Table 4 Mapping to the characteristics of an innovation likely to affect its adoption

Relative advantage (the perceived efficiencies gained by the innovation relative to current tools or procedures)

• Convenience

• Empowerment

• Confidence

• Motivation

• Better measurements

• Could potentially reduce workloads

• Anxiety/dependence in small numbers of patients

• Professional concerns about creating dependency

• Concern about workloads

Complexity/ difficulty to learn

• Most patients found telemonitoring easy

• Professional interfaces complex

• No clear signals for professionals in COPD data

• Lack of intelligent decision support

Compatibility with the pre-existing system

• Preference for adoption within current system which influenced later implementations

• Lack of fit of professional system interfaces with workflows within practices

• Concern about roles

Trialability or testability

• High –particularly for patients

Potential for reinvention (using the tool for initially unintended purposes)

• Patients used data to manage day to day activity

Observed effects

• Higher workloads – reduced with learning and external drivers such as pressure on the system.

• Patients using data to support self management.

• Increased responsibility for the patient in study 7 was acceptable

• Limitations and extra work created by system design

• Empowered patients bypassing nurses or therapists, particularly with regard to prescribing