From FITT to FISTT: The task-skills fit before the introduction of assistive, digital health technologies.

Objective: To enhance the predictive power of the Fit between Individuals, Task and Technology (FITT) framework in mobile, individual consumer settings by restructuring the individual-task fit to prominently emphasise the task-skills fit. Design: A mixed study involving a quantitative survey of 679 potential patients (adopters) and a qualitative content analysis of ten semi-structured interviews with clinic assistants. Setting: For the survey, three combined random samples of potential patients from Atteridgeville, Bapong and Garankuwa (South Africa). Ten Unjani clinic assistants were also interviewed about their tasks, skills, and related properties and attributes using a semi-structured interview guide. Participants: Participants in the survey were potential patients over 18 years of age in the three sampled locations. In the qualitative study, interviewed participants were employed as clinic assistants in ten clinics within the Unjani Clinic Network. Main outcome measures: in the quantitative study, the statistical significance of the relationships between smartphone experience and health motivation on the one hand and the adopter's perceived self-efficacy on the other. In the qualitative study, the extent to which task properties, context, and the adopters' levels of education and training affect their perceived self-efficacy. Findings: There is a significant relationship between smartphone experience and perceived self-efficacy and a moderately significant relationship between health motivation and perceived self-efficacy. Furthermore, task properties, task context, and an adopter's level of education and training considerably influence their perceived self-efficacy on a given future assistive digital health technology (ADHT). Conclusion: Extending the FITT to the FISTT framework to explicitly include the task-skills fit may improve the explanatory and predictive power of the traditional FITT framework in mobile individual consumer settings.

Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review.

BACKGROUND: Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact. AIM: The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability. METHODS: A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases. RESULTS: Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof. CONCLUSION: The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.

A Practical Framework for Value Creation in Health Information Systems From an Ecosystem Perspective: Evaluated in the South African Context.

Performance improvement in any field depends on establishing goals that align the interests of relevant stakeholders, which may be defined as creating value for stakeholders. In the healthcare context, the concept of value creation and its analysis from an ecosystem perspective has been neglected and is hard to achieve in practice. This research adopts an innovation ecosystem perspective to develop and evaluate a practical framework to guide value creation for healthcare settings in a developing country context. The resulting framework serves as a tool that can guide stakeholders to co-create value by defining the inputs, activities, and outputs/outcomes to enable the process of value co-creation through a heath information system. Design Science Research Methodology (DSRM) was followed to develop the framework (artifact); it entailed the evaluation of the preliminary framework through a range of cycles. A relevance cycle was completed through a literature review. Since the investigation was done from an ecosystem perspective, it provided an understanding of the core characteristics of ecosystems, information systems, and value to inform the development of a preliminary framework. The preliminary framework was evaluated through two design cycles: the first was based on in-depth semi-structured interviews with six industry experts, and the second comprised a framework ranking exercise. The observations from the two stages informed the modification and refinement of framework items. The evaluated framework provides practical and actionable elements of a value creation system based on three canvasses: (1) the pre-use canvas defines the healthcare system and its stakeholders; (2) the tool guideline provides an overview of the development of ecosystem canvas elements; and (3) the ecosystem canvas represents the process of value creation along with a conceptual canvas with descriptions or implications of each of the framework's concepts.

Concept and development of an interactive tool for trial recruitment planning and management.

BACKGROUND: Predicting and monitoring recruitment in large, complex trials is essential to ensure appropriate resource management and budgeting. In a novel partnership between clinical trial investigators of the South African Medical Research Council and industrial engineers from the Stellenbosch University Health Systems Engineering and Innovation Hub, we developed a trial recruitment tool (TRT). The objective of the tool is to serve as a computerised decisions-support system to aid the planning and management phases of the trial recruitment process. METHOD: The specific requirements of the TRT were determined in several workshops between the partners. A Poisson process simulation model was formulated and incorporated in the TRT to predict the recruitment duration. The assumptions underlying the model were made in consultation with the trial team at the start of the project and were deemed reasonable. Real-world data extracted from a current cluster trial, Project MIND, based in 24 sites in South Africa was used to verify the simulation model and to develop the monitoring component of the TRT. RESULTS: The TRT comprises a planning and monitoring component. The planning component generates different trial scenarios for predicted trial recruitment duration based on user inputs, e.g. number of sites, initiation delays. The monitoring component uses and analyses the data retrieved from the trial management information system to generate different levels of information, displayed visually on an interactive, user-friendly dashboard. Users can analyse the results at trial or site level, changing input parameters to see the resultant effect on the duration of trial recruitment. CONCLUSION: This TRT is an easy-to-use tool that assists in the management of the trial recruitment process. The TRT has potential to expedite improved management of clinical trials by providing the appropriate information needed for the planning and monitoring of the trial recruitment phase. This TRT extends prior tools describing historic recruitment only to using historic data to predict future recruitment. The broader project demonstrates the value of collaboration between clinicians and engineers to optimise their respective skillsets.

The design and development of technology platforms in a developing country healthcare context from an ecosystem perspective.

BACKGROUND: Research on the development and functioning of technology platforms specifically for health applications in sub-Saharan Africa (SSA), is limited. The healthcare sector has also been resistant to platform adoption due to characteristics such as sensitive data and high cost of failure. A framework for the design, development and implementation of technology platforms in the South African health context could therefore contribute to the gap in research as well as provide a practical tool that platform owners could use to potentially increase the adoption of platforms in this context. METHODS: The research design for this study was based on the Grounded Theory Conceptual Framework Analysis process. The process focused on mapping and investigating data sources, categorising and integrating concepts, synthesising these concepts into a framework and iteratively evaluating the framework. The first stage of the evaluation process was a preliminary evaluation exploring an existing Health platform in South Africa (MomConnect). The second evaluation stage included local and international interviews with nine experts to identify any missing concepts in the framework. Stage three included a case study and case study interviews which led to the formulation of the final framework and management tool. RESULTS: The developed and evaluated framework comprised three components, namely the pre-use component, which includes considerations the platform owner should be aware of prior to using the framework. The framework comprises of two dimensions, 1) an ecosystem dimension to guide the platform owner to consider different ecosystem actors before embarking on designing a platform 2) a platform development dimension that include typical platform development components and presents an interpretation of the viewpoints included in the ecosystem levels. CONCLUSIONS: The final framework can be used by platform owners as a management tool. A unique contribution of this study is that the framework draws from two platform perspectives, namely the engineering and the economic perspectives to provide a holistic understanding of platforms. Finally, a contribution of this article is the tailoring of the framework for the South African health context.