Understanding frictions in patient-reported outcome-based community healthcare - An institutional logics perspective

Patient-reported outcome (PRO) measures in community-based healthcare play a significant role in the emerging field of digital health. This qualitative study explored healthcare professionals' (HCPs') experiences of integrating 'MyPROfile' as a dialogue tool in consultations in community healthcare.

Adopting a qualitative approach with a social constructivist perspective, the study utilised qualitative interviews, participant observations, and focus group interviews. Data were analysed using reflective thematic analysis, guided by theories on institutional logics.

In the analysis, we identified two distinct institutional logics related to HCPs' experiences integrating PRO measures into their existing practice. Frictions emerged as HCPs integrated the PRO-based dialogue tool, highlighting frictions between an existing Care logic rooted in a holistic health promotion paradigm and the introduced PRO logic. According to the HCPs, the PRO-based practice was perceived as divergent from holistic, narrative-based care, emphasising a shift towards a more reductionist and evaluative model of care.

The study underscores the importance of understanding institutional logics in integrating technologies like PRO measures in healthcare settings. The identified frictions necessitate reflexive venues and collaborative relationships to align differing logics for successful integration. Additionally, incorporating citizens' perspectives is vital for developing effective rehabilitation and prevention programmes. Moving forward, stakeholder engagement in reflective discussions and workshops is crucial to bridge the gap between the introduced technology and the existing health promotion paradigm, ensuring a seamless and meaningful integration of PRO measures in community healthcare settings.