany people/services will buy these technologies but few will use themSupporting routines (personal, family, healthcare provider)
Metaphor for how technologies are taken upBusiness drivers, regulatory levers, innovation value chain, silver marketCreative, adaptive and perhaps heroic human effortMarket dominationRoutinisation
Assumed consequences of (widespread) use of telehealth/telecare technologies‘Demographic time bomb’ will be contained; healthcare costs will fall; people will be healthier and happier; new markets for assistive products and services will boost the economyPositive: can support independent living. Negative: may reduce/replace human contact, cause stress, medicalise the life-world, become the ‘patient’ when they break downPublic funds diverted into private business. Loss of service-sector jobs and traditional services (eg, district nurses). Institutionalised ageism inscribed in technologyOrganisational tasks and processes made more efficient; staff time freed up to do other work; health outcomes improved
Non-use of telehealth/telecare technologies explained in terms ofEducation gap, motivation gap, awareness gap, incentive gapUniqueness and complexity of individual circumstances; meaning of technologyResistance to dominationIndividual-, organisational- and sector-level barriers to change