Page - 56 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

2.2. Use case 1: The design of a Mobile Health IT system to improve healthcare delivery in Windhoek rural health centres A mobile health IT system was designed to improve the healthcare delivery service in Windhoek rural health centres, in Namibia [26]. The aim was to help ensure the provision of efficient and effective healthcare services to patients and to enable efficient work processes of both nurses and doctors [26]. Acceptance, perceived usefulness and ease of use of the MHSF was crucial in this study and UCD provides an approach for evaluating these factors. As previously mentioned, the UCD approach begins with a thorough understanding of the needs and requirements of the user. Interaction amongst potential users was very important for the MHSF and based on the UCD approach, establishing the context in which users may use the system should be defined at the beginning. Therefore, participants involved in requirement elicitation were purposely selected. This involved conducting the study in rural areas and early integration of potential users involved in the delivery and receiving healthcare delivery service in the design process. AT helped provide a structure and a richer understanding of the needs of subjects/users as well as their related activities/tasks. This study demonstrates an emphasis on using AT in investigating the patient needs and requirements; activities are then separated into subjects, tools and objects. The healthcare delivery needs and requirements in Windhoek rural hospitals were then analysed using constructs from AT within a UCD framework, which also included evaluating acceptance of the mobile phones using principles of UCD [26]. Reflecting on Engeström's activity system model (Figure 3), we note the different constructs of AT and how these are featured in this case study. AT is used to understand the interaction amongst the subjects (doctors, nurses and patients) and the objects (activities and processes involved in providing and receiving healthcare delivery service). The tools in this study are the patient health cards used to record patient health information and activities; this was described as a mediating tool between the patients, nurses and doctors. The rules guiding these activities include the queuing and payment process, vital signs checking, diagnosis and drug prescription. The community which takes part in these activities include the doctor, the nurses and patients, and within these activities, work is divided among them. The nurses are responsible for checking vital signs; the doctors are responsible for diagnosing the patients and prescribing drugs while the patients are receiving this healthcare delivery service. Structured interviews were conducted with doctors, nurses and patients to investigate the healthcare needs of patients. The findings helped establish the current work process, daily activities in the rural health centres, needs and requirements of the patients. These subsequently informed the design and development of the MHSF. A doctor, a nurse, IT specialists and researcher then provided expert opinion on the proposed MHSF. Although there was no iteration in this study, it was indicated that the framework would be expanded which would lead to another iteration of the UCD approach. Hence some of the requirements might change or be redefined [26]. Table 2 illustrates how UCD principles were enabled by applying activity theory. The table highlights the different stages during the UCD lifecycle and how the related UCD principles are applied to the relevant stages in the featured Use Case by using AT within UCD methods. A.GoodandO.Omisade /LinkingActivityTheorywithUserCentredDesign56