Collaborative domestication: how patients account for their experience of video consultations with their general practitioner

Video consultations are a new doctor-patient communication subgenre within the genre of consultation forms (Laursen, Brøgger, Fage-Butler, Møller, & Grønning, in preparation). They are being implemented in general practices with the aim of remedying the growing pressure and lack of resources in health care and thus securing a sustainable health care sector in Denmark (Sundheds- og Ældreministeriet [Ministry of Health], Finansministeriet [Ministry of Finance], Danske Regioner [Danish Regions], & Kommunernes Landsforening [Local Government Denmark], 2018). Denmark is leading the 2020 ranking of the 193 United Nations Member States in terms of digital Government (United Nations, 2020) making it an important case to investigate. In this study, we pose the following research question: How do patients account for their experience of video consultations with their general practitioner (GP)? To answer this question, we conducted a qualitative study. Our approach was based on domestication theory with the aim of investigating how patients integrate video consultations into their daily lives. The concept of domestication focuses on describing and analysing processes of acceptance, rejection and use of media technologies (Berker, Hartmann, Punie, & Ward, 2006). Silverstone and colleagues divide the domestication process into four phases: Appropriation, objectification, incorporation and conversion (Silverstone, Hirsch, & Morley, 1992). These phases represent the stages of domestication from a user’s initial use of the technology to how use of the technology affects the relation between the user and the world. This study is an attempt to counteract the lack of research about the use of video consultations in general practice. Moreover, our approach accounts for the context in which individual patients experience video consultations, which has similarly received little attention. We conducted in-depth interviews with 13 patients and their GP from a practice in a larger Danish city. To include different perspectives, the patients included 11 users and two non-users of video consultations. We analysed the interviews from the perspective of domestication theory’s four phases. Our results show that technological literacy and the amount of guidance the patients received from the GP impacted the success of the video consultation. In spite of varying outcomes, however, there is a general optimism surrounding the use of video consultations. Moreover, our results show that the GP plays a central role in the patients’ domestication process. Consequently, we propose the term collaborative domestication, which we define as the ongoing mutual influence and interdependency of the users involved in using the technology in a specific interactional context, in this case the GP and the patient. We also found that saving transport time and working hours is perceived as a key advantage of video consultations. Finally, and most importantly, we found that each patient differed regarding which matters they perceived as being suitable for video consultations and the degree to which they regard video consultations as an impersonal consultation form. As a result, based on these findings we argue that qualitative studies are crucial for developing our understanding of the object of study.