| dc.description.abstract | Norway is experiencing a demographic shift, caused by an ageing population. The shift will result in an increased proportion of inhabitants with chronic Non-communicable diseases (NCDs). One of the innovations tested to keep the Norwegian municipal healthcare model financially sustainable is the pro-active service of remote patient monitoring (RPM). RPM is a branch of welfare technology, where digital technology is used to collect clinical and other forms of health data from users in one location, transmitting that information electronically and securely to a response-centre for assessment and recommendation by a healthcare professional. The RPM program started in 2016 and consisted of four regions (Oslo, Sarpsborg, Stavanger and Trondheim). This thesis investigates the innovative dynamics of RPM and aims to answer (1) What are the drivers and barriers for implementing RPM in Norwegian municipalities, and (2) How can RPM be perceived as a part of a wider socio-technical transition. The analytical framework employed builds on a functional pattern analysis, derived from the theories of technological innovation system (TIS). The Multi-level perspective (MLP) is adapted to analyse RPM as a socio-technical transition, through the three layers (landscape, regime and niche) of socio-technical analysis. The methodology relies on a qualitative case study approach. Data collection is based on a triangulation approach, applying the methods of document analysis, literature review, interviews, observations and field-work to answer the thesis questions. The main drivers found were increased patient related effects on improved feeling of safety, improved health literacy and a healthier diet, especially for users with Diabetes mellitus. This creates legitimacy among users, interest groups and home-care workers. Remote patient monitoring is also viewed as a favourable work-environment by nurses. The main observed barriers are manifold, but primarily revolve around uncertainties of the cost-effectiveness, and difficulty of proving the effectiveness of a pro-active service. Uncertainty around the use and quality of medical technical equipment (MTE), and lack of solid scientific evidence leads to scepticism and resistance from general practitioners (GPs). The wider socio-technical transition of welfare technology and RPM is here understood as the external pressure of the demographic shift, changes in the patient role towards patient activation and, particular for a Norwegian context, fluctuating oil prices. These external factors create pressure on the existing socio-technical configuration, creating a window of opportunity for welfare technology, which encourages RPM implementation and testing through co-creation and co-evolution. Resistance mechanics is observed in the regime of usual care, changing the intention of RPM as a pro-active service, towards being a re-active service, through the recruitment of users that are severely ill. Public policies and political power do however favour RPM as it increases coordination and knowledge sharing between healthcare actors in both the primary and secondary healthcare provisions. | nob |