Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care

Carolyn Steele Gray; Meena Ramachandran; Christopher Brinton; Milena Forte; Mayura Loganathan; Rachel Walsh; Julie Callaghan; Ross Upshur; David Wiljer

doi:10.1016/j.socscimed.2024.116962

Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care

Soc Sci Med. 2024 Jul:353:116962. doi: 10.1016/j.socscimed.2024.116962. Epub 2024 May 12.

Authors

Carolyn Steele Gray¹, Meena Ramachandran², Christopher Brinton³, Milena Forte⁴, Mayura Loganathan⁴, Rachel Walsh⁵, Julie Callaghan⁶, Ross Upshur⁷, David Wiljer⁸

Affiliations

¹ Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada. Electronic address: Carolyn.SteeleGray@sinaihealth.ca.
² Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; School of Physical and Occupational Therapy, McGill University, Canada.
³ Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; Michael G. DeGroote School of Medicine, McMaster University, Canada.
⁴ Mount Sinai Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada.
⁵ Sunnybrook Health Sciences Centre, Canada.
⁶ Community Health and Quality, Unison Health and Community Services, Canada.
⁷ Department of Family and Community Medicine, University of Toronto, Canada.
⁸ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Canada; The Centre for Addiction and Mental Health, Canada; Education Technology Innovation, University Health Network, Canada.

PMID: 38908092
DOI: 10.1016/j.socscimed.2024.116962

Abstract

Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a "digital-first" primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers' views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.

Keywords: Digital health; Ethnography; Primary care; Science and technology studies; Social representation; Therapeutic relationship; Virtual care.

MeSH terms

Adult
Aged
Anthropology, Cultural / methods
COVID-19* / psychology
COVID-19* / therapy
Digital Technology
Female
Health Personnel / psychology
Humans
Male
Middle Aged
Ontario
Physician-Patient Relations
Primary Health Care*
Professional-Patient Relations
Qualitative Research
SARS-CoV-2
Telemedicine