See Phases

Contextual Inquiry

What is the contextual inquiry?

The first step in any eHealth development project is a thorough investigation of the context, and consists of the sub phases stakeholder identification, stakeholder analysis, and describing the current situation. In order for an eHealth technology to be successful, it should provide a solution for relevant issues, it should be accepted by stakeholders such as the users, funders and policy makers, and it should fit the physical, social and cultural environment in which it will be used [1, 2]. These requirements should be accounted for during the entire development process. This is necessary because the development team has to be aware of the daily lives of the users, other involved stakeholders, their environments, and any practical constraints such as rules and regulations [3]. The contextual inquiry helps the development team to get a grasp of the intended context through the of using multiple methods. The outcomes of the contextual inquiry serve as a basis for the rest of the development process. It assists in keeping a focus on the people and their environment [4, 5].

Aim of the contextual inquiry

The contextual inquiry has several main objectives:

  • The relevant stakeholders – anyone who affects or is affected by a potential eHealth technology – have to be identified.
  • The identified stakeholders have to be analysed: it should be clear what the tasks and roles of the stakeholders are in order to identify the key stakeholders.
  • The current situation and its weak and strong points have to be described in order to find out if and in what way an eHealth technology can contribute to the current situation.

A contextual inquiry entails the activities that are undertaken to get a good grasp of the problems, how technology can contribute to resolving these issues, and who might benefit from the technology. The contextual inquiry was introduced as a phenomenological research method that makes use of many qualitative methods in design [6]. It is part of contextual design, which aims to aggregate data from stakeholders in the context where they are living and working, and applying these findings into a final product [7]. Consequently, the goal of the contextual inquiry in eHealth development is to get a thorough understanding of the prospective users, other important stakeholders and their environment. Together they make up the context in which the technology can be used. Consequently, there has to be a thorough understanding of the potential end-user’s day-to-day environment. This requires, for example, insight into their daily tasks, activities, or procedures [8]. An in-depth contextual inquiry is necessary to achieve a fit between the technology, its users, other stakeholders and their context. If this is achieved, chances are very high that the technology that is developed is going to be used and implemented sustainably [9].

Because multiple perspectives ensure a broader view on the context, the development team should consist of multiple groups of people, like researchers, policy makers, designers and potential end-users. In the contextual inquiry, the team learns about the context by combining information from both science and practice. eHealth developers have to be familiar with important literature on their topic in order to know the scientific context, but they must also account for the perspectives of important stakeholders and learn about their environment by means of multiple methods [8].

What are the outcomes of the contextual inquiry?

The specific research questions that should be answered in a contextual inquiry depend on the type of project. To illustrate this a bit further, the following questions can be central during the contextual inquiry:

  • who are the stakeholders that are relevant for the project and its development? Which stakeholders are the most important?
  • what does the current situation look like? What is going well? What could be improved?
  • what problem has to be addressed? Who has a problem? What does the problem entail and what are its causes according to stakeholders and literature?
  • what kind of behaviour has to be changed? What are the causes of this behaviour according to people and literature?
  • what rules, regulations and ethical concerns are applicable to the context the technology has to be used in?
  • what kind of eHealth technologies are already being used in the context, and what are the experiences of users and other stakeholders?

Not conducting a contextual inquiry, or even conducting it too superficially, can lead to a mismatch between the technology, context and users. It is always advisable to use multiple methods to collect information since this enables the eHealth developers to paint a good, comprehensive picture of the context. These methods can have very different characteristics, ranging from explorative and qualitative methods that can provide a broad view on a certain topic or situation, to more fact-checking and quantitative approaches that can assess how ‘big’ or widespread a problem or situation is. Combining methods decreases the chances of overlooking important information.

References

[1] Coiera, E. (2004). Four rules for the reinvention of health care. BMJ, 328, 1197-1199.

[2] Glasgow, R.E., Phillips, S.M., & Sanchez, M.A. (2014). Implemententation science approaches for integrating eHealth research into practice and policy. International Journal of Medical Informatics, 83(7), e1-e11.

[3] Sjöström, J., von Essen, L., & Grönqvist, H. (2014). The Origin and Impact of Ideals in eHealth Research: Experiences From the U-CARE Research Environment. JMIR Research Protocols, 3(2):e28.

[4] Holtzblatt, K., & Jones, S. (1993). Contextual inquiry: A participatory technique for system design. In A. Namioka & D. Schuler (Eds.), Participatory design: Principles and practices (pp. 177-210). Hillsdale, NJ: Lawrence Erlbaum Associates.

[5] Wentzel, J., van Velsen, L., van Limburg, M., de Jong, N., Karreman, J., & Hendrix, R. (2014). Participatory eHealth development to support nurses in antimicrobial stewardship. BMC MedicalIinformatics and Decision Making, 14(1), 45.

[6] Whiteside, J., Bennett, J., & Holtzblatt, K. (1988). Usability engineering: Our experience and evolution. Handbook of Human-Computer Interaction, 35.

[7] Beyer, H. & Holtzblatt, K. (1998). Contextual Design: Defining Customer-Centered Systems. San Francisco: Morgan Kaufmann. 

[8] Beerlage-de Jong, N., van Gemert-Pijnen, J.E., Wentzel, J., Hendrix, R., & Siemons, L. (2017). Technology to support integrated antimicrobial stewardship programs. A user centered and stakeholder driven development approach. Infectious Disease Reports.  

[9] Van Gemert-Pijnen, J.E., Nijland, N., Limburg, M. van, Ossebaard, H.C., Kelders, S.M., Eysenbach, G., & Seydel, E.R. (2011) A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4): e111.