Concordance: A Critical Participatory Alternative in Healthcare IT

Abstract

The healthcare sector is undergoing large changes in which technology is given a more active role in both in-clinic and out-of-clinic care. Authoritative healthcare models such as compliance and adherence which relies on asymmetric patient-doctor relationships are being challenged as society, patient roles and care contexts transforms, for example when care activities move into non-clinical contexts.Concordance is an alternative model proposed by the medical field that favours an equal and collaborative patient-doctor relationship in the negotiation of care. Similarly, HCI researchers have applied diverse models of engagement in IT design ranging from authoritative models (e.g. perceiving people as human factors to design for) to more democratic design processes (e.g. Participatory Design). IT design has also been crafted as on-going processes that are integrated parts of everyday use. Based on the best practice of participation from the medical and the HCI fields, we identify critical alternatives for healthcare design. These alternatives highlight opportunities with ongoing design processes in which the design of care regimens and care IT are perceived as one process.

A Systematic Review of the Effect of Gamification on Adherence Across Disciplines

“…However, we modified 'retention rate' to 'retention' to also include studies that, for example, report on customer and employee retention. Finally, 'compliance' and 'concordance' were added to include papers that use a less authoritative approach to describe adherence [28]. We therefore built on their work and extended the search string: gamif* AND (adherence OR attrition OR dropout OR drop-out OR noncompleters OR non-completers OR "lost to follow up" OR withdrawal OR nonresponse OR non-response OR "completion rate" OR "did not complete" OR retention OR loss OR compliance OR concordance).…”

Creating Conditions for Patients' Values to Emerge in Clinical Conversations

“…In this section we discuss our findings in relation to recent work by Bagalkot et al [2] and Grönvall et al [14] that called for concordance as a design ideal in HCI. Drawing on a report by Horne et al [17], they defined concordance as "a patient-doctor negotiation process that gives the patients equal importance."…”

Opportunities for recommended mental health strategies to reduce stress at work

“…A third important topic for a research agenda is a stronger involvement of professional coaches. Similar to concordance, an "alternative model proposed by the medical field that favours an equal and collaborative patient-doctor relationship in the negotiation of care" [12], a professional coach and an employee should develop a relationship that involves a collaborative empiricism [5]; a collaboration to motivate employees effectively. This will enable employees to explore recommended strategies and beliefs outside their therapy session.…”