Care Navigation in Older People with Multimorbidity - Feasibility and Acceptability of using ICT

Jolien Vos, Conor Linehan, Kathrin Gerling, Karen Windle, Niroshan Siriwardena


Introduction: The increase in long-term conditions (LTCs) and multimorbidity, particularly in older people, has led to increased demand in health and social care. Patients with multimorbidity need a seamless connection between the health and social care systems as well as between the different carers. However, health and social care systems currently present these patients with a variety of options for highly specialised care, provided at different settings. With little to no guidance, patients are expected to select the providers and services they need in relation to the LTCs they are diagnosed with. They build as it were their own ‘personal care network’ (PCN), but the structure of these PCNs is unknown. Further, the use of care navigators to guide patients with multimorbidity is limited and not without obstacles. A promising opportunity to address the care navigation challenge in this group is that of Information and Communication Technology (ICT). Research shows that ICT can provide valuable opportunities for older people, especially by supporting age-related needs while also reducing the cost of health care. However, there are no insights into the benefits of ICT on navigation through the care system. This PhD explores the feasibility, acceptability, and requirements establishment to support the design of ICT interventions to support older adults with multimorbidity to independently navigate the care system. Method: A mixed method approach is applied combining the use of questionnaires and semi-structured interviews. Social network analysis and descriptive statistics are used for the quantitative data. Qualitative data are analysed through framework analysis. All data are then integrated and reported in the form of data-driven personas. Results: Firstly, we bring together the existing literature around care navigation in older people with multimorbidity. We then visualise the PCNs of older people with multimorbidity and gain an understanding of how these PCNs function. Following this, we investigate how ICT can provide a sustainable alternative for care navigation support in older people with multimorbidity (the end-users). This includes the identification of end-users’ needs and requirements for such an ICT support tool. The fifth phase concludes this PhD by producing usable personas of older people with multimorbidity.


  1. Adlin, T. and Pruitt, J., 2010. The Essential Persona Lifecycle: Your Guide to Building and Using Personas, Morgan Kaufmann Publishers. USA.
  2. Age Concern and Help the Aged, 2009. Introducing another World: older people and digital inclusion, Age Concern and Help the Aged and.
  3. onals/Computers-and-technology/140_0809_introduci ng_another_world_older_people_and_digital_inclusio n_2009_pro.pdf?dtrk=true.
  4. Albert, B., 2012. Navigating care management. Healthcare Financial Management, 66(12), 62-66.
  5. Arksey, H. and O'Malley, L., 2005. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32.
  6. Bhandari, G. and Snowdon, A., 2012. Design of a patientcentric, service-oriented health care navigation system for a local health integration network. Behaviour & Information Technology, 31(3), 275-285.
  7. Blomkvist, S., 2002. Persona - an overview (Extract from the paper: The User as a personality. Using Personas as a tool for design). Position paper for course work 'Theoretical perspectives in Human-Computer Interaction' available from: ourse/homepage/hcidist/v04/Persona-overview.pdf.
  8. Blozik, E., van den Bussche, H., Gurtner, F., Schäfer, I. and Scherer M., 2013. Epidemiological strategies for adapting clinical practice guidelines to the needs of multimorbid patients. BMC Health Serv Res., 16(13).
  9. Campbell-Kelly, M., Aspray, W., Ensmenger, N. and Yost, J.R., 2013. Computer: A History of the Information Machine. The Perseus Books Group, Third Edition.
  10. Carla, P. and Coleman, E.A., 2010. Active Roles for Older Adults in Navigating Care Transitions: Lessons Learned from the Care Transitions Intervention. Open longevity science, 4, 43-50.
  11. Cooper, A., 1999. The inmates are running the asylum. SAMS/Macmillan, Indianapolis, First Edition.
  12. Creswell, 2009. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. SAGE, California, Third Edition.
  13. Czaja, S., 2015. Can Technology Empower Older Adults to Manage Their Health? Journal of the American Society on Aging, 39(1), 46-51.
  14. Department of Health, 2012. Long Term Conditions Compendium of Information. Published to DH website, available from: ent/uploads/system/uploads/attachment_data/file/2165 28/dh_134486.pdf.
  15. Detsky, A.S., Gauthier, S.R. and Fuchs, V.R., 2012. Specialization in medicine: how much is appropriate? JAMA, 307(5), 463-464.
  16. Ferrante, J.M., Cohen, D.J. and Crossen, J.C., 2010. Translating the patient navigator approach to meet the needs of primary care. Journal of the American Board of Family Medicine, 23(6), 736-744.
  17. Fortin, M., Soubhi, H., Hudon, C., Bayliss E.A. and van den Akker, M., 2007. Multimorbidity's many challenges: time to focus on the needs of this vulnerable and growing population. British Medical Journal, 334 (7602), 1016-1017.
  18. GMC, 2011. Specialties, sub-specialties and progression through training the international perspective. Available from: nts/content/Specialties_subspecialties_and_progressio n_through_training___the_international_perspective.p df_45500662.pdf.
  19. Goodman-Deane, J., Keith E.S. and Whitney, G., 2009. HCI and the older population. Univ Access Inf Soc, 8, 1-3.
  20. GVO, 2012. Government Digital Strategy. Available from: /uploads/attachment_data/file/296336/Government_Di gital_Stratetegy_-_November_2012.pdf.
  21. Hanneman, R.A. and Riddle, M., 2005. Introduction to social network methods. University of California, Riverside.
  22. Health Foundation (HF), 2014. Person-centred care made simple. Available from: ication/person-centred-care-made-simple 15/11/2015.
  23. Jackson, K., Oelke, N.D., Besner, J., Harrison, A., 2012. Patient Journey: Implications for improving and integrating care among older adults with chronic obstructive pulmonary disease. Canadian Journal of Aging, 31(2), 223-233.
  24. Khosravia, P. and Ghapanchia, A.H., 2016. Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review. International Journal of Medical Informatics, 85, 17-26.
  25. Marchibroda, J.M., 2015. Technologies Hold Great Promise for Allowing Older Adults to Age in Place. Journal of the American Society on Aging, 39 (1), 52- 55.
  26. Miaskiewicz, T., Sumner, T. and Kozar, K.A., 2008. A Latent Semantic Analysis Methodology. CHI 2008 Proceedings - Character Development. Florence, Italy.
  27. National Audit Office, 2013. Digital Britain 2: Putting users at the heart of government's digital services. Available from:
  28. 3-001-Digital-Britain-2-Book.pdf.
  29. NHS Improvement, 2013. Managing multi-morbidity in practice: what lessons can be learnt from the care of people with COPD and multi-morbidities? Available from: nical-resources//media/Files/CIRC/RCGP-COPD-Mu lti-Morbidities-April-2013.ashx.
  30. Office for National Statistics, 2013. Chapter 7 - General health (General Lifestyle Survey Overview - a report on the 2011 General Lifestyle Survey). Available from:
  31. ONS, 2009. Helping to shape tomorrow: The 2011 Census of Population and Housing in England and Wales. Presented to Parliament by the Minister to the Cabinet Office, by Command of Her Majesty Laid before the National Assembly for Wales by the Minister for Finance and Public Service Delivery December 2008.
  32. Perruccio, A. V., Katz, J.N. and Losina, E., 2012. Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone. J Clin Epidemiol., 65(1), 100-106.
  33. Plano Clark, V. L., 2010. The adoption and practice of mixed methods: U.S. trends in federally funded healthrelated research. Qualitative Inquiry, 6(6), 428-440.
  34. Polit, D.F., and Beck, C.T. (2010) Essentials of Nursing Research: Appraising Evidence from Nursing Practice. Wolters Kluwer Health. Philadelphia, 7th edition.
  35. PSSRU, 2010. Unit Costs of Health and Social Care. Available from: 10/uc2010.pdf.
  36. Ravenscroft, E.F., 2010. Navigating the health care system: insights from consumers with multimorbidity. Journal of Nursing & Healthcare of Chronic Illnesses, 2(3), 215-224.
  37. Sinnot, C., Mc Hugh, S., Browne, J., Bradley, C., 2013. GPS' perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open, 3(9).
  38. Smith, S.M., Soubhi, H., Fortin, M., Hudon, C. and O'Dozd, T., 2012. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings, BMJ, 345, 1-10.
  39. Starfield, B., 2011. Point: The changing nature of disease: implications for health services. Med Care, 49 (11), 971-972.
  40. Tashakkori, A. and Teddlie, C., 2003. Handbook of Mixed Methods in Social & Behavioral Research. SAGE. California.
  41. Teddlie, C. and Tashakkori, A., 2009. Foundations of Mixed Methods Research. SAGE. California.
  42. Wagner, N., Hassanein, K. and Head, M., 2010. Computer use by older adults: A multidisciplinary view. Computers in Human Behaviour, 26, 870-882.
  43. Wandke, H., Sengpiel, M. and Sönksen, M., 2012. Myths about Older People's Use of Information and Communication Technology. Gerontology, 58, 564-570.
  44. WHO, 2009. Patient empowerment and health care. Available from: B K144022/
  45. WHO, 2012. First European Conference on Patient Empowerment - living with chronic disease. Available from:
  46. 12/04/first-european-conference-on-patient-empower ment-living-with-chronic-disease.
  47. Wilcox, Hur and Miller, 2010. 7 phases of user-centred design. Available from:
  48. signmap1.png.
  49. World Health Organization, 2008. Primary Health Care: Now More Than Ever. Available from
  50. World Health Organization, 2014. World Health Statistics 2014: Large gains in life expectancy. Available from. world-health-statistics-2014/en/
  51. Wright, P.C. and McCarthy, J.C., 2010. ExperienceCentered Design. Morgan and Claypool Publishers.

Paper Citation

in Harvard Style

Vos J., Linehan C., Gerling K., Windle K. and Siriwardena N. (2016). Care Navigation in Older People with Multimorbidity - Feasibility and Acceptability of using ICT . In Doctoral Consortium - DCICT4AWE, (GISTAM 2016) ISBN , pages 15-24

in Bibtex Style

author={Jolien Vos and Conor Linehan and Kathrin Gerling and Karen Windle and Niroshan Siriwardena},
title={Care Navigation in Older People with Multimorbidity - Feasibility and Acceptability of using ICT},
booktitle={Doctoral Consortium - DCICT4AWE, (GISTAM 2016)},

in EndNote Style

JO - Doctoral Consortium - DCICT4AWE, (GISTAM 2016)
TI - Care Navigation in Older People with Multimorbidity - Feasibility and Acceptability of using ICT
SN -
AU - Vos J.
AU - Linehan C.
AU - Gerling K.
AU - Windle K.
AU - Siriwardena N.
PY - 2016
SP - 15
EP - 24
DO -