Technosociality in the daily lives of primary care professionals and health promotion: scoping review

Silva, Tamires Carolina; Carvalho, Andresa Guerra de; Tholl, Adriana Dutra; Borrego, Maria Aurora Rodriguez; Soto, Pablo Jesús López; Viegas, Selma Maria da Fonseca

doi:10.1590/0103-1104202113117I

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REVIEW • Saúde debate 45 (131) • Oct-Dec 2021 • https://doi.org/10.1590/0103-1104202113117I copy

Technosociality in the daily lives of primary care professionals and health promotion: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aimed to map the available evidence on technosociality in the daily lives of primary care professionals to promote the health of people/families. This is a scoping review based on the Joanna Briggs Institute and Prisma-ScR. The PCC strategy (participants, concept and context) was used. The sample comprises 25 articles. The predominant language was English, the year, 2018, the strength of evidence, 5 and the quality of evidence, high and moderate. Technologies are part of the daily life of PHC professionals and include health control, curative and medication measures. They are sources of communication between professionals and professionals and users. For the use of technologies, it is essential that professionals are trained, using evidence-based practices to achieve the objectives in view of the needs of each one. The use of technologies to promote the health of people/families represents a technological innovation in Primary Health Care, with the possibility of impacting health conditions and promoting healthier life choices.

KEYWORDS
Technology; Primary Health Care; Mobile applications; Social networking; Health promotion

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Reference (year)	Article/ Type of study/ Database/ Level of evidence/ Sample	Study objective	Conclusions
Ramsey et al.^{⁵5 Ramsey AT, Satterfield JM, Gerke DR, et al. Technology-Based Alcohol Interventions in Primary Care: Systematic Review. Journ al of Medical Internet Research. 2019 [acesso em 2020 abr 29]; 21(04):12. Disponível em: https://doi.org/10.2196/10859 https://doi.org/10.2196/10859...} (2019)	Technology-Based Alcohol Interventions in Primary Care: Systematic Review Systematic Review PubMed Level of Evidence: 1 Sample: 42 studies	Review recent literature on the use of technology to provide, enhance or support the implementation of interventions related to alcohol use by PHC users.	- Evidences the use of technological platforms, computer, web or cell phone for actions to support the change in the behavior of alcohol users; - The use of technologies by professionals is efficient to promote interventions related to alcohol use.
Jong et al.^{⁶6 Jong CC, Ros WJG, Leeuwen MV, et al. The challenge of involving elderly patients in primary care using an electronic communication tool with their professionals: a mixed methods study. Journal of Innovation in Health Informatics. 2017 [acesso em 2020 abr 30]; 24(3):275-283. Disponível em: http://dx.doi.org/10.14236/jhi.v24i3.937 http://dx.doi.org/10.14236/jhi.v24i3.937...} (2017)	The challenge of involving elderly patients in primary care using an electronic communication tool with their professionals: a mixed methods study Study of mixed methods, with a quantitative approach Scopus Level of Evidence: 3 Sample: 22 patients	Examine whether an electronic communication tool (Congredi) designed for professionals, including a care plan and secure email, is usable for patient systems and what their experiences are.	- Congredi technology aims the electronic communication with other professionals, informal caregivers and patients; - The use of this tool allows sharing and drawing up the care plan for the patient; - Patient and professionals communicate using technology through the patient portal, which allows the patient to view the care plan; - Barriers: not all professionals were linked to Congredi, and when informal caregivers did not receive feedback from professionals, there was no incentive for them to use the tool later.
Berman et al.^{⁷7 Berman AH, Kolaas K, Petersén E, et al. Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care. BMC Family Practice. 2018 [acesso em 2020 mar 5]; 19(139):01-11. Disponível em: https://doi.org/10.1186/s12875-018-0829-z https://doi.org/10.1186/s12875-018-0829-...} (2018)	Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care Qualitative study Scopus Level of Evidence: 5 Sample: 46 health professionals	Explore the perceptions of clinicians working in PHC about promoting a healthy lifestyle, with or without screening and digital intervention.	- Working with health promotion using digital interventions, considered as a positive challenge; - The initial use of digital inventions can change the practice of health professionals; - The article does not show the type of technology used to carry out digital interventions in favor of health promotion; - It is necessary to maintain a balanced view of digital interventions, declaring their role in promoting a healthy lifestyle.
Marin-Gomez et al.^{⁸8 Marin-Gomez FX, Cuyas FG, Reig-Bolano R, et al. Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey. JMIR mHealth and uHealth. 2018 [acesso em 2020 abr 30]; 06(12):12. Disponível em: https://doi.org/10.2196/11147 https://doi.org/10.2196/11147...} (2018)	Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey Cross-sectional, descriptive study PubMed Level of Evidence: 5 Sample: 483 health professionals	Explore the use of social networking apps for mobile phones among PHC professionals for work-related purposes.	- The use of social networking applications such as Facebook, WhatsApp, Twitter, Instagram and others, by health professionals is aimed at communication actions between professionals, clinical or drug consultations and, mainly, for professional development, as well as actions of health promotion.
Oliver-Mora & Iñiguez-Rueda^{²¹21 Oliver-Mora M, Iñiguez-Rueda L. El uso de las tecnologías de la información y la comunicación (TIC) en los centros de salud: la visión de los profesionales en Cataluña, España. Revista Interface. 2017 [acesso em 2020 mar 5]; 21(63):945-955. Disponível em: https://doi.org/10.1590/1807-57622016.0331 https://doi.org/10.1590/1807-57622016.03...} (2017)	El uso de las tecnologías de la información y la comunicación (TIC) en los centros de salud: la visión de los profesionales en Cataluña, España Experience reports Scielo Level of Evidence: 5 Sample: 9 health professionals	Identify experiences using information and communication technologies capable of improving the public management of Health Centers in Catalonia (Spain) and which were promoted ‘from the bottom up’ by PHC professionals.	- The use of virtual communication, such as blogs, can be seen as a tool for both health promotion and health education, as well as for promoting patient involvement and awareness of their health status; - The use of these technologies can make it possible for patients to freely express their discomfort and dialogue with health professionals; - Patient blogs are the result of the desire to open new avenues for communication between healthcare professionals and patients.
Plessis et al.^{²²22 Plessis LM, Koornhof HE, Marais ML, et al. Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa Western Cape Province, South Africa. South African journal of child health. 2017 [acesso em 2020 fev 10]; 11(04):164-169. Disponível em: http://www.scielo.org.za/pdf/sajch/v11n4/09.pdf http://www.scielo.org.za/pdf/sajch/v11n4...} (2017)	Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa Cross-sectional descriptive study Cochrane Level of Evidence: 5 Sample: 5,193 participants	Assess the implementation of health promotion messages and identify barriers faced.	- Although the study investigates the use of mobile technologies by health professionals for health promotion actions related to infant and child feeding, they have not yet been implemented in the investigated PHC teams. It is noted that professionals still use posters, pamphlets and educational material for this purpose.
Mastellos et al.^{²⁵25 Mastellos N, Bliźniuk G, Czopnik D, et al. Feasibility and acceptability of TRANSFoRm to improve clinical trial recruitment in primary care. Family Practice. 2016 [acesso em 2020 fev 20]; 33(02):186-191. Disponível em: https://doi.org/10.1093/fampra/cmv102 https://doi.org/10.1093/fampra/cmv102...} (2016)	Feasibility and acceptability of TRANSFoRm to improve clinical trial recruitment in primary care Randomized Controlled Study Cinnahl Level of Evidence: 2 Sample: 5 doctors and 10 patients	Assess the acceptability and feasibility of TRANSFoRm to improve clinical trial recruitment in PHC.	- The use of TRANSFoRm technology enables data collection, patient identification, pre-screening and monitoring of users; - The medical acceptability of the TRANSFoRM tool was positive, as well as by the patients, due to its simple and easy-to-use application.
Lofters et al.^{²⁶26 Lofters AK, Slater MB, Angl EN, et al. Facebook as a tool for communication, collaboration, and informal knowledge exchange among members of a multisite family health team. Journal of Multidisciplinary Healthcare. 2016 [acesso em 2020 mar 20]; 25(9):29-34. Disponível em: https://doi.org/10.2147/JMDH.S94676 https://doi.org/10.2147/JMDH.S94676...} (2016)	Facebook as a tool for communication, collaboration, and informal knowledge exchange among members of a multisite family health team Descriptive study scopus Level of Evidence: 5 Sample: 26 health professionals	Implement and evaluate a private Facebook group for members of an Ontario, Canada family health team to facilitate improved communication and collaboration.	- The use of the Facebook private group aimed at communication between the team’s professionals; - Professionals show concern for the patient’s privacy and that its use can increase the workload.
Keyworth et al.^{²⁷27 Keyworth C, Hart J, Armitage CJ, et al. What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review. BMC Medical Informatics and Decision Making. 2018 [acesso em 2020 mar 15]; 18(93):21. Disponível em: https://doi.org/10.1186/s12911-018-0661-3 https://doi.org/10.1186/s12911-018-0661-...} (2018)	What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review PubMed Level of Evidence: 1 Sample: 69 studies	Identify interventions with a successful technological component to change professional practice; determine whether interventions are theory-based; examine barriers and enablers for successful implementation.	- The use of technology to support change in the professional’s health practices aimed at communication actions between them, interventions and support for decision-making; - It proved to be effective in changing professionals practices, raising the confidence of professionals for decision-making and care management; - Barriers faced: increased workload, insufficient access to information technology resources and software updates, causing limitations in computer performance.
Smailhodzic et al.^{²⁸28 Smailhodzic E, Hooijsma W, Boonstra A, et al. Social media use in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals. BMC Health Services Research. 2016 [acesso em 2020 abr 15]; 16(442):14. Disponível em: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1691-0 https://bmchealthservres.biomedcentral.c...} (2016)	Social media use in healthcare: a systematic review of effects on patients and on their relationship with healthcare professionals Literature systematic Review PubMed Level of Evidence: 1 Sample: 22 articles	Provide an overview of the existing literature on the effects of patients’ use of social media for health reasons and its relationship to the actions of health professionals.	- The use of social media facilitates health communication with patients and between professionals; - It can encourage more equal communication, a more harmonious relationship, greater exchange of information with doctors, but less than ideal personal interaction between the patient/professional.
Cavalcante et al.^{²⁹29 Cavalcante RB, Silva HRM, Silva TIM, et al. Diffusion of the technological innovation e-sus ab: acceptance or rejection? Cogitare Enfermagem. 2018 [acesso em 2020 abr 15]; 23(3):01-13. Disponível em: https://dx.doi.org/10.5380/ce.v23i3.55911 https://dx.doi.org/10.5380/ce.v23i3.5591...} (2018)	Diffusion of the technological innovation e-sus ab: acceptance or rejection? Study of unique case, holistic, of qualitative approach PubMed Level of Evidence: 3 Sample: 14 participants	To analyze the diffusion of technological innovation ‘e-SUS AB strategy’ in a family health team in western Minas Gerais.	- The use of e-SUS AB technology enables data collection and recording, not involving health promotion actions; - The implementation of technology has shown situations that increase its rejection: need for administrative reorganization of work, manual re-registration of several files, difficulty for professionals to extract reports, misunderstandings related to codes used in systems and software; - Rapid and constant changes in the instruments used for data collection make access to information more difficult.
Daltro et al.^{³⁰30 Daltro EFMA, Barbosa DSJ, Machado APR, et al. Aceitação e uso de tecnologias móveis de informação pelos agentes comunitários de saúde de Sapeaçu. Revista Baiana de Saúde Pública. 2017 [acesso em 2020 abr 2]; 41(02):324-333. Disponível em: https://doi.org/10.22278/2318-2660.2017.v41.n2.a1333 https://doi.org/10.22278/2318-2660.2017....} (2017)	Aceitação e uso de tecnologias móveis de informação pelos agentes comunitários de saúde de Sapeaçu Exploratory and descriptive, with a quantitative approach Scielo Level of Evidence: 5 Sample: 23 community health agents	Analyze the conditioning factors for the acceptance and use of mobile technologies (tablets) by community health agents in the municipality of Sapeaçu, Bahia, Brazil.	- The use of mobile technology (tablet) by community health agents is aimed at recording data; - Even with the difficulties encountered, the incorporation of technology at the regional level was considered favorable. The conditioning factors for acceptance and use were the Community Health Agents’ little previous experience with similar technologies and insufficient training in the use of the equipment; - Weaknesses are the concomitance of manual and computerized records and the relative delay in transmitting the collected data.
Bernardes et al.^{³¹31 Bernardes VP, Dias LF, Pereira MA, et al. Facebook como Ferramenta Pedagógica em Saúde Coletiva: Integrando Formação Médica e Educação em Saúde. Revista Brasileira de Educação Médica. 2019 [acesso em 2020 abr 3]; 43(01):652-661. Disponível em: http://dx.doi.org/10.1590/1981-5271v43suplemento1-20190192 http://dx.doi.org/10.1590/1981-5271v43su...} (2019)	Facebook como Ferramenta Pedagógica em Saúde Coletiva: Integrando Formação Médica e Educação em Saúde Experience report Scielo Level of Evidence: 4 Sample: 144 medical interns	Report the experience of using a Facebook page to promote health education.	- The use of Facebook by medical interns is aimed at actions for health education and promotion, preventing risks and injuries, directed at the community in general; - Among the topics highlighted on the Facebook page are the consequences of sedentary lifestyle, sleep deprivation, self-care, importance of physical exercise, combating suicide, fibromyalgia, early screening for cervical and prostate cancer, antivaccine movement, dengue epidemic in Brazil, prevention of prematurity, fight against Acquired Immunodeficiency Syndrome (AIDS) and anxiety disorder, in addition to promoting a blood donation campaign; - The use of technology proved to be efficient for dissemination in health and as a powerful pedagogical tool for health education.
Glynn et al.^{³²32 Glynn LG, Glynn F, Casey M, et al. Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory. BMC Family Practice, United Kingdom. 2018 [acesso em 2020 abr 15]; 19(48):10. Disponível em: https://doi.org/10.1186/s12875-018-0737-2 https://doi.org/10.1186/s12875-018-0737-...} (2018)	Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory Qualitative study PubMed Level of Evidence: 3 Sample: 14 participants	Conduct a theoretically informed analysis, using the theory of normalization processes, of possible barriers and levers for implementing a mobile health intrvation to promote physical activity in PHC.	- The use of the SmartMove app is intended to promote physical activities; - It was observed that the application was well accepted by users, as there was an incentive to exercise; - Professionals were concerned about whether they would be able to encourage the use of the application and whether users would know how to use it.
Bonn et al.^{³³33 Bonn SE, Alexandrou C, Steiner KH, et al. App-technology to increase physical activity among patients with diabetes type 2 - the DiaCert-study, a randomized controlled trial. BMC Public Health. 2018 [acesso em 2020 mar 5]; 18(119):01-07. Disponível em: https://doi.org/10.1186/s12889-018-5026-4 https://doi.org/10.1186/s12889-018-5026-...} (2018)	App-technology to increase physical activity among patients with diabetes type 2 - the DiaCert-study, a randomized controlled trial Randomized Controlled Study Web of Science Level of Evidence: 2 Sample: 200 patients	Evaluate the effect of a physical activity intervention using a smartphone app on patients with type 2 diabetes.	- The use of the DiaCert smartphone app is aimed at monitoring physical activity performed by patients; - The app encourages patients to adopt healthier habits, such as daily physical exercise; - This technology can be used as a new data sharing solution between patients and healthcare professionals.
Morrissey et al.^{³⁴34 Morrissey EC, Glynn LG, Casey M, et al. New self-management technologies for the treatment of hypertension: general practitioners’ perspectives. Family Practice. 2018 [acesso em 2020 abr 5]; 35(03):318-322. Disponível em: https://doi.org/10.1093/fampra/cmx100 https://doi.org/10.1093/fampra/cmx100...} (2018)	New self-management technologies for the treatment of hypertension: general practitioners’ perspectives Qualitative research PubMed Level of Evidence: 5 Sample: 10 general practitioners	Explore general practitioner perspectives on self-management technology to support medication adherence and blood pressure control in patients with hypertension.	- Using wireless apps or blood pressure monitors via smartphone can increase the amount of data available to healthcare professionals, enabling better clinical decisions to be made in the treatment of hypertension. This collaborative approach to patient care can facilitate greater awareness and self-management by patients themselves; - The reluctance of professionals can be alleviated when conducting research that proves the effectiveness of these applications; - Doctors are concerned about the increased workload.
Recio-Rodriguez^{³⁵35 Recio-Rodriguez JI, Conde CA, Calvo-Aponte MJ, et al. The Effectiveness of a Smartphone Application on Modifying the Intakes of Macro and Micronutrients in Primary Care: A Randomized Controlled Trial. The EVIDENT II Study. Nutrients, Switzerland. 2018 [acesso em 2020 abr 5]; 10(10):16. Disponível em: https://doi.org/10.3390/nu10101473 https://doi.org/10.3390/nu10101473...} (2018)	The Effectiveness of a Smartphone Application on Modifying the Intakes of Macro and Micronutrients in Primary Care: A Randomized Controlled Trial. The EVIDENT II Study Randomized Controlled Study Scopus Level of Evidence: 2 Sample: 833 individuals	Evaluate the long-term (12 months) effectiveness of adding a diet smartphone app.	- The use of the diet smartphone app by health professionals was seen as a complementary strategy to nutritional counseling. This combination can bring benefits mainly for people with diabetes or obesity, considering that the use of the application favors awareness and self-education about nutrition; - Using the app proved to be able to increase the intake of healthy foods and reduce the intake of trans fats and consumption of processed meats, which contributes to weight reduction, in addition to encouraging and analyzing users’ physical activity.
Wang et al.^{³⁶36 Wang F, Xião LD, Wang K, et al. Evaluation of a WeChat-based dementia-specific training program for nurses in primary care settings: A randomized controlled trial. Applied Nursing Research, Philadelphia. 2017 [acesso em 2020 abr 10]; 38(01):51-59. Disponível em: https://doi.org/10.1016/j.apnr.2017.09.008 https://doi.org/10.1016/j.apnr.2017.09.0...} (2017)	Evaluation of a WeChat-based dementia-specific training program for nurses in primary care settings: A randomized controlled trial Randomized Controlled Study Cochrane Level of Evidence: 2 Sample: 101 nurses	Determine whether a dementia-specific education program, which incorporates WeChat-based learning interactions, could improve knowledge and attitudes, meeting nurses’ intentions to make changes to achieve early detection and a timely diagnosis of dementia.	- The use of WeChat technology by nurses is aimed at specific training on dementia, which can influence the adoption of changes that facilitate early detection and timely diagnosis of dementia; - Well-trained nurses can promote health education actions for caregivers of people in condition of dementia; - Conducting short-term training based on WeChat can improve nurses’ knowledge and attitude. The use of technology was well accepted by healthcare professionals.
Pinto & Rocha^{³⁷37 Pinto LF, Rocha CMF. Innovations in Primary Health care: the use of communications technology and information tools to support local management. Ciênc. Saúde Colet. 2016 [acesso em 2020 mar 2]; 21(05):1433-1448. Disponível em: https://doi.org/10.1590/1413-81232015215.26662015 https://doi.org/10.1590/1413-81232015215...} (2016)	Innovations in Primary Health care: the use of communications technology and information tools to support local management Descriptive Studies PubMed Level of Evidence: 5 Sample: 16 Observatories of Information Technology and Communications in Health - OTICS Network in Rio de Janeiro.	Describe the results obtained with the implementation of Local Networks of Observatories by the Municipal Health Department of Rio de Janeiro, covering ten areas of health planning in the city.	- The use of social media through blogs is aimed at recording information, attendance, monitoring of health care, health promotion and management of health education; - Communication channels, such as Twitter and PHC blogs, can help in the exchange of information and communication in health.
Jones et al.^{³⁸38 Jones A, Mitchell LJ, O’Connor R, et al. Investigating the Perceptions of Primary Care Dietitians on the Potential for Information Technology in the Workplace: Qualitative Study. Journal of Medical Internet Research. 2018 [acesso em 2020 abr 10]; 20(10):27. Disponível em: https://doi.org/10.2196/jmir.9568 https://doi.org/10.2196/jmir.9568...} (2018)	Investigating the Perceptions of Primary Care Dietitians on the Potential for Information Technology in the Workplace: Qualitative Study Descriptive exploratory approach study. PubMed Level of Evidence: 3 Sample: 20 nutritionists	Explore the perceptions of PHC nutritionists about the use of information technology in their workplace.	- The use of information technologies by nutritionists, such as mobile applications, aims at tracking food intake, administrative technology, patient management systems and the Nutritics system, used for electronic health records; - Technology considered useful to help clients track their eating behaviors, as well as the progress between appointments; - They found the lack of time to implement new technologies, lack of information about technologies and resistance to change as a challenges; - Nutritionists also expressed concern regarding the use of technology by the elderly, a population with greater demand; - There is easy access to patient information and communication with other professionals.
Pereira et al.^{³⁹39 Pereira IM, Bonfim D, Peres HHC, et al. Mobile application for data collection in health research. Acta Paulista de Enfermagem. 2017 [acesso em 2020 abr 2]; 30(5):479-488. Disponível em: https://doi.org/10.1590/1982-0194201700069 https://doi.org/10.1590/1982-01942017000...} (2017)	Mobile application for data collection in health research Applied research of technological production Scielo Level of Evidence: 5 Sample: 418 health professionals	Describe the development of a mobile technology application for data collection in researches about time and movement of health professionals of the Family Health Strategy, in carrying out car interventions/activities.	- The development and use of the DropSync mobile app aims at collecting and managing data; - The use of the application proved to be an optimized, safe process for recording, storing and sending information. In addition, data collection becomes dynamic, fast, secure and with integrity in the sharing of collected information.
Kolltveit et al.^{⁴⁰40 Kolltveit BCH, Gjengedal E, Graue M, et al. Telemedicine in diabetes foot care delivery: health care professionals’ experience. BMC Health Services Research. 2016 [acesso em 2020 mar 10]; 16(134):08. Disponível em: https://doi.org/10.1186/s12913-016-1377-7 https://doi.org/10.1186/s12913-016-1377-...} (2016)	Telemedicine in diabetes foot care delivery: health care professionals’ experience Inductive interpretive description. It is part of a cluster-randomized controlled trial PubMed Level of Evidence: 2 Sample: 33 participants	Explore the experience of health professionals in the initial phase of the introduction of telemedicine technology in the care of diabetic people with foot ulcers.	- The use of telemedicine to treat wounds enables communication and discussion of the case; - Telemedicine users have seen improvements in wound assessment, documentation and records, in addition to communication.
Houghton et al.^{⁴¹41 Houghton LC, Howland RE, Mcdonald JA. Mobilizing Breast Cancer Prevention Research Through Smartphone Apps: A Systematic Review of the Literature. Mobilizing Breast Cancer Prevention Research. 2019 [acesso em 2020 mar 2]; 07(01):15. Disponível em: https://doi.org/10.3389/fpubh.2019.00298 https://doi.org/10.3389/fpubh.2019.00298...} (2019)	Mobilizing Breast Cancer Prevention Research Through Smartphone Apps: A Systematic Review of the Literature Systematic review PubMed Level of Evidence: 1 Sample: 82 studies	Determine how mobile apps are being used for the prevention and control of breast cancer among women around the world.	- Applications are used for breast cancer prevention, clinical care, healthy lifestyle management and quality of life, as well as to improve medication and assess clinical manifestations, behaviors and risks; - The use of apps to promote tertiary prevention was more prevalent than for secondary and primary prevention.
Oberg et al.^{⁴²42 Oberg U, Orre CJ, Isaksson U, et al. Swedish primary healthcare nurses’ perceptions of using digital eHealth services in support of patient self‐management. Scandinavian Journal of Caring Sciences, 2018 [acesso em 2020 abr 30]; 32(2):961-970. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/scs.12534 https://onlinelibrary.wiley.com/doi/10.1...} (2018)	Swedish primary healthcare nurses’ perceptions of using digital eHealth services in support of patient selfmanagement Qualitative descriptive preparatory study PubMed Level of Evidence: 4 Sample: 20 nurses	Describe the perceptions of Swedish PHC nurses regarding the use of e-Health digital systems and services to support patients’ self-management.	- The use of e-Health technology is aimed at recording information and assistance, aiming to support self-management of patients with chronic diseases; - Nurses demonstrate that they are against the use of telemedicine, due to the loss of professional-patient interaction, in addition to not having sufficient skill to use this technology; - Participants claim that the use of the internet will be increasingly present and there is a need to train professionals.
Banks et al.^{⁴³43 Banks J, Farr M, Salisbury C, et al. Use of an electronic consultation system in primary care: a qualitative interview study. British Journal of General Practice, Londres. 2018 [acesso em 2020 abr 29]; 68(666):01-08. Disponível em: https://doi.org/10.3399/bjgp17X693509 https://doi.org/10.3399/bjgp17X693509...} (2018)	Use of an electronic consultation system in primary care: a qualitative interview study Qualitative study PubMed Level of Evidence: 5 Sample: 23 health professionals.	Assess whether an electronic consultation system improves staff’s ability to manage workload and access.	- The use of e-consultation technology has an impact on the workload of health professionals; - The team recognized the benefits offered to patients, including the ability to access the system at any time, avoiding a busy phone system, and providing an opportunity to raise undiscussed issues.