=Paper=
{{Paper
|id=None
|storemode=property
|title=Methodology Choices in Health Related ICT-Design
|pdfUrl=https://ceur-ws.org/Vol-984/paper4.pdf
|volume=Vol-984
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==Methodology Choices in Health Related ICT-Design==
https://ceur-ws.org/Vol-984/paper4.pdf
Methodology Choices in Health Related ICT-Design
Marjo Rissanen
Aalto University School of Science and Technology, Finland
Abstract. ICT-supported health promotion has diverse development challenges.
Methodological selections guide the design and development of solutions and
artefacts and are critical in area where utility and cost-effectiveness are required
of applications and systems. The article gives an example of an ICT-project at
the occupational health which methodological choices and framing was consid-
ered from view of one popular guideline frame [11] in design science research
in Information Systems. Good familiarity and understanding of the ideology of
the frame are essential when trying to reach more sinew with aid of it.
Keywords: ICT-design, methodological framing, occupational health
1 Introduction
Health related ICT-design projects are typically pragmatic by nature and emphasize
the usefulness of designed products. Also iterative product development is common in
this field because long-lasting maturation phases are often the rule rather than the
exception. Unfortunately even trial-and error searching would characterize develop-
ment in health related ICT-design. Also balanced synergy between relevance and
rigor and reliance on creativity are meaningful issues in this area. The ideas presented
in these guidelines for design science research by Hevner et al [11] and their illumi-
nating examples [10, 12, 13] emphasize aspects which are typical or desirable in
health related ICT-design. Guidelines [11] are also actively discussed by other au-
thors. Information systems (IS) design science research (ISDSR) has a common body
of knowledge and a cumulative tradition [4]. There are also so called process models
in the IS sector concentrating on the process chains of design [16] as well as models
concentrating on paradigms, theories, taxonomies, or patterns in this area.
The goal of the integrated case study was to produce a supporting tool for occupa-
tional health promotion and training. The prototype was aimed at supporting blended
health training programmes which combine classical class interventions and self-
paced learning. The multidisciplinary production team consisted of domain experts
from different fields. The author of this article worked in this project as the main de-
signer and the project coordinator. This article describes how the given guidelines
[11] refreshed with some newer specifications by Hevner [10], by Hevner and Chat-
terjee [13], and insights presented by other authors [e.g., 24] inspired by these guide-
lines fit the principles, ideas, and design practice undertaken in this project. In this
Copyright © 2013 by the paper's authors. Copying permitted for private and academic purposes.
In: H. Gilstad, L. Melby, M. G. Jaatun (eds.): Proceedings of the European Workshop on Practical Aspects
of Health Informatics (PAHI 2013), Edinburgh, Scotland, UK, 11-MAR-2013, published at
http://ceur-ws.org
32
analysis formal reasoning and literature review were utilized with gathered experi-
ence.
2 Main ideas in guidelines
Design-science research provides contributions in the areas of design artifact, design
construction knowledge, and design evaluation knowledge. The purpose is to create
and evaluate purposeful IT artifacts which are intended to solve identified organiza-
tional problems or to address solved problems in more effective and efficient ways.
[11] Design theories are an answer to developmental questions [12]. The model by
Hevner et al [11] contains an information systems research framework and seven
design guidelines. The presented guidelines assist researchers and designers to under-
stand the principles and requirements for effective design-science research. The seven
guidelines are following: design as an artefact, problem relevance, design evaluation,
research contributions, research rigor, design as a search process, and communication
of research. Hevner et al advice against mandatory use of the guidelines but remind
that each guideline should be addressed in some manner in complete design-science
research. [11] The goal of design science is utility and “rigor must be assessed with
respect to the applicability and generalizability of the artefact” [12]. Design science
in information systems research requires a wide range of scientific foundations and is
derived from the effective use of knowledge base. In a rigorous design it is meaning-
ful that “design science research is grounded on existing ideas drawn from the do-
main knowledge base” while inspiration for creative design can be drawn from multi-
ple sources. The goal is also domain–independent understanding which means
knowledge which can be applied to any research project. [12] Hevner [10] adds to this
list so called “additional sources of creative insights” [2]. Wang and Wang [24] also
emphasize the meaning of cross-disciplinary involvement and alignment in relevant
design research. While rigor can be achieved “by appropriately applying existing
foundations and methodologies” an overemphasis of rigor can even decrease rele-
vance and artefact and focus environments themselves may defy excessive formalism
[11]. Therefore, synergy between practice and theory is needed in good design sci-
ence research [10].
In the presented model [11] it is emphasized that “design as a search process” re-
quires experience, creativity, intuition, and problem solving capabilities with connect-
ed design iterations. The theory basis addresses both the process and the designed
product. Problem solving represents a search process and a design artefact is complete
when it satisfies settled requirements and constraints of the settled problem. In evalua-
tion functionality, completeness, consistency, accuracy, performance, reliability, usa-
bility, and fit with the organization with relevant quality attributes are in focus. [11]
Faludi [3] reminds that a problem is actually a relevant set of objectives: such a set is
only seldomly possible to clarify at once and requires therefore iterative rounds of
specifications. Finally design–science often simplifies a problem by decomposing it
into simpler set of sub-problems [11]. Design research cycles are named as following:
relevance cycle (requirements, field testing), design cycle (processes in design and
evaluation), and rigor cycle (theory grounding, additional sources) [13]. To control
33
acceptance problems it is useful to understand the combination of technology-based,
organization-based, and people-based artefacts [11].
Original guidelines inspired Wang and Wang [24] to present useful aspects in their
contribution; design as a new layer “can be useful not only for solving the existing
problems in business but also for initiating new needs for business”. They also re-
mind that IT innovation can never be optimal; e.g., “rigorous tests for an IT innova-
tion design artifact might be difficult to define and might take longer time than the
artefact’s life cycle itself “. They also point out that “to reduce biases in research, it is
necessary to conduct independent experimental tests that are outside of the design
circle”. [24]
3 Methodological emphasizes in the project
3.1 Problem relevance and creativity in health related design
In the health sector the question is often stated as; how to create more beneficial, effi-
cient, and user-centred services or applications? Problem relevance as a basis may
empower the practical nature of the development process. However, this requires
openness to identify and also realize so called “blind spots” in focus environment.
Such a problem-driven approach is not too limited or stiff in its nature and it also
makes genuine problem identification possible. It also means eagerness to find quite
new paths, insights, and views in design process. Actually the question is about some
kind of deep analysis of the focus environment. On the other hand this means true
acceptance on the fact that the existing set of unsolved problems do not form the one
and only source of inspiration [e.g., 24]. When searching research rigor in health care,
so called additional sources of creative insights [2] should also have space. Besides
making creative systems there is also a need to create adaptive systems for the sector.
Gregor and Jones [8] highlight this issue with the term “artefact mutability” which
means that artefacts are in an almost constant state of changes.
3.2 Methodological choices in the project vs. guideline framing
Insights presented in guidelines [11] can be identified in the methodological framing
of this project. One aspect of the project was to develop an artefact which was aimed
at support tutor-driven, blended programmes at occupational health. The main audi-
ence consists of employees of enterprises. The questioning focused on the following
developmental challenges: how to generate a product which could support differently
implemented learning phases (tutored and self-paced) and how could its evolution be
guaranteed towards such adaptation which suits its focus environment but however
could create more dynamics to its practices and thereby also manifest creativity as-
pects of design. The typical aspects of DSR were recognizable in this project: prob-
lem relevance, research rigor, design as a search process, design as an artefact, and
plans for evaluation and communication. Research rigor in the project means specifi-
cation and customization of a suitable theory framing. In this area the design activity
typically requires multidisciplinary theory understanding to be useful in the situation.
34
The following Table 1 describes presented guidelines and connective design phases
with their primary issues in this project.
Table 1. Design elements in the project based on guidelines by Hevner et al [11]
Guideline The main task & process
Problem relevance Neck-shoulder disorders at work
Research rigor Theoretical frames & specifications& creativity
Design as a search process Design procedure & iterative development
Design as an artefact Prototype & service product combination
Design evaluation Evaluation during design, plans for follow-up
Research contributions Significance & implementability evaluation
Communication of research Interest groups & specifications
4 Methodological choices and alignment with guidelines
4.1 Problem relevance
Health is one of the key components of workplace well-being [18]. In the occupation-
al health sector there is a need for projects and tools which could motivate employees
to take part in health promotion activities. Neck pain with its associated disorders is
quite a common symptom, experienced in different situations and environments [9].
However, further research is needed to identify factors causing work related neck pain
as well as to develop appropriate primary prevention strategies [e.g., 7]. The combina-
tion of high job strain and high perceived muscular tension is associated with a higher
risk of neck pain than the combination of high physical exposure and high perceived
muscular tension [22]. Only a minority of people with neck pain seek intensively
health services [9]. Actually multiple visits and treatments may even worsen the situa-
tion [14]. Exercise training and mobilization are seen effective and beneficial exam-
ples for cure and prevention in non-traumatic neck pain [9]. Questioning focuses on
the following aspects: how to create appropriate learning arrangements and how to
optimize these with successful toolkit and method integration?
A clearly expressed mission is one element for well-focused artefacts and inter-
ventions. The purpose of the application is to offer more empowerment for health
training and prevent neck and shoulder disorders and thereby enhance well-being at
work. Flexibility in training was also targeted because too fixed models were not
wanted. New kinds of health technologies are typically adopted by younger users with
better health and less of those who would need those [25]. That means a continuous
design challenge. However, it is important that health promotional activities are based
on the voluntary interest of participants at least in the sense of what comes to provid-
ed training methods. Therefore, there is a need for differently organized training and
options which take into account individual preferences (fully self-paced, blended,
tutor-led).
35
4.2 Searching research rigor; theory frames and creative insights in design
When the complexity and multidimensionality in design task increases that often
means a need for a more detailed theory inspection in spite of the possibility that the
project could be occupied with experts for its every sub-field. In occupational health
training the question is about learning and therefore connective theory basis forms
one of the key frames. Health education combines many aspects from different disci-
plines. Medical knowledge, occupational medicine and health form the basis for in-
structional content design. Hence the quality and trustworthiness of offered infor-
mation has a critical role. Theoretical understanding covers the overall attributes of
information quality. Information quality contains aspects like relevance, accuracy,
completeness, timeliness, and usability as well as users’ ability to understand offered
information [20]. Qualified information improves decision effectiveness whereas
increasing information quantity impairs it [15]. Therefore, information filtering and
compression in such a way which is not a threat to quality is of great importance.
Educational technology research field, computer supported learning, and connect-
ed theory basis offer principles and models for best practices. Socio-cultural ap-
proach of learning focuses on questions of how individual and social learning would
be integrated and emphasized in each situation. In the occupational field the training
process may consist of different phases. Blended programmes utilize typically offline
and online training phases. Blending ideology as such improves flexibility and helps
to avoid excessive formalism when applying different learning approaches. The tutor
can combine the models of direct instruction and collaborative learning. Direct in-
struction may be needed in informative intensive parts of training program and on the
other hand, collaborative approach is useful when the purpose is to give much respon-
sibility and space for learners’ individual common contemplations and questions.
In this project quality theoretical framing underlines especially customer-, prod-
uct-, process-, and ethical quality aspects. Customer quality means actualization of the
principles of user-centred design. However, user-acceptance may actualize even with
products with questionable value. Therefore product’s real usefulness and its ethical
acceptability are meaningful aspects. On the other hand, beneficial product without
user acceptance is meaningless. In software design quality Budgen [1] highlights the
aspects of reliability, efficiency, maintainability, and usability. Ease of use plays a
critical role in system quality [17]. Actualization of these attributes needs to be con-
sidered along any project. Design strategies form the starting point for the overall
design culture and is constructed around the principles of evidence-based-, user-
centred-, and value-driven design emphasis. Finally, general design theoretical ap-
proaches customized for the health related ICT-sector offer guidelines for the toolkit
design. Nowadays normal practices in occupational health give inspirations how to
develop these protocols for a better fit which as such remains as a creativity chal-
lenge.
4.3 Design as a search process
Iterative development policy which gathers signals from different work environments
and tries to maturate the product with the aid of these signals is well suited to this
project. Hence, the development policy resembles ideas of software prototyping with
36
an aim to generate adaptive solutions. The training entity is a combination of a prod-
uct, instructional methods, and focus environment. Therefore this integration design is
an essential part of the project’s implementation planning. Different work sectors
have their own special needs and features and these emphases should be integrated
into the design and implementation of the training entity. The purpose is that the ap-
plication can be elaborated according to noted signals. However, the blending ideolo-
gy itself gives flexibility and makes possible to integrate different techniques, meth-
ods, and emphases for each training intervention whenever sector specific wishes can
be detected.
Hevner et al [11] refer to Gelernter [5] with the theme “machine beauty”; meaning
“the essence of style in IS design” or combination “between simplicity and power that
drives innovations”. In the example project it was planned that the application can
give sinew for classical classroom type learning interventions but also supports em-
ployees’ self-learning periods. If applications which are targeted at self-management
in health issues are too time-intensive in use this phenomenon may decrease the user’s
interest to adopt these for genuine utilization [6]. To find such a level which repre-
sents a reasonable simplicity but does not make a threat on quality issues means a
dialogical search process. Compactness and straightforwardness are therefore some
targets in design in this field and represent at least certain aspects of machine beauty.
4.4 Design as an artefact
“DSR must produce a viable artefact in the form of a construct, a model, a method,
or an instantiation” [11] or it means improvements of existing IT artifacts or stream-
lining of solved problems [24, 11]. In this case the designed artefact forms one part of
the training entity. The designed prototype consists of components like text, audio,
illustrations, video clips (Fig.1), supporting tools for interactive sessions, and self-
evaluative tests. The approach was planned to be holistic, and therefore aspects con-
nected to neck related disorders and symptoms, like stress-related factors, issues con-
nected to individual health management, and arrangements promoting well-being at
work were included in the application. These theme areas form an entity in which
each theme has its specific task and role.
37
Fig. 1. Working environment; adjusting the seat
4.5 Design evaluation
The mission of the project and product combination is to deliver more well-being for
employees (the primary outcome level, mission level). The sub-mission level means
the planned service concept. This means evaluation of the application and its ability to
support tutored and self-paced learning as well as evaluation of the connected instruc-
tional processes (the service level; design cycle). In artefact evaluation it is meaning-
ful to test whether the artefact and its embedded functional principles form an answer
to the presented meta-requirements [23]. When the product is an essential part in
framing the training entity, each training experience gives insights; how to develop
the prototype towards better adaptation. This practice represents the iterative cycles of
design. Another aim in this project was to create better adaptation and “to pay atten-
tion to toolkit’s internal operations and interactions with its environment” [e.g., 19].
Planned desire was that the feedback gathered in training situations could give data
for product maturation. The evaluation during design with the prototype consisted of
test situations with individual users. These test results led to design iterations and also
represented formative evaluation during the project. Evaluation during design covered
one training situation for a group of employees in the early design phase.
The evaluation of the framing theory basis in the project means evaluation of the
instructional and pedagogical approaches, quality aspects, and design principles (the
framing level; rigor cycle). This customization work represents area of “research
contributions” concerning area of theoretical foundations. Environmental frames,
organizational requirements; different work places may have their own specific needs.
These represent organization-based structures and systems which should be taken into
account in the area of technology acceptance [11]. Hence, success of this integration
design forms one evaluation point (contextualization level; relevance cycle) (Table 2).
38
Table 2. Model for the evaluation in the case
Categories Level type Subject Focus in evaluation
Mission level Outcome Work well-being Long-lasting effects
Sub-area: Service Service concept Usability of artefact &
Design cycle service concept
Sub-area: Design Methods, Theory fit, integration &
Rigor cycle frames theories / creativity customization
Sub-area: Context Organizational Service-environment
Relevance cycle requirements integration
The product or service is the combination of an application (technology-based ar-
tefact) and a training programme (people-based artefact) and hence this entity should
form a satisfying experience for the participants. However, satisfaction of participants
does not tell much about the actual, wanted outcome (better ability to cope with neck
pain resulting in enhanced well-being at work). Helpful IS design means considera-
tion of the long-term challenges [24]. The perceived usefulness and satisfaction of
participants can be evaluated after each training entity. On the other hand the target-
ing of the primary mission and the longitudinal effects can be tested only with time.
Tutors’ observations during training interventions and its analysis are naturally im-
portant evaluation sources. Evaluative focuses and the iterative design cycle must in
this case also cover the entire service entity (pedagogical approaches, lecturing con-
tent, supporting application, contextualization component). The evaluative focus
should cover several aspects of quality; customer-, process- and product quality cate-
gories are naturally in primary focus, but attributes of efficiency and ethics are equal-
ly important areas of assessment.
4.6 Research contributions and communications
Hevner et al [11] emphasize the novelty, generality, and significance of the designed
product when most often all attention is on the appearance of the artefact itself. In this
case the application and planned training process together form the service product.
At the moment the presented artefact offers an option for training challenges at the
occupational health. Training sessions with action research arrangements are one
flexible way to communicate the ideas and also to learn new aspects to be considered.
In best case the purpose of DSR is also to offer extensions or enhance the level of
theoretical foundations and methodological frames. In this case it offers one example
of the connected frame combination which comes into question with needed customi-
zation and specifications without further extensions or development of theory fram-
ing. However, in this field most of the projects need innovative insights as a part of
grounding frames and in this way may also offer catalytic validity value.
5 Conclusions
This study deals with methodology aspects grounded with a case study around a
health promotion project. Methodological framing and process chain in the project are
39
studied according to the principles presented in guidelines [11] for design science in
information systems research. The ideology embedded in these guidelines with their
connected specifications was recognizable in this project.
In generally the methodology frame by Hevner et al [11] can support IT-projects
by systematizing their design protocols. However, it is important that this framing and
its features are known and understood clearly enough. Hevner et al [10, 11] refer to
other authors and remind that beside the theoretical frames, creativity is an important
inspirational source and too much rigor emphasis may even disturb relevance. Pro-
found understanding in applying can give sinew but also needed balance and reduces
this way gap between theory and practice in health related IT-projects. In their discus-
sion Wang and Wang [24] offer useful insights which are relevant in health sector. In
this sector all problems are not visible and therefore existing identified problems or
already, at a certain degree solved problems can not be the only inspirational source
for design. IT innovations are needed in enhancement of current structures and sys-
tems as well as in creating quite new artefacts for the area. In this area relevance in
design of IT innovations means always a versatile understanding of those quality
aspects which are needed in evaluation throughout the design and development. In the
whole health sector effective information delivery forms a complex area with its
growing needs. The problems to be handled are not self-explanatory and therefore
besides multidisciplinary expertise there is also a need for concentration on design
challenges and issues from the view of methodological choices. In ISDSR body of
knowledge also contains various useful emphases and models with their specifications
for design philosophy. Finally, as Venable [21] states further work in this research
area is welcome.
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