Teledermatology for chronic disease management: coherence and normalization

Objective: To explore the importance of 'coherence' in the normalization of treatment interventions by examining teledermatology for skin disease management from the perspectives of patients and their advocates. Methods: Twelve teledermatology services were studied using semi-structured interviews. Participants were patients (n = 20) and health professionals, managers and patient advocates (n = 68). Results: Teledermatology lacked coherence for patients and advocates. It was seen to be different from standard dermatology care, but the objectives of it - what it is for - were neither clear nor understandable to participants. Teledermatology 'fitting in' with the patient's own lifeworld appeared to be unlikely for patients suffering a range of skin diseases, as features of teledermatology (e.g. absence of talk with consultant, and diagnostic uncertainty) were incongruent with the wide-ranging needs of patients and limited their participation in management. Discussion: Healthcare technology may facilitate greater self-management of chronic disease. However, successful normalization of technology for this purpose will require greater understanding of what it means to patients in the context of their experiences of disease and the parameters of their lives.