Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure

BACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. OBJECTIVE: The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. METHODS: We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. RESULTS: We identified 5 high-level macrocognitive processes affecting medication management-sensemaking, planning, coordination, monitoring, and decision making-and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. CONCLUSIONS: Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation

Investigating and Supporting Sensemaking within Online Health Communities

This dissertation focuses on understanding and supporting individual and collective sensemaking within online health communities (OHCs). This major goal was achieved in three aims. In Aim 1, this dissertation contributes a rich descriptive account of collective sensemaking in OHCs forums by describing how it occurs and develops, what triggers it, what elements constitute collective construction of meaning, and what conversational moves positively contribute to this process. Further, it describes how collective sensemaking in OHCs is impacted by the interplay between informational and socio-emotional needs of OHCs members. Moreover, it examines how design of different social computing platforms influences OHCs members’ ability to meet their informational and socio-emotional needs and engage in collective sensemaking. In Aim 2, this dissertation explores the design space of tools for supporting individual sensemaking through optimized information access. Through the design and evaluation of a prototype DisVis it examines the impact of such tools on OHCs members’ ability to understand information within discussion threads. In the final Aim 3, this dissertation proposes a novel approach for meeting the three main needs identified in Aims 1 and 2: promoting individual sensemaking, while at the same time encouraging collective sensemaking, and facilitating development of social awareness and ties among community members. The design and evaluation of the novel solution for visualizing discussion threads that synergistically addresses these three needs—dSense—provides insights for future research and design of interactive solutions for supporting individual and collective sensemaking within OHCs

Finding a Future Beyond the Field: Exploring ICT-Mediated Practices of Student Athletes

Our preliminary research design explores the life of college student athletes and their use of information and communication technologies (ICTs) as they plan their transition beyond graduation. While ICTs such as social media, smartphones, and the internet are becoming more ubiquitous in college campuses, student athletes contend with finding ways to seek information in determining the optimal time to transition into professional play. To expand the literature on ICT use among student athletes, our exploratory study seeks to uncover factors that affect ICT use in both their athletic and academic environments. In collecting qualitative data through semi-structured interviews, our work aims to inform future design implications for ICTs used by student athletes

A framework to maximise the communicative power of knowledge visualisations

Knowledge visualisation, in the field of information systems, is both a process and a product, informed by the closely aligned fields of information visualisation and knowledg management. Knowledge visualisation has untapped potential within the purview of knowledge communication. Even so, knowledge visualisations are infrequently deployed due to a lack of evidence-based guidance. To improve this situation, we carried out a systematic literature review to derive a number of “lenses” that can be used to reveal the essential perspectives to feed into the visualisation production process.We propose a conceptual framework which incorporates these lenses to guide producers of knowledge visualisations. This framework uses the different lenses to reveal critical perspectives that need to be considered during the design process. We conclude by demonstrating how this framework could be used to produce an effective knowledge visualisation

Making evaluations matter: a practical guide for evaluators

This guide is primarily for evaluators working in the international development sector. It is also useful for commissioner of evaluations, evaluation managers and M&E officers. The guide explains how to make evaluations more useful. It helps to better understand conceptual issues and appreciate how evaluations can contribute to changing mindsets and empowering stakeholders. On a practical level, the guide presents core guiding principles and pointers on how to design and facilitate evaluations that matter. Furthermore, it shows how to get primary intended users and other key stakeholders to contribute effectively to the evaluation proces

Management challenges for future digitalization of healthcare services

eHealth is considered a solution to current challenges in healthcare. However, its use is not very well developed, and its potential has been little exploited. There are many reasons for the limited diffusion of eHealth. Knowledge, opportunities for training and collaborative activities are examples of factors that influence diffusion. Managerial responsibility is decisive in transforming healthcare. This paper aims at exploring middle management strategies that can facilitate workplace learning when introducing eHealth and new ways of providing healthcare. Introduction of eHealth will imply new and innovative working processes, where both employees and managers need to be aware that their work will change fundamentally, from routine work to work that involves learning, skills development and continuous changes in work practice. This study takes a qualitative approach by analysing data collected through focus group interviews. The findings indicate a necessity for a shift towards learning-oriented leadership and adaptive management that emphasizes employee involvement and opportunities for learning. Helping employees make sense of the complexities associated with continuously changing work practices is another identified middle management strategy. Scenario planning and backcasting stand out as suitable tools for sensemaking in complex organizations and as techniques that can promote workplace learning.publishedVersio

Change is inevitable but compliance is optional : coworker social influence and behavioral work-arounds in the EHR implementation of healthcare organizations

textThe implementation of planned organizational change is ultimately a communication-related phenomenon, and as such, it is imperative that organizational communication scholars examine the interactions surrounding EHR implementation and understand how users (e.g. healthcare practitioners) utilize, evaluate, and deliberate this new technological innovation. Previous research on planned organizational change has called for researchers to adopt a more dynamic perspective that emphasizes the active agency of organizational members throughout implementation processes and focuses on informal implementers and change reinvention (work-arounds) as individuals actively reinterpret and personalize their work roles during implementation socialization. This dissertation seeks to fill this gap in research by demonstrating how communication between doctors, nurses, and other health professionals affects the adoption, maintenance, alternation, modification, or rejection of EHR systems within health care organizations. To delve into these inquiries and examine the intersecting domains of medical informatics and organizational communication research, this dissertation proceeds in the following manner: First, a literature review, capitalizing on Laurie Lewis’s work in planned organizational change and social constructionist views of technology use in organizations, outlines the assumptions that undergird this research. Next, this dissertation builds a model that predicts the communicative and structural antecedents of the study outcome variables, which include 1) organizational resistance to EHR implementation, 2) employees’ perception of EHR implementation success, 3) levels of change reinvention—or work-arounds—due to change initiatives and activities, and 4) employees’ perceptions of the quality of the organizational communication surrounding the change. Hypotheses guiding the model specification are provided and are followed by a description of the empirical methods and procedures that were utilized to explore the variable relationships. Results of the SEM model suggest that work-arounds could play a mediating role governing the relationship between informal social influence and the outcome variables in the study. In addition, one-way ANOVAs and multiple regression analyses reveal that physicians are the most resistant to EHR implementation and perceived change communication quality positively predicts perceived EHR implementation success and perceived relative advantage of EHR and negatively predicts employee resistance. A discussion of the expected and unexpected results is offered in addition to study limitation and future directions.Communication Studie