Design

The output of the contextual inquiry and the value specification serves as the blueprint for the actual eHealth technology, which is developed in the design phase. This phase consists of the sub phases develop lo-fi and hi-fi prototypes, conduct usability tests, and add persuasive elements. A good design is also closely related to implementation, since a technology that fits the wishes and needs from the stakeholders will – in most cases – be used more and longer than a technology that doesn’t. That is why, during the design phase, the development team constantly has to keep the contextual inquiry and value specification in mind.

It is important that the final technology should not be developed at once, since chances are that, if that happens, a lot of important issues can be missed and arise just after its been implemented in practice. That is why multiple prototypes of the technology have to be developed to visualize and elaborate on initial ideas. A prototype is a visual representation of an idea about the eHealth technology, a simplified version of a final end-product. To make sure that issues are identified and that a technology fits with the needs and preferences of the users and other stakeholders, the prototypes have to be tested with them. This enables the development team to remove any critical issues and to add elements that are missed by the target group, and adapt the design accordingly. This is an iterative process, since constant changes to the idea and prototype of the technology can and should be made [1, 2]. 

Besides ensuring that the design and content of a technology appeal to the user, the development team should also ensure that the technology influences cognitions or behaviours of users that should be adapted in order to reach the value of the technology. This can be achieved by using theory to add elements to the technology, for example from the Persuasive System Design (PSD) model, and by using Behaviour Change Techniques (BCTs). This ensures that a technology is persuasive: it is compelling without being coercive [3], and consequently increases adherence and behaviour change. 

The design phase is an extremely dynamic, iterative and collaborative phase, during which the development team actively collaborates with stakeholders like designers, psychologists, users, content experts and funders. Not just by testing and perhaps even developing the prototypes, but also by ideating, creating, and discussing ideas together. 

What is the aim of the design phase?

The design phase has several main objectives:

• Both low-fidelity (lo-fi) and high-fidelity (hi-f) prototypes of the technology have to be developed.
• Usability tests of the prototypes have to be conducted with end-users, experts and possibly other stakeholders
• Persuasive elements and/or Behaviour Change Techniques have to be added to the design.

What are the outcomes of the design phase? 

The main outcome of the design phase is the first version of the eHealth technology that will actually be used in practice by the stakeholders. Consequently, the output of the contextual inquiry and value specification has to be used in the design to make sure that there still is a fit between context, technology and people: the technology has to address the issue identified in the contextual inquiry, it has to incorporate the requirements and aim to reach the values that were identified in the value specification. Furthermore, the constant usability testing and the adding of persuasive elements assists in ensuring that the user will actually start and keep on using the technology. It is important to note that a design is never really finished: in most cases, adaptations or improvements are required.

References

[1] Beerlage-de Jong, N. Eikelenboom-Boskamp, A., Voss, A., Sanderman, R., & van Gemert-Pijnen, L. (2014). Combining user-centered design with the persuasive systems design model: The development process of a web-based registration and monitoring system for healthcare-associated infections in nursing homes. International Journal on Advances in Life Sciences, 6(3-4), 262-271.

[2] 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.

[3] Fogg, B. J. (2009). A behavior model for persuasive design. In S. Chatterjee & P. Dev (Eds.), Proceedings of the 4th international Conference on Persuasive Technology (Article No. 40). New York, NY: ACM.

What is developing lo-fi and hi-fi prototypes?

After a multidisciplinary project team has come up with the initial ideas about a technology by means of ideation, the first prototypes can be developed. A distinction can be made between low-fidelity (lo-fi) and high-fidelity (hi-fi) prototyping. The design process usually starts with lo-fi prototypes: prototypes that not have to resemble the final technology, as long as the most important features and the goal can be communicated clearly. They can be ‘built’ by people with little technical skills, using the following kinds of methods [1, 2, 3, 4]. Hi-fi prototypes have a higher resemblance to the final version of the eHealth technology and are suitable for testing specific details of the technology. Developing them requires more technical expertise. The method to develop the hi-fi prototype depends on the technology that is being developed and the skills of the designer.

What is the aim of developing lo-fi and hi-fi prototypes?

Lo-fi and Hi-fi prototypes can be used to communicate a first version of an eHealth technology to a possible end user or stakeholders to collect feedback. With this feedback, improved versions can be developed. By using prototypes, instead of final versions, adjustments can still be made without high costs involved.

References

[1] Holtzblatt, K., Wendell, J. B., & Wood, S. (2004). Rapid contextual design: a how-to guide to key techniques for user-centered design. San Francisco, CA: Morgan Kaufmann.

[2] Maguire, M. (2001). Methods to support human-centred design. International Journal of Human-Computer Studies, 55(4), 587-634.

[3] Signer, B., & Norrie, M. C. (2007). PaperPoint: a paper-based presentation and interactive paper prototyping tool. In B. Ullmer & A. Schmidt (Eds.), Proceedings of the 1st International Conference on Tangible and embedded interaction. (pp. 57-64). New York, NY: ACM.

[4] Snyder, C. (2003). Paper prototyping: The fast and easy way to design and refine user interfaces. San Francisco, CA: Morgan Kaufmann.

What is conducting usability tests?

Prototypes have to be tested with people to identify flaws, gather overall opinions or collect recommendations. This is called usability testing. Broadly speaking, there are two ways of testing usability: expert-based and user-based.

• Expert-based usability testing. In this kind of usability testing, experts on design or the subject the technology is designed for are conducting the usability evaluation. They use their own knowledge about good design, the target group or the subject.
• User-based usability testing. Here, the test is performed with potential end-users.

What is the aim of conducting usability tests?

Usability tests can be used for several purposes, for example, to observe how an end-user interacts with the system, to test the ease of use and user-friendliness of the technology, or to assess whether user requirements are correctly translated into the design. Information on these kinds of topics can be used to improve the technology.

What is adding persuasive elements?

In the design phase, persuasive elements should be added to the prototype to increase its effects. Examples of models that can be used to add persuasive elements are the Persuasive System Design (PSD) [1] and BCTs [2].

What is the aim of adding persuasive elements?

Persuasive technology is technology that is designed to change attitudes or behaviour [3]. To achieve this, persuasive elements should be added to the prototype during the design phase. Most eHealth technologies aim to influence specific behaviours or cognitions. Consequently, Behaviour Change Techniques (BCTs) can be added to the design as well, especially since research has shown that more extensive use of theory in technology results in increased effects [4]. BCTs are derived from behaviour change theories from psychology and can be defined as a general technique to influence or create changes in the predictors of specific behaviour. 

References

[1] Oinas-Kukkonen, H., & Harjumaa, M. (2009). Persuasive systems design: Key issues, process model, and system features. Communications of the Association for Information Systems, 24(1), 28.

[2] Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., . . . Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81-95.

[3] Fogg, B. J. (2009). A behavior model for persuasive design. In S. Chatterjee & P. Dev (Eds.), Proceedings of the 4th international Conference on Persuasive Technology (Article No. 40). New York, NY: ACM.

[4] Webb, T., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12(1): e4.