The technological transformation of self-care: A patient-driven adaptation of the Technology Acceptance Model for evaluation of patient-accessible electronic medical records

The primary aim of this dissertation is an exploration and description of what patients living with chronic illness know or think they know about patient-accessible electronic medical records (PA-EMR) to ultimately understand how healthcare organisations can best approach formative evaluation of this technology in the social context of the patient-user. The research projects comprising this dissertation employ naturalistic inquiry, qualitative data, and critical and interpretative approaches to analysis (1) to broaden understanding of patient perspectives about and experiences with PA-EMR, (2) to identify variables and clarify relationships between variables, (3) to adapt an established theoretical framework from a related field, and (4) to develop an early evaluative instrument for use in future research.; The dissertation is comprised of three parts: (1) A discussion and clarification of the terms and contexts employed in this research (e.g., what is a patient?; what do patients do with information?; why and how would patients use PA-EMR?); (2) an empirical section, comprised of three reports (a critical literature review on PA-EMR, a grounded theory study exploring the meaning of information in the life-world context of patients living with chronic illness, and meta-ethnography of interpretative literature on patients, information, information technology and self-care); and (3) a patient-centric adaptation of an accepted theoretical framework for technology evaluation (The Technology Acceptance Model (TAM) of Davis and Venkatesh) with a discussion of its implications.; The work identifies three key principles: First, patients are EMR users with motivations and work requirements that are distinct from organisational employees and professionals; second, patients living with chronic illness perceive usefulness of an EMR system in terms of its promotion of illness ownership, patient-driven communication, personalisation of content, and confirmation of mutual trust between physicians and patients; and third, trust appears to function as the essential co-variable for all predictors of PA-EMR utilisation.; Therefore, patient-user based formative evaluation of PA-EMR requires critical assessment of the channels and patterns of trust between patients and professionals, healthcare organisations, the health system, and the healthcare institution.