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Motivation & acceptance Using the AT and UCD approach helps to increase the likelihood of user motivation and acceptance by collaborative decision making and to place the users at the forefront of the design. The evaluation of MHSF enabled users to provide feedback on the acceptance. Acceptance was analysed using constructs that includes perceived usefulness and perceived ease of use. Trust Trust is critical to the success of a mHealth system [28]. Evaluating user perspectives of the system during interviews highlighted that users were concerned about the security of their personal information. These concerns can then be implemented and evaluated in the next iteration of the project design. Confidence in use AT coupled with UCD enabled a broad understanding of user needs which also includes assessing aspects of technical literacy. The UCD approach helped to understand how well users who lack technical literacy were able to use the system. MHSF was designed to be intuitive with good ease-of-use to enable usage by people with limited computer proficiency. Intuitive and user-friendly designs could help to increase user confidence. Table 5. The determinant factors for success using AT and UCD in Use Case 2. Critical Success Factor Description within the use case: MomConnect Efficiency Using AT in an observational ethnographic study, coupled with the interview, the results from the deployment evaluation study indicated that the registration process on the MomConnect system did not afford optimum efficiency, leading to complaints from pregnant women to the clinic because they had not been registered. By taking the perspective and practices of the staff, AT helped to describe how MomConnect can be used in the clinic, by presenting a series of nested activity system with different goals. AT helped break down goals to improve the operation of the clinic to enable effective registration on MomConnect. Breaking down the goals will then inform the redesign of the MomConnect system by allocating resources in a way that promotes efficiency. Motivation & acceptance Using AT to evaluate the system in use, interviews highlighted that acceptance was driven by motivation from not only the main users but clinic managers themselves. The analysis showed that these clinic managers who are not involved in the registration process, do in fact have some influence over the practice of using MomConnect to register pregnant women. The study demonstrated that motivation to use the MomConnect could be influenced by the level and type of clinical management. Women would use the system if it were recommended and benefits are promoted by more senior members of staff because they are more likely to be assigned as ‘experts’. Trust A UCD approach to evaluating the system in use enabled users to identify confidentiality concerns during the interviews and ethnographic observational studies. This was important to address in the redesign of MomConnect to help increase the future success of the system. Users’ perception of the confidentiality of their data, needs to be considered in context to inform the next iteration of UCD design, the requirement stage. Confidence in use The ethnographic observational studies, as well as interviews, helped identify issues relating to technical literacy in both staff and the pregnant women. Lack of technical literacy will impact upon user’s confidence. This analysis will help in the design of a more intuitive system in future iterations. A.GoodandO.Omisade /LinkingActivityTheorywithUserCentredDesign60