Towards Integrated Care for the Elderly: Exploring the Acceptability of Telemonitoring for Hypertension and Type 2 Diabetes Management

Matic Mihevc, Tina Virtič Potočnik, Črt Zavrnik, Zalika Klemenc-Ketiš, Antonija Poplas Susič, Marija Petek Šter

Keywords: acceptability, mobile health, telemonitoring, aged, self-management, integrated care

Background:

Telemonitoring has been proposed as an effective method to support integrated care for older people with arterial hypertension (AH) and type 2 diabetes (T2D). However, its acceptability in this population remains underexplored, despite challenges such as cognitive impairment, multiple chronic conditions, and technology hesitancy.

Research questions:

To what extent is telemonitoring acceptable among older people with AH and T2D, and how does it support the components of integrated care? What barriers hinder its scale-up within integrated care models?

Method:

A concurrent triangulation mixed-methods study, including in-depth interviews (n=29) and quantitative acceptability tool (n=55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Qualitative data were analysed using template content analysis (TCA), while quantitative responses were scored on a Likert scale to identify regional variations and overall trends.

Results:

TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. Participants noted improvements in health literacy, behavioural changes, and patient-provider relationships. However, challenges such as technological barriers, increased family involvement burden, and infrastructure gaps in rural areas limit its scalability.

Conclusions:

For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes. Addressing these barriers will ensure broader adoption and sustainable integration into integrated care models for older adults with AH and T2D.

Points for discussion:

How can telemonitoring interventions be tailored to address the specific challenges faced by older adults, such as cognitive impairments, physical limitations, and technology hesitancy, to enhance acceptability and usability?

What role do family members and caregivers play in the successful implementation of telemonitoring, and how can their contributions be supported?

What strategies can be implemented to ensure that telemonitoring benefits are sustained over the long term, beyond pilot projects and initial implementation?

#47