Background: Little is known about patients� and carers� experiences of interacting with home haemodialysis (HHD)\ntechnology, in terms of user experience, how the design of the technology supports safety and fits with home use,\nand how the broader context of service provision impacts on patients� use of the technology.\nMethods: Data were gathered through ethnographic observations and interviews with 19 patients and their carers\nassociated with four different hospitals in the UK, using five different HHD machines. All patients were managing\ntheir condition successfully on HHD. Data were analysed qualitatively, focusing on themes of how individuals used\nthe machines and how they managed their own safety.\nResults: Findings are organised by three themes: learning to use the technology, usability of the technology, and\nmanaging safety during dialysis. Home patients want to live their lives fully, and value the freedom and autonomy\nthat HHD gives them; they adapt use of the technology to their lives and their home context. They also consider\nthe machines to be safe; nevertheless, most participants reported feeling scared and having to learn through\nmistakes in the early months of dialysing at home. Home care nurses and technicians provide invaluable support.\nAlthough participants reported on strategies for anticipating problems and keeping safe, perceived limitations of\nthe technology and of the broader system of care led some to trade off safety against immediate quality of life.\nConclusions: Enhancing the quality and safety of the patient experience in HHD involves designing technology\nand the broader system of care to take account of how individuals manage their dialysis in the home. Possible\ndesign improvements to enhance the quality and safety of the patient experience include features to help patients\nmanage their dialysis (e.g. providing timely reminders of next steps) and features to support communication\nbetween families and professionals (e.g. through remote monitoring).
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