Page - 61 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

4. Discussion mHealth technologies must be designed to meet the wide spectrum of end-user needs, as well as enable optimum acceptance and clinical impact, where relevant. There are several examples of how the interdisciplinary field of HCI has been instrumental in providing the necessary tools in designing these technologies [7,15,35,36]. The application of HCI in mHealth has seen the employment of multidisciplinary theoretical frameworks including activity theory, as well as others including distributed cognition and cognitive ergonomics. HCI has also given rise to the development of design frameworks such as UCD which makes use of several user centred methods used within the reiterative project life cycle. UCD has been shown to be an effective framework in the design of mHealth interventions by linking Activity Theory to provide a theoretical lens during various stages of the project lifecycle [26,27]. Activity theory can help provide a broader framework for understanding human computer interaction. The elements within Engestrom’s model of activity help to provide a multifaceted analysis of users, their activities and the relationships between them. The use cases presented in this chapter illustrate how AT combined with UCD can be applied throughout the different stages of the intervention lifecycle for the mobile intervention, from analysis through to deployment. The use cases also illustrate how the application of AT and UCD can help maintain or solve success or failure factors of mHealth systems. Whilst the benefits of using this approach have been illustrated, some discussion around its limitations can help in providing a critically balanced argument for its use in mHealth. Whilst AT can provide valuable insights into understanding user needs and their activities, the theory itself can be difficult to comprehend, particularly for system designers that are not from a cultural-historical/psychology background. It is not a rigid theory and does require some understanding of its historical context to be able to utilise its principles in practice. Engestrom’s model of activity (Figure 3) highlights the complexity of understanding human activities however, it can be difficult for those involved with system design to decompose the model to specific focal points in the design [36]. AT can also be a time-consuming process and care needs to be taken to ensure that this process does not impact negatively upon time constrained subjects. There are however many examples in healthcare and other domains, where it has been advantageous to complement AT with other methods. For example, combining AT with cognitive load theory and flow experience theory to enable the development of a more integrated framework for analysing internet-mediated experiences of children, as well many examples of AT combined with distributed cognition theory to provide a conceptual framework for Computer Supported Collaborative Work (CSCW) research [37]. The application of AT does enable a broader understanding of conceptualising human in context, which is particularly relevant when trying to understanding how humans will interact with systems. The importance of undertaking a comprehensive user analysis cannot be understated. If users’ needs and expectations are not met, then this will inevitably impact upon the success of a system. mHealth systems that are designed for users to help manage their healthcare, not only need to be usable but must also enable clinical impact where relevant. Acceptance of the intervention and providing a positive user experience are then key. Linking AT to a UCD framework that involves users throughout the project lifecycle of a mHealth system can help to achieve these goals. A.GoodandO.Omisade /LinkingActivityTheorywithUserCentredDesign 61