Participation, knowledges and experiences design of IT-systems in e-home health care

Abstract: People working in the home health care sector are seldom consulted when development and implementation of ICT is involved and which effects their work practices. This is surprising given the assumptions of participatory design principles that have in¬fluenced Scandinavian re¬search and design work. To address this shortcoming, this thesis takes the perspective of the homecare personnel. A central purpose of the thesis is to explore care staff's participation in, experiences and knowl¬edge of the design and use of ICT in home health care services, with a special focus on care assistants. The methodological approach for this exploration is based on qualita¬tive methods and interpretive and hermeneutic perspectives applied in four different research and development projects. The empirical ma¬terial was conducted with focused interviews, undertaken work with focus groups, facilitated workshops, engaged in systematic observations and used the storyboard technique with personnel working in the home health care services. Thus a variety of participatory design meth¬ods and techniques have been used. The gathered data has been ana¬lysed using different methods: discourse analysis, the cyborg figure, thematic analysis, and reflective analysis. The findings from each analy¬sis complement each other and bring forward different perspectives. Common assumptions about participatory approaches are that partici¬pation improves workplace democracy and increases user acceptance. Nonetheless, it is not that straight forward. This research has revealed that participation involves conscious reflections on when, where, and how the users should participate in the design process. The degree of participation is an issue where the ultimate level is shared collaborative decision-making for reaching effective and high quality systems that supports the work processes. An additional issue in the design process is the quest for official power. The conducted research confirms that participatory design is difficult and takes time, participation and participatory design techniques that have been used demonstrate the complexity in the work practice and that it is not only to "get the work done". Further, if the point of de¬parture is taken in (participatory) action research and participatory de¬sign it is possible to intervene in the process and change the direction of a research and development project in order to engage all stake¬holders that are involved in the care of the client. Finally, when applying an appreciative approach, care staff were en¬abled to value their situated knowledge and how it contributes to the services delivered i.e., they were enabled to reflect on their work, learn, and share together. Findings indicate that by integrating the principles of participatory action research (PAR) in the participatory design (PD) process, the users participate during the full development process, make decisions and take part in the design work. With this degree of participation, the care staff are able to follow the whole process, reach a realistic expectation of what to expect from the de¬signed technology and additionally develop their situated knowledge about the relations between technology and work practices.