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A FEMALE-FOCUSED DESIGN STRATEGY FOR DEVELOPING A SELF-CARE INFORMATION SYSTEM XUE LISHAN (BA.ID. (Hons.), NUS) (Volume 1) A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF ARCHITECTURE NATIONAL UNIVERSITY OF SINGAPORE 2009 Acknowledgments I have been extremely fortunate in grant support. Institutions that provided valuable help in the form of research scholarship, funding and knowledge resource include the National University of Singapore (NUS), School of Design and Environment (SDE), Industrial Design (ID) Programme and the Department of Obstetrics and Gynaecology at NUHS. In particular, I am grateful for my supervisors guidance Dr Yen Ching Chiuan, Assistant Professor and Course Director of the Industrial Design Programme, Department of Architecture and A/P Mahesh Choolani, Research Director at the Department of Obstetrics and Gynaecology at the Yong Loo Lin School of Medicine and Senior Consultant Obstetrician and Gynaecologist at High Risk Pregnancy Clinic, National University Hospital (NUH) for the many discussions and debates we have had. Dr Yen, an excellent mentor and confidant over these years, remained firm that I needed to revise and update my material, and offered constructive comments all the way. Dr Mahesh, thank you for your guidance which was shaped by a clearcut firmness to achieve highest excellence in everything I do. I appreciate your confidence in me at moments it was needed most. In the course of time, many went the extra mile and read early parts and versions of the dissertation. These include A/P Chan Hock Chuan from the School of Computer, Department of Information Systems who advised on the validation of the conceptual model and A/P Tan Say Beng, director of the Clinical Trials and Epidemiology Research Unit (CTERU), Duke- NUS Graduate Medical School, who supported me much on statistical issues and formalization of the survey data. I am grateful to Dr Christian Bourcharenc from the Department of Architecture, Dr Leanne Chang from the Communications and New Media Programme, Faculty of Arts and Social Science, and Dr Henry Duh from the Department of Electrical and Computer Engineering/Interactive and Digital Media for reading portions of the dissertation draft. I must also thank the thousand over survey participants, designers, and staff from the National University Healthcare System (NUHS) women s clinics and National Healthcare Group (NHG) in participating polyclinics who have so kindly responded, cooperated and supported in my investigation. Without them, survey research would not have been made possible. Junior student researchers from our very own ID programme provided much support for research and design activities. They provided extraordinarily able, cheerful, and willing help at every juncture, and made me reaffirmed my passion for design. Finally, there is also my wonderful family which I wish to thank them for contributing in their own special way to my writing, especially my beloved parents and maiden family who have always been very proud of me and cheered me on at difficult times. I would also like to thank my husband, Jackie, who was my sparring partner in technical and emotional issues surrounding my dissertation, design research, and practice. He has relentlessly supported, encouraged, and inspired me on countless occasions. Lastly, I am grateful for God s grace and strength for allowing me to complete this dissertation over these years. Indeed, like reason, our research is-and ought to be- a slave of our passions. ii Table of Contents SUMMARY... ii ACKNOWLEDGMENT... iii TABLE OF CONTENTS... iv LIST OF TABLES... vi LIST OF FIGURES... vii ACRONYMS & ABBREVIATIONS... ix TERMINOLOGY... xi LIST OF PUBLICATIONS... xiv INTRODUCTION... xv Research Aims & Objectives... xvi Outine of the Thesis... xix References... xxi 1. AN INTRODUCTION TO FEMALE-FOCUSED DESIGN AND ITS RELATION TO SELF-CARE OF WOMEN Background The Meaning of Female-focused A Self-care Information System (SIS) A Female-focused Design Strategy (FDS) The Research Hypothesis Method for Literature Review Population Technologies Data Synthesis Elements of a Conceptual Framework Design for Self-care Health IT and Content Content Users: Women Professionals: Designers and Healthcare Personnel The Opportunities of the FDS Design for Self-care as a Consequence of the FDS Design by Means of the FDS Areas of Enquiry & Discovery Contexts Summary References RESEARCH METHODOLOGY: SYNCHRONISING EXISTING PERSPECTIVES & DESIGN ANALYZES Ideological Marginalization Triangulation and Complementarity Normative Research Method Existing Design Emphasis and Problems in Design for Health Overview of Research Area Framework Qualitative and Quantitative Studies Realm of Theory: Research for Design Discovery Divergence Realm of Practice: Research through Design Application iii 2.6.2 Convergence Summary References COLLECTION AND ANALYSIS OF QUANTITATIVE AND QUALITATIVE DATA IN RESEARCH OF A SELF-CARE INFORMATION SYSTEM (SIS) Towards Female Preferences in Design Consideration for the Design of a SIS Women s Perception and Acceptance towards the SIS Reasons of Women for Seeking Health Information Online Women s Health Concerns Design Qualitities for a SIS Latent Concerms for Using the SIS Caregivers and Clinicians Methodological Limitations Implications of Findings Summary References A FEMALE-FOCUSED DESIGN STRATEGY (FDS): THE FRIEND MODEL Constructing the FDS The FRIEND Model First Level Impact of FRIEND Tailoring Age Differences in the FRIEND Model Implications of FDS Summary References APPLICATION OF THE FEMALE-FOCUSED DESIGN STRATEGY (FDS) TO THE DESIGN PROCESS Users of Strategy Understanding F.R.I.E.N.D Identifying Characters User Scenario Design Graphical Representation of FRIEND for SIS Design Concept Generation Users of Application Opinion about the SIS Summary References CONCLUSION AND FURTHER DIRECTIONS Application of FDS to Design Challenges for Female-focused Design Conclusions drawn from the Findings Opportunities and Future Development References iv Summary This study is derived from the desire for designers and healthcare professionals to better create a self-care information system (SIS) for women, especially to benefit those who practise self-care where the development of home-care products usually was assigned with low priority although their benefits to lay-users and the community have been substantial. Women are under-represented in the design of current information systems (IS) and femalefocused design can help improve their self-care. Acquiring user needs and acceptability levels from the female lay user about the system which they will handle is as one of the most important tools to better design, where the validity of female-focused design can be justified not only from a utilitarian perspective. The study has developed a conceptual female-focused acceptance model (FAM) which empirically examine the derived research hypotheses concerning the perception and acceptance of female users in the context of adopting the IS and introduce a female-focused design strategy (FDS) which addressed fundamental issues in designing and marketing IS for women s health. A tripartite theoretical framework, grounded on review of literature, followed by qualitative and quantitative surveying was structured. The normative research approach was used which explored current models used for women healthcare; evidence of the potential barriers; views of target audience i.e. female lay-users and their family members and healthcare professionals; describing the FAM that highlighted women s pragmatic approach to technology in self-monitoring systems. Empirical data was described and analysed using frequency tables and multiple linear regression to access differences among the female population. This study tested and confirmed that the FAM works well for detecting factors that influence women s perception and acceptance of the self-care IS. To date, this study is the only one that has examined the underlying motives for such self-care innovation adoption by women. They would consider adopting it only if its use proved effortless and its technological value already demonstrated. Women want flexibility and empathic designs, which is responsive for them to manage, intricate in its detailing, with natural dialogues used, and dependable in both physical and virtual interactivity. Their preferences are illustrated through the FRIEND model. The study also reveals that the social factor (intended in this work as the importance of others point of view in determining our choices and attitude) does not play a fundamental role in woman acceptance of the SIS. Women believed that the SIS is useful and easy to use and going to have beneficiary outcomes has not only strong but significant direct contributions. FRIEND can be represented in different graphical ways for women from different age groups to determine and aid in the future design of healthcare and self-care technologies across society. The FAM with its constructs and possible extensions should give new insights to overcome age, user characteristics, and technology generation barriers, and provide a profile of how women from different backgrounds use new communication media to seek health information. The FDS could be aligned with design in terms of advertising, marketing, packaging, and service. Future research can include refining sampling procedures and measurement instrument, testing alternate conceptual models with other constructs, investigating new research contexts, and incorporating qualitative methods such as participatory design for the development of a potential SIS. v List of Tables Chapter Common human factors activites that occur during product development Five methods of learning Chapter Identifying three key approaches in design research Chapter Classification of concerns Relationship between schemes and product properties Summary of existing information and results from present study Measures for predictors of FAM Characteristics of respondents Women s expection of the SIS Reliability of scale measures Cross loadings Linear regression analysis results Correlation matrix of health topics Choice of health concerns among pregnant and non-pregnant women Design qualities for the SIS architecture and attributes Chapter Comparison of wording Conceptual framework for women s perceptions of icare Profile of respondents Implications from findings vi List of Figures Introduction A Design concept of ibloom... xv B Application of the female-focused design strategy within design processes... xviii C Outline of the thesis... xx Chapter Health problems pertinent to women From a doctor-centred model to a patient-centred model and to female-focused model of healthcare Pictogram of a strategy Literature review for female-focused design Some of the questions review of literature can answer Literature search tree Elements contributing to the new strategy Relationship between a user interface design process and the U.S. FDA design controls Brief evolution of medical design from early records to near future A schematic representation of design characteristics for self-care in near future Framework examining female user response to GUI for e-health information A systems representation of human-technology interfaces Sequence of medical procedures and design processes Inter-linked agents in the design of the SIS Design control and the waterfall model with feedback Chapter Normative study Iterative design process Areas of research for female-focused design study Research for design Lateral thinking Research through design Types of new product Stages in concept development Chapter Final selection of mobile phones Final selection of mp3 players Final selection of fragrance bottles Aesthetic key points between the genders Functional key points between the genders Social key points between the genders Possible function and workflow of the SIS Technology acceptance model (TAM) Conceptual female-focused acceptance model (FAM) Locations for the survey of the SIS National University Healthcare System Women s Clinics and National Healthcare Group polyclinics Full dataset results of FAM Future research model Reasons for seeking health information online vii 3.15 Choice of health topics among women sample Methods of learning medical devices Items to learn of the SIS Product information to know about the SIS Reference of a medical device which could possibly induce stress Reasons that may induce stress Reasons for stress among total sample Chapter Preliminary model The FRIEND model Steps in using the FDS Preferences of women aged 24 and below Preferences of women aged 25 to Preferences of women aged 35 to Preferences of women aged 45 to Chapter FDS within the waterfall model Discussion and brainstorming among the young designers Exploration of isses with the FRIENDmodel Expansion of user concerns from the FRIEND model Static personas to dynamic archetypes Personas for the SIS design A potential contextual scenario for SIS users Illustration of a persona using the SIS Illustration of a persona in her familiar environment Mood collage illustrating the Empathy attribute Graphical representation of FRIEND for SIS users Interaction design during concept generation Project interaction process Projected SIS design Screen shots of the animation Chapter Conceptual visualisation for a future FDS design blog viii Acronyms & Abbreviations AAMI BSS BSRI CGMP DIA DoH DSRB EC EMR FDS FHAs FRIEND GMP GUI HPB HCI HMI HSA ICT ICU IEEE IMG IRB ISA ITU MDD MeSH MHCU MDDI MOH NHG NHS Association for the Advancement of Medical Instrumentation Breast Screen Singapore Bem s Sex Role Inventory Current Good Manufacturing Practice Dynamic interactive aesthetics Department of Health Domain Specific Review Board European Council Electronic medical records Female-focused design strategy Female-focused healthcare applications Flexibleness. Responsiveness. Intricateness. Empathy. Naturalness. Dependableness Good manufacturing practice Graphical user interface Health Promotion Board Human computer interaction Human-machine interface Health Sciences Authority Information and communication technology Intensive Care Unit Institute of Electrical and Electronics Engineers Image Institutional Review Board Information system architecture Intention to use Medical Device Directives Medical Subject Headings Mobile health communication unit Medical Device and Diagnostic Industry Ministry of Health National Healthcare Group National Health Service ix NLP NPD NUHS OQ PACS PCC PDS PEOU PHR PNI PU QoL RD ScHARR SE SIS SI SN U.S. FDA WCC Natural Language Processing New product development National University Health System Output quality Picture archiving and retrieval systems Patient-centred care Product design specifications Perceived ease of use Personal health records Psychoneuroimmunlogy Perceived usefulness Quality of life Result demonstrability School of Health and Related Research Self-efficacy Self-care information system Social influence Subjective norm U.S. Food and Drug Administration Women-centred care x Terminology Concept: Detailing: Female-focused: Female-focused Design: A design proposal for a product, through a selection of ideas. Usually a series of different design proposals will be suggested to facilitate a definite concept choice. A proposal may exist out of drawings, additional text and design models. To create a fair opinion of the design proposals, it is necessary to detail them equally. Detailing may concern: materials, standard parts, manufacturing techniques, cost calculations, form details, finishing, etc. The final concept will be tailed in greater length. This term refers to a female user-centric focus, which has considered women s needs, preferences, and biology to enhance their user experiences and adherence to recommendations. It refers to design with female user-centric focus in medical devices for women s health, which ultimately contributes to better quality to their healthcare, self-care, and personal well-being. Female-focused Such applications refers to customizable and mobile wireless Healthcare healthcare interventions such as or network-based clinical Applications: information system transforming a general purpose computer into a special-purpose monitoring device component which users can access to validated advice for effective self-care, manage, and share their personal health information, and that of others for whom they are authorised in a secure, confidential, and non-hospital environment. Female user-friendliness: Gender-specific: Healthcare design: Idea generation: This term is understood that to achieve it, it needs to involve female users in the design-process, possibly helping in redressing the imbalance between male and female designers and users of information and communication technologies (ICT), hence the userfriendliness of the design would then received more attention, such that even computer-illiterates or women who are usually fearful of ICT could participate. It refers to the socially constructed roles and responsibilities assigned to women and men in a given culture. The term healthcare design is used throughout this dissertation to refer to the design of responsible products such as monitoring devices and systems such as e-health applications which could directly impact the safety, operation, clinical outcomes, and self-care management of people now and into the future. A controlled grow process of the human mind with the objective to gain insight in developing ideas. Medical adherence: It is defined as the extent to which a user s behavior (in terms of taking medications, following diets, or executing lifestyle changes) xi coincides with medical or health advice, working towards better health management. Model: Models are used in the design process to communicate ideas and visions. Models, when 2-dimensional, refer to diagrams and schematic representations. When they are 3-dimensional, one can relate them as display prototypes where they can be held up and tested. In this way, a better understanding of the design can be achieved/ Models are useful tools in early as well as later stages of the design process. Professional: The term professional can refer to a designer or a healthcare/medical provider (i.e. the clinician), who is the person providing the service to the healthcare consumer. For healthcarerelated professionals, it extends to other personnel involved in the healthcare system, including the minority of viewers involved in the process of visual consumption such as healthcare professionals (i.e. nurses) and women s health advocates. Prosumer: P-value: Regression analysis: Prosumer is a portmanteau formed by contracting either the word producer or professional with the word consumer. However, it is also said that it refers to a proactive consumer. Prosumers are of particular value to marketers looking to anticipate future trends because they act as an early detector about the consumer next. Typically making up percent of any group, they are not connected than others, so they function as human media, voicing out their points of views and exerting influence over their less passionate friends. Euro RSCG s proprietary research shows that what prosumers think now, consumers will think next, typically over a period of 6 to 18 months. In statistical hypothesis testing, the p-value is the probability of obtaining a result at least as extreme as a given data point, under the null hypothesis. The fact that p-values are based on this assumption is crucial to their correct interpretation. Generally, one rejects the null hypothesis if the p-value is smaller than or equal to the significance level, often represented by the Greek letter α (alpha). If the level is 0.05, then the results are only 5% likely to be as extraordinary as just seen, given that the null hypothesis is true. In the above example,
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