Page - 55 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

As illustrated in Figure 3, the components of activity include subject, object, tools, rules, community, division of labour, transformation process and outcomes. Engeström modified the original activity framework to include ‘rules and division’ of labour to understand work activities. An activity is bounded by its subjects (individual or subgroup) and objects (objective). Activities are directed at objects [or tasks] and are motivated by the need to transform the object into an outcome [12]. The relationship between the subject and object of the activity is mediated by a tool or instrument. Tools are the means used in performing an activity; they can enable the subject to transform objects into outcome. This is located within a community, and the community is governed by a set of rules and organised through a division of labour. AT can be applied at different stages in the UCD life cycle. It is particularly effective in capturing the requirements for a computer system design to establish what it is the end-user wants from the proposed computer system [22]. AT has also been used for the design of context- aware applications [23] because it is fundamentally user centred in its approach. 2. Linking Activity Theory with a User Centred Design approach in mHealth interventions This section provides an overview of how an HCI approach can be used in the design of mHealth interventions, by using AT to provide a conceptual framework when using the UCD framework. Firstly, the importance of a UCD approach in mHealth is highlighted, along with the theoretical framework that AT provides. Two use cases are then provided to illustrate how AT can be linked within a UCD framework and then applied throughout different stages of the reiterative project lifecycle. In the first use case, AT and UCD are applied in the initial three stages: requirements analysis, design and evaluation, whereas the second use case provides an example of usage in the deployment stage and then returns to the requirements stage following analysis. 2.1. Overview of how User Centred Design has been used in mHealth Interventions UCD begins with a thorough understanding of the needs and requirements of the users. This is critical to the success of mHealth interventions. Understanding user requirements can improve user satisfaction and user experience, increase acceptance and adoption rates and reduce the need for training [24]. The role of user requirements analysis in the development of healthcare interventions is fundamental [7, 17]. Users are generally not brought into the developmental process until after the design brief for a new product has been produced, which can lead to assumptions being made and ultimately lead to the failure of systems [15, 7]. It is recommended that patients are actively involved in the design of healthcare technologies, to help promote a better match to user needs and increase acceptance. UCD provides an approach that enables end users to participate during the life cycle of technology intervention. UCD does this by adhering to core principles that were outlined in section 1. AT has been used to provide a theoretical framework for collaborative decision making in analysing mHealth systems [25]. The process of engaging patients in decision making can help provide a positive impact upon treatment adherence and health outcome. AT can be applied at different stages in the project life cycle. The two use cases presented below give examples of how activity theory has been applied to a user centred design framework of implementing mHealth interventions. A.GoodandO.Omisade /LinkingActivityTheorywithUserCentredDesign 55