This research-in-progress paper presents an examination of, and reflections on, the challenges of using information and communication technologies (ICTs) to support patients suffering chronic respiratory conditions to achieve increased levels of selfmanagement and self-efficacy. These research insights arise as part of the planning and on-going implementation of the Pathways Home for Respiratory Illness project (Pathways). This project seeks to assist patients with either chronic obstructive pulmonary disease (COPD) or cystic fibrosis (CF) to acquire skills that empower them to comprehend and initiate action in relation to alterations in their conditions. The overall aim of Pathways is to evaluate the impact of these newly acquired skills for improving health outcomes at individual and population levels and is due for completion in 2008.

Achieving benefits from the introduction of ICTs as part of processes aimed at building sustainable self-efficacy and self-management is very difficult, not least because of a desire to avoid simply replacing patient dependency on health professionals with dependency on technology. Reflections on the challenges and experiences within the project to-date illuminate some implicit assumptions underpinning existing IS models for evaluating impact in terms of adoption, usage and benefit and the end-points we presume in our system development processes.