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Theory and practice in digital behaviour change: a matrix framework for the co-production of digital services that engage, empower and emancipate marginalised people living with complex and chronic conditions


Kayser, L and Nohr, C and Bertelsen, P and Botin, L and Villumsen, S and Showell, C and Turner, P, Theory and practice in digital behaviour change: a matrix framework for the co-production of digital services that engage, empower and emancipate marginalised people living with complex and chronic conditions, Informatics, 5, (4) Article 41. ISSN 2227-9709 (2018) [Refereed Article]


Copyright Statement

Copyright 2018 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

DOI: doi:10.3390/informatics5040041


Background: The WHO framework on integrated people-centred health services promotes a focus on the needs of people and their communities to empower them to have a more active role in their own health. It has advocated five strategies including: Engaging and empowering people and communities; co-ordinating services within and across sectors; and, creating an enabling environment. Any implementation of these strategies needs to occur at individual, community, and health service levels. Useful steps to reorganising health service provision are already being guided by existing models of care linked to increased adoption and use of digital technologies with examples including: Wagner’s Chronic Care Model (CCM); Valentijn’s Rainbow Model of Integrated Care (RMIC); and Phanareth’s et al.’s Epital Care Model (ECM). However, what about individuals and the communities they live in? How will strategies be implemented to address known inequities in: the social determinants of health; access to, and use of digital technologies, and individual textual, technical, and health literacies? Proposal of a matrix framework: This paper argues that people with complex and chronic conditions (PwCCC) living in communities that are at risk of being under-served or marginalised in health service provision require particular attention. It articulates a step-by-step process to identify these individuals and co-produce mechanisms to engage, empower and ultimately emancipate these individuals to become activated in living with their conditions and in their interactions with the health system and community. This step-by-step process focuses on key issues related to the design and role of digital services in mitigating the effects of the health service inequity and avoiding the creation of an e-health divide amongst users when advocating digital behaviour change initiatives. This paper presents a matrix framework providing a scaffold across three inter-related levels of the individual; the provider, and the health and care system. The matrix framework supports examination of and reflection on the design and role of digital technologies in conjunction with pre-existing motivational instruments. This matrix framework is illustrated with examples from practice.

Conclusion: It is anticipated that the matrix framework will evolve and can be used to map and reflect on approaches and practices aiming to enrich and stimulate co-production activities supported by digital technology focused on enhancing people-centred health services for the marginalised.

Item Details

Item Type:Refereed Article
Keywords:complex chronic conditions, health informatics, engaged, empowered, emancipated
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health informatics and information systems
Objective Division:Information and Communication Services
Objective Group:Information services
Objective Field:Information services not elsewhere classified
UTAS Author:Showell, C (Dr Chris Showell)
UTAS Author:Turner, P (Associate Professor Paul Turner)
ID Code:130170
Year Published:2018
Web of Science® Times Cited:10
Deposited By:Information and Communication Technology
Deposited On:2019-01-14
Last Modified:2019-03-05
Downloads:111 View Download Statistics

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