Participatory Design (PD) methods in the field of health informatics have mainly been applied to the development of small-scale systems with homogeneous user groups in local settings. Meanwhile, health service organizations are becoming increasingly large and complex in character, making it necessary to extend the scope of the systems that are used for managing data, information and knowledge. This study reports participatory action research on the development of a PD framework for large-scale system design. The research was conducted in a public health informatics project aimed at developing a system for 175,000 users. A renewed PD framework was developed in response to six major limitations experienced to be associated with the existing methods. The resulting framework preserves the theoretical grounding, but extends the toolbox to suit applications in networked health service organizations. Future research should involve evaluations of the framework in other health service settings where comprehensive HISs are developed.
Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45–85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.
In this study, we address the role of Participatory Design (PD) in emerging public sector governance forms and, more specifically, civic engagement and we-government initiatives. We achieve this by first providing a research overview of the development of PD approaches since they originated in the 1970s, identifying different PD generations and associated concepts, contexts, and challenges, and then relating them to current public sector trends. Next, we link the overview to a practical example by presenting a case of applying PD to a civic engagement project that takes place in the Swedish emergency response system. Our example findings sustain previously identified needs to return to broad change processes and balance this with ICT re-configuration and structuration of the collaborative processes, the related stakeholders, and their needs, this time in a context where work tasks and responsibilties are not yet defined, known or experienced among stakeholders. We then suggest methodological ways to handle this by 1) applying an interdisciplinary PD approach, 2) replacing the traditional design group with a combination of various qualitative methods and PD techniques, e.g. focus groups, modified scenario-based Future workshops, exercises and after-action-reviews, and 3) support PD activities with context-specific frameworks. We argue that applying PD concepts to the governance forms that are emerging in resourceconstrained public sector organizations poses a number of challenges, many of them relating direcly to the unknown character of the work setting and the practical difficulties of involving civil citizens as end-users. However, if they are addressed and handled adequately, making civic engagement initiatives work processes and ICT support to work smoothly, this can contribute to a re-politicisation of PD in terms of space, action and the empowerment of citizens both by enhancing their skills and by having them represented in design activities.
Purpose This study aims to explore recent public sector trends, inter-organizational and cross-sector collaborations, and analyzes these in terms of implications for participative development of information systems (IS). These trends are understood as being part of emerging forms of e-government. Initial suggestions for how to develop IS in the new contexts are provided. Design/methodology/approach Three cases involving the trends described above, taking place in the Swedish emergency response system, are studied and used as basis for identified participative IS development challenges and suggested adaptation needs. Data collection involves semi-structured interviews, focus groups and future workshops. Findings The identified challenges concern balancing ideological versus practical needs, lack of resources, lack of know-how and design techniques and tool challenges. Some practical implications for participative IS development include more extensive focus on stakeholder and legal analysis, need for interdisciplinary design teams, merging of task and needs analysis for yet-undefined user tasks and using on-line alternatives for interacting with users. Research implications/limitations The study is exploratory where the three cases are in different, but at the same time interrelated, collaboration contexts. The identified implications and challenges provide proposals that in future research can be applied, formalized and integrated when developing practically feasible participative IS development approaches. Originality/value It is argued that the results point toward a current emerging form of e-government initiatives directed toward certain demarcated groups of citizens actually carrying out certain tasks for their co-citizens and society rather than the broad masses, having far-reaching practical implications and complicating the issue of IS development.
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