JMIR Publications

ABSTRACT

Background:

A transformation towards healthcare provision with digitally enabled workflows and patient paths is happening these years. With new digital services, there is an expectation that more people, including older adults, will be able to gain the advantages of these services. On an individual level, this includes increased health literacy, self-efficacy, and self-management, and on an organizational level, it may reduce the burden on healthcare staff, due to fewer in-person consultations. To realize these expectations, those designing the digital services need the knowledge and skills, to create inclusive solutions that can work in a socio-technical ecosystem with actors from different professions and organizations. To be successful with this, multi-disciplinary teams need to collaborate, using innovative methods, and frameworks that support socio-technical developments, such as the Epital Care Model (ECM) and the Readiness and Enablement Index for Health Technologies (READHY) and be aware of existing gaps in the field.

Objective:

To propose a structure for design guidelines to be used in developing digital technologies and services for socio-technical ecosystems and provide examples of how ECM and READHY can inform infrastructuring, ensure inclusion, and increase adoption of digital services.

Methods:

The principles presented are from an EU-, and Canadian research council co-funded project, Smart Inclusive Living Environment (SMILE). A collaboration with partners, in Canada, Denmark, the Netherlands, and Norway. SMILE used innovative methods to design digital infrastructures, to reduce social isolation, increase health literacy, and enhance well-being. As an example, a conversational agent, SMILEbot, was designed based on co-design principles, with input from older adults with frailty or impairment. The work was informed by four frameworks; a matrix to include, engage, empower, and emancipate marginalized people (4E), the ‘GO TO’ as a design navigator, the ECM to inform infrastructuring, and READHY to stratify service users.

Results:

Design guidelines used to develop new digital services and technologies should consist of three principles 1) A common vocabulary including theories, frameworks, and models, 2) templates and protocols for methods, including detailed guidelines and templates for the planned development of the technologies, and 3) methods to implement and provide education and training of service users, and informal and formal caregivers. It is essential to involve relevant stakeholders in the process of implementing guidelines to obtain preparedness in the organizations, and among service users to ensure adoption. Moreover, it is important to align expectations, have a common understanding of the applied frameworks and methods, and have access to necessary resources to reach successful results.

Conclusions:

Informed by experiences from the SMILE-project, a solid structure for design guidelines, frameworks, methods, and reflections on the value in practice have been made, which will be helpful for similar projects.