Power and agency in health information technology: towards a more meaningful participatory design for sustainable development

Abstract

The role of information technology (IT) in improving healthcare has been acknowledged in existing literature [1,2]. However, implementation of health IT projects in the global South has yielded mixed results. Some projects have failed outright, while others have been wildly successful at improving the effectives and efficiency of healthcare but eventually failed due to decreasing levels of external support. Participatory design has been highlighted as a possible solution to this unsustainable development. However, the few evaluative studies of these projects have indicated that even participatory design does not ensure project sustainability. A rethinking of participatory design is needed if it is to remain a vital aspect of sustainable development. To that end, this paper first reviews several health IT case studies in India to show the reasons for their long-term failure despite using participatory design. These case studies are unique because the client population is community health workers with scant resources and little agency in their day to day routines. The community health workers often have to follow guidelines imposed on them from the top-down despite knowing more about the local situation. This paper argues that participatory design is too often centered on technology and fails to deal with existing issues of disempowerment that health workers may face. Instead, participatory design with the client community must seek to change existing power relationships in order to give them agency in championing the new IT when external support decreases. The concept of lay participatory design is suggested as a possible approach to changing power relationships.

Mobile Application to Support Community Health Workers Using GeneXus Smart Devices

“…Mushtaq and Hall [3] conducted a study on the health systems in India, focusing on health professionals. These systems were developed using a participatory design strategy, but were not successful.…”

“…The authors say that IT designers should be concerned about the real problems that make difficult to people to do their work in daily activities and therefore it is important to involve users. Mushtaq and Hall [3] shows that, there is still a deficiency in the development of mobile applications as well as applications that target the CHW's work, what makes it an open research area.…”

Engineering Requirements for Social Sustainability

“…Yet, the problem of software impact on its user communities has been faced, primarily within the organisational context, for a long time [32] [58] [57] [49] [39] and has, to some degree, been addressed via such techniques as value-based design [36] [29] [42], participatory design [23] [54] [60], user experience evaluation [44] [75] [22], and even iterative agile development [65]. Essentially, all these techniques allow for explicit [29] or implicit [65] [23] incorporation of user values into the intended software systems.…”

The Status of Hospital Information Systems in Iranian Hospitals

“…In spite of promising advantages of e-Health, it is the least developed e-technology ( 26 ) compared to other fields such as e-commerce and e-banking. However, there is evidence that largely point to failures or unsustainable e-Health utilization in different countries ( 27 , 28 ) for different reasons, such as a lack of standardization of e-Health applications ( 8 ), cost of such systems ( 29 , 30 ), costs of training ( 30 ), and the diversity of platforms resulting in technical difficulties ( 31 , 32 ).…”