2021): Unintended consequences of technology-enabled work activities experienced by healthcare professionals in tertiary hospitals of sub-

Background There is a rapid uptake of mobile-enabled technologies in lower- and upper-middle–income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings. Objective This study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, “How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?” Methods A qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model. Results The findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery. Conclusions The opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals.

Background The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants’ data were addressed as per the university ethics review committee and provincial department of health. Results The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs.

Background: With the rise of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA), the concept of digital self-management presents great opportunities for relieving some of the burdens healthcare systems face. However, for this to be realised, effective use of digital health in self-management and assessment is essential.Objective: The objective of this scoping review was to identify social determinants and cognitive factors with potential influence on digital health use in self-management of chronic medical conditions associated with NCDs in SSA.Method: The 5-stage scoping review framework was used to search, identify, and filter publications over a 10-year period from two major databases, Google Scholar and Pubmed. Based on the inclusion criteria, a total of 12 documents were chosen for analysis.Results: Findings reveal that social determinants such as cultural values and societal practices demand a rethinking of how digital health for self-management of chronic diseases are designed and developed for use in SSA, whereas a cognitive factor such as self-efficacy is central in digital health use in self-management of chronic conditions, particularly in areas like adherence to medication, diet and exercise programmes.Conclusion: Owing to the unique characteristics of digital health users in SSA, technologies and content (particularly those for self-management of chronic diseases) should be tailored to the diverse needs of the population. It is through this that the region can fully benefit from the potential of digital health use in self-management of chronic diseases associated with NCDs.

BACKGROUND In the wake of the unexpected outbreak of Corona virus disease (COVID-19) pandemic and the calls for physical distancing, information and communication technologies (ICTs) are increasingly essential to augment human efforts and enhance efficiencies of work activities in the healthcare sector. In hospital settings, the interplay between human agency and technology performativity is critical to the success or failure of ICTs usage in routine practice; this is rarely explored when designing for the sub-Saharan Africa contexts. OBJECTIVE The objective of this paper was to explore how quality of service delivery and job performance are influenced by technology-enabled work activities of healthcare professionals at points-of-care. The study focused on how healthcare professionals performed the tasks of their work activities, challenges of technology-enabled work activities and the factor that influence the effective use of health ICTs. METHODS The authors assumed an interpretivist perspective to understand the socially constructed realities of healthcare professionals at points-of-care in a hospital setting. A qualitative service design strategy was adopted to engage healthcare professionals in co-design sessions. Open-ended questions were used engage 12 participants including eight doctors and four nurses to get insights on their work activities, health ICTs being used and the enabling or inhibiting contextual conditions that may influence the quality of service delivery. Ethical concerns about safety and privacy of participants were addressed accordingly and a thematic analysis was used to sort the textual data. RESULTS The findings suggest that the attributes of human agency and technology features that drive technology performativity influences the transformation of human-machine interactions and ultimately, the quality of healthcare service delivered at points-of-care. A major contribution is the breakdown of why an interplay exists between human agency and technology performativity. CONCLUSIONS The way healthcare professionals perform the tasks of their work activities at points-of-care should determine the types of health ICTs and its design features for service delivery. Healthcare professionals consider the value-added benefits of the automation of their work activities to determine the satisfaction of their job performance, quality of service delivery, the continued and effective use of health ICTs otherwise they eventually discard the technologies.