Sociotechnical design of mHealth applications for chronic diseases

This workshop paper aims at briefly presenting the authors’ previous experience in the field of sociotechnical design of mHealth applications and at illustrating the opportunity in joining forces of multidisciplinary researchers, domain experts, and practitioners for improving the field

Consumer Health Informatics: Empowering Healthy-Lifestyle-Seekers Through mHealth

People are at risk from noncommunicable diseases (NCD) and poor health habits, with interventions like medications and surgery carrying further risk of adverse effects. This paper addresses ways people are increasingly moving to healthy living medicine (HLM) to mitigate such health threats. HLM-seekers increasingly leverage mobile technologies that enable control of personal health information, collaboration with clinicians/other agents to establish healthy living practices. For example, outcomes from consumer health informatics research include empowering users to take charge of their health through active participation in decision-making about healthcare delivery. Because the success of health technology depends on its alignment/integration with a person's sociotechnical system, we introduce SEIPS 2.0 as a useful conceptual model and analytic tool. SEIPS 2.0 approaches human work (i.e., life's effortful activities) within the complexity of the design and implementation of mHealth technologies and their potential to emerge as consumer-facing NLM products that support NCDs like diabetes

Ambivalence in digital health: co-designing an mHealth platform for HIV care

In reaction to polarised views on the benefits or drawbacks of digital health, the notion of ‘ambivalence’ has recently been proposed as a means to grasp the nuances and complexities at play when digital technologies are embedded within practices of care. This article responds to this proposal by demonstrating how ambivalence can work as a reflexive approach to evaluate the potential implications of digital health. We first outline current theoretical advances in sociology and organisation science and define ambivalence as a relational and multidimensional concept that can increase reflexivity within innovation processes. We then introduce our empirical case and highlight how we engaged with the HIV community to facilitate a co-design space where 97 patients (across five European clinical sites: Antwerp, Barcelona, Brighton, Lisbon, Zagreb) were encouraged to lay out their approaches, imaginations and anticipations towards a prospective mHealth platform for HIV care. Our analysis shows how patients navigated ambivalence within three dimensions of digital health: quantification, connectivity and instantaneity. We provide examples of how potential tensions arising through remote access to quantified data, new connections with care providers or instant health alerts were distinctly approached alongside embodied conditions (e.g. undetectable viral load) and embedded socio-material environments (such as stigma or unemployment). We conclude that ambivalence can counterbalance fatalistic and optimistic accounts of technology and can support social scientists in taking-up their critical role within the configuration of digital health interventions

The Utility of Mobile Phones for Health Among Women Living with HIV in Urban Malawi

The use of mobile phones are becoming ubiquitous with growing interest by healthcare providers to utilize mobile phone technology for various health-related applications, called mHealth. This is especially true in low-income countries such as those in sub-Saharan Africa. When implementing mHealth applications, it is important to understand the dynamic social, cultural and environmental factors where mHealth will be implemented to ensure that interventions developed are effective. A qualitative study to explore the sociotechnical factors experienced by women participating in an HIV support group in urban Malawi was conducted to enhance our understanding of women’s experience with mobile phone use and its implications on their health. Ten individual interviews and one focus group interview were completed with women, using narrative methods and a sociotechnical view to inform data analysis. Narrative structural and thematic analysis were used to analyze the individual interview data, and thematic analysis was used to analyze the focus group interview data. This study offers valuable insights into the sociotechnical factors impacting mobile phone use and its implications on health within this urban context. Findings are discussed under four main areas: 1. Health-related activities and tasks; 2. Social related activities and tasks; 3. Income generation activities and tasks; and 4. Technical challenges. Implications for policy discussed include the scaling up of programs incorporating mobile phones in sub-Saharan Africa as part of the HIV prevention and treatment plan and partnering with NGO’s and churches to leverage funding and existing community based resources. Implications for future research include an opportunity for further theory development around community health frameworks that are sensitive to the African world view of person and community in addition to further exploring the utility of mobile phone technology in enhancing health outcomes for people living with HIV

Sociotechnical design for mobile anticoagulant therapy

In this paper we present MANTRA (Mobile ANticoagulant TheRApy), a project aimed at studying feasibility and acceptability of the introduction of mobile technology in the management of anticoagulant therapy involving both patients and health practitioners in their design. By the evaluation of the MANTRA Project, we developed a general approach to mHealth in the remote management of chronic diseases by supporting the communication among patients and healthcare practitioners. Patients usually have to make frequent visits to surgeries to meet nurses for the tests, and General Practitioners (GPs) for receiving drug prescriptions. We report on the implementation of the project as a proof of concept in London. A group of patients, General Practitioners, nurses, and healthcare assistants from the National Health Service (NHS) participated in design and evaluation phases. The distinct characteristics of the NHS as one of the world's largest publicly funded health services posed a number of sociotechnical challenges to the design team. We present how we approached and addressed these challenges through MANTRA. Patients and Healthcare practitioners recognized the validity of our proposed design approach not only for supporting the remote therapy practice preserving an efficient and effective communication with the patients, but also as a way for better managing resources in anticoagulant clinics in the context of the NHS. With our research we explored the process that needs to be followed to develop a mobile system that would fit the sociotechnical ecosystem of anticoagulant therapy. Furthermore, we are now able to identify the changes that will be necessary in the ecosystem itself to make an effective use of the mobile system

Public Health and Epidemiology Informatics: Recent Research and Trends in the United States

Objectives To survey advances in public health and epidemiology informatics over the past three years. Methods We conducted a review of English-language research works conducted in the domain of public health informatics (PHI), and published in MEDLINE between January 2012 and December 2014, where information and communication technology (ICT) was a primary subject, or a main component of the study methodology. Selected articles were synthesized using a thematic analysis using the Essential Services of Public Health as a typology. Results Based on themes that emerged, we organized the advances into a model where applications that support the Essential Services are, in turn, supported by a socio-technical infrastructure that relies on government policies and ethical principles. That infrastructure, in turn, depends upon education and training of the public health workforce, development that creates novel or adapts existing infrastructure, and research that evaluates the success of the infrastructure. Finally, the persistence and growth of infrastructure depends on financial sustainability. Conclusions Public health informatics is a field that is growing in breadth, depth, and complexity. Several Essential Services have benefited from informatics, notably, “Monitor Health,” “Diagnose & Investigate,” and “Evaluate.” Yet many Essential Services still have not yet benefited from advances such as maturing electronic health record systems, interoperability amongst health information systems, analytics for population health management, use of social media among consumers, and educational certification in clinical informatics. There is much work to be done to further advance the science of PHI as well as its impact on public health practice

User-Centered Design of A Novel Risk Prediction Behavior Change Tool Augmented With an Artificial Intelligence Engine (MyDiabetesIQ):A Sociotechnical Systems Approach

BACKGROUND: Diabetes and its complications account for 10% of annual health care spending in the United Kingdom. Digital health care interventions (DHIs) can provide scalable care, fostering diabetes self-management and reducing the risk of complications. Tailorability (providing personalized interventions) and usability are key to DHI engagement/effectiveness. User-centered design of DHIs (aligning features to end users’ needs) can generate more usable interventions, avoiding unintended consequences and improving user engagement. OBJECTIVE: MyDiabetesIQ (MDIQ) is an artificial intelligence engine intended to predict users’ diabetes complications risk. It will underpin a user interface in which users will alter lifestyle parameters to see the impact on their future risks. MDIQ will link to an existing DHI, My Diabetes My Way (MDMW). We describe the user-centered design of the user interface of MDIQ as informed by human factors engineering. METHODS: Current users of MDMW were invited to take part in focus groups to gather their insights about users being shown their likelihood of developing diabetes-related complications and any risks they perceived from using MDIQ. Findings from focus groups informed the development of a prototype MDIQ interface, which was then user-tested through the “think aloud” method, in which users speak aloud about their thoughts/impressions while performing prescribed tasks. Focus group and think aloud transcripts were analyzed thematically, using a combination of inductive and deductive analysis. For think aloud data, a sociotechnical model was used as a framework for thematic analysis. RESULTS: Focus group participants (n=8) felt that some users could become anxious when shown their future complications risks. They highlighted the importance of easy navigation, jargon avoidance, and the use of positive/encouraging language. User testing of the prototype site through think aloud sessions (n=7) highlighted several usability issues. Issues included confusing visual cues and confusion over whether user-updated information fed back to health care teams. Some issues could be compounded for users with limited digital skills. Results from the focus groups and think aloud workshops were used in the development of a live MDIQ platform. CONCLUSIONS: Acting on the input of end users at each iterative stage of a digital tool’s development can help to prioritize users throughout the design process, ensuring the alignment of DHI features with user needs. The use of the sociotechnical framework encouraged the consideration of interactions between different sociotechnical dimensions in finding solutions to issues, for example, avoiding the exclusion of users with limited digital skills. Based on user feedback, the tool could scaffold good goal setting, allowing users to balance their palatable future complications risk against acceptable lifestyle changes. Optimal control of diabetes relies heavily on self-management. Tools such as MDMW/ MDIQ can offer personalized support for self-management alongside access to users’ electronic health records, potentially helping to delay or reduce long-term complications, thereby providing significant reductions in health care costs

Mobile Applications for Diabetes Self-Management: Status and Potential

Background:Advancements in smartphone technology coupled with the proliferation of data connectivity has resulted in increased interest and unprecedented growth in mobile applications for diabetes self-management. The objective of this article is to determine, in a systematic review, whether diabetes applications have been helping patients with type 1 or type 2 diabetes self-manage their condition and to identify issues necessary for large-scale adoption of such interventions.Methods:The review covers commercial applications available on the Apple App Store (as a representative of commercially available applications) and articles published in relevant databases covering a period from January 1995 to August 2012. The review included all applications supporting any diabetes self-management task where the patient is the primary actor.Results:Available applications support self-management tasks such as physical exercise, insulin dosage or medication, blood glucose testing, and diet. Other support tasks considered include decision support, notification/alert, tagging of input data, and integration with social media. The review points to the potential for mobile applications to have a positive impact on diabetes self-management. Analysis indicates that application usage is associated with improved attitudes favorable to diabetes self-management. Limitations of the applications include lack of personalized feedback; usability issues, particularly the ease of data entry; and integration with patients and electronic health records.Conclusions:Research into the adoption and use of user-centered and sociotechnical design principles is needed to improve usability, perceived usefulness, and, ultimately, adoption of the technology. Proliferation and efficacy of interventions involving mobile applications will benefit from a holistic approach that takes into account patients\u27 expectations and providers\u27 needs

Socio-technical approach to community health: designing and developing a mobile care data application for home-based healthcare, in South Africa

The aim of this report is to describe the design and development considerations related to a mobile home-based healthcare application for care givers in a community in the Western Cape, South Africa. In order to do this we first describe current practices of health care givers in the Western Cape in capturing and reporting the data of their patients in practice. Although the overall aims of home-based healthcare are the same everywhere in the world, the context of a particular country is important because it determines how home-based healthcare is implemented in practice. In this instance the design and development of the mobile care data application were undertaken by a local university as part of a funded project to stimulate innovation by using informatics to address real needs in communities.International Bibliography of Social Science

A sociotechnical systems approach toward tailored design for personal health information management

We used a sociotechnical systems approach—which conceptualizes a system of interacting people, technologies, and tasks, to identify individual differences in personal health information management (PHIM) that can inform the design of patient-friendly environments, tools, and technologies. We conducted a secondary thematic analysis of data collected as part of a parent project, vizHOME. The goal of vizHOME was to improve health and health outcomes through identifying key features in the environment that will inform the design of consumer health information technology HIT. We analyzed interview data collected from 20 individuals with diabetes. We found seven dimensions of PHIM: (1) level of privacy preferred for PHIM; (2) amount of engagement in PHIM; (3) extent of guidance preferred for PHIM; (4) level of documentation preferred for PHIM; (5) degree of physical distribution of PHIM; (6) amount of flexibility in PHIM routine; and (7) use of external cues to manage PHIM. Our results suggest that each dimension exists as a continuum, which are anchored from low to high. Exploring the interaction between PHIM and the sociotechnical system in which PHIM is performed revealed key dimensions of PHIM as well as individual differences in those PHIM dimensions. Identification of individual differences in PHIM can support the creation of human-centered design considerations for tailored environments, products, processes, and technologies that support PHIM. Future research will seek to validate PHIM dimensions in a larger population and develop a PHIM-typing measure to identify PHIM types toward tailoring processes, products, and to individual needs in context. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len