This research has examined how Information and Communication Technologies (ICTs) can promote healthy eating habits amongst African Americans in low-income neighborhoods, a population that faces disproportionately high rates of diet-related health problems. In this dissertation, I describe the formative research I conducted to obtain system design guidelines and how I used those guidelines to develop two applications: EatWell and Community Mosaic. I also describe the results of the in-depth field studies I conducted to evaluate each application. Both EatWell and Community Mosaic incorporate the cultural construct of collectivism, a social orientation in which interdependence and communal responsibility are valued over individual goals and independence. As researchers have generally characterized the African American culture as collectivistic and argued for the value of designing collectivistic health interventions for this population, I examined the implications of taking such an approach to designing health promotion technologies. EatWell and Community Mosaic are collectivistic because they empower users to care for the health of their local community by helping others learn practical, locally-relevant healthy eating strategies. I discuss the results of my formative fieldwork and system evaluations, which characterize the value, challenge and nuances of developing community-based health information sharing systems for specific cultural contexts. By focusing on health disparities issues and the community social unit, I extend previous health technology research within Human-Computer Interaction (HCI). In particular, my results describe 1) a set of characteristics that help make shared material useful and engaging, 2) how accessing this information affects how people view the feasibility of eating well in their local context, 3) the way in which sharing information actually benefits the contributor by catalyzing personal behavior reflection, analysis and modification and 4) how sharing information and seeing that information's impact on others can help to build individuals' capacity to be a community health advocate. In addition, my work shows how examining cultural generalizations such as collectivism is not a straightforward process but one that requires careful investigation and appreciation for the way in which such generalizations are (or are not) manifested in the lives of individual people. I further contribute to HCI by presenting a set of important considerations that researchers should make when designing and evaluating community-based health systems. I conclude this dissertation by outlining directions for future HCI research that incorporates an understanding of the relationship between culture and health and that attempts to address health disparities in the developed world.

Significant challenges to patient monitoring systems in a hospital environment include the reliable and energy-efficient transmission of data and their real-time display. This thesis proposes innovative and novel mechanisms for the reliable transmission of patient data in Body Area Network (BAN) communication, which simultaneously ensure high throughput, low data latency, and low energy consumption by implementing energy and QoS aware routing protocols. Five main contributions are made in this regard. Firstly, a novel patient monitoring system (ZK-BAN peering framework) is proposed for real-time hospital BAN communication that displays patient data on the display units by considering data privacy, low energy consumption, better control on the devices, and patient mobility. Secondly, a novel energy-aware peering routing protocol (EPR) is introduced in which the choice of next hop is based on the residual energy and geographic information of the neighbor nodes. EPR contains three main components: a Hello protocol, a neighbor table constructor algorithm, and a routing table constructor algorithm. Thirdly, a new modular QoS-aware routing protocol (QPRD) is designed to handle the ordinary and delay-sensitive data for BAN communication in hospitals. QPRD provides an end-to-end path delay mechanism to calculate the path delays of all possible paths from a source to destination and then chooses the best path with the lowest path delay for delay-sensitive packets. Fourthly, a novel modular QoS-aware routing protocol (QPRR) is developed to handle ordinary and reliability-sensitive data for BAN communication in hospitals. The modular architecture of QPRR includes five modules: a reliability module, a packet classifier, a Hello protocol module, a routing services module, and a QoS-aware queuing module. The proposed mechanisms for end-to-end path reliability calculation and data transmission using redundant paths ensure more reliable BAN communication. Finally, a new integrated energy and QoS aware routing protocol (ZEQoS) is designed to deal with ordinary, delay-sensitive, and reliability-sensitive data packets. Extensive simulations in the OMNeT++ based Castalia 3.2 simulator show that EPR, QPRD, QPRR, and ZEQoS perform better than other similar energy and QoS aware routing protocols.

Background: Information Communication Technologies (ICT)-mediated support can reduce family caregiver burden and may bridge service gaps caused by time constraints and language or cultural barriers. (Non)-usage behaviour can be explained using Andersen’s Behavioural Model of Health Service Utilization, Venkatesh’s Unified Theory of Use and Acceptance of Technology, Eysenbach’s Law of Attrition, and Wilson’s and Chatman’s Information Behaviour Theories. Purpose: This study aimed to describe and explain (non)-usage behaviour of ehealth services among Chinese caregivers. Method: This two-phase study used a mixed methods design involving 46 Chinese caregivers who cared for a family member with dementia. Usability of the ICT tools designed in the study was tested. Phase I participants (N=28) had access to a bilingual information site and personalized email support from professionals. Phase II participants (N=18) were randomized to use one of three enhanced features. Pre- and post-intervention data were collected, and qualitative interviews were conducted. Results: The Phase I ICT tools supported the core functions without major usability issues. Perceived efforts to use the ICT-mediated services influenced the consent decisions of Phase I caregivers (p=.036). Caregivers initiated service earlier if they had a higher acceptance of the service (p=0.017). Frequent users of email support experienced a decline of perceived burden compared with an escalation of perceived burden by non-users (p=0.023). An older age, greater caregiving competence, and lower English or computer proficiency explained non-usage behaviour. Requirements were identified to enhance the Phase I ICT tools. In Phase II, a test of three enhanced features showed there was no major usability issue. The intervention study found the enhanced features did not influence email use as hypothesized. Qualitative analysis showed usage patterns were explained by caregiver needs, caregiving beliefs, personal capacity, social support, ICT factors, and style of use. Non-users preferred Chinese to English compared with users (p=0.046). Integrating the theories and empirical findings, three concepts were developed to explain (non)-usage behaviour: usage in context, usage paths, and stages of use. Conclusion: Usage and non-usage behaviour can be explained by the service needs in the caregiving context, the use of non-ICT-mediated resources, and the access barriers to Internet use. Use of ICT-based support can be beneficial to caregivers if they do not drop out of the service.

Background: Information Communication Technologies (ICT)-mediated support can reduce family caregiver burden and may bridge service gaps caused by time constraints and language or cultural barriers. (Non)-usage behaviour can be explained using Andersen’s Behavioural Model of Health Service Utilization, Venkatesh’s Unified Theory of Use and Acceptance of Technology, Eysenbach’s Law of Attrition, and Wilson’s and Chatman’s Information Behaviour Theories. Purpose: This study aimed to describe and explain (non)-usage behaviour of ehealth services among Chinese caregivers. Method: This two-phase study used a mixed methods design involving 46 Chinese caregivers who cared for a family member with dementia. Usability of the ICT tools designed in the study was tested. Phase I participants (N=28) had access to a bilingual information site and personalized email support from professionals. Phase II participants (N=18) were randomized to use one of three enhanced features. Pre- and post-intervention data were collected, and qualitative interviews were conducted. Results: The Phase I ICT tools supported the core functions without major usability issues. Perceived efforts to use the ICT-mediated services influenced the consent decisions of Phase I caregivers (p=.036). Caregivers initiated service earlier if they had a higher acceptance of the service (p=0.017). Frequent users of email support experienced a decline of perceived burden compared with an escalation of perceived burden by non-users (p=0.023). An older age, greater caregiving competence, and lower English or computer proficiency explained non-usage behaviour. Requirements were identified to enhance the Phase I ICT tools. In Phase II, a test of three enhanced features showed there was no major usability issue. The intervention study found the enhanced features did not influence email use as hypothesized. Qualitative analysis showed usage patterns were explained by caregiver needs, caregiving beliefs, personal capacity, social support, ICT factors, and style of use. Non-users preferred Chinese to English compared with users (p=0.046). Integrating the theories and empirical findings, three concepts were developed to explain (non)-usage behaviour: usage in context, usage paths, and stages of use. Conclusion: Usage and non-usage behaviour can be explained by the service needs in the caregiving context, the use of non-ICT-mediated resources, and the access barriers to Internet use. Use of ICT-based support can be beneficial to caregivers if they do not drop out of the service.

IT is often seen as a solution to many problems concerning effectiveness in organizations. Information systems within the healthcare sector is often viewed as medical devices rather than just systems or services. These medical devices are thoroughly regulated by laws, standards and certifications. In this study I participated in an innovative project that aimed to bring new life and use to the old fashioned patient journal by giving it a visual representation through the use of an avatar. I aimed to study the effects of regulators connected with the patient journal as a source of information for the innovative project. I drew upon Actor-network theory as a theoretical lens to trace the patient journal and connect it with regulatory aspects important to innovative projects such as the studied scenario. I also aimed to research the possibilities and obstacles provided with today’s IT-climate in Swedish healthcare. I found that regulatory aspects according to Actor-network theory proved to be an actor that stabilizes the network that is the innovative project. Certain regulatory aspects such as quality management standards provided support for unifying the vision concerning the innovation. Further the regulatory aspects proved to be an actor that can shift power between project developers and external actors. The regulatory aspects did not show any significant effect on the innovation or its original vision. These aspects did however show proof of being a heavy provider of project complexity and experience concerning these aspects was shown to be hard to find. I also found that there are two distinct ways for an innovator to realize a vision within Swedish healthcare, the healthcare way and the patient way, these two ways are represented in a model framework for future research. Last but not least I presented a framework for future IT-architecture based on modern technology and the results found in this study.

The implementation of electronic medical record (EMR) systems is a complex process that is receiving more focus in developing countries to support understaffed and overcrowded health facilities deal with the HIV/AIDS epidemic. This thesis research uses exploratory-grounded theory to study clinician perceived benefits of EMRs in antiretroviral therapy (ART) clinics at four hospitals in Ethiopia. The study is designed to understand the process, technology, social and organizational challenges associated with EMR implementation in resource-limited areas. The research found the attitude of ART clinicians towards the implementation of EMR systems to be overwhelmingly positive. The data showed that perceived benefits of EMRs are improved continuity of care, timely access to complete medical record, patient care efficiency, reduced medication errors, improved patient confidentiality, improved communication among clinicians, integration of various HIV programs, timely decision support and overall job motivation. Conversely, drawbacks to EMR implementation include productivity loss and negative impact on the interaction and relationship between clinicians and their patients. The study proposes a conceptual framework classifying key components for successful EMR implementation in Ethiopia.

Eine stetig wachsende Zahl von Nutzern sucht im Internet nach Gesundheitsinformationen. Hierzu steht ihnen eine Vielzahl ganz unterschiedlicher Anbieter zur Verfügung, die bei divergierenden Interessen gesundheitsrelevante Angebote im Internet vorhalten. Abgesehen von der Informationsflut, mit der die Nutzer bei der Suche überhäuft werden, erhalten sie auch falsche, irreführende, veraltete und sogar gesundheitsgefährdende Informationen. In den letzten zehn Jahren haben verschiedene Wissenschaftler die Anforderungen an ein ideales Gesundheitsinformationssystem ermittelt. Im Rahmen des in diesem Beitrag beschriebenen Projekts wurde ein Gesundheitsinformationssystem als Prototyp zur anamnesebezogenen, internetbasierten Patienteninformation entwickelt und anhand einer Studie evaluiert. Dabei wird die Untersuchung auf deutschsprachige Erwachsene mit Kopfschmerzen eingegrenzt. Insgesamt wird die Hypothese überprüft, dass eine angeleitete, anamnesebezogene Internetsuche für den Patienten bessere Ergebnisse liefert, als dies durch die herkömmliche Nutzung von Gesundheitsportalen oder Suchmaschinen erreicht werden kann. Zur Evaluation wurde eine kontrollierte Zweigruppenstudie mit insgesamt 140 Teilnehmern in zwei Studienabschnitten durchgeführt. Dabei wurde im ersten Abschnitt festgestellt, dass bei einfach strukturierten Krankheitsfällen das Informationssystem gleichgute Ergebnisse liefert wie die herkömmliche Suche. Im zweiten Abschnitt konnte allerdings festgestellt werden, dass bei komplexen Kopfschmerzfällen mit Hilfe des Prototyps signifikant (P=0,031) bessere Diagnosen gestellt werden konnten als ohne. Medizinische Expertensysteme in Kombination mit einer Meta-Suche nach maßgeschneiderten qualitätsgesicherten Informationen erweisen sich als probate Möglichkeit, den Ansprüchen an eine geeignete Versorgung mit Gesundheitsinformationen gerecht zu werden. / A steadily increasing number of users search for health information online. Therefore, a multitude of totally different providers with diverging interests offer information. Apart from the information overload the users are flooded with, they may access false, misleading or even life threatening information. In the last 10 years scientists have determined the requirements of an ideal health information system. In the study described in this paper a prototype health information system providing anamnesis related internet-based consumer health information is evaluated. In total, the hypothesis that a computer-aided anamnesis-related internet search provides better results than the use of conventional search engines or health portals is evaluated. For evaluation a randomised controlled study with 140 participants has been conducted in two study sections. In the first section it was found, that for a less complex diagnosis the prototype information system did equally well as the conventional information retrieval. In the second study section it was found, that dealing with complex headache cases participants using the prototype determined significantly better (P=0.031) diagnoses than the control group did without prototype support. It has been shown, that medical expert systems in combination with a meta-search for tailored quality controlled information represents a feasible strategy to provide reliable health information.

Submitted by Valdinei Souza (neisouza@hotmail.com) on 2017-06-07T20:40:38Z No. of bitstreams: 1 Angela Cristina Cordeiro - dissertacao.pdf: 1563714 bytes, checksum: 3ea9e96b6a530db7d50d564c70429204 (MD5) / Approved for entry into archive by Urania Araujo (urania@ufba.br) on 2017-06-14T19:35:23Z (GMT) No. of bitstreams: 1 Angela Cristina Cordeiro - dissertacao.pdf: 1563714 bytes, checksum: 3ea9e96b6a530db7d50d564c70429204 (MD5) / Made available in DSpace on 2017-06-14T19:35:24Z (GMT). No. of bitstreams: 1 Angela Cristina Cordeiro - dissertacao.pdf: 1563714 bytes, checksum: 3ea9e96b6a530db7d50d564c70429204 (MD5) / Capes / As Informações em Saúde no Brasil constituem-se um quadro complexo e diversificado da realidade sanitária do território e apoiam as deliberações para a gestão do Sistema Único de Saúde (SUS). Essas informações são geradas em razão dos serviços de atenção à saúde e são os insumos que diariamente alimentam os sistemas de informações do Ministério da Saúde/DATASUS. Os Sistemas de Informações em Saúde (SIS) configuram-se como mecanismos de transferência de informações para a gestão em saúde, no entanto, vários problemas podem ser diagnosticados quanto à utilização desses sistemas: produção de informações de baixa qualidade e subutilizadas, duplicação de sistemas de informações de forma verticalizada e não-integrada, dificuldades quanto à retroalimentação desses sistemas. Percebe-se que as informações que alimentam esses SIS possuem um viés meramente para fins estatísticos e na maioria dos casos, a utilização desses SIS pelos gestores em saúde é feita de forma compulsória. Neste contexto, o objetivo desta pesquisa é verificar se os mecanismos de transferências de informações dos hospitais convergem com as diretrizes da Política Nacional de Informação e Informática em Saúde (PNIIS) e do Plano de Desenvolvimento para a nformação e a Tecnologia da Informação em Saúde (PlaDITIS). Para tanto, são identificadas as fontes e os mecanismos de transferência de informações utilizadas nos organismos de serviços de saúde e, se estas estão em conformidade com estas diretrizes. O arcabouço teórico, metodológico da pesquisa procurou ressaltar a importância da PNIIS e o PlaDITIS para uma gestão integrada, acesso e uso da informação e da tecnologia da informação na definição das políticas de saúde. A pesquisa é exploratória e descritiva com uma abordagem quali-quantitativa. A população para a realização desta pesquisa são 39 hospitais com termo de adesão à Rede de Inovação e Aprendizagem em Gestão Hospitalar. Para o levantamento dos dados utilizou-se como instrumento o questionário e o roteiro semi-estruturado para a entrevista, com a finalidade de alcançar os objetivos propostos. O tratamento dos dados foi realizado por meio da estatística descritiva e análise de conteúdo. Os resultados revelam a necessidade da disseminação das políticas de informação e informática e a necessidade da difusão do uso de mecanismos de transferência de informações entre os organismos prestadores de serviços de atenção à saúde no Brasil. / ABSTRACT - Health information in Brazil constitute a complex and diverse picture of the reality of health and support the deliberations for the management of the unified health system (SUS).This information is generated as a result of health care services and are the inputs that feed the information systems of the Ministry of health/DATASUS. Health Information systems (SIS) configure themselves transfer mechanisms for information management in health, however, several problems can be diagnosed on the use of these systems: production of low-quality information and under-utilized, duplication of information systems of vertical and non-integrated form, difficulties with regard to the feedback of these systems. You understand that the information that feed these SIS have a bias merely for statistical purposes and in most cases, the use of SIS for health managers is compulsory. In this context, the objective of this research is to verify if the information transfer mechanisms of hospitals converge with the guidelines of the national information Policy and health informatics (PNIIS) and the development plan for the information and information technology in health (PlaDITIS). Are identified the sources and information transfer mechanisms used in health services organizations and, where these are in accordance with these guidelines. The methodological research, sought to highlight the importance of PNIIS and PlaDITIS for integrated management, access and use of information and information technology in the definition of health policies. The research is exploratory and descriptive with a quali-quantitative approach. The population for this research are 39 hospitals with term of membership of the learning and innovation network in hospital management. To survey the data used as a tool the questionnaire and semi-structured interview script, in order to achieve the proposed objectives. The treatment of the data was performed by descriptive statistics and content analysis. The results reveal the need for dissemination of information and informatics policies and the need for the dissemination of the use of mechanisms for information transfer between agencies providers of health care in Brazil.

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No. of bitstreams: 1 Tese Marcelo Fornazin v6.7.pdf: 1947262 bytes, checksum: 1728309026e097eb7fa686774dc57ed3 (MD5) Previous issue date: 2015-05-07 / Information and Communication Technologies (ICT) have been used in many areas and common activities, but although there are initiatives undertaken by government and private institutions, health informatics are still an open challenge in Brazil. Today’s scenario raises questions about difficulties related to informatics usage in health and healthcare practices, as well as, the effects of these difficulties on Brazilian society. Aiming to discuss the aforementioned questions, this thesis presents four papers about health informatics in Brazil. The first paper reviews literature about ICT in health. Therefore, based on two theoretical perspectives – (a) European studies about Health Information Systems (HIS) in Developing Countries and (b) studies on Information and Informatics in Health, in the Sanitary Reform Movement –, the paper proposes an integrated model linking analytical dimensions and contextual factors in order to understand HIS in Brazil. The second paper presents theoretical and methodological concepts from Actor-Network Theory (ANT), a research approach to investigate controversies associated with scientific discoveries and technological innovations, based on the network of actors related to such actions. The ANT theoretical approach has supported IS research since 1990 and inspired the analysis conducted in the third and fourth papers presented in this thesis. The final two papers have been written based on the case analysis from the deployment of an HIS in a public hospital in Brazil, conducted during 2010 and 2012. In order to analyze the case, the actors involved in the controversies that emerged during the deployment of the HIS were followed. The third paper focuses on the activities of system analysts and users involved in the HIS deployment. The changes observed over the course of the system deployment reveal that success has not been achieved by the strict and technical execution of the planned tasks. Rather, the success has been constructed collectively through negotiation among actors and the introduction of ‘devices of interessement’ during the project. The fourth paper, based on the Information Infrastructures concept, discusses how the CATMAT system has been merged with the E-Hosp. The analysis reveals how the installed base of CATMAT has been a relevant condition leading to is selection during the E-Hosp deployment. Moreover, it describes negotiations and heterogeneous operations that occurred during the integration of CATMAT into E-Hosp. Thus, this thesis argues that HIS deployment is an effort of collective construction, involving system analysts, health professionals, politicians and technical artifacts. In addition, it makes clear how HIS inscribes definitions and agreements, influencing actors’ preferences in health and healthcare. / As tecnologias da informação e comunicação (TIC) estão presentes nas mais diversas áreas e atividades cotidianas, mas, em que pesem as ações de governos e instituições privadas, a informatização da saúde ainda é um desafio em aberto no Brasil. A situação atual leva a um questionamento sobre as dificuldades associadas à informatização das práticas em saúde, assim como, quais efeitos tais dificuldades têm causado à sociedade Brasileira. Com objetivo de discutir as questões acima citadas, esta tese apresenta quatro artigos sobre processo de informação da saúde no Brasil. O primeiro artigo revisa a literatura sobre TIC em saúde e baseado em duas perspectivas teóricas – estudos Europeus acerca dos Sistemas de Informação em Saúde (SIS) nos Países em Desenvolvimento e estudos sobre Informação e Informática em Saúde, no âmbito do Movimento da Reforma Sanitária –, formula um modelo integrado que combina dimensões de análise e fatores contextuais para a compreensão dos SIS no Brasil. Já o segundo artigo apresenta os conceitos e teóricos e metodológicos da Teoria Ator-Rede (ANT), uma abordagem para o estudo de controvérsias associadas às descobertas científicas e inovações tecnológicas, por meio das redes de atores envolvidos em tais ações. Tal abordagem tem embasado estudos de SI desde 1990 e inspirou as análises dois artigos empíricos desta tese. Os dois últimos artigos foram redigidos a partir da análise da implantação de um SIS em um hospital público no Brasil ocorrida entre os anos de 2010 e 2012. Para a análise do caso, seguiram-se os atores envolvidos nas controvérsias que surgiram durante a implantação do SIS. O terceiro artigo se debruçou sobre as atividades dos analistas de sistema e usuários envolvidos na implantação do SIS. As mudanças observadas durante a implantação do sistema revelam que o sucesso do SIS não foi alcançado pela estrita e técnica execução das atividades incialmente planejadas. Pelo contrário, o sucesso foi construído coletivamente, por meio da negociação entre os atores e de dispositivos de interessamento introduzidos durante o projeto. O quarto artigo, baseado no conceito das Infraestruturas de Informação, discutiu como o sistema CATMAT foi incorporado ao E-Hosp. A análise revelou como a base instalada do CATMAT foi uma condição relevante para a sua escolha durante a implantação do E-Hosp. Além disso, descrevem-se negociações e operações heterogêneas que aconteceram durante a incorporação do CATMAT no sistema E-Hosp. Assim, esta tese argumenta que a implantação de um SIS é um empreendimento de construção coletiva, envolvendo analistas de sistema, profissionais de saúde, políticos e artefatos técnicos. Ademais, evidenciou-se como os SIS inscrevem definições e acordos, influenciando as preferências dos atores na área de saúde.

Abstract Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency towards the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through the use of mobile technologies (mHealth) has grown exponentially in recent years. However, only a fraction of these solutions takes into consideration the views of relevant stakeholders like healthcare professionals or even patients. The use of behavioral change models (BCM) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. This doctoral thesis is framed in Consumer Health Informatics within the field of Medical Informatics and Information Systems. The focus of this work was to discover factors for the design of mHealth solutions for chronic patients; to do so, negotiations between medical knowledge, BCM and gamification were explored through an embedded case study research methodology. The data obtained was thematically analyzed to create the Model for Motivational Mobile-health Design for Chronic conditions (3MD). The 3MD model guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are: 1) Condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; 2) Motivation related, which are factors that address how to influence behaviors in an engaging manner; and 3) Technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. 3MD also provides a series of high level illustrative design questions for designers to use and consider during the design process. The work on this thesis addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients. / Tiivistelmä Krooniset sairaudet ovat maailman yleisin kuolinsyy. Akuutissa hoidossa ja diagnostiikassa on tapahtunut merkittäviä parannuksia, ja aikaisemmin kuolemaan johtaneista sairauksista on tullut kroonisia ja ihmisten on opittava hallitsemaan niitä itse. Mobiiliteknologiat tarjoavat mahdollisuuksia sairauksien itsehallintaan, koska teknologiaa on yleisesti saatavilla ja se on kustannustehokasta. Terveyspalvelujen tarjoaminen mobiiliteknologian avulla on lisääntynyt huomattavasti viime vuosina. Kuitenkin vain murto-osa näistä ratkaisuista ottaa huomioon sidosryhmien, kuten terveydenhuollon ammattilaisten ja jopa potilaiden, näkemykset. Käyttäytymismuutosmallit ovat osoittautuneet tärkeiksi kehitettäessä onnistuneita terveysratkaisuja, mutta potilaiden osallistaminen kehittämiseen on yhä vaikeaa. Pelillistäminen on mobiilien terveysratkaisujen suunnittelutrendi, ja pelielementeillä pyritään vaikuttamaan ihmisten käyttäytymiseen ja sitoutumiseen. Mobiilien terveyssovellusten suunnittelijoilla ei ole selkeää näkemystä siitä, mitkä sovellustekijät vaikuttavat merkittävimmin kroonisissa sairauksissa sairastavien potilaiden käyttäytymisen muutokseen. Tämä väitöskirja tarkastelee kuluttajille suunnattua terveysteknologiaa, joka hyödyntää lääketieteellistä informatiikkaa ja tietojärjestelmätieteitä. Työn tavoitteena oli selvittää kroonisia sairauksia sairastaville potilaille tarkoitettujen mobiilien terveyssovellusten suunnitteluun liittyviä tekijöitä. Tämän vuoksi lääketieteen tietämyksen, käyttäytymismuutoksien mallien ja pelillistämisen yhdistämistä tutkittiin sulautetun tapaustutkimuksen avulla. Saatuja tietoja temaattisesti analysoimalla luotiin kroonisia sairauksia varten motivoivan mobiilin terveyssovelluksen suunnittelumalli (3MD = Model for Motivational Mobile-health Design). 3MD-malli ohjaa sairauksien hallintaan tarkoitettujen pelillistettyjen ja käyttäytymismuutoksiin tähtäävien mobiilien terveyssovellusten suunnittelua. Mallin pääkomponentit ovat: 1) Sairautta kuvaavat tekijät, jotka kuvaavat tekijöitä, jotka on mukautettava ja sovitettava kullekin krooniselle sairaudelle. 2) Motivaatioon liittyvät tekijät, jotka vaikuttavat innostavasti käyttäytymiseen. 3) Teknologiaan perustuvat tekijät, jotka liittyvät suoraan mobiiliteknologian teknisiin ominaisuuksiin. 3MD tarjoaa myös havainnollisia suunnittelukysymyksiä, joita suunnittelijat voivat käyttää ja pohtia suunnitteluprosessin aikana. Tämä väitöskirja käsittelee yleisesti tunnistettua puutetta tutkimuksessa ja suunnittelukäytännössä ja esittelee ainutlaatuisen mallin, josta voi olla hyötyä uusien ratkaisujen luomisessa ja kroonisia sairauksia sairastavien potilaiden auttamisessa.