How patient work changes over time for people with multimorbid type 2 diabetes: qualitative study

Kathleen Yin*, Joshua Jung, Enrico Coiera, Kenneth W. K. Ho, Sanjyot Vagholkar, Ann Blandford, Frances Rapport, Annie Y. S. Lau

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
42 Downloads (Pure)


Background: The experiences of patients change throughout their illness trajectory and differ according to their medical history, but digital support tools are often designed for one specific moment in time and do not change with the patient as their health state changes. This presents a fragmented support pattern where patients have to move from one app to another as they move between health states, and some subpopulations of patients do not have their needs addressed at all.

Objective: This study aims to investigate how patient work evolves over time for those living with type 2 diabetes mellitus and chronic multimorbidity, and explore the implications for digital support system design.

Methods: In total, 26 patients with type 2 diabetes mellitus and chronic multimorbidity were recruited. Each interview was conducted twice, and interviews were transcribed and analyzed according to the Chronic Illness Trajectory Model.

Results: Four unique illness trajectories were identified with different patient work goals and needs: living with stable chronic conditions involves patients seeking to make patient work as routinized and invisible as possible; dealing with cycles of acute or crisis episodes included heavily multimorbid patients who sought support with therapy adherence; responding to unstable changes described patients currently experiencing rapid health changes and increasing patient work intensity; and coming back from crisis focused on patients coping with a loss of normalcy.

Conclusions: Patient work changes over time based on the experiences of the individual, and its timing and trajectory need to be considered when designing digital support interventions.

International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-022163
Original languageEnglish
Article numbere25992
Pages (from-to)1-13
Number of pages13
JournalJournal of Medical Internet Research
Issue number7
Publication statusPublished - 15 Jul 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • patient work
  • self-management
  • diabetes
  • chronic conditions
  • chronic illness trajectory
  • consumer informatics


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