Macroergonomic factors in the patient work system: examining the context of patients with chronic illness

Abstract

Human factors/ergonomics recognizes work as embedded in and shaped by levels of social, physical, and organizational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identifies seventeen factors across physical, social, and organizational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative, or varying effects on health and health behavior. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients’ health-related activities but also specific factors to consider in future research, design, and policy efforts.

Human factors in mental healthcare: A work system analysis of a community-based program for older adults with depression and dementia

“…The focus of data collection and analysis was on the core elements of the model: actors, artifacts, actions and outcomes. We acknowledge the importance of the peripheral components of the model, temporality, aggregation, and context, but did not perform the separate macroergonomic analysis required to fully understand these (Holden, Valdez, Schubert, Thompson, & Hundt, 2017). The study was performed May to December 2015 and was approved by the Indiana University Institutional Review Board and the studied health system.…”

Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure

“…Planning and replanning often created new routines and leveraged known resources such as pillboxes [56] or a patient’s “self-care workspace” [71]. …”

Know thy eHealth user: Development of biopsychosocial personas from a study of older adults with heart failure

“…The use of biopsychosocial variables including elements of the person and their context is useful when considering chronic illness and heart failure in particular, given the multiple, cross-level factors affecting chronic illness clinical management and heart failure self-care [27–29]. For example, the importance of comorbid diabetes in our heart failure study suggests self-management technologies supporting self-management for both conditions.…”

“…A third example implication relates to differences between those who are discharged from the hospital with or without formal and informal caregiving support in the home: for those who do not have such support, technology could provide access to one’s physically distributed social network or locally available social services. These and other biopsychosocial factors play a complicated role in determining the value of IT for older adults with heart failure and other conditions [29, 61], which means they must be considered by eHealth designers. The complex identities and contexts of patients and other health-seekers is one reason multidimensional personas and other UCD methods have been recommended in the domain of health and healthcare [6, 62].…”