This research paper examines the challenges in the development and adoption of 
an electronic patient diary within the Pathways Home for Respiratory Illness 
Project. This project supported community-based patients suffering from chronic 
obstructive pulmonary disease (COPD) to achieve increased levels of 
self-management and self-efficacy using electronic-monitoring techniques and 
mentoring by community health nurses. Participants had the option of voluntarily 
adopting an electronic patient diary to support their self-monitoring, which 
provided patients, nurses and clinicians with access to symptom and 
psycho-social data. This aimed to improve the identification, comprehension and 
initiation of early action in relation to alterations in their conditions. The 
paper presents data on technology adoption, electronic diary usage and, 
self-reported data quality, as well as examining the impact of the technology on 
hospitalisations (frequency and duration). The participants who chose to use the 
online patient diary continued their involvement with the project for the entire 
trial period (85% vs 54% completion). Participants were more likely to maintain 
use of the online patient diary than the paper diary. Both the groups 
experienced a positive improvement in their self-efficacy to self-manage their 
condition scores. The data highlight the problems implicit in some of the 
assumptions underpinning existing information systems models, especially in 
evaluating impact and the end-points presumed to be relevant in systems 
development life cycles.