Using a e-health tool for childhood obesity follw-up care: issues in the health care pathway
Résumé
Our study focuses on ApplicationAP device, a follow-up tool of the physical activity practice for obese children and teenagers, conceived by the RéPPOP (Prevention and Care of Paediatric Obesity Network). It aims for optimising the children health care pathway in physical activity and for supporting motivation to move by customised goals and exchanges with the nursing staff. It allows the child and the professional to exchange by an intern messaging service, but also to follow the patient evolution about his efforts and his sensations during physical activity. This device is based on the principles of Therapeutic Education Program (ETP), which is the model recommended by the Health High Authority (HAS) for the childhood obesity care, a pathology considered as chronic. This device questions in a frontal way the impact of e-health on the health care pathway, quite especially with children. Indeed, such a tool questions particularly about its place in the care, but also about ethical, social and clinical issues linked with its use. The RéPPOP declared strategy involves relying on present practices and representations to try to transform them. We question the effective realities of this display but also the actual impact of « non-humans » on the health care pathway and logics with the increasing development of e-health devices. So, this research comprehends the more or less maximalist characteristic of coordination modes between humans and non-humans engaged in conception and test phases of this application, especially considering the representations about therapeutic education and childhood obesity mobilised by the involved actors. The survey is based on ethnographic observations (150 hours) made inside the RéPPOP’s coordination team during various working times concerning the application development and setting up (meetings, exchanges with adapted physical activities teachers, etc.). As well as interviews (32) led with some of the RéPPOP members and adapted physical activities teachers who tested this device. We show that this e-health tool use in the patient health care pathway isn’t self-evident. Moreover, despite of the health democracy display of the RéPPOP, the children and their families are mostly mobilised from the designers’ representations. This survey reports the hopes and fears of the latter and the difficulties they encounter to interest and enrol to organise this type of health care pathway. Moreover, it shows the multiple issues of ETP’s introduction into e-health.
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