This thesis is concerned with the aspect of Health Informatics that relates to IT adoption in the NHS. It focuses on the identification of the factors that influence significantly the implementation of LORENZO, the Electronic Health Record system that is being implemented in the Strategic Health Authorities (SHAs) in the North, Midlands, and East of England (NME) region as part of the National Programme for Information Technology (NPfIT) in the NHS. As a result of a review of the literature it was concluded that the study should be based on the underlying ideas of the Teclmology Acceptance Model (TAM). However, rather than the quantitative approach usually associated with the TAM, a qualitative research methodology was used to approach this area. The data was obtained by conducting faceto- face semi-structured interviews with people who represented the end users in the NHS and the designing company (the LSP). By contrast with most academic studies, the research, therefore, studied the NPfIT from the bottom up (i.e. the end user perspective). NVivo was used to aid the analysis of the interview data. This analysis was used to develop an extended TAM model and to suggest a theoretical model of the relationship benveen LORENZO development methodology and users' acceptance.

This thesis presents the author's work on the transdisciplinary development of artificially intelligent assistive technologies (IATs) for supporting wellbeing, which includes the conceptualisation of novel techniques for guiding IAT development as well as the creation, testing, and evaluation of functional prototypes. The work described in this thesis was conducted between 2002 to 2014. The first chapter introduces the background, scope, and structure of the thesis. Chapter 2 begins by introducing artificial intelligence, assistive technology, and zero-effort technologies followed by models for describing assistive technology interventions. The facets of wellbeing, occupational therapy treatment continuum, and transactionalism are put forward as user-centric schema an IAT development team can use to frame a research challenge. The chapter closes with ethical considerations regarding the design and use of IATs. Chapter 3 defines transdisciplinary teamwork and discusses its benefits and barriers before establishing themes and stages for guiding transdisciplinary IAT development. The next three chapters present the author's work in the development of novel IATs. Each chapter begins with an overview of the research challenge and a literature review, followed by a discussion of the IAT's development; specifically, a robot for guiding upper limb post-stroke rehabilitation (Chapter 4), an ambient environment for guiding hand-washing for older adults with dementia (Chapter 5), and a multi-touch surface for supporting arts therapy for older adults with dementia (Chapter 6). These chapters demonstrate the application of the concepts presented in Chapters 2 and 3. Chapter 7 summarises the significance of this work, followed by potential future research directions and concluding remarks. This thesis presents novel methods for information gathering, prototype construction, and efficacy testing that have resulted in successful, functional IATs. The author's research leadership has guided the creation of techniques for fostering transdisciplinary teamwork, which this dissertation shows to be key for innovative, user-driven device and systems development.

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Health care delivery systems face different obstacles when engaged in health information systems implementation. The success of such systems is dependent upon many factors. These factors must be identified and carefully considered to ensure successful system implementation. This study investigates possible factors affecting successful information systems implementation in the Kuwaiti health care delivery system within the public and private sectors. The research was designed as an exploratory study in which qualitative and quantitative approaches were used. In the first stage (qualitative) a focus group was formed and then a semi-structured interview was administered. Themes that emerged from the interviews were used to develop a questionnaire that was used in the second (quantitative) stage of the study. The study covered stakeholders from the public and private sectors in Kuwait. The qualitative part investigated the impact of certain factors on system implementation successfulness. Based on interviewees' responses, three major themes emerged. Those were used to develop the questionnaire which was used in the quantitative part of the study. The questionnaire was aimed at describing the perception of the stakeholders to the preset factors with regard to their effects on the success of implementation in their respective organisations. From both sectors, a sample of 493 respondents was randomly 2 selected. The response rate for the questionnaire from the two sectors ranged from 59% to 72% depending on the stakeholders' group of respondents. When examining the findings of the questionnaire, the perceptions of the top management in the public sector at MOH and Al-Amin hospital were similar toward most of the factors studied. However, they were different from those of the end users. On the other hand, the perceptions of the top management and the end users were similar in the private sector. . The top management in the public sector (MOH and Al-Amin hospital) ranked the following factors in this order as the most important factors that affected successful health information systems implementation in the public sector: Accountability; Resistance to change; Organisational diversity; Organisational stability; and Incentives. The end users in the public sector ranked the following factors as the most important factors that affected successful health information systems implementation in the public sector: Lack of end user involvement; Insufficient planning; Training; Incentives; and Uncertainty of benefits. Both the top management and end users of the public sector ranked "Incentives" as one of the most important factors that affected successful health information system implementation, but this was the only point of agreement between them. In the private sector, the top management ranked the following factors as the most important factors that affected successful health information systems implementation: Resistance to change; Ease of usage; Competition; Incentives; and Compatibility. The end users in the private sector ranked the following factors: Ease of usage; Timeliness; Incentives; Relative advantage; and Competition. The top management and end users in the private sector concurred over the importance of the following factors: Ease of usage; and Competition. In conclusion, both the public and private sector participants (top management and end users) ranked `Incentives' as one of the most important factors that affected successful health information system implementation, while the top management in both sectors (MOH, Al-Amiri and Al-Mowasat hospitals) ranked `Resistance to change' as one of the most important factors that affected successful health information system implementation. In all, the results show that the primary factor affecting successful implementation of health information system regardless of the sector and the employment category is `Incentives', followed by `Resistance to change'. The information produced in the current study was used to produce recommendations on the successful future implementation of health information systems in Kuwait. The recommendations are based on empirical findings, and are to be respectfully commended to strategists concerned with improving health care delivery system in Kuwait. 4 The first and most obvious recommendation regarding future research would be a replication of the same study, but with the inclusion of more comprehensive attributes such as: 1) Vendor services (e. g. hardware performance, expansion and growth potential, ease of modification, interface capabilities, ease of installation, and upgrading capabilities. 2) Vendor selection factors (e. g. vendor reputation and company philosophy, system pricing, and vendor resources. 3) Patient satisfaction with the system benefits. The second recommendation is to use the same organisational, cultural and user satisfaction factors to examine health information systems implementation in a specific facility such as an Army or Police hospital versus a public hospital.

The potential impact of smart phones in the improvement of personal health outcomes is staggering. Found everywhere, in the pockets of billions around the world, truly ubiquitous, a mobile portal to all of mankind's information ... yet the current health model has not adapted adequately to facilitate their arrival, and perhaps rightly so. There are an unprecedented number of health apps available to the public, for which the benefit of adopting, and their true efficacy, is yet to be established. This work focuses on addressing this issue, exploring the perceived barriers and keys to adoption, proposing a number of solutions which utilise and extend the knowledge in the areas of context-aware computing and behaviour change, and evaluates their efficacy in two longitudinal, smartphone facilitated, health interventions, both in the areas of dementia treatment and prevention.

The literature on e-health systems is frequently characterised by reports of success accompanied by the promise of a bright future, but the future never seems to arrive. The story of health informatics in England over the last decade has been dominated by the NHS National Programme for IT. One element of that programme is the Map of Medicine, a software tool designed to deliver evidence-based clinical knowledge from authoritative sources. Although the system had been made available to users across the NHS, very little was known about whether health professionals actually used it. The aim of this project was to undertake a mixed methods case study to evaluate the implementation of the Map of Medicine in primary and community care settings. The main findings from the quantitative phase of the case study were that around half of the GPs and around a quarter of Community health staff used the system. The findings from the qualitative phase indicated some marked differences between the two groups in terms of why they did, or did not, use the system. Normalisation Process Theory was used as a lens to understand how practices became embedded, or failed to become embedded, into their social context. It is concluded that emphasising the technical aspects of system implementation at the expense of the social aspects probably accounted for much of the variation in use, but there are no simple project management checklists that can guarantee successful implementation. Finally, the implications are considered. Policy makers need to take account of the social factors when implementing e-health systems, to recognise that it can take a long time for systems to become normalised and that there are risks from withdrawing project support before changes in working practices have become embedded. The health informatics profession needs to become more evidence-based, and the evaluation of e-health should play the same role as clinical audit does for the medical profession.

The majority of IT projects across various countries and industries fail or do not realise all their intended benefits. Despite previous research into this area and the development of various project success models, IT projects continue to fail at an alarming rate. This research examines the reasons for this phenomenon and extends the existing knowledge by providing insight and learning into how to successfully manage IT enabled change projects within the National Health Service (NHS) in the UK. The research used interpretive, retrospective case studies to examine the outcomes of four IT enabled change projects in the NHS. Forty-three face-to-face, semistructured interviews were conducted to collect a rich source of data for the analysis. A comprehensive body of literature was reviewed and key areas/themes were identified that could be expected to influence project outcomes. These themes were used to develop and structure the interview questions and guide the data analysis. The research was designed to first learn from successful projects and then contrast the findings with those from less successful projects. In the first empirical study, P1, two case studies of successful PACS (Picture Archiving and Communication System) projects in two NHS hospitals were undertaken. The reasons for their success were fully explored and discussed. The second empirical study, P2, consisted of two case studies of less successful projects: the implementations of an electronic Theatre System and an electronic Order Communication System were studied, and the reasons for their lack of success were explored, studied and contrasted with those in P1. Analysis of the evidence from the interviews and review of relevant documents, showed that the main differences between the successful and less successful projects were in the management of the following areas: development of the business case for investment, clinical engagement and involvement, stakeholder management (and, in particular, the clinician/manager relationship), awareness and ownership of benefits, project leadership and the capabilities of the project manager, and the type of the deployed technology. Cont/d.

Many care receivers feel like a burden and this perception is socially constructed (Gorvin & Brown, 2012). To explore why care receivers may feel this way, the research uses a critical discourse analysis, as suggested by Edley (2001), to examine caregivers' posts on publically accessible internet support sites, specifically exploring how caregivers construct care receivers. Two interpretative repertoires that caregivers' used widely to account for their tasks are presented. These are: care is a family responsibility and caring is harmful. When used together, these position care receivers as a burden and caregivers as burdened. Within care as a family responsibility, there is an ideological dilemma for caregivers as they address the question: when 1 care, who am I? Here, they debate who they are in relation to the person they care for: a caregiver, a family member, or both. Most caregivers constructed care as something additional to normal relating, allowing them to speak of their suffering. Caregi vers constructed care receivers as frustrated and with diminished autonomy. The implications of these constructions for care receivers and counselling psychologists are discussed.

Information systems (IS) and information technology (IT) failures appear to consistently make headline news in the media and to be a topic of discussion in the IS literature. In the UK, and untill very recently, such problems have largely focused upon organisations in the private sector. However, during the last decade, the public sector has been the subject of wide-ranging reforms involving the introduction of competitive practices, and significantly, the introduction of IS and IT to aid in this task. Many of these new developments have encountered problems. Included within this new area of IS implementation, we find systems associated with the NHS Resource Management Initiative (RMI), particularly the Case Mix system which is at the centre of the project. The Initiative revolves around cultural and structural change, and the provision of relevant information for clinical and management audit to support these purposes: to this end, Case Mix provides a tool for collecting and analysing data from all areas of hospital operations. However, the RMI Case Mix development has received very little attention in the IS literature, particularly with respect to the determinants of Case Mix project outcomes. An examination of existing theories concerning IS implementation reveals inadequacy, both in general, and in specific application to Case Mix. For example, it is apparent that numerous theories are linear and simplistic, or in many instances are too general to be of any real value other than as a very loose frame of reference. In short, they tend to lack sufficient attention to the process and context of implementation. In addition, there is evidence that the evaluation of systems is not being approached in a way that reflects stakeholders i!l an organisation. This thesis aims to tackle these problems by examining the introduction of Case Mix in four hospitals, using an approach adapted to overcome many of the criticisms voiced above: that of grounded theory. It aims to identify the context and processes oflS development which consequently affect project outcomes. However, the methodology integrates another contemporary technique of phenomenological analysis, that of cause mapping, reconciling the differences in the approaches, and building on the strengths of each. Together with such qualitative data, which are analysed using the assistance of specialist computer software, some quantitative data are also integrated via a survey. The result is a combination of interpreted cause map data and quantitative construct data. The results are very positive: the approach appears an excellent way of tackling research into this area, providing a detailed insight into the introduction of Case Mix and the subsequent outcomes of this new development. Among these results, in addition to the novel methodology for this type of research, a framework and a number of interesting findings were produced. The framework and findings suggest that in order to more fully account for experiences and outcomes related to Case Mix in hospitals, one should reflect upon overarching context, the behaviour of key individuals, the process pursued by the organisation, and the degree to which an IS project is localised, particularly via its evaluation and objectives. Similarly, in practitioner terms, hospitals are more likely to receive favourable outcomes if they understand that managing Case Mix requires attention to process and context, and not merely the importance of technology per se. The study concludes that more research is needed into Case Mix, and similar developments, and suggests that the mode of investigation pursued in this thesis could be productively employed elsewhere.

Previous research has shown that Internet-based health behaviour interventions can have variable effects on health -related outcomes. Effectiveness may be improved by optimising the design of interventions. However, there have been few systematic investigations to identify the specific effects on outcomes of different ways of delivering intervention content. This thesis describes the theory-based development and evaluation of three different versions of an Internet-based health intervention to compare user engagement with two interactive design features - tailoring and self management (self-assessment and activity planning). To inform the design of the intervention, reviews of the quantitative and qualitative literatures and two qualitative think-aloud studies of individuals' reactions to the intervention, and another intervention, were undertaken. A quantitative study using a partial factorial design showed that self-assessment and activity planning were more engaging when provided in conjunction with tailored feedback. The version providing self- assessment and activity planning without tailored feedback was rated as less engaging than the version which also provided tailored feedback, and a version which only provided generic information. Self-assessment and activity planning without tailored feedback was also associated with greater drop out and lower satisfaction. The think-aloud study suggested that self-assessment without tailored feedback may have been less engaging because participants were disappointed and frustrated by completing self-assessment quizzes, which offered no personal benefit and no personalised advice. The quantitative study, and a second think-aloud study of a different intervention, also suggested that participants' intrinsic motivation, health locus of control beliefs, and confidence in self-caring for medical symptoms may be associated with differences in their engagement with intervention design. This thesis has shown that there are differences between the individual and combined effect of different interactive design features on user engagement with Internet-based health behaviour interventions. This thesis also suggests that users' preferences and beliefs may influence their engagement with intervention design.