A FEMALE-FOCUSED DESIGN STRATEGY FOR DEVELOPING A SELF-CARE INFORMATION SYSTEM XUE LISHAN (BA.ID. (Hons.), NUS) (Volume 1) A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF ARCHITECTURE NATIONAL UNIVERSITY OF SINGAPORE 2009 Acknowledgments I have been extremely fortunate in grant support. Institutions that provided valuable help in the form of research scholarship, funding and knowledge resource include the National University of Singapore (NUS), School of Design and Environment (SDE), Industrial Design (ID) Programme and the Department of Obstetrics and Gynaecology at NUHS. In particular, I am grateful for my supervisors’ guidance – Dr Yen Ching Chiuan, Assistant Professor and Course Director of the Industrial Design Programme, Department of Architecture and A/P Mahesh Choolani, Research Director at the Department of Obstetrics and Gynaecology at the Yong Loo Lin School of Medicine and Senior Consultant Obstetrician and Gynaecologist at High Risk Pregnancy Clinic, National University Hospital (NUH) for the many discussions and debates we have had. Dr Yen, an excellent mentor and confidant over these years, remained firm that I needed to revise and update my material, and offered constructive comments all the way. Dr Mahesh, thank you for your guidance which was shaped by a clearcut firmness to achieve highest excellence in everything I do. I appreciate your confidence in me at moments it was needed most. In the course of time, many went the extra mile and read early parts and versions of the dissertation. These include A/P Chan Hock Chuan from the School of Computer, Department of Information Systems who advised on the validation of the conceptual model and A/P Tan Say Beng, director of the Clinical Trials and Epidemiology Research Unit (CTERU), DukeNUS Graduate Medical School, who supported me much on statistical issues and formalization of the survey data. I am grateful to Dr Christian Bourcharenc from the Department of Architecture, Dr Leanne Chang from the Communications and New Media Programme, Faculty of Arts and Social Science, and Dr Henry Duh from the Department of Electrical and Computer Engineering/Interactive and Digital Media for reading portions of the dissertation draft. I must also thank the thousand over survey participants, designers, and staff from the National University Healthcare System (NUHS) women’s clinics and National Healthcare Group (NHG) in participating polyclinics who have so kindly responded, cooperated and supported in my investigation. Without them, survey research would not have been made possible. Junior student researchers from our very own ID programme provided much support for research and design activities. They provided extraordinarily able, cheerful, and willing help at every juncture, and made me reaffirmed my passion for design. Finally, there is also my wonderful family which I wish to thank them for contributing in their own special way to my writing, especially my beloved parents and maiden family who have always been very proud of me and cheered me on at difficult times. I would also like to thank my husband, Jackie, who was my sparring partner in technical and emotional issues surrounding my dissertation, design research, and practice. He has relentlessly supported, encouraged, and inspired me on countless occasions. Lastly, I am grateful for God’s grace and strength for allowing me to complete this dissertation over these years. Indeed, like reason, our research is-and ought to be- a slave of our passions. ii Table of Contents SUMMARY ii ACKNOWLEDGMENT iii TABLE OF CONTENTS . iv LIST OF TABLES . vi LIST OF FIGURES vii ACRONYMS & ABBREVIATIONS . ix TERMINOLOGY xi LIST OF PUBLICATIONS . xiv INTRODUCTION . xv Research Aims & Objectives . xvi Outine of the Thesis . xix References . xxi 1. AN INTRODUCTION TO FEMALE-FOCUSED DESIGN AND ITS RELATION TO SELF-CARE OF WOMEN 1.1 Background 1.2 The Meaning of Female-focused 1.2.1 A Self-care Information System (SIS) 1.2.2 A Female-focused Design Strategy (FDS) . 10 1.2.3 The Research Hypothesis . 12 1.3 Method for Literature Review . 14 1.3.1 Population . 16 1.3.2 Technologies . 18 1.3.3 Data Synthesis 19 1.4 Elements of a Conceptual Framework 20 1.4.1 Design for Self-care 21 1.4.2 Health IT and Content 25 1.4.3 Content Users: Women . 27 1.4.4 Professionals: Designers and Healthcare Personnel . 32 1.5 The Opportunities of the FDS 33 1.5.1 Design for Self-care as a Consequence of the FDS 33 1.5.2 Design by Means of the FDS 34 1.6 Areas of Enquiry & Discovery Contexts 35 1.7 Summary . 37 References . 37 2. RESEARCH METHODOLOGY: SYNCHRONISING EXISTING PERSPECTIVES & DESIGN ANALYZES 44 2.1 Ideological Marginalization . 44 2.1.1 Triangulation and Complementarity . 46 2.1.2 Normative Research Method 46 2.2 Existing Design Emphasis and Problems in Design for Health . 48 2.3 Overview of Research Area Framework 49 2.4 Qualitative and Quantitative Studies 50 2.5 Realm of Theory: Research for Design 53 2.5.1 Discovery 54 2.5.2 Divergence 55 2.6 Realm of Practice: Research through Design . 59 2.6.1 Application . 61 iii 2.7 2.6.2 Convergence . 61 Summary . 65 References . 66 3. COLLECTION AND ANALYSIS OF QUANTITATIVE AND QUALITATIVE DATA IN RESEARCH OF A SELF-CARE INFORMATION SYSTEM (SIS) 69 3.1 Towards Female Preferences in Design . 72 3.2 Consideration for the Design of a SIS . 80 3.2.1 Women’s Perception and Acceptance towards the SIS 81 3.2.2 Reasons of Women for Seeking Health Information Online 99 3.2.3 Women’s Health Concerns . 102 3.2.4 Design Qualitities for a SIS 106 3.2.5 Latent Concerms for Using the SIS 109 3.3 Caregivers and Clinicians 117 3.4 Methodological Limitations . 119 3.5 Implications of Findings 120 3.6 Summary 121 References 123 4. A FEMALE-FOCUSED DESIGN STRATEGY (FDS): THE FRIEND MODEL . 130 4.1 Constructing the FDS . 130 4.2 The FRIEND Model 133 4.3 First Level Impact of FRIEND 136 4.4 Tailoring Age Differences in the FRIEND Model . 140 4.5 Implications of FDS . 146 4.6 Summary 147 References . 147 5. APPLICATION OF THE FEMALE-FOCUSED DESIGN STRATEGY (FDS) TO THE DESIGN PROCESS 151 5.1 Users of Strategy 152 5.2 Understanding F.R.I.E.N.D 154 5.3 Identifying Characters 155 5.4 User Scenario Design . 158 5.5 Graphical Representation of FRIEND for SIS Design 161 5.6 Concept Generation . 162 5.7 Users of Application 165 5.8 Opinion about the SIS 168 5.9 Summary 169 References . 170 6. CONCLUSION AND FURTHER DIRECTIONS . 172 6.1 Application of FDS to Design 172 6.2 Challenges for Female-focused Design . 173 6.3 Conclusions drawn from the Findings . 176 6.4 Opportunities and Future Development . 178 References . 182 iv Summary This study is derived from the desire for designers and healthcare professionals to better create a self-care information system (SIS) for women, especially to benefit those who practise self-care where the development of home-care products usually was assigned with low priority although their benefits to lay-users and the community have been substantial. Women are under-represented in the design of current information systems (IS) and femalefocused design can help improve their self-care. Acquiring user needs and acceptability levels from the female lay user about the system which they will handle is as one of the most important tools to better design , where the validity of female-focused design can be justified not only from a utilitarian perspective. The study has developed a conceptual female-focused acceptance model (FAM) which empirically examine the derived research hypotheses concerning the perception and acceptance of female users in the context of adopting the IS and introduce a female-focused design strategy (FDS) which addressed fundamental issues in designing and marketing IS for women’s health. A tripartite theoretical framework, grounded on review of literature, followed by qualitative and quantitative surveying was structured. The normative research approach was used which explored current models used for women healthcare; evidence of the potential barriers; views of target audience i.e. female lay-users and their family members and healthcare professionals; describing the FAM that highlighted women’s pragmatic approach to technology in self-monitoring systems. Empirical data was described and analysed using frequency tables and multiple linear regression to access differences among the female population. This study tested and confirmed that the FAM works well for detecting factors that influence women’s perception and acceptance of the self-care IS. To date, this study is the only one that has examined the underlying motives for such self-care innovation adoption by women. They would consider adopting it only if its use proved effortless and its technological value already demonstrated. Women want flexibility and empathic designs, which is responsive for them to manage, intricate in its detailing, with natural dialogues used, and dependable in both physical and virtual interactivity. Their preferences are illustrated through the FRIEND model. The study also reveals that the social factor (intended in this work as the importance of others’ point of view in determining our choices and attitude) does not play a fundamental role in woman acceptance of the SIS. Women believed that the SIS is useful and easy to use and going to have beneficiary outcomes has not only strong but significant direct contributions. FRIEND can be represented in different graphical ways for women from different age groups to determine and aid in the future design of healthcare and self-care technologies across society. The FAM with its constructs and possible extensions should give new insights to overcome age, user characteristics, and technology generation barriers, and provide a profile of how women from different backgrounds use new communication media to seek health information. The FDS could be aligned with design in terms of advertising, marketing, packaging, and service. Future research can include refining sampling procedures and measurement instrument, testing alternate conceptual models with other constructs, investigating new research contexts, and incorporating qualitative methods such as participatory design for the development of a potential SIS. v List of Tables Chapter 1.1 Common human factors activites that occur during product development 22 1.2 Five methods of learning . 30 Chapter 2.1 Identifying three key approaches in design research . 45 Chapter 3.1 Classification of concerns 70 3.2 Relationship between schemes and product properties 77 3.3 Summary of existing information and results from present study . 78 3.4 Measures for predictors of FAM 84 3.5 Characteristics of respondents . 90 3.6 Women’s expection of the SIS 91 3.7 Reliability of scale measures . 92 3.8 Cross loadings 92 3.9 Linear regression analysis results 94 3.10 Correlation matrix of health topics 105 3.11 Choice of health concerns among pregnant and non-pregnant women . 105 3.12 Design qualities for the SIS architecture and attributes . 106 Chapter 5.1 Comparison of wording . 151 5.2 Conceptual framework for women’s perceptions of iCare 167 5.3 Profile of respondents 167 5.4 Implications from findings . 169 vi List of Figures Introduction A Design concept of ibloom . xv B Application of the female-focused design strategy within design processes . xviii C Outline of the thesis xx Chapter 1.1 Health problems pertinent to women . 1.2 From a doctor-centred model to a patient-centred model and to female-focused model of healthcare . 1.3 Pictogram of a strategy 11 1.4 Literature review for female-focused design . 15 1.5 Some of the questions review of literature can answer 19 1.6 Literature search tree 20 1.7 Elements contributing to the new strategy . 21 1.8 Relationship between a user interface design process and the U.S. FDA design controls . 22 1.9 Brief evolution of medical design from early records to near future . 23 1.10 A schematic representation of design characteristics for self-care in near future 24 1.11 Framework examining female user response to GUI for e-health information . 31 1.12 A systems representation of human-technology interfaces 32 1.13 Sequence of medical procedures and design processes . 34 1.14 Inter-linked agents in the design of the SIS . 35 1.15 Design control and the waterfall model with feedback 36 Chapter 2.1 Normative study . 47 2.2 Iterative design process 48 2.3 Areas of research for female-focused design study . 51 2.4 Research for design 53 2.5 Lateral thinking 57 2.6 Research through design 59 2.7 Types of new product . 62 2.8 Stages in concept development 64 Chapter 3.1 Final selection of mobile phones . 74 3.2 Final selection of mp3 players . 75 3.3 Final selection of fragrance bottles 75 3.4 Aesthetic key points between the genders . 79 3.5 Functional key points between the genders . 79 3.6 Social key points between the genders 79 3.7 Possible function and workflow of the SIS 81 3.8 Technology acceptance model (TAM) 82 3.9 Conceptual female-focused acceptance model (FAM) 83 3.10 Locations for the survey of the SIS 89 3.11 National University Healthcare System Women’s Clinics and National Healthcare Group polyclinics . 89 3.12 Full dataset results of FAM . 93 3.13 Future research model 99 3.14 Reasons for seeking health information online 101 vii 3.15 3.16 3.17 3.18 3.19 3.20 3.21 Choice of health topics among women sample 104 Methods of learning medical devices . 111 Items to learn of the SIS . 112 Product information to know about the SIS . 114 Reference of a medical device which could possibly induce stress . 114 Reasons that may induce stress 115 Reasons for stress among total sample 116 Chapter 4.1 Preliminary model 132 4.2 The FRIEND model . 133 4.3 Steps in using the FDS 137 4.4 Preferences of women aged 24 and below . 141 4.5 Preferences of women aged 25 to 34 . 142 4.6 Preferences of women aged 35 to 44 . 143 4.6 Preferences of women aged 45 to 54 . 144 Chapter 5.1 FDS within the waterfall model 152 5.2 Discussion and brainstorming among the young designers 153 5.3 Exploration of isses with the FRIENDmodel 154 5.4 Expansion of user concerns from the FRIEND model . 155 5.5 Static personas to dynamic archetypes . 156 5.6 Personas for the SIS design 157 5.7 A potential contextual scenario for SIS users 159 5.8 Illustration of a persona using the SIS . 160 5.9 Illustration of a persona in her familiar environment . 160 5.10 Mood collage illustrating the Empathy attribute 161 5.11 Graphical representation of FRIEND for SIS users . 162 5.12 Interaction design during concept generation 163 5.13 Project interaction process . 163 5.14 Projected SIS design 164 5.15 Screen shots of the animation 166 Chapter 6.1 Conceptual visualisation for a future FDS design blog 180 viii Acronyms & Abbreviations AAMI Association for the Advancement of Medical Instrumentation BSS Breast Screen Singapore BSRI Bem’s Sex Role Inventory CGMP Current Good Manufacturing Practice DIA Dynamic interactive aesthetics DoH Department of Health DSRB Domain Specific Review Board EC European Council EMR Electronic medical records FDS Female-focused design strategy FHAs Female-focused healthcare applications FRIEND Flexibleness. Responsiveness. Intricateness. Empathy. Naturalness. Dependableness GMP Good manufacturing practice GUI Graphical user interface HPB Health Promotion Board HCI Human computer interaction HMI Human-machine interface HSA Health Sciences Authority ICT Information and communication technology ICU Intensive Care Unit IEEE Institute of Electrical and Electronics Engineers IMG Image IRB Institutional Review Board ISA Information system architecture ITU Intention to use MDD Medical Device Directives MeSH Medical Subject Headings MHCU Mobile health communication unit MDDI Medical Device and Diagnostic Industry MOH Ministry of Health NHG National Healthcare Group NHS National Health Service ix NLP Natural Language Processing NPD New product development NUHS National University Health System OQ Output quality PACS Picture archiving and retrieval systems PCC Patient-centred care PDS Product design specifications PEOU Perceived ease of use PHR Personal health records PNI Psychoneuroimmunlogy PU Perceived usefulness QoL Quality of life RD Result demonstrability ScHARR School of Health and Related Research SE Self-efficacy SIS Self-care information system SI Social influence SN Subjective norm U.S. FDA U.S. Food and Drug Administration WCC Women-centred care x Chapter Application and Evaluation of the Female-Focused Design Strategy (FDS) to the Design Process Six women volunteered to be interviewed and this was considered sufficient for collecting a rich amount of data through a series of deep and open-ended interviews investigating on the experience of others, which are then analysed through iterative readings, is useful to produce an outcome space (Reid 1997; Marton & Booth 1997). Their profile was considered to be suitable as they are parallel to the survey population established before (see Table 5.3). The mean age of the total respondent group is also 29 years. At the beginning of each depth interview session, the purpose and procedure were described in layman terms. All respondents agreed to have their interviews recorded (typed directly into computer or jotted on paper). It was also emphasised that their comments and feedback would be kept strictly confidential. The respondents were then shown a Flash animation in which a model user in the approximate age range of participants demonstrated the primary functions of the SIS, in scenarios consistent with the projected environment of use. The range of clinical measurements that the SIS could provide (e.g.; the recording clinical indicators of a patient’s health status, such as temperature, breath moisture and voice dynamics as well as providing feedback to users include food facts, wellness screening tests, measurement scheduling, and the possibility storing the images of the unborn child captured during prenatal scanning in softcopy) were shown in the animation. In the midst of viewing the animation, respondents were prompted to interact with the mock of the virtual interface, to familiarise with the functions described, enact typical routines in a simulated context and then react to conceptual technology interventions. These were performed by respondents in order to better answer the questions measuring the SIS and user communication. The depth interview approach enabled the research to achieve the explication of subjectivemeaning structures of the respondents’ view on the product and their relation to the more readily observable outcomes (Ramsden 1992). In addition, observation notes were jotted down at the side to document the non-verbal interactions and general atmosphere of the discussion. Each discussion lasted for approximately 90 minutes. The end point of each discussion was when all the essential questions were completed through the system, and no new information within the topic area surfaced (Fontana & Frey 1994; Ritchie 2001; Rahimpour et al. 2008). For every hour of interview, the transcription of the data collected was estimated to be about three hours. 5.8 Opinion about the SIS The main concern was how the SIS would enable women to understand and respond effectively and safely to symptoms and risk factors may be constantly improved to satisfy 168 Chapter Application and Evaluation of the Female-Focused Design Strategy (FDS) to the Design Process changing needs and growing demands for information presented in ways which the female user would find relevant, and are equipped to play a more direct role in enhancing their wellbeing. The implications of the findings from this evaluation, with respect to the theoretical framework, development, and implementation of the SIS are shown in Table 5.4 whereas the questions and complete set of results may be found in Appendix H. Table 5.4 Implications from findings Findings In relation to theoretical framework of female acceptance of the SIS Potential users’ concerns related to cost Potential users’ concerns related to “ease of use”, SIS self-efficacy and anxiety Some respondents relate the system as a mobile phone or PDA, despite being informed they not need computer knowledge to use the SIS, and it is not a PC Potential users’ concerns related to adequate clinical support of the SIS by clinicians Potential users’ perceptions of the SIS were generally positive Potential users suggested practical implications 5.9 Implications It was proposed that the two constructs, SIS self-efficacy and anxiety be included in the future FAM. Within self-efficacy, the definition remains quite board. Perceived self-efficacy is defined as people's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives; self-efficacy beliefs determine how people feel, think, motivate themselves and behave; such beliefs produce these diverse effects through four major processes and include cognitive, motivational, affective and selection processes (Rahimpour et al. 2008). Such processes should be considered in order to create the strongest sense of efficacy for the SIS. The SIS needs to be provided at reasonable prices. Prices range from as low as SGD$100+ to $500 for products which system support required subscription after sale. If manufacturers are looking at providing a one-time off sale item, the women are willing to pay up to $1500, and subsequently fork out $200 for upgrades which changes 30-50% of the device’s capabilities in 1-2 years time after sale. In addition, support by the government or insurance companies with regard to the health policies they sell to overcome the problem of cost is likely to promote the diffusion of FHA innovations. Some women are willing to wait for the technologies to be slightly obsolete before adopting them, hoping that this would reduce the pricing. Not only does the SIS need to be as easy as possible to use, the tailored programme needs to be developed to be able to be customised according to individuals’ levels of SIS self-efficacy and anxiety to improve their self-efficacy and decrease anxiety. In any training programs for the SIS, it should be explained that it is not required for users to have any knowledge about computers. Having the design team to conduct a walk-through demonstration session with users would be most desirable. Furthermore, a doctor or health professional to answer questions from the floor at the Q&A session would be even more assuring. Believe that the SIS acts as a secondary data support to most clinicians, while the access to health care is not in any way obstructed. They appreciate: • The scanning of food facts • Health seminars and reminders of vaccinations • Development of a multi-language prototype. • Addition of voice technology, to instruct users • The system with a touch screen and projection facility for private spaces. • The icons and the interaction on the screen appear to be able to attract much attention for long. • Inclusion of normal ranges on measurements, with indications to inform patients when their measurements exceeded the normal limits and which deliver relevant action plans • Provision of necessary feedback to the patients about their health status • It was mentioned that the design of the SIS (i.e. iCare in Flash animation) presented does not look anything like a PC, never too similar to a press powder case; hence it is attractive. • Development of a multi-user SIS rather than the single user version • To have the Careline (component for detecting body temperature and contextual factors) to be more accurate. • Clinicians’ acceptance and promotion of the SIS needs to be further investigated and promoted before implementation of major SIS initiatives. Summary The design process of SIS is the combination of women’s needs and preferences in the FDS which ties in with current product design methods to communicate women’s desires towards 169 Chapter Application and Evaluation of the Female-Focused Design Strategy (FDS) to the Design Process their own healthcare. The qualitative and quantitative data from the evaluation methods served well for refining the product development, not only in terms of correcting aesthetics, but also to provide an insight to the pragmatism and scenario for similar systems in the next to years time. However, it should be noted that new knowledge from biotechnology and new capabilities provided by the evolving global information infrastructure would be already transforming healthcare in the next five years. The confluence of these technologies will change clinical laboratory equipment into portable devices, easing the administrative details involved in delivering care and ushering in a new age of monitoring clinical states. Hence, the user scenario projected for the project design, which envisions the clinical and patient network, should truly hold the power to transform healthcare, making it truly female-focused as this research has urged. The steps suggested for FDS which could take through the test of time of potential users, designers, and healthcare professionals would then prove its quality. Designers should strive to use the steps of the strategy individually or collectively to make each representation a well-designed system, filled with smart content and informed choices for women’s health. References Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: W.H. Freeman and Company. Bruseberg, A. and McDonagh-Philip, D. (2000). User-Centred Design Research Methods: The Designer’s Perspective. Available at: www.cs.bath.ac.uk/~anneb/Usercentred%20design%202000E&PDE.pdf [4 Nov 2008]. Cross, N. (1995). “Discovering design ability”, in Buchanan, R. and Margolin, V. (eds.), Discovering Design-Explorations in Design Studies. Chicago: The University of Chicago Press, p. 107. Cross, N. (2006). Design and Designing. Milton Keynes: The Open University. Davis, F. (1986). A technology acceptance model for empirically testing new end-user information system: theory and results, Doctorate Dissertation, Sloan School of Management, MIT. Demiris, G., Rantz, MJ., Aud, MA., Marek, KD., Tyrer, HW., Skubic, M. and Hussam, AA. (2004). Older adults’ attitudes towards and perceptions of ‘smart home’ technologies: a pilot study, Medical Informatics and the Internet in Medicine 29(2): 87–94. Demiris, G., Speedie, SM. and Finkelstein, S. (2001). Change of patients’ perceptions of telehomecare, Telemedicine Journal and E-Health 7(3): 241–248. Finkelstein, S., Speedie, S., Hoff, M. and Demeris, G. (1999). Tele-Homecare: telemedicine in home health care. Proceedings/IEEE Engineering in Medicine and Biology Society, vol. 21, Monash University, Caulfield, Victoria, p. 681. Fontana, A. and Frey, JH. (1994). “Interviewing”, in NK. Denzin and YS. Lincoln (eds.), Handbook of Qualitative Research, CA: Sage, Thousand Oaks, pp. 361-374. Garner, S. and Duckworth, A. (1999). “Identifying key competencies of industrial design and technology graduates in small and medium sized enterprises”, in Roberts, P.H., Norman, E.W.L. (eds.), Proceedings of the International Conference on Design and Technology Educational Research and Curriculum Development. Department of Design and Technology. Loughborough University, Loughborough, pp. 88–96. Goodwin, K. (2001). Perfecting Your Personas. Available at: www.cooper.com/journal/2001/08/perfecting_your_personas.html [4 Mar 2008]. Hekkert, P. and van Dijk, M. (2001). “Designing from context: Foundations and applications of the ViP approach”, in P. Loyd and H. Christiaans (eds), Designing in Context: Proceedings of DTRS 5, Delft University Press. Marton, F. and Booth, S. (1997). Learning and Awareness. New Jersey: Lawerence Erlbaum Associates. Nielsen, J. and Molich, R. (1990). Heuristic evaluation of user interfaces. Proceedings of the ACM 170 Chapter Application and Evaluation of the Female-Focused Design Strategy (FDS) to the Design Process CHI'90 Conference (Seattle, WA, 1-5 April), pp. 249-256. Nielsen, J. (1994). “Heuristic evaluation”, in J. Nielsen and RL. Mack (eds.), Usability Inspection Methods, New York: John Wiley & Sons, pp. 25-62. Pering, C. and Ahn, E. (2008). Dynamic Archetypes and Lifestyle Changes. Available at: http://designmind.frogdesign.com/articles/health/dynamic-archetypes-and-lifestylechanges.html?page=1 [18 Feb 2008]. Rahimpour, M., Lovell, NH., Celler, BG. and McCormick, J. (2008). Patients’ perceptions of a home telecare system. International Journal of Medical Informatics 77(7): 486-498. Ramsden, P. (1992). Learning to Teach in Higher Education. London: Routledge. Reid, A. (1997). The meaning of music and the understanding of teaching and learning in the instrumental lesson. In A. Gabrielsson (Ed.) Proceedings of the Third Triennial ESCOM Conference (pp. 200–205).Uppsala: Uppsala University. 3. Ritchie, J. (2001). “Not everything can be reduced to numbers”, in C. Bergland (ed.), Health Research, Melbourne: Oxford University Press, pp 150-173. Saffer, D. (2007). Designing for Interaction. CA: New Riders. Stappers, PJ., van Rijn, H., Kistemaker, S., Hennink, A. and Sleeswijk Visser, F. (2008). Designing for other people’s strengths and motivations: Three cases using context, visions, and experiential prototypes. Advanced Engineering Informatics 23(2): 175-183. Story, MF., Mueller, JL., Montoya-Weiss, M. and Ringholz, D. (1999). The development of universal design performance measures, in Spotlight on Technology: Proceedings of the RESNA ’99 Annual Conference, RESNA, Arlington, VA, pp. 100-102. Woods, KF., Kutlar, A., Johnson, JA., Waller, JL., Grigsby, RK., Stachura, ME. and Rahn, DW. (1999). Sickle cell telemedicine and standard clinical encounters: a comparison of patient satisfaction. Journal of Telemedicine 5(4): 349–356. Zhang, J., Johnson, TR., Patel, VL., Paige, DL. and Kubose, T.(2003). Using usability heuristics to evaluate patient safety of medical devices. Journal of Biomedical Informatics 36: 23–30. 171 Conclusion and Further Directions This chapter presents the cumulative thinking and work of the research which has examined FDS with regard to the SIS meant for women’s health. Literature reviewed and surveys conducted put into context and perspective to develop what is called female-focused design. The introduction of the concept of female-focused design and its relation to self-care for women (Chapter 1), the collection and analysis of quantitative and qualitative data in research of the SIS among women (Chapter 3), the theoretical model of the FAM and its application to understand about female user acceptance and intentions and the essential considerations of design to form the FDS (Chapter 4) and the applicability of the FDS for designers and marketers and the SIS for female users (Chapter 5), have been demonstrated in this study. However, there remains a strong need to examine the transformation from a theoretical to a commercial application in the broader context of self-care, continuity of care, and design as a whole. 6.1 Application of FDS to Design Female-focused design can help improve the well-being of women especially when applied to self-care devices and IS. Through the user research process, the SIS to be designed would be: • • • • • • An automated system that allows users to keep track of their own medical records and accesses them whenever they want. A reminder system that helps users remember when to take medication, vaccinations and go for wellness screening, to help prevent over-or-under-medicating. A system that has self-measuring capabilities to detect changes of vital signs for the user. A system that supports the user with better self-care and helps her feel confident when communicating with healthcare providers. A system that supports the user feel secure and more in control of managing their health. A system that understands the user’s dynamic contexts of healthcare activities and encourages her to form an emotional attachment to the product. One very interesting discovery about what others understand or perceived female-focused design is that people associate such a design to be able to relate to their experience with love to mother’s care. This can be comprehended easily. With a bit of imagination and abstraction to the nine months of pregnancy, mothers no doubt provide the most conducive environment for us which are irreplaceable by any other means. The temperature and cushioning is always 172 Chapter Conclusion and Further Directions right, and there are multiple ways for us to occupy our time and to have different opportunities for absorbing new knowledge. Ironically, products would break down, and then they would never have the opportunity to develop such a relationship with the user. The bottom line is that great bonding and attachment is quite as important as great quality to the modern age woman. 6.2 Challenges for Female-focused Design The concerns of QoL, humanism, and consumerism in healthcare have brought a new dimension in design. There is a vision which includes providing effective design guidelines and strategies to designers and developers of effective, efficient and sustainable systems. Female-focused design would be a new, interesting, and exciting concept in healthcare in the near future. It is important to consider design applications that actively promote a sense of well-being and reassurance for female patients/users. However, many challenges and barriers remains, for example, the limitations in technological knowledge among designers, their lack of skills in conducting user-centric studies, a practitioner-focused mentality in the healthcare system and a lack of focus on the part of on prevention. The consideration of FDS in healthcare device design is highly dependent on the manufacturers’ interests and willingness in employing such elements and the healthcare providers’ support in validating and recommending the use of such applications. Industrial design, like other professions, does not only need to understand the commercial viability of what manufacturers are aiming for, but also more importantly, to educate them from a system point of view to make an appropriate choice in creating a better life for users and help integrate this concept into the overall objective. Radical design thinking is needed to view the FDS for the future of IS especially those for the self-care context. Real life evidence from the research findings demonstrates that numerous benefits can be gained from the implementation of the FDS in healthcare device design. The FDS and its potential applications are significant as they are very much guided by both theoretical background and users’ actual needs and preferences. Furthermore, the market for the SIS will expand as the trend towards concepts like PCC healthcare and public awareness increases. However, most healthcare providers and manufacturers have yet to discover these new opportunities for design. Therefore, a highly significant objective of this study was to enlighten the healthcare industry by establishing the FDS and demonstrating its applicability. It is believed that the current development in electronic communications is still as its infant stages. Within these recent years, many innovations in telehealth have emerged but a number 173 Chapter Conclusion and Further Directions of them have also disappeared quickly, leaving a trail of unclear returns on investment. The digital divide across the world has also widened. Sadly, many technological developments have not been able to benefit the needy and it is also unclear whether it is even helping the most privileged. It is getting more and more difficult to foresee the shape or extent of their effects on the health system than what our ancestors could have foreseen the blossoming of science that followed after the invention of the printing press (Zuger & Miles 1987; Jadad & Delamothe 2004). There are a number of factors which make female-focused design research challenging: 1. When distributing the quantitative survey at real clinical environments, besides having the need to fulfill certain regulatory protocols, it is not all the time easy to gain access freely. The considerations included ethics, confidentiality, and even issues arising from the patient charter. The benefits of onsite distribution is information may be obtained almost immediately (before coding takes place), and from the onsite situation, it helped in gauging a near accurate response of the crowd and did enhance the preparedness of the research administrators when the survey was to be distributed in the same or similar location in the following days. However, the limitation of such a method was that responses were restricted to those who are on site, and this could lead to a possible bias. The opening hours of clinics are usually shorter than normal office hours as well. Some participants felt annoyed when they could not concentrate on completing the survey whilst having to keep a look out for their turn to see their doctor or to collect their medication from the pharmacy. For future research, more visual cues and illustrative figures could be added to the survey to make it more attractive for participants to relate to the topic. They could also be offered the option of filling out and return on site or take home the survey and then return on their next visit. This option may be effective for pregnant subjects or patients with chronic conditions who would be required to visit their doctors within a designated period of time. If the survey could be taken home, web links could also be provided on it to give participants the chance to “google” for additional explanation. 2. It can get really difficult to get real users to participate in certain stages of the product development process due to avoiding the hassle of certain governance protocol or to be cost efficient. To thank participants with incentives has always been a debatable issue. Accordingly to Martin and his colleagues (2008), “developers may have to consider using proxies in the place of real users particularly early on in the design process”, such as “using healthy participants” instead of patients to test the usability of a device, or asking healthcare professionals to provide 3rd party opinion. By engaging the expert help from product or 174 Chapter Conclusion and Further Directions system developers or other staff as proxies, applying methods, such as cognitive walkthroughs or heuristic evaluations which can be performed during design conceptualisation would help in identifying and fixing problems early in development. It also ensures that copyrights of new technologies are protected to some extent. It is also difficult to get such expert help in person as there are not many such trained professionals working in Singapore. The alternative used in this research was to contact relevant people who were either delegates in previous design conferences or associates who have practical experience from certain institutions. However this type of evaluation may be a conventional route to addressing user issues, it could be bias to some extent and should never entirely replace testing with actual users. They are not a monotype as they include women from different ages, educational levels, health conditions, and role players. There are differences with respect to their previous experience. Users have expectations of how a system will work using it for the first time and these may be based on their previous experience of performing the task before with the previous version of the system or with similar applications (Jordon 2002). 3. It would be safer to apply more than one data collection method at each stage of the product development process. According to Garmer and colleagues (2004), “different methods are effective at identifying different types of data”. A wider range of data could also be captured from the process (ISO 13407 1999; Lin et al. 1998; Salvemini 1999; Garmer et al. 2002a, b). Sterne and colleagues (2001) state that “quantitative notions of personalistic probability may have some place, especially perhaps in the planning stage of an investigation”, however, statistical significance testing may sometimes have a limited role, acting as a supplement to estimates and hypotheses. In addition, research publications may report statistical evidence but sometimes not necessarily reflect methods in practice or propose viable solutions; some methods may be very established and recognised so there is no need for further validate them; methods reported in some scientific literature may be obsolete in reality whilst existing practices in the industry could be subjected to non-disclosure (Martin et al. 2008). The objective of collecting quantitative data and presenting numerical data sets in this thesis was to emphasise the scientific knowledge gained from a doctorate research available to strengthen the innovative and creative capacity of those working on real-life systems and designs for better self-care. Hence publication is after all relevant and vital since this area of research is also relatively distinctive. 4. It has been the trend nowadays to not only focus on the tangible and physical entities of any design, but also for the abstract qualities which lies within for engaging a more intangible experience with its users. These characteristics are known as the “essence” of the design, and indeed they give a more lasting quality and impression. Designers have since then been using 175 Chapter Conclusion and Further Directions expressive and metaphoric language to define the object’s essence. The attributes of the FDS are very much formulated based on this belief, and it acknowledges that the knowledge and evidence supporting the FDS requires updating, extending, or revising the expectation which it is based on. Further research into women’s appreciation of a wide range of products and systems must be carried out so it could then provide more definitive conclusions on how and when the FDS can effectively be used as a design strategy. The process of this continued research can be labourious but it is not difficult to appreciate the value of its outcome. 5. The findings and their implications presented here were obtained from a single study that targeted a possible female user group in Singapore. However, if given more time aside from presenting the doctorate research, patterns of user practice for the FDS and their interaction with environments can be observed using other methods to help develop understanding. One possibility is to use the ethno-methodological approach where the impact of technological solutions could be investigated through a strong understanding of user habits and practice. As a method, it is used in ethnographic studies to describe people's methods that they use in everyday situations (Collins & Makowsky 1978). Although ethnography is not based on large numbers of cases, ethnographic research is an in-depth procedure which requires a longer time frame and conclusions tend to arrive at only after lengthy considerations. A deeper consideration of user practice and needs can help better understand the social and cultural implications of new technologies. Further research could also be carried out to access similar issues across broader social and cultural horizons where the survey results may differ when it is being conducted in less highly regulated and standardised society, such as in Singapore. 6.3 Conclusions drawn from the Findings This study is the first of its kind aimed with the priority of gathering female concerns and preferences into the design of information systems for self-care. Women-centred care principles did provided an opportunity to rethink traditional design methods and develop a liberating inspiration for designing the SIS. • Current thinking with regard to the implementation of female-focused design research in self-care is summarised to the effect that: − there is a constant struggle in the choice of some terminologies − it is only in its early stages but has great potential. − it has drawn the attention of healthcare providers and academics to itself. − the medical field may have felt its importance but the medical equipment industry and actual implementations have yet to express views about it. − the forces driving the FDS in existing theoretical frameworks are similar to those in the 176 Chapter Conclusion and Further Directions design practice. − a tension due to lack of real life evaluation exists between the benefits claimed and findings from this study. • Opportunities and constraints for implementing the SIS are to: − increase consumer awareness in self-care − offer tremendous opportunities for those organisations which seek to want to address design and user-centred principles for women successfully. • Bottom line benefits for adopting the SIS are: − prevention and maintaining well-being for women − its considerations of self-efficacy to reduce the likelihood of user error − better educating of self-care knowledge to women − due to its female-focused design attributes in place to encourage medical adherence • Barriers for implementing the FDS in design are: − potential cost increases in terms of time spent in female user studies − some existing medical standards and regulations which are supposed to be unisex − professional resistance impeding the progress, i.e. reluctance from designers, marketers, or manufacturers • The techniques for identifying female-focused needs are: − open-ended questions are preferred to closed. − the current constructs which make up the FAM as well as potential variables from more research in the field of HCI • The design principles generated from this study: − the FRIEND model aka the FDS • The constraints of existing design strategies: − focuses on clinician-centredness regardless of patient needs. − there is a poor understanding of the use of design and ergonomics. − it is more incremental than radical. − lack of research for comparison especially conducted in Asian context. 177 Chapter 6.4 Conclusion and Further Directions Opportunities and Future Development There have been two obvious contributions; in terms of academic interest, the interest and importance of female-focused design considerations with regard to designing a SIS has been established. A female-focused design methodology and the theoretical model for detecting the variables essential for female-focused design, the FAM, is formed. For design practice, the FDS conceived is envisaged to help design practitioners and marketers to improve their decision making on product differentiation, attachment, and prolonged relationships. The strategy embraces/has provided the FRIEND model to consider when making decisions on product design (both physical appearance and the semantics and pragmatism of an interactive healthcare IS. It is envisioned that the FDS could be aligned with design in terms of advertising, marketing, packaging, and service as well, so that companies can deliver a more powerful brand message to female consumers. The FAM with its constructs and possible extensions can give new insights to overcome age, user characteristics, and technology generation barriers, and provide a profile of how females with different demographic characteristics use new communication media to seek health information. At the turn of the century, many institutions and organisations have been overly concerned with the future development of ICT and health care provision (Van Bemmel & McCray, 1995; Van Bemmel 1996; Haux 1997; Greenes & Lorenzi 1998; Stead & Lorenzi 1999; Haux et al. 2000; Ammenwerth et al. 2001; Ball & Lillis 2001; Fessler & Gremy 2001; Kuhn & Guise 2001). Existing ICT applications have tried to reach out to diabetic patients (Lee et al. 2007), others who may be suffering from conditions, such as congestive heart failure (CHF) and chronic obstructive pulmonary diseases (COPD) (Rahimpour et al. 2008), and even to the aged (Demiris et al. 2004). There has been a keen interest in understand how innovations can improve health and healthcare for all age groups, from the healthy to those with persistent chronic condition, benefitting not only the white collar but reaching even to the very poor (Jadad & Delamothe 2003). According to an article published by the Internet Wire (2008), “mobile device technology, as well as mobile content and application development, is on the rise”. More than one out of six people worldwide own mobile devices (Katz 2005). There has been an increase in the number of mobile devices available that can process digital data and media (Anderson & Blackwood 2004). Perhaps the broadband penetration and the use of the Internet for purposes other than email and information searches are almost certainly going to become more widespread over the next 10 to 15 years and these are central to enhance productivity in the information age. Mobile devices, such as mobile phones, with a multitude of functions apart from the 178 Chapter Conclusion and Further Directions traditional one of making a phone call, may be the type of devices which not only appeal to the young but is increasingly being adopted by the elderly. According to Katz (2005), the positive interest in mobile phone services are ranked accordingly: • • • • • • • navigation help when lost: 84.4% hotline to a doctor: 71.2% games: 31.2% brief health information notices: 24.9% getting informed about special local merchandise offers: 14.2% getting advertisement about products or services: 12.3% watching TV from the screen of a mobile phone: 11.6% It is easy to understand that interventions, such as accessing to the doctor and directional assistance when lost are ranked as very important features for mobile communication devices, whilst the research showed the level of interest in brief health information is comparable to that of game playing. Hence these comparisons would serve as a realistic index to perceived potential value. Further research can be explored using the FAM for different age groups of female users to design the SIS to be incorporated on existing mobile phone platforms and network for the near future as it reaches out easily to a lot of potential users. In addition, most mobile networks are mature, widely-applied in and accepted by most of the industry. It was felt that future research could ride on this and use the infrastructure of mobile communication to conduct relevant studies. A person could always carry a mobile phone which has wireless connectivity and data synchronisation everywhere throughout his life (Wei & Leung 1999; Sharples 2000; Economides & Grousopoulou 2009). The ‘mobile component’ of the mobile devices is the most important feature which should make it very popular and convenient worldwide (Brown et al. 2001; Economides & Grousopoulou 2009). Of course if healthcare information could be accessed from such mobile devices, reasons like safety and contact with medical professionals anytime could be further facilitated and brought convenient (Wehrman 2002; Aoki & Downes 2003). Moreover, using mobile devices to educate people about their current health statues and healthcare management has a lot of advantages over full-size computers and even human power (Triantafillou et al 2008). A research team from Finland developed a mobile communication tool which is customisable depending on user requirements and physician guidance (Koskinen & Salminen 2007), whilst another team from the United Kingdom experimented the treatment of obesity using a mobile phone to share activity information among groups of friends - their results revealed that “awareness encouraged reflection and increased motivation for daily activity” (Anderson et al. 2007). The SIS through independent devices or tapping on the network of mobile devices should enable 179 Chapter Conclusion and Further Directions women to preserve or improve their own health. Ideally it even aims to reach out to those who are less familiar with the internet or new media tools among the female population. For future research into the usefulness and applicability of the FDS, investigation can be conducted to show how experienced designers use existing female user data or preference tools (i.e. books, handbooks, software packages, online sources, etc) in design consultancies. It is highly possible that their exploration from such avenues is minimal and limited. Much of their design could be based on experience and intuition partly because projects are often rushed for time. Experimental methods, such as physical prototyping and engaging with actual users to provide designers with data and information during their design process could be the other more popular option. Experienced designers perceive and evaluate such methods as more effective and useful compared to referring to anthropometric data sources or strategies that are less hands-on. Hence, based on designers’ usual practices, there is a potential for the FDS to be designed and developed specifically for designers and with the intention of it being better accommodated within their design process. This could be done by adopting designers’ existing approach to the collection and usage of user information and by adapting the attributes of the FDS and its variations into that workflow. Figure 6.1 Conceptual visualisation for a future FDS design blog 180 Chapter Conclusion and Further Directions To test the viability of the strategy, it could be possible and relevant to design a website or a design blog to introduce the FDS to get as many potential users of the strategy involved (i.e. designers and marketers) (see Figure 6.1). It is an easier and faster way to broadcast and encourage the uptake of the strategy. Participation from bloggers through the discussion forum available through the online platform could enable a breakthrough from the real users at the cutting edge of the design scene. These users often have strong influence in predicting the next trend and contribute to research identifying potential female users or consumers of applications. Informed by user input, data analysis from such a channel of feedback can then guide future research in identifying access and interpretation barriers associated with the use of the SIS. A certain extent of the HCI principles involved could be examined from such a procedure. The design blog or website is intended as such to study the accessibility of the future self-care system and this virtual platform can also be used to evaluate accessibility of similar types of applications. It is essential to take note of some boundary conditions when interpreting the presented work. Besides getting positive feedback from users or experts, there needs to be more substantial recognisable evaluation other than “importing conventional methods of evaluation, such as randomised controlled trials” (Jadad & Delamothe 2004). These may answer many of the evaluative questions, but may not have sufficient flexibility and power to handle the complex, dynamic, and rapidly expanding nature, such as what the SIS intends to embrace (Jadad & Delamothe 2004). The rapid developments in ICT may be outpacing researchers’ ability to judge their impact. In reality some developments may not necessarily fulfill expected demands hence the “call for follow-up studies on the appropriate measures of the success of NPD and on the conditions leading to such success” is essential (Person et al. 2008). This research has introduced the FDS for practitioners to address the fundamental issues in design and uptake and enhance the usability experience of self-care devices by the female population. Women can become informed consumers they desire to be through such designs that helps them better manage their own health and well-being. It would be important to understand how the SIS could relate to users coming from different racial and cultural backgrounds in optimising their health. The evidence of the impact of these innovations when used in different settings in the future should provide valuable insights into the realm of design research. 181 Chapter Conclusion and Further Directions References Ammenwerth, E., Knaup, P., Meier, C., Mludek, V., Singer, R., Skonetzki, S., Wolff, AC., Haux, R. and Kulikowski, C. (2001). Digital libraries and recent medical informatics research. Methods of Information in Medicine 40:163-168. Anderson,P. and Blackwood, A. (2004). Mobile and PDA technologies and their future use in education. JISC Technology and Standards Watch 4(3). Anderson, I., Maitland, J., Sherwood, S., Barkhuus, L., Chalme, M., Hall, M., Brown, B. and Muller, H. (2007). Shakra: tracking and sharing daily activity levels with unaugmented mobile phones. Mobile Networks and Applications 12 (2–3): 185–199. Aoki, K. and Downes, EJ. (2003). An analysis of young people’s use of and attitudes toward cell phones. Telematics and Informatics 20: 349–364. Ball, MJ. and Lillis, JC. (2001). E-health: transforming the physician/patient relationship. International Journal of Medical Informatics 61:1-10. Brown, B., Green, N. and Harper, R. (eds.) (2001). Wireless world: Social and Interactional Aspects of the Mobile Age. London: Springer. Collins, R. and Makowsky, M. (1978). The Discovery of Society. London: Random House. Demiris, G., Rantz, MJ., Aud, MA., Marek, KD., Tyrer, HW., Skubic, M. and Hussam, AA. (2004). Older adults’ attitudes towards and perceptions of ‘smart home’ technologies: a pilot study. Medical Informatics and the Internet in Medicine 29(2): 87–94. Economides, AA. and Grousopoulou, A. (2009). Students’ thoughts about the importance and costs of their mobile devices’ features and services. Telematics and Informatics 26: 57–84. Fessler, JM. and Gremy, F. (2001). Ethical problems in health information systems. Methods of Information in Medicine 40: 359-361. Garmer, K., Liljegren, E., Osvalder, AL. and Dahlman, S. (2002a). Arguing for the need of triangulation and iteration when designing medical equipment. Journal of Clinical Monitoring and Computing 17: 105–114. Garmer, K., Liljegren, E., Osvalder, A. and Dahlman, S. (2002b). Application of usability testing to the development of medical equipment. Usability testing of a frequently used infusion pump and a new user interface for an infusion pump developed with a Human Factors approach. International Journal of Industrial Ergonomics 29: 145–159. Garmer, K., Ylven, J. and Karlsson, ICM. (2004). User participation in requirements elicitation comparing focus group interviews and usability tests for eliciting usability requirements for medical equipment: a case study. International Journal of Industrial Ergonomics 33: 85–98. Greenes, RA. and Lorenzi, NM. (1998). Audacious goals for health and biomedical informatics in the new millennium. Journal of the American Medical Informatics Association 5(5): 395-400. Haux, R. (1997). Aims and tasks of medical informatics. International Journal of Medical Informatics 44(1):9-20. Haux, R., Knaup, P., Herzog, W., Bauer, AW., Reinhardt, ER., U¨ berla, K., van Eimeren, W. and Wahlster, W. (2000). Information processing in health care at the start of the third millennium potential and limitations. Methods of Information in Medicine 40:156-162. Internet Wire (2008). Survey Reveals Surging U.S. Mobile Adoption and How Mobile Users are Spending their Time: Prosumers and Young Professionals Lead the Way as Power Mobile Users and Early Adopters of Advanced Content and Social Networking Services. Internet Wire. Available at: http://co.azukisystems.com/index.php?/pages/p/survey_reveals_surging_us_mobile_adoption_and_ how_mobile_users_are_spending/ [29 Oct 2008]. ISO 13407, 1999. Human-Centred Design Processes for Interactive Systems. Jadad, AR. and Delamothe, T. (2003). From electronic gadgets to better health: where is the knowledge? British Medical Journal 327:300-1. Jadad, AR. and Delamothe, T. (2004). What next for electronic communication and health care? British Medical Journal 328:1143-4. Jordan, P. (2002). An Introduction to Usability. London: Taylor & Francis. Katz, JE. (2005). “Mobile phones in educational settings”, in K. Nyiri (ed.). A Sense of Place: the Global and the Local in Mobile Communication. Wien : Passagen, pp. 305-317. Koskinen, E. and Salminen, J. (2007). A customizable mobile tool for supporting health behavior Interventions. Annual International Conference of the IEEE Engineering in Medicine & Biology Society (Conference Proceedings), pp. 5908–5911. Kuhn, KA. and Guise, DA. (2001). From hospital information systems to health information systemsproblems, challenges, perspectives. Methods of Information in Medicine 40: 275-287. 182 Chapter Conclusion and Further Directions Martin, JL., Norris, BJ., Murphy, E. and Crowe, JA. (2008). Medical device development: the challenge for ergonomics. Applied Ergonomics 39:271-283. Lee, M., Delaney, C. and Moorhead, S. (2007). Building a personal health record from a nursing perspective. International Journal of Medical Informatics 76(2):308-316. Lin, L., Isla, R., Doniz, K., Harkness, H., Vicente, KJ. and Doyle, DJ. (1998). Applying human factors to the design of medical equipment: patient controlled analgesia. Journal of Clinical Monitoring and Computing 14: 253–263. Person, O., Schoormans, J., Snelders, D. and Karjalainen, TM. (2008). Should new products look similar or different: the influence of the market environment on strategic product styling. Design Studies 29(1): 30-48. Rahimpour, M., Lovell, NH., Celler, BG. and McCormick, J. (2008). Patients’ perceptions of a home telecare system. International Journal of Medical Informatics 77(7): 486-498. Salvemini, AV.(1999). Challenges for user-interface designers of telemedicine systems. Telemedicine Journal 5: 163–168. Sharples, M. (2000). The design of personal mobile technologies for lifelong learning. Computers and Education 34: 177–193. Stead, WW. and Lorenzi, NM. (1999). Health informatics: linking investment to value. Journal of the American Medical Informatics Association 6(5): 341-348. Sterne, JAC., Smith, GD. and Cox, DR. (2001). Sifting the evidence – what’s wrong with significance tests? British Medical Journal 322: 226-31. Triantafillou, E., Georgiadou, E. and Economides, AA. (2008). The design and evaluation of a computerized adaptive test on mobile devices. Computers and Education 50(4): 1319-1330. Van Bemmel, JH. (1996). Medical informatics, art or science. Methods of Information in Medicine 35: 157- 201 (with discussion). Van Bemmel, JH. and McCray, A. (eds.) (1995). Yearbook of Medical Informatics 1995. The Computer-Based Patient Record. Stuttgart: Schattauer. Wehrman, J. (2002). College students overwhelmingly use cell phones. Naples News. Wei, R. and Leung, L. (1999). Blurring public and private behaviors in public space: policy challenges in the use and improper use of the cell phone. Telematics and Informatics 16: 11–26. Zuger, A. and Miles, SH. (1987). Physicians, AIDS and occupational risk. Journal of American Medical Association 258: 1924-8. 183 [...]... to Female- Focused Design and its Relation to Selfcare of Women Background Medical devices, products and information systems (IS) are increasingly made available in many countries, to encourage home and self- care, thus changing the façade of how people view and approach health systems People are able to play a greater part in maintaining their own health The potential benefits of self- care are substantial... Qualititative Data in Research of a Self- care Information System (SIS) Chapter 4 A Female- focused Design Strategy (FDS): the FRIEND model Illustration and exploration in practice Chapter 5 Application and Evaluation of the Female- focused Design Strategy (FDS) in the Design Process Structure of Female- focused Design System Architecture Existing Design Protocols and Processes Relationships, Strengths and Weaknesses... the ability to better manage their health and 1 Chapter 1 An Introduction to Female- Focused Design and its Relation to Self- care of Women access high quality clinical care, providing cost-effective healthcare and supporting strong clinical research” Singapore’s National Healthcare Group (NHG) is offering a NetCare portal that enables patients to view their online personal medical and health dossier and... ultimately contributes to better quality to their healthcare, self- care, and personal well-being Female- focused Healthcare Applications: Such applications refers to customizable and mobile wireless healthcare interventions such as or network-based clinical information system transforming a general purpose computer into a special-purpose monitoring device component which users can access to validated advice... consumer satisfaction The SIS supports for pathways to be made available in self- care for women Expanding the preliminary concept of the SIS, a FDS 4 The designers are Erica Eden (American), Agnete Enga (Norwegian), Yvonne Lin (Chinese-American), and Gina Reimann (British) 6 Chapter 1 An Introduction to Female- Focused Design and its Relation to Self- care of Women would be developed to aid in all future design. .. represented for analysis later on The research objectives and questions are examined again in detail xix Discussion of available literature Theoretical contribution to literature Chapter 1 An Introduction to Female- focused Design and its Relation to Selfcare of Women Chapter 2 Research Methodology Synchronising Existing Perspectives and Design Analyses Chapter 3 Collection and Analysis of Quantitative and Qualititative... making treatment decisions, choosing and evaluating insurance programs or healthcare providers, or managing healthcare benefits; Disease management—monitoring, recordkeeping, and communication devices for managing a chronic disease, usually in conjunction with healthcare providers; Healthcare tools—means of maintaining or accessing health records and interacting with healthcare providers This category... understand the relationship between female users and a self- care information system (SIS) and their acceptance levels that may result from their initial perception The SIS found its beginnings from a concept design named as the Ibloom (Figure A) , conceived as a mobile health communication unit (MHCU)1 targeted at women who may need to refer to a networkbased healthcare information system (IS) that functions... been developed and used as the basis for some clinical practice, such as maternity care Not surprisingly, the abundance of data and opinion from both medical and social research fields tends to confusion To consider the true needs for a FDS and their relationship, there is a need to systematically organise the large and diverse amount of material available, in a way that is compact and comprehensible,... Concept: A design proposal for a product, through a selection of ideas Usually a series of different design proposals will be suggested to facilitate a definite concept choice A proposal may exist out of drawings, additional text and design models Detailing: To create a fair opinion of the design proposals, it is necessary to detail them equally Detailing may concern: materials, standard parts, manufacturing . users can access to validated advice for effective self-care, manage, and share their personal health information, and that of others for whom they are authorised in a secure, confidential, and. Research of a Self-care Information System (SIS) Chapter 4 A Female-focused Design Strategy (FDS): the FRIEND model Chapter 5 Application and Evaluation of the Female-focused Design Strategy. their health management and well-being. • To suggest a Female-focused Design Strategy (FDS) for health information system design. • To publish in the design field investigating about female-focused