This thesis proposes intelligent decision support System in diabetes eHealth care in order to improve the quality of life of Diabetes patients. Diabetes is one of the chronic diseases that can cause the serious health complication. Patients of diabetes especially elder people need more care than others as well as regularity in medicine. Only patients themselves or doctors cannot provide the care that patient needs. To improve the quality of daily life of patient a team of care providers work together. This thesis covers the different fields of intelligent decision support system for the diabetes type2 patients. The proposed intelligent decision support system is 24-hours accessible for the patients and care providers. The system stores the patients’ information and gives them optimal advices according to their condition entered by them. It also provides adequate and detail information about the patient to the health-care providers that help them to take an optimal decision about the patients. If system analyzes any alarming condition of the patient, it generates automatic alarming message for the health-care providers to help the patients. We validate our study by conducting interviews with diabetes health-care providers and perform questionnaires filled from diabetes type2 patients.

Context: Internet of Things (IoT) is an exciting new development and opportunity in the global ICT field. In short, IoT means that all objects will have their own IP address and be constantly online, connected to other similar actors. After this expansion Internet will not only be humans communicate with humans (H2H) more but machines will automatically communicate with machines (M2M) and humans (H2M) as well . The already today big amounts of data will become extreme as a result of this and it will require new and smarter ways of designing future ICT systems. Many more things needs to be taken into account for these demanding ICT development projects to fall out in productive ways. As of right now it does not seem to be clear to developers what all matters need to be looked at and in that order and why. Clear IoT systems design guidelines, templates and view-models are missing or they are at least not available to the mainstream designers. Objectives: In this study the objective is to investigate a) what views and concepts would need to be taken into account for developers to design better Information Systems for IoT type of setups and b) what kind of an ISD framework such design could result in. Methods: In this thesis a number of research methods have been used, such as: a) conducting a broad literature review on related IS concepts; b) analyzing how the found concepts tie togehter; c) compiling an ISD framework based on the concepts and 2) apply the ISD framework on a real eHealth case. Results: The result of the study was that there is a need for a new ISD framework for larger systems design based on a stakeholder centric viewpoint. This work puts forward an example of such an ISD framework. Conclusions: Designing and developing large Information Systems for IoT setups is a very demanding task and a logical/clear design frameworks will help in this matter. If nothing else, a predefined view-model will help in asking the right (kind) of questions and keeping the communication about the objectives on track and focused. eHealth is a field where IoT systems should be implemented but if it's not done in the correct way taking matters like stakeholders objectives and IPR's on both systems and data into account very little productive results will be achieved.

Abstract Behavior change support systems (BCSSs) help people to achieve personal goals that they cannot necessarily achieve on their own. Typical BCSSs include health-related systems and applications. Significant policy and research attention has been aimed at information technologies that enable behavior change in regard to individuals’ health and wellbeing activities. The aim of this dissertation is to build a comprehensive view of health BCSSs, ranging from technology adoption to engagement, persuasion, and habit formation. As its main research question, the present thesis asks: What can user experiences of health BCSS reveal about behavior change? In addition, it proposes a framework for different approaches, which can help developers solve ethical issues in their BCSS design. This dissertation comprises four qualitative studies and one conceptual study. Hermeneutics has been the most influential research method in conducting these studies. Ontologically, hermeneutics leans toward socially constructed reality. The primary conceptual lenses for interpreting the data are the BCSS framework and Persuasive Systems Design model. This thesis extends prior research on eHealth, including non-adoption, flow esperience, use adherence, habit formation, and ethics. The results emphasize that persuasive systems design can affect user experience in different stages of system adoption and learning a new, healthier lifestyle. The presented work addresses health behavior change as a complex issue. Many individuals regard system usefulness in terms of perceived value for themselves rather than in terms of the system’s instrumental value. People are less likely to use the systems if they do not fit into their daily routines. Flow experience appears not to play as fundamental part in the BCSS use experience as is expected. The results suggest that self-monitoring, reminders and tunneling can help users to achieve better outcomes. These persuasive features can help increasing subject’s compliance and commitment, which in turn can help individuals to achieve better habits. Additionally this thesis presents a framework where different ethical approaches are divided to three distinct categories. / Tiivistelmä Käyttäytymismuutosta tukevat tietojärjestelmät auttavat ihmisiä saavuttamaan henkilökohtaiset tavoitteensa, joita he eivät välttämättä yksin saavuttaisi. Tyypillisesti tällaiset järjestelmät ja applikaatiot liittyvät terveyteen. Sekä tutkimuksessa että julkishallinnossa on kiinnitetty huomiota, kuinka yksilöiden terveyttä ja hyvinvointia voidaan edistää informaatioteknologian avulla. Tämän väitöskirjan tarkoituksena on rakentaa kokonaisvaltainen näkemys terveyttä edistävistä käyttäytymismuutosta tukevista tietojärjestelmistä lähtien järjestelmän käytöstä ja osallistavuudesta, suostuttelevuuteen ja tapojen muodostumiseen. Väitöskirjan keskeisin tutkimuskysymys on: mitä käyttäjien kokemukset terveyttä edistävistä käyttäytymismuutosta tukevista tietojärjestelmistä paljastavat mitattavasta käyttäytymismuutoksesta? Lisäksi tämä väitöskirja tarjoaa viitekehyksen, joka voi auttaa suunnittelijoita ratkaisemaan eettisiä ongelmakohtia, kun he suunnittelevat käyttäytymismuutosta tukevia tietojärjestelmiä. Väitöskirja pitää sisällään neljä kvalitatiivista osajulkaisua ja yhden konseptuaalisen osajulkaisun. Hermeneutiikka on osajulkaisujen kannalta keskeisin tutkimusmenetelmä. Ontologisesti hermeneutiikka nojaa sosiaalisesti konstruoituun todellisuuteen. Aineiston tulkitsemisen kannalta keskeisimmät konseptuaaliset viitekehykset ovat olleet BCSS framework ja Persuasive Systems Design model. Väitöskirja laajentaa aiempaa tutkimuksellista näkökulmaa eHealth-teemasta pitäen sisällään näkökulmat järjestelmän hylkäämisestä, flow-kokemuksesta, järjestelmän käyttöön sitoutumisesta, elintapojen muodostumisesta ja eettisyydestä. Väitöskirjan tulokset korostavat, että suostuttelevien järjestelmien suunnittelumenetelmät voivat vaikuttaa käyttäjäkokemukseen eri vaiheissa järjestelmän käyttöönotosta uuden terveellisemmän elintavan omaksumiseen. Väitöskirjassa esitellyt osajulkaisut osoittavat, että terveyttä edistävä käyttäytymismuutos on monimutkainen kokonaisuus. Moni haastatelluista koki järjestelmän hyödyllisyyden liittyvän enemmän itsensä kehittämiseen kuin välineelliseen hyötyyyn. Ihmiset olivat vastentahtoisia käyttämään järjestelmää, jos se ei sopinut heidän arkielämäänsä. Väitöskirjan tulokset antavat ymmärtää, että itsemonitorointi, muistutukset ja tunnelointi auttavat käyttäytymismuutosta tukevien tietojärjestelmien käyttäjiä saavuttamaan parempia lopputuloksia. Nämä suostuttelevat elementit voivat helpottaa käyttäjiä noudattamaan ohjeita ja sitoutumaan muutosprosessiin kohti terveellisempiä elämäntapoja. Väitöskirja tarjoaa lisäksi viitekehyksen, jossa erilaiset eettiset lähestymistavat on jaotelty kolmeen eriteltävään kategoriaan.

The fast technical development enables new application areas within health care, and theimportance of eHealth increases. Meanwhile, conscious behavioral change throughpersuasive technology has shown to be a functional and effective method. This studyaimed at producing a design model, customized for persuasive design within eHealth. Themodel took the shape of a toolbox, containing tools which aim to respond to key aspectsassociated with the field, and was qualitatively evaluated through interviews with expertswho assessed the quality. The interview recordings were abductively analyzed, and themodel revised by the analysis’ results. The findings contributed to a widenedcomprehension of the area and resulted in a new version of the model, and other valuableinsights about the aspect of context within persuasive design and eHealth. / Den snabba tekniska utvecklingen möjliggör nya användningsområden inom hälsoområdet,och vikten av eHälsa ökar. Samtidigt har medveten beteendeförändring genom persuasivedesign visat sig vara en funktionell och effektiv metod. I den här studien var målet attproducera en modell, anpassad för design inom eHälsa. Modellen tog formen av enverktygslåda, innehållande verktyg avsedda att besvara nyckelfaktorer inom fältet, ochevaluerades kvalitativt genom intervjuer med experter för att öka dess kvalité.Intervjuinspelningarna analyserades abduktivt, och modellen reviderades efter analysensresultat. Resultaten bidrar till en utvidgad förståelse inom fältet, en ny version av modellenoch andra värdefulla insikter angående kontext som en aspekt inom persuasive design ocheHälsa.

A large number of attitudes and methods of dealing with health service, or, more precisely, health, occur in theory and practice. The aim is to examine the efficiency of the implementation of the current projects, i.e. efficient application of tools of managing the quality of health. Theoretical rationales characterize understanding of conception of the quality of health especially in the sphere of health service. Moreover, this part introduces selected tools of managing the quality of health. The analytical part is focused on the institutional environment in connection with current challanges of eHealth implementation. The Central Repository of electronic prescriptions as the tool of managing the quality of health and the basis for ePrescription is one of the mentined challenges. The final part concerns with future trends in the Central Repository of electronic prescriptions and international projects, e.g. epSOS project. The EU is established on the principle of benchmarking, among other things. Possible future advances need to be considered in the context of foreign projects. For this reason, the Danish eHealth situation is included in the conclusion.

This thesis is concerned with electronic prescription of drugs in the Czech republic. The objective is to find a proper standard for electronic medical data exchange and use it for building a new data communication interface for the e-prescription system. This work attends to the evolution and actual situation of the national e-prescription system. The system is based on one central storage for e-prescriptions, however, currently it isn't being used. On basis of valid legislation, electronic prescription and drug dispense processes are analyzed. Furthermore, present central storage data interface is explored. Considering advantages, that are bound to utilization of electronic data exchange standards, main objective of this thesis is given, to design a new interface for transmission of e-prescriptions and drug dispense notifications. New interface shall adhere to standards. Czech standard DASTA and europian norm EN13606 were examined. After all, set of specifications HL7 (Health Level Seven) has been chosen, which suits the requirements best. Data interface design, with HL7 standards, is based on exchange of documents. Documents (prescription, dispense notification) are expressed in the Clinical Document Architecture (CDA) format, and exchanged between applications by means of the Medical Records domain messages. The structure of wrappers, forming a message, results from common HL7 Specification Infrastructure. Presented design has been inspired by Finnish solution eResepti. The design tries to transform present interface of central storage to format, which is defined by selected HL7 specifications. It can be used in both local and central e-prescription systems. It may also support the development of systems for electronic health(care) records exchange.

The development of internet-based technologies, the design and adoption of wireless wearable and smart devices have been a growing study spot in all domains. The healthcare sector as many others is making technological progress to improve healthcare services and patients wellbeing and avoid or minimize the use of manual and traditional practices such as the use of paper notes to record the vital signs parameters data. The vital signs parameters are the most monitored physiology features, they produce a big amount of data and request a close follow up to define the health condition of a patient. Continuous vital signs monitoring involves the usage of different devices and systems, which if appropriate positively impact the activities involved, by enabling the continuous generation of data and information about the overall health status of patients and contribute to the wellbeing of individuals, in terms of preventing and reducing fatal risks. To investigate this situation, this research’s focus was in three parts; first, investigate recent research about patient’s health predictions based on vital signs parameters and the impacts of continuous monitoring on the care given. Second, explore the availability in terms of i.e. sensors used in devices that can continuously track vital signs parameters. Last, to provide a possible design recommendation to improve and/or replace the existing devices for vital signs parameters measuring and monitoring in emergency and post-operative care. A qualitative approach and participatory design approach were used to collect data. The qualitative part was achieved through interviews and the participatory design part was accomplished by the future workshop and two prototyping techniques, paper and digital prototypes. The findings of this research were analysed using conceptual analysis, and also discussed using those concepts. Together with the participants, this research resulted in three design suggestions which if implemented shall improve the vital signs continuous monitoring activities, by facilitating the healthcare professionals in their clinical responsibilities and improving the patients wellbeing while admitted in Emergency and Post-operative wards.

Abstract Developments in information technology have had a big impact in healthcare, producing vast amounts of data and increasing demands associated with their secure transfer, storage and analysis. To serve them, biomedical data need to carry patient information and records or even extra biomedical images or signals required for multimodal applications. The proposed solution is to host this information in data using data hiding algorithms through the introduction of imperceptible modifications achieving two main purposes: increasing data management efficiency and enhancing the security aspects of confidentiality, reliability and availability. Data hiding achieve this by embedding the payload in objects, including components such as authentication tags, without requirements in extra space or modifications in repositories. The proposed methods satisfy two research problems. The first is the hospital-centric problem of providing efficient and secure management of data in hospital networks. This includes combinations of multimodal data in single objects. The host data were biomedical images and sequences intended for diagnoses meaning that even non-visible modifications can cause errors. Thus, a determining restriction was reversibility. Reversible data hiding methods remove the introduced modifications upon extraction of the payload. Embedding capacity was another priority that determined the proposed algorithms. To meet those demands, the algorithms were based on the Least Significant Bit Substitution and Histogram Shifting approaches. The second was the patient-centric problem, including user authentication and issues of secure and efficient data transfer in eHealth systems. Two novel solutions were proposed. The first method uses data hiding to increase the robustness of face biometrics in photos, where due to the high robustness requirements, a periodic pattern embedding approach was used. The second method protects sensitive user data collected by smartphones. In this case, to meet the low computational cost requirements, the method was based on Least Significant Bit Substitution. Concluding, the proposed algorithms introduced novel data hiding applications and demonstrated competitive embedding properties in existing applications. / Tiivistelmä Modernit terveydenhuoltojärjestelmät tuottavat suuria määriä tietoa, mikä korostaa tiedon turvalliseen siirtämiseen, tallentamiseen ja analysointiin liittyviä vaatimuksia. Täyttääkseen nämä vaatimukset, biolääketieteellisen tiedon täytyy sisältää potilastietoja ja -kertomusta, jopa biolääketieteellisiä lisäkuvia ja -signaaleja, joita tarvitaan multimodaalisissa sovelluksissa. Esitetty ratkaisu on upottaa tämä informaatio tietoon käyttäen tiedonpiilotusmenetelmiä, joissa näkymättömiä muutoksia tehden saavutetaan kaksi päämäärää: tiedonhallinnan tehokkuuden nostaminen ja luottamuksellisuuteen, luotettavuuteen ja saatavuuteen liittyvien turvallisuusnäkökulmien parantaminen. Tiedonpiilotus saavuttaa tämän upottamalla hyötykuorman, sisältäen komponentteja, kuten todentamismerkinnät, ilman lisätilavaatimuksia tai muutoksia tietokantoihin. Esitetyt menetelmät ratkaisevat kaksi tutkimusongelmaa. Ensimmäinen on sairaalakeskeinen ongelma tehokkaan ja turvallisen tiedonhallinnan tarjoamiseen sairaaloiden verkoissa. Tämä sisältää multimodaalisen tiedon yhdistämisen yhdeksi kokonaisuudeksi. Tiedon kantajana olivat biolääketieteelliset kuvat ja sekvenssit, jotka on tarkoitettu diagnosointiin, missä jopa näkymättömät muutokset voivat aiheuttaa virheitä. Siispä määrittävin rajoite oli palautettavuus. Palauttavat tiedonpiilotus-menetelmät poistavat lisätyt muutokset, kun hyötykuorma irrotetaan. Upotuskapasiteetti oli toinen tavoite, joka määritteli esitettyjä algoritmeja. Saavuttaakseen nämä vaatimukset, algoritmit perustuivat vähiten merkitsevän bitin korvaamiseen ja histogrammin siirtämiseen. Toisena oli potilaskeskeinen ongelma, joka sisältää käyttäjän henkilöllisyyden todentamisen sekä turvalliseen ja tehokkaaseen tiedonsiirtoon liittyvät haasteet eHealth-järjestelmissä. Työssä ehdotettiin kahta uutta ratkaisua. Ensimmäinen niistä käyttää tiedonpiilotusta parantamaan kasvojen biometriikan kestävyyttä valokuvissa. Korkeasta kestävyysvaatimuksesta johtuen käytettiin periodisen kuvion upottamismenetelmää. Toinen menetelmä suojelee älypuhelimien keräämää arkaluontoista käyttäjätietoa. Tässä tapauksessa, jotta matala laskennallinen kustannus saavutetaan, menetelmä perustui vähiten merkitsevän bitin korvaamiseen. Yhteenvetona ehdotetut algoritmit esittelivät uusia tiedonpiilotussovelluksia ja osoittivat kilpailukykyisiä upotusominaisuuksia olemassa olevissa sovelluksissa.

Aims/Objectives: The objectives of this thesis were to examine and discuss the existing information and communication technology (ICT) tools used in the healthcare sector for older adults with dementia, the benefits and challenges of using these ICT tools from the perspective of older adults with dementia and their health care providers. Research methods: Data was collected using semi-structured interviews with older adults with dementia and health care providers and managers at a nursing home in Nigeria. All interviews were audio recorded with the consent of the research participants and then transcribed verbatim. All interview transcripts were analyzed using qualitative content analysis using the deductive approach. The coding scheme used for data analysis was derived from an existing framework called the Human-Organization-Technology fit (HOT) Framework. In addition, existing literature were reviewed on the use of ICT tools by older adults with dementia, their caregivers and their health care providers. Empirical findings: A total of six participants were interviewed for this study: two older adults with dementia, two nurses and two managers (one senior manager and one manager from the medical team). One older adult was 72 years old and was diagnosed with dementia one year ago. The other older adult was 70 years old and was diagnosed with dementia two years ago. The nurses that I interviewed have been working at this nursing home for 3 and 4 years respectively. The mangers that I interviewed have also been working at this nursing home for 3 and 4 years respectively. Two ICT tools are currently being used at this nursing home: 1) a GPS tracker and 2) a device that assists older adults with their daily activities. Eight themes emerged from the interviews: system quality, service quality, user satisfaction (perceived usefulness), system use, user expectation, organization structure, organization environment and net benefits. Conclusion and Future research: This study demonstrated that older adults with dementia and their caregivers (i.e. nurses) perceived the GPS tracker and the ADL assistant as userfriendly and helpful for supporting the daily activities. Most of the existing research on ICT tools used for dementia care have been conducted in North America and Europe. Therefore, there is a need for more research in Africa.

Bakgrund: Fysisk aktivitet är en viktig del av behandlingen hos personer med kroniskt obstruktiv lungsjukdom (KOL), då det kan förbättra personens self-efficacy. Fysisk aktivitet kan även förbättra den fysiska kapaciteten och upplevda livskvalitén. Efterfrågan på tillgänglighet, delaktighet och självständighet i egenvård har ökat vilket medfört en snabb utveckling av digitala lösningar. Kunskapsluckor föreligger fortfarande i hur effektivt en aktiv e-hälsointervention påverkar personer med KOL. Syfte: Genom denna strukturerade litteraturstudie undersöka om nyttjandet av aktiva e-hälsointerventioner har effekt på fysisk kapacitet, self-efficacy samt upplevd livskvalité hos personer med KOL.Metod: Datainsamling genomfördes i databaserna Pubmed, Cinahl, Web of science. En sållning utifrån titel och abstrakt följdes av en relevans och kvalitetsbedömning på potentiellt relevanta artiklar. Etiska aspekter beaktades i granskningen. Data extraherades och sammanställdes samt analyserades kvalitativt. Resultat: Totalt inkluderades sju studier: sex stycken randomiserade kontrollerade studier och en experimentell crossover studie. Kvalitetsbedömningen för systematiska bias var låg till medelhög. Fysisk kapacitet och livskvalité förbättrades signifikant i samtliga studier med nämnda utfallsmått. Däremot visade endast en av studierna på signifikant förbättring jämfört med kontrollgrupp för fysisk kapacitet och två studier för livskvalité. Self-efficacy förbättrades signifikant inom två av fyra studier varav det i en av dessa uppvisades en signifikant förbättring jämfört med kontrollgrupp. Slutsats: Denna strukturerade litteraturstudie indikerar att aktiva e-hälsointerventioner leder till förbättringar av fysisk kapacitet och upplevd livskvalité hos personer med KOL och kan användas som ett alternativ till sedvanlig behandling. Det går inte att dra någon slutsats gällande effekten av en aktiv e-hälsointerventionen på self-efficacy. / Background: Physical activity is an important part of the treatment of people with chronic obstructive pulmonary disease (COPD), as it can increase the person's self-efficacy. Physical activity may also increase the physical capacity and perceived quality of life. The demand for accessibility, participation and independence in self-care has increased as a result and rapid development of digital solutions. Knowledge gaps are still built in how effectively an active e-health intervention affects people with COPD.Aim: Through this structured literature study, to investigate whether the use of active e-health interventions has an effect on physical capacity, self-efficacy and perceived quality of life in people with COPD.Method: Data collection was performed in the databases Pubmed, Cinahl, Web of science. A screening based on title and abstract was followed by a relevance and quality assessment of potentially relevant articles. Ethical aspects were considered in the review. Data were extracted and compiled and analyzed qualitatively.Results: A total of seven studies were included: six randomized controlled trials and one experimental crossover study. The quality assessment for systematic bias was low to medium. Physical capacity and quality of life improved significantly in all studies physical capacity and quality of life improved significantly in all studies with the mentioned outcome measures. However, only one of the studies showed significant improvement compared with the control group for physical capacity and two studies for quality of life. Self-efficacy improved significantly in two of four studies, one of which showed a significant improvement compared with the control group. Conclusion: This structured literature study indicates that active e-health interventions lead to improvements in physical capacity and perceived quality of life in people with COPD and it can be used as an alternative to conventional treatment. It is not possible to draw any conclusions about the effect of an active e-health intervention on self-efficacy.