The medical technology sector in Germany is considered an innovative, fast-growing and promising industry, being third behind the USA and Japan as the biggest market in the world, worth 17.1 billion euros. Consequently, supply chain success is of high importance. This research identified the Critical Success Factors (CSFs) for Original Equipment Manufacturers that are involved within medical technology supply chains in Germany. This thesis begins with a full literature review on Supply Chain Management (SCM) in the medical technology sector and presents the current state of academic discussion on CSFs in this context. The literary analysis identified that most academic research focuses on developing theory based on supply chains of the manufacturing sector with the consumer market as their primary concern, with limited insights into Medical Technology Supply Chains (MTSCs). This was a main driver for the exploration of the drivers and barriers extant in this sector. Two studies were designed to address the identified research gaps. The first study was a qualitative research using multiple case studies and was divided in two phases. Phase A involved 15 German manufacturers of medical technology products and focused on identifying the CSFs in this sector. Phase B involved 14 German manufacturers and uncovered issues and weaknesses of their current SCM strategies by means of an assessment tool developed specially for this study. The second study consisted of an action research project, using interviews and participative workshops to develop an understanding on how organisations in this sector can improve operations using the CSFs concept while offering insights into the actual implementation of SCM strategies and the behavioural aspects of change management in this context. The findings extend theory and provide insights into real-world practitioner challenges and priorities. The outcomes of this study propose that the prioritised combination of the identified CSFs leads to better performance of OEMs in the German MTSC sector, which shifts our understanding of how practitioners prioritise CSFs. Furthermore, this thesis addresses the qualitative knowledge gap around the relational aspects of implementing SCM practices within this sector, while exploring relationships between stakeholders during the process of introducing these changes. These findings challenge existing generic assumptions about supply chain CSFs, as well as adding to SCM, CSF, and medical technology research and knowledge.

Over the last decade the beneficial properties of hydrogels as artificial cell culture supports have been extensively investigated. Certain synthetic hydrogels have been proposed to be similar in composition and structure to the native extracellular matrix of the stem cell niche, their in vivo cell habitat, which is a powerful component in controlling stem cell fate. The stem cell differentiation pathway taken is influenced by many factors. When culturing cells within or upon hydrogels the choice can be strongly dependent on the underlying 3D hydrogel chemistry which strongly influences hydrogel-cell interactions. The interrelationship between hydrogel chemistry and that of biomolecules in controlling cellular response ideally requires analysis methods to characterise the chemistry without labels and normally in 3D. Time-of-flight secondary ion mass spectrometry (ToF SIMS) has the potential to be utilised for through thickness characterisation of hydrogels. The frozen-hydrated sample format is well suited to minimise changes associated with dehydration or the complication of chemical ‘fixation’. There is however significant challenges associated with this sample format. Frost formation occurs on cold samples in the ambient atmosphere affecting the quality of chemical information acquired from depth profiling frozen hydrogel samples. We develop a simple method to remove this frost by blowing with gas prior to entry into the instrument which is shown to produce remarkably good profiles on a poly(2-hydroxyethyl methacrylate) (pHEMA) hydrogel film where a model protein, lysozyme, is incorporated to demonstrated how biomolecule distribution within hydrogels can be determined. A comparison of lysozyme incorporation is made between the situation where the protein is present in the polymer dip coating solution and lysozyme is a component of the incubation medium. It is shown that protonated water clusters H(H2O)n+ where n=5-11 that are indicative of ice are detected through the entire thickness of the pHEMA and the lysozyme distribution through the pHEMA hydrogel films can be determined using the intensity of characteristic fragment secondary ions. Quantitative TOF-SIMS analysis is highly desirable in biomaterial analysis as the amount and type of molecule in the material analysed may be determined. This has significant interest in hydrogel chemical analysis as cellular development on or within hydrogels may be highly influenced by the concentration and type of soluble molecule. Unfortunately, the matrix effect in SIMS changes the measured signal intensity of the analyte, preventing accurate quantitation. For this reason, we apply X-Ray Photoelectron Spectroscopy (XPS) on the equivalent samples as the ToF-SIMS in an attempt to correlate molecular ion yields to exact elemental concentrations. Similarly to ToF-SIMS the frozen-hydrated format in XPS is however still relatively unexplored. We apply the developed preparatory procedure in 3D XPS analysis of pHEMA/lysozyme hydrogel films in a hydrated state. We show that this format is suitable for alternative high vacuum analysis techniques. Furthermore, we show that lysozyme ingression and concentration can be determined through XPS. This work describes the first example of the characterisation of a hydrogel by ToF-SIMS and XPS in a frozen hydrated format, characterising hydrogels in a format most reflecting its native hydrated state at culture conditions. The described procedure allows for the mapping of biomolecules in a label free manner in 3D, furthermore allowing quantitative determination of biomolecule concentrations in hydrogels.

Epithelial crypts isolated from normal colon mucosa have been cultured in vitro in the form of organoids. These organoids have been shown to have regenerative potential when implanted in mouse models of denuded colon mucosa. However, a major limitation in the translation of these studies to a clinical setting is the use of Matrigel, which is clinically unsuitable due to its undefined composition and potential for tumourigenicity. Additionally, enclosed organoids do not fully reproduce the structure and function of native tissue, and do not lead to full integration into the host. Therefore, the overall aim of this thesis was to investigate different scaffolds for their ability to support growth of primary colon epithelial cells in order to form an open monolayer structure that resembles native epithelium. It was anticipated that in vitro culture of primary colon cells would be more efficient with isolated stem cells than with an entire heterogeneous epithelial cell population. Therefore, the side population technique was explored using established cell lines as a method of isolating a population enriched in stem cells, based on their ability to efflux the Hoechst 33342 dye. This was found to be irreproducible and unreliable so was not pursued further. Various scaffolds were manufactured, characterised and seeded with colon epithelial cell lines to investigate how their morphological and biochemical characteristics influenced cell proliferation and differentiation. Electrospun nanofibre and microfibre scaffolds made from the synthetic material PET, and the natural polymer gelatin were fabricated. All electrospun scaffolds supported proliferation, and cells on gelatin nanofibre scaffolds differentiated to form tight junctions that are typical of epithelial cells, while also expressing increased levels of the stem cell marker ABCG2. Thereby, gelatin nanofibres demonstrated the ability to support appropriate cell differentiation while maintaining a pool of stem cells. Gelatin in the form of hydrogel scaffolds was also investigated for its ability to support cell proliferation and influence cell differentiation. Moreover, a novel method of rapidly 3D printing scaffolds using unmodified gelatin was presented. Both planar and 3D gelatin scaffolds were able to support proliferation and tight junction formation in Caco2 cells. Thus, it was concluded that gelatin hydrogels are a suitable substrate for proliferation and differentiation of colon carcinoma cell lines, and that the addition of the printed topography did not have any negative effects on cell growth and behaviour. Epithelial crypts were isolated from human colon mucosa and expanded in vitro in the form of organoids, as previously published. It was found that the precise nature and source of organoid media components are critical for successful primary cell culture. A method in which the Wnt signalling cascade is indirectly activated by GSK3β inhibition was found to be partially successful for growing organoids and may be a potential alternative culture method. Primary organoid cells were seeded onto gelatin nanofibre and hydrogel scaffolds, however the cells did not proliferate in these preliminary experiments. Overall, it was concluded that although the gelatin scaffolds demonstrated promising results with colon carcinoma cell lines, more research would be required in order to produce scaffolds that can support growth of primary colon epithelial cells.

A introdução das tecnologias duras no setor saúde transformou o processo de trabalho, e, apesar dos inestimáveis benefícios, deve ser vista com cautela pelos trabalhadores devido a problemas relativos à confiabilidade, à fidedignidade dos dados e à necessidade de manutenção preventiva e corretiva de aparelhos por especialistas. Por outro lado, há exigências impostas em termos de conhecimentos e habilidades para a sua utilização, pois há riscos de erros e iatrogenias que devem ser identificados e trabalhados pela organização com vistas à segurança no desempenho, satisfação e bem estar do trabalhador. Nesse sentido, a sua utilização acarreta o aumento do número de tarefas, a intensificação do ritmo de trabalho, devido à necessidade de controle extenuante por parte do trabalhador no intuito de manter o equilíbrio das demandas advindas da máquina e do paciente. Tais exigências repercutem na saúde do trabalhador e acarreta problemas de ordem física e psíquica. Objetivou-se neste estudo: identificar a percepção do trabalhador de enfermagem sobre a utilização da tecnologia dura em Unidade de Terapia Intensiva (UTI); descrever os fatores intervenientes em relação ao uso da tecnologia dura pelo trabalhador de enfermagem em UTI e analisar as repercussões da utilização da tecnologia dura para o processo de trabalho e a saúde do trabalhador de enfermagem em UTI. Estudo qualitativo descritivo, cujos dados foram obtidos em uma UTI de um hospital público situado no município de Niterói-RJ no período de dezembro 2011 a fevereiro 2012 com 25 trabalhadores (11 enfermeiros e 14 técnicos de enfermagem), a partir dos critérios de inclusão adotados. Trabalhou-se com a técnica de entrevista semiestruturada, mediante um roteiro contendo questões sobre a problemática do estudo. O projeto atendeu as exigências presentes na Resolução 196/96, do Ministério da Saúde (MS), tendo sido aprovado pelo Comitê de Ética em Pesquisa (CEP) sob n CAAE: 2063000025811. Na categorização dos depoimentos utilizou-se a técnica de análise do conteúdo de Bardin e os resultados discutidos a luz da Psicodinâmica do Trabalho. Identificou-se que a incorporação da tecnologia dura em UTI, na visão dos trabalhadores de enfermagem é um instrumento de trabalho por proporcionar maior segurança, rapidez na execução das tarefas, confiabilidade e controle em relação ao estado clínico do paciente e minimizar atividades repetitivas. Por outro lado há problemas relativos à manutenção preventiva e corretiva dos aparelhos que acarretam incômodo, interrupções e sobrecarga mental e física devido à necessidade de ajustes frequentes dos alarmes e parâmetros estabelecidos, troca de aparelhos e reposição de peças; fatores limitantes e que exigem a intervenção de especialistas. Diante desta situação de trabalho, as tecnologias duras utilizadas em UTI configuraram-se como fatores de risco psicossocial por acarretarem estresse ocupacional e cujos recursos internos e externos utilizados pelos trabalhadores mostraram-se insuficientes para o seu enfrentamento. Cabe a organização do trabalho, juntamente com os trabalhadores realizar ações que minimizem os fatores de riscos apontados com vistas à satisfação, a motivação e a saúde dos trabalhadores de enfermagem e demais membros da equipe. / The introduction of hard technologies in health sector has transformed the work process, and, although priceless benefits, it must be seen by workers with caution due to problems related to reliability, data authenticity and corrective and preventive maintenance by specialists. On the other hand, there are some imposed demands in terms of knowledge and abilities for their use, for there are error risks and iatrogenis which must be identified and worked on by the organization aiming at performance safety, satisfaction and worker welfare. At this point, its use brings about the increase of assignments number, work rhythm intensification, due to the need of strenuous control by workers to keep the balance of demands from the machine and the patient. Such demands coaxes on worker health and causes mental and physical problems. It has aimed at identifying the nursing workers perception about ICU hard technology use; describing intervening factors in relation to nursing workers hard technology use at the ICU for the working process and Intensive Care Unit (ICU) nursing workers health. A descriptive qualitative study wich data have been obtained from a public hospital ICU located at Niterói district-RJ between December 2011 and February 2012 with 25 workers (11 nurses and 14 nursing technicians), from adopted inclusion criteria. The semi structured interview has been used through a script of this study problematic questions. The project has answered the demands of Resolution 196/96 from The Ministry of Health (MS), and has been aproved by the Committee of Ethics in Research (CEP) under the number CEP CAAE: 2063000025811. In the testimonies categorization the content analysis technique has been used Bardin, and the outcomes have been discussed under the light of Work Psychodynamics. It has been identified that ICU hard technology incorporation, under the sight of nursing workers, is a working tool for it provides more security, speed in tasks accomplishment, reliability and control related to the patients clinical status and decreasing repetitive actions. On the other hand, there are problems related to machines corrective and preventive maintenance which cause annoyance, interruptions and mental and physical overcharge due to the need of frequent alarm adjustments and set parameters, equipment changes and pieces replacement; limiting factors and which demand specialists intervention. Facing this work situation, hard technologies used in ICU configure as psychosocial risk factors for they cause occupational stress which internal and external resources used by workers show insufficient for their coping. The work organization with workers themselves must perform actions that minimize the marked risk factors aiming at nursing workers satisfaction, motivation and health as well as for the other members of the team.

Thesis (MTech(Medical Technology))--Cape Technikon, Cape Town, 1996 / Haematol.ogical defects observed in cl.onal deletions of mtDNA and the inhibition of mitochondrial function by benzene and chloramphenicol., suggest a role for mtDNA in the pathogenesis of radiation - induced preleukaemia (MDS). The fact that leukaemia cell.s contain abnormal mitochondria and abnormally structured mtDNA, makes it reasonable to assume mtDNA mutations could be central to the pathogenesis of both MDS and l.eukaemia. It was decided to examine MDS patients for the presence of mtDNA length mutations (dimers and cocantameres). Such topol.ogical forms have already been reported in the literature in association with human leukaemia. These steric considerations suggest that mtDNA dimers are probably non-functional due to supercoil.ing. Thus, it was felt that a progressive accumulation of non-functional dimers in the haematopoietic compartment could account for many of the cl.inical. features associated with MDS. Transmission electron microscopy was used to examine haematopoietic mtDNA in the bone marrow of six patients with MDS. Abnormal mtDNA dimer formation was found in al.l instances. The proportional. number of these dimers were found to roughly correlate with the Myeloid/ Erythroid cell. ratio in the bone marrow, and it appeared likely that the dimers were generated in the myeloid compartment during early MDS. Control.l.ed radiation studies were performed on 20 wistar rats in an attempt to elucidate the approximate time when abnormal mtDNA dimer formation occurred, fol.l.owing fractionated gamma or gamma-neutron irradiation. Gamma-irradiated rats demonstrated abnormal mtDNA dimer formation at the time hypoplastic marrow recovery was first observed.

A introdução das tecnologias duras no setor saúde transformou o processo de trabalho, e, apesar dos inestimáveis benefícios, deve ser vista com cautela pelos trabalhadores devido a problemas relativos à confiabilidade, à fidedignidade dos dados e à necessidade de manutenção preventiva e corretiva de aparelhos por especialistas. Por outro lado, há exigências impostas em termos de conhecimentos e habilidades para a sua utilização, pois há riscos de erros e iatrogenias que devem ser identificados e trabalhados pela organização com vistas à segurança no desempenho, satisfação e bem estar do trabalhador. Nesse sentido, a sua utilização acarreta o aumento do número de tarefas, a intensificação do ritmo de trabalho, devido à necessidade de controle extenuante por parte do trabalhador no intuito de manter o equilíbrio das demandas advindas da máquina e do paciente. Tais exigências repercutem na saúde do trabalhador e acarreta problemas de ordem física e psíquica. Objetivou-se neste estudo: identificar a percepção do trabalhador de enfermagem sobre a utilização da tecnologia dura em Unidade de Terapia Intensiva (UTI); descrever os fatores intervenientes em relação ao uso da tecnologia dura pelo trabalhador de enfermagem em UTI e analisar as repercussões da utilização da tecnologia dura para o processo de trabalho e a saúde do trabalhador de enfermagem em UTI. Estudo qualitativo descritivo, cujos dados foram obtidos em uma UTI de um hospital público situado no município de Niterói-RJ no período de dezembro 2011 a fevereiro 2012 com 25 trabalhadores (11 enfermeiros e 14 técnicos de enfermagem), a partir dos critérios de inclusão adotados. Trabalhou-se com a técnica de entrevista semiestruturada, mediante um roteiro contendo questões sobre a problemática do estudo. O projeto atendeu as exigências presentes na Resolução 196/96, do Ministério da Saúde (MS), tendo sido aprovado pelo Comitê de Ética em Pesquisa (CEP) sob n CAAE: 2063000025811. Na categorização dos depoimentos utilizou-se a técnica de análise do conteúdo de Bardin e os resultados discutidos a luz da Psicodinâmica do Trabalho. Identificou-se que a incorporação da tecnologia dura em UTI, na visão dos trabalhadores de enfermagem é um instrumento de trabalho por proporcionar maior segurança, rapidez na execução das tarefas, confiabilidade e controle em relação ao estado clínico do paciente e minimizar atividades repetitivas. Por outro lado há problemas relativos à manutenção preventiva e corretiva dos aparelhos que acarretam incômodo, interrupções e sobrecarga mental e física devido à necessidade de ajustes frequentes dos alarmes e parâmetros estabelecidos, troca de aparelhos e reposição de peças; fatores limitantes e que exigem a intervenção de especialistas. Diante desta situação de trabalho, as tecnologias duras utilizadas em UTI configuraram-se como fatores de risco psicossocial por acarretarem estresse ocupacional e cujos recursos internos e externos utilizados pelos trabalhadores mostraram-se insuficientes para o seu enfrentamento. Cabe a organização do trabalho, juntamente com os trabalhadores realizar ações que minimizem os fatores de riscos apontados com vistas à satisfação, a motivação e a saúde dos trabalhadores de enfermagem e demais membros da equipe. / The introduction of hard technologies in health sector has transformed the work process, and, although priceless benefits, it must be seen by workers with caution due to problems related to reliability, data authenticity and corrective and preventive maintenance by specialists. On the other hand, there are some imposed demands in terms of knowledge and abilities for their use, for there are error risks and iatrogenis which must be identified and worked on by the organization aiming at performance safety, satisfaction and worker welfare. At this point, its use brings about the increase of assignments number, work rhythm intensification, due to the need of strenuous control by workers to keep the balance of demands from the machine and the patient. Such demands coaxes on worker health and causes mental and physical problems. It has aimed at identifying the nursing workers perception about ICU hard technology use; describing intervening factors in relation to nursing workers hard technology use at the ICU for the working process and Intensive Care Unit (ICU) nursing workers health. A descriptive qualitative study wich data have been obtained from a public hospital ICU located at Niterói district-RJ between December 2011 and February 2012 with 25 workers (11 nurses and 14 nursing technicians), from adopted inclusion criteria. The semi structured interview has been used through a script of this study problematic questions. The project has answered the demands of Resolution 196/96 from The Ministry of Health (MS), and has been aproved by the Committee of Ethics in Research (CEP) under the number CEP CAAE: 2063000025811. In the testimonies categorization the content analysis technique has been used Bardin, and the outcomes have been discussed under the light of Work Psychodynamics. It has been identified that ICU hard technology incorporation, under the sight of nursing workers, is a working tool for it provides more security, speed in tasks accomplishment, reliability and control related to the patients clinical status and decreasing repetitive actions. On the other hand, there are problems related to machines corrective and preventive maintenance which cause annoyance, interruptions and mental and physical overcharge due to the need of frequent alarm adjustments and set parameters, equipment changes and pieces replacement; limiting factors and which demand specialists intervention. Facing this work situation, hard technologies used in ICU configure as psychosocial risk factors for they cause occupational stress which internal and external resources used by workers show insufficient for their coping. The work organization with workers themselves must perform actions that minimize the marked risk factors aiming at nursing workers satisfaction, motivation and health as well as for the other members of the team.

Abstract Magnetic resonance imaging (MRI) has excellent soft tissue contrast, which can be enhanced by different contrast agents, multiplanar imaging capability and high temporal and spatial resolution. Even blood vessels can be easily visualised, and MRI parameters are sensitive to temperature. Therefore, MRI has the greatest potential for guiding and monitoring interventional and surgical procedures. The aim of this study was to design and evaluate new solutions for MR-guided procedures and surgery, to develop the technique and to assess the feasibility of MR-guided nerve root infiltration, bone biopsy and sacroiliac (SI) joint arthrography. The possibilities for versatile use of MR scanners were studied with a setup where an MR scanner with a 0,23 T open magnet was installed in a full-scale operating room (OR) to allow diagnostic MRI examinations, research, radiological interventions and neurosurgical operations to be performed in the same facility. All of the 144 MR-guided radiological interventions and neurosurgical operations performed in Oulu University Hospital between February 1999 and September 2000 were included in the study. The studied setup was a functionally feasible solution for combined neurosurgical and radiological use. To further improve MR-guided interventions, a new user interface was developed and preliminary tested with simulated clinical experiments. The new user interface seemed to be easily adobted by radiologists for interventional procedures. MR-guided nerve root infiltrations were studied by using MRI guidance on 34 consequent patients referred for first sacral root infiltration. Needle placement into the first sacral nerve root sheath was successful in 34 of the 35 (97%) cases, and the average duration of the procedure was 32 minutes. Bone biopsies were performed using a bone biopsy set designed in our institution to be connected to an optical tracking system. The feasibility of this new guiding system was evaluated with biopsies from five different anatomical areas. The bone biopsy system was successfully applied to all patients and provided a safe and accurate guidance method for all phases of the procedure. Twenty patients with low back pain suspected to arise from the SI joint underwent MR-guided SI joint arthrography. The procedure was successfully performed in all cases. The needle guiding with optical tracking inside the soft tissues proved to be accurate enough for successful procedures. In conclusion, versatile use of MR scanners for diagnostic imaging, radiological procedures and neurosurgery is feasible if planned properly. The prototype of a new user interface for MR-guided procedures allows radiologist to fully control the MR-scanner during the procedure. MRI is a suitable and accurate guidance method for musculoskeletal interventions.

Abstract The use of image-guidance in surgery and radiotherapy has significantly improved patient outcome in neurosurgery and radiotherapy treatments. This work developed volume definition and verification techniques for image-guided applications, using a number of algorithms ranging from image processing to visualization. Stereoscopic visualization, volumetric tumor model overlaid on an ultrasound image, and visualization of the treatment geometry were experimented with on a neurosurgical workstation. Visualization and volume definition tools were developed for radiotherapy treatment planning system. The magnetic resonance inhomogeneity correction developed in this work, possibly the first published data-driven method with wide applicability, automatically mitigates the RF field inhomogeneity artefact present in magnetic resonance images. Correcting the RF inhomogeneity improves the accuracy of the generated volumetric models. Various techniques to improve region growing are also presented. The simplex search method and combinatory similarity terms were used to improve the similarity function with a low additional computational cost and high yield in region correctness. Moreover, the effects of different priority queue implementations were studied. A fast algorithm for calculating high-quality digitally reconstructed radiographs has been developed and shown to better meet typical radiotherapy needs than the two alternative algorithms. A novel visualization method, beam's light view, is presented. It uses texture mapping for projecting the fluence of a radiation field on an arbitrary surface. This work suggests several improved algorithms for image processing, segmentation, and visualization used in image-guided treatment systems. The presented algorithms increase the accuracy of image-guidance, which can further improve the applicability and efficiency of image-guided treatments.

The fragmented nature of modern health care provision makes it increasingly difficult to achieve continuity of care. This is equally true in the context of the South African healthcare landscape. This results in a strong emphasis on the informational dimension of continuity of care which highlights the importance of the continuity of medical records. Paper-based methods of record keeping are inadequate to support informational continuity of care which leads to an increased interest in electronic methods of record keeping through the adoption of various Health Information Technologies (HITs). This research project investigates the role that various HITs such as Personal Health Records (PHRs), Electronic Medical Records (EMRs), and Health Information Exchanges (HIEs) can play in improving informational continuity of care resulting in the development of a standards-based technological model for the South African healthcare sector. This technological model employs appropriate HITs to address the problem of informational continuity of care in the South African healthcare landscape The benefits that are possible through the adoption of the proposed technological model can only be realized if the proposed HITs are used in a meaningful manner once adopted and implemented. The Delphi method is employed to identify factors that need to be addressed to encourage the adoption and meaningful use of such HITs in the South African healthcare landscape. Lastly, guidelines are formulated to encourage the adoption and meaningful use of HITs in the South African healthcare landscape to improve the continuity of care. The guidelines address both the technological requirements on a high level, as well as the factors that need to be addressed to encourage the adoption and meaningful use of the technological components suggested. These guidelines will play a significant role in raising awareness of the factors that need to be addressed to create an environment conducive to the adoption and meaningful use of appropriate HITs in order to improve the continuity of care in the South African healthcare landscape.

The health care systems of developing countries, which are already weak, have to carry an additional strain brought on by the burden of infectious diseases. This added strain means that the health care provided is not of the highest quality. The use of home community based care (HCBC) was introduced as an attempt to provide basic health care services to people through the services of community health care workers (CHCW). With the development of HCBC in developing countries and the CHCW playing a vital role in ensuring that the lives of people living with diseases are improved, the need for information and communication technology (ICT) solutions is increased. The information that is collected by the CHCW is paper-based and it cannot be analysed and used efficiently and effectively. This study embraces the adoption of a socio-technical perspective when an ICT solution is introduced in an environment. A socio-technical perspective focuses on three dimensions: the user, the environment and the technology used. These three need to be in coherence to ensure that the technology is used effectively by the user within the environment. Therefore the objective of this study is to identify a list of socio-technical factors that affect CHCWs when they are using mobile phones for data collection purposes in home community based care. In order to achieve this it was necessary to understand how the socio-technical subsystems of the HCBC environment are constituted. The study followed a qualitative approach, including interviews and observations, to collect the data which will best enable the researcher to understand the home community based care environment, its people and the use of the technology to collect data in this environment, in particular mobile phones. A qualitative content analysis approach was followed to analyse the data and constitute a list of factors affecting the use of mobile devices for remote data collection in home community based care. It is hoped that this research will assist to inform the design of appropriate mobile health applications to both ease the burden of CHCWs (i.e. it should be faster and easier to use than paper) and improve the healthcare service provided through enabling access to patient records to all partners in the care continuum.