Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia.
J Am Med Inform Assoc. 2022 Jun 14;29(7):1244-1252. doi: 10.1093/jamia/ocac061.
To understand the nature of health consumer self-management workarounds during the COVID-19 pandemic; to classify these workarounds using the Substitution, Augmentation, Modification, and Redefinition (SAMR) framework; and to see how digital tools had assisted these workarounds.
We assessed 15 self-managing elderly patients with Type 2 diabetes, multiple chronic comorbidities, and low digital literacy. Interviews were conducted during COVID-19 lockdowns in May-June 2020 and participants were asked about how their self-management had differed from before. Each instance of change in self-management were identified as consumer workarounds and were classified using the SAMR framework to assess the extent of change. We also identified instances where digital technology assisted with workarounds.
Consumer workarounds in all SAMR levels were observed. Substitution, describing change in work quality or how basic information was communicated, was easy to make and involved digital tools that replaced face-to-face communications, such as the telephone. Augmentation, describing changes in task mechanisms that enhanced functional value, did not include any digital tools. Modification, which significantly altered task content and context, involved more complicated changes such as making video calls. Redefinition workarounds created tasks not previously required, such as using Google Home to remotely babysit grandchildren, had transformed daily routines.
Health consumer workarounds need further investigation as health consumers also use workarounds to bypass barriers during self-management. The SAMR framework had classified the health consumer workarounds during COVID, but the framework needs further refinement to include more aspects of workarounds.
了解 COVID-19 大流行期间健康消费者自我管理的解决方法的本质；使用替代、增强、修改和重新定义（SAMR）框架对这些解决方法进行分类；并观察数字工具如何协助这些解决方法。
我们评估了 15 名患有 2 型糖尿病、多种慢性合并症和数字素养较低的自我管理老年患者。访谈于 2020 年 5 月至 6 月 COVID-19 封锁期间进行，参与者被问及他们的自我管理与之前有何不同。自我管理的每一次变化都被确定为消费者的解决方法，并使用 SAMR 框架进行分类，以评估变化的程度。我们还确定了数字技术协助解决方法的实例。
观察到所有 SAMR 级别的消费者解决方法。替代，描述工作质量或基本信息如何沟通的变化，很容易实现，并涉及替代面对面交流的数字工具，如电话。增强，描述增强功能价值的任务机制变化，不包括任何数字工具。修改，即显著改变任务内容和上下文，涉及更复杂的变化，如进行视频通话。重新定义的解决方法创建了以前不需要的任务，例如使用 Google Home 远程照顾孙子孙女，这些变化改变了日常生活。
需要进一步研究健康消费者的解决方法，因为健康消费者也会在自我管理过程中使用解决方法来绕过障碍。SAMR 框架对 COVID 期间的健康消费者解决方法进行了分类，但该框架需要进一步细化，以包括更多的解决方法方面。
