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Tadas, Shreya
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Tadas, Shreya
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Tadas, Shreya
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- PublicationUser-centred Digital Health in Cardiovascular Rehabilitation and Self-managementAn acute cardiac incident is a life changing event and people face emotional and physical challenges during their transition from hospitalisation to self-management. Supervised rehabilitation programs, like, cardiac rehabilitation play a vital role in supporting this transition. Lack of knowledge, transportation, and motivation limits the uptake of such programs. Increasingly, sensor technologies providing patient-generated data are showing potential to overcome these limitations. But, evidence regarding its routine use and effectiveness is mixed and the commonly reported barriers include insufficient time, data lacking context, unfamiliar structure, misaligned objectives, usability, and reliability issues. Therefore, a greater understanding of patients’ experiences and factors that impact their behaviour after hospitalisation is needed to design such technologies. Also, to increase their success when deployed in real-world clinical contexts, designing by integrating both clinicians' and patients' perspectives is important. User-centred design approaches emphasise the importance of situating user experiences, needs, and preferences as the driver of the digital intervention design. Given the strong evidence from the field of human-computer interaction that user-centred and iterative design methods increase the success of digital health interventions, limited studies were identified that involved users in the design process and applied iterative methods. To contribute new insights to an area lacking in empirical research, this thesis applies the user- centred design methods and the co-design framework to design technology-mediated solutions to support cardiac rehabilitation and self-management. This thesis engages more directly with patients’ and clinicians’ post-hospitalisation experiences and the impact of patient-generated data through a series of studies. Four studies were conducted to achieve the aims of the thesis: a qualitative systematic grounded theory literature review; semi- structured interviews with cardiac patients; co-design study with cardiac rehabilitation clinicians; and field study for system deployment in real-world clinical context. Building on the collective findings of the studies conducted in this thesis, empirically grounded user-centred recommendations are presented to improve the design of technology-mediated support for CR and self-management. The key design recommendations presented in this thesis include: (i) the use of technology to support a normal life, leveraging social influences to extend participants’ sense of normality; (ii) the use of technology to provide both emotional and physical safe zoning; (iii) a focus on recognising capability and providing recommendations that are positive and reinforce this capability; (iv) supplementing objective data from consumer wearable devices with subjective patient experience data to enable meaningful and actionable insights for clinicians; (v) adopting structured approach to subjective data collection grounded in the clinicians’ workflow and co-designed with the clinicians to allow for such data to be shared in a familiar presentation; (vi) the importance of carefully considering the timing, type of App, context, and type of data presentation while sharing data between patients to avoid negative consequences and to empower patients to use technology to self-manage their condition.
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