Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Information Technology in the Faculty of Informatics and Design, at the Cape Peninsula University of Technology / Transitioning from childhood to adulthood is typically coupled with many puberty related challenges, and such challenges are heightened by access deficiency to reproductive health information. The situation is worsened in under-resourced communities in Southern Africa as the youth’s socio-economic status is hampered by a lack of timely informed education. Such youth groups are referred to as youth-at-risk. The youth are the most affected in recent days as they are exposed to various health disturbances. The youth need to be aware of critical life information, particularly reproductive health information, in order to make better choices. With mobile technology being an integral part of everyday life and more appealing to the youth, opportunities are opened up for the use of mobile functionalities or an extension thereof to provide relevant mobile-based services for information access. Recently, health information is shared and is accessible on different mobile platforms. This research project focuses on mobile-based services to promote reproductive health information for youth-at-risk groups, aged 18 to 24 from the Grabouw community in the Western Cape of South Africa. Most of mobile technology’s solutions and proposed mobile-based services come from elsewhere with little or no consideration of the communities and people who will use these services. The youth was engaged in different activities as participants to design a mobile-based service to promote reproductive health information, putting them at the center of the design process as design partners. Service design methods and tools were used as the methodology in a systematic manner. A Double Diamond framework consisting of four phases (Discover, Define, Develop and Deliver) was followed in order to collect the data. The phases guided the design process from ideation to co-designing of the service prototyped herein. Different ways of accessing information especially reproductive health information by youth-at-risk were identified. The available technology and existing practices to access reproductive health information were also identified. Results clearly indicate that the youth are motivated to use mobile phones to share and receive health information. The youth currently have access to reproductive health information and services, however some services require the youth to travel long distances by vehicle or by walking. The youth walk as a result of lack of transport in some locations because there is no infrastructure in place to support vehicles. Furthermore, the information available to the youth currently is not contextualised, therefore making it irrelevant with consideration to resources available in this particular community. The research project recommends that when a solution is being designed for any community, all the relevant stakeholders have to be involved in the design and development process to allow for a co-design interaction that allows for a usable and relevant solution design with and for the intended users. Involving the user in the design process accelerates adoption if an innovation and easy technology appropriation in the user’s environment. The users add the value needed as they are sharing knowledge, experiences and way of doing things which have a positive effect on the solution. The study recommends service to be developed in the future according to the findings herein. The implementation, testing and use of the mobile-based service (RHIAY) prototyped in this thesis are for future work.

Purpose: The purpose of this thesis is to determine what is known from the literature about the use of Clinical Information Systems (CIS’s) to support the information needs of individual health care providers (HCP), in particular the nurse case manager, and the inter-professional team providing chronic illness care in the community setting. Methods and Analysis: This is a scoping review with a pilot study for feasibility. MEDLINE, CINAHL, and WEB OF SCIENCE were searched up to April 2017. Reference lists and a citation manager of included studies were searched to identify further studies. Relevant full text papers were obtained and screened against inclusion criteria. Data from eligible articles was extracted using a predefined extraction form. Thematic narrative descriptions and descriptive statistics were used to summarize findings. Nurse case managers were recruited from diabetes and chronic kidney disease clinics for an exploratory questionnaire and follow up interview. Descriptive content analysis and nonparametric statistics were used to summarize findings of the pilot study. Results: 45 articles were identified meeting the inclusion criteria. Three themes emerged (1) patient information elements (2) visualization formats, techniques, and organization and (3) visualization of patient information elements. Diagnostics and observations were the most frequently mentioned information elements. Text was the main representation format. Four participants completed the pilot study initial questionnaire and one completed the follow up interview. There was 100% agreement for 11 elements. Six themes emerged (1) required information can change (2) information is required for different purposes (3) information required for communication is related to nurse case manager concerns (4) required information varies depending on the discipline reviewing it (5) certain types of information need to be grouped together and (6) it is difficult for a HCP to visualize what is necessary in a CIS without first seeing or trying it. Recommendations: The recommendations are a concept-oriented view customizable to the role of the HCP to display: diagnostics, outcomes and comparisons as graphs and colour coded, observations, medications, problem lists, clinical events, guidelines, the care plan, clinician to clinician communication, patient to clinician communication and clinician to patient communication as text, and clinical events as a timeline. Conclusion: This review and accompanying pilot study is a starting point for a framework of guidelines with the recommendations of proposed patient information elements and the visualization formats, techniques and organization. / Graduate

Philosophiae Doctor - PhD / This research explores a poorly understood area of health systems: the nature of managerial decision-making in primary healthcare facilities, and the information that informs decision-making at this level. Located in the emerging field of Health Policy and System Research, this research draws on constructivist and participatory perspectives to understand the role of information and, more broadly, learning and knowledge in decisions that primary healthcare managers make, and the systemic factors influencing this. Using a multiple case study design with iterative cycles of in-depth data collection and analysis over a three year period, it examined the decision-making and information use in three cases of managerial responsibility in 17 primary healthcare facilities in a sub-district in Cape Town. The cases were: improving efficiency of service delivery, implementing programme priorities and managing leave of absence. Using multiple strategies for engaging primary healthcare facility managers, often as co-researchers of their own practice, the research sought to elicit both their explicit and tacit, experience-based knowledge on these phenomena. Key insights gained in the research are that firstly, operational health management at facility level is less linear and simple than policy-makers and planners often assume, and is, instead, characterised by considerable on-the-spot problem solving and people management to meet multiple agendas, which can be surprisingly complex. Secondly, contrary to prevailing views, managers do actively use information in decision-making, but require a wide range of information which is outside of the current, and indeed the globally-advocated, health information system (HIS). Thirdly, they not only use, but generate, information in their management routines and practices, and must learn from experience in order to adapt new interventions for successful implementation in their facilities and communities. This research thus makes explicit the value and use of informal information and knowledge in decision-making. It demonstrates, amongst others, a relationship of functional interdependence between the use of formal information in the HIS, and informal information and knowledge, suggesting that the latter has the potential to improve the use and utility of formal health information by making sense of it within the local context. Furthermore, building on the public policy literature on governance, this research develops a model to understand the multiple contextual influences on decision-making and information use, showing the central role of values and relationships across the health system. It proposes a causal mechanism for strengthening the use of information in decision-making. Finally, in giving priority to the informational needs of facility managers, this research offers a bottom-up perspective which argues for an integrated approach to health system strengthening which moves beyond atomised treatment of HIS strengthening. It suggests the need to re-think how to support facility managers by re-positioning the HIS relative to organisational learning, and leadership and management development.

The purpose of the study was to examine the relationships between types of health information tasks and the Internet information search processes of Chinese graduate students at the University of North Texas. the participants' Internet information search processes were examined by looking at the source used to start the search, language selection, use of online translation tools, and time spent. in a computer classroom, 45 Chinese graduate students searched the Internet and completed three health information search tasks: factual task, interpretative task, and exploratory task. Data of the Chinese graduate students’ health information search processes were gathered from Web browser history files, answer sheets, and questionnaires. Parametric and non-parametric statistical analyses were conducted to test the relationships between the types of tasks and variables identified in the search process. Results showed that task types only had a statistically significant impact on the time spent. for the three tasks, the majority of Chinese graduate students used search engines as major sources for the search starting point, utilized English as the primary language, and did not use online translation tools. the participants also reported difficulties in locating relevant answers and recommended ways to be assisted in the future when searching the Internet for health information. the study provided an understanding of Chinese graduate students' health information seeking behavior with an aim to enrich health information user studies. the results of this study contribute to the areas of academic library services, multilingual health information system design, and task-based health information searching.

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Background: Covid-19 is disrupting the healthcare industry. Policies and regulatory changes in general necessitate adaptation from the healthcare industry, particularly those affecting the payment system, clients, and the environment. On the other hand, as policymakers around the world look to digital transformation to make healthcare systems more resilient, affordable, and accessible, a rare and remarkable opportunity for the information systems research community to leverage its in-depth knowledge to both advance theory and influence practice and policy has emerged.    Problem discussion: The changes brought by Covid necessitate resilience in the healthcare industry, which most countries are not yet prepared for, as it will necessitate a large number of workers and effective policies for the recovery process in the post of Covid 19. Crucially, many people lack the resources to scale up health interventions as well as the financial resources to implement support measures and improve resilience. This research will answer the following considerable question, how can countries now build more resilient healthcare systems capable of withstanding pandemics? What role can technology play in these efforts?    Purpose: The thesis will aim to discover how the healthcare industry in developing countries will be resilient as they digitize their operations in the post of Covid disruption situations. The finding in this research will be identified by the combination of the HIT framework following four major sectors of health information technology: financial, functional, user, and environmental, and the resilience capabilities such as anticipating, monitoring, responding, and learning. The result of the finding will be involved in chapter 4.    Method: In this paper, a qualitative method was used to answer the research question. Inductive and deductive techniques were used to expand the research by moving from individual data to broader generalizations and ideas. The detail of all the methodology steps will be explained in chapter 3.  First, we began with specific observations and measurements by interviewing organizations and individuals related to the healthcare industry in one highlighted developing country for the primary data and used reliable websites such as Google Scholar, Microsoft Academic, Academic databases, etc for the secondary data. Due to the limitation of the interview responses, we chose Vietnam as our sample. Then we started noticing the HIT strategies, then we went a step further with interpretation to explain these preliminary discoveries that we wanted to investigate, and finally ended up developing some general digital conclusions or theories. Conclusion: Putting these innovations in place now helps the healthcare sector build a stronger resilience health ability, allowing it to be better prepared for future peaks and valleys. In conclusion, some innovative technology solutions from HIT strategies have been proposed, such as the top-down governance system which has been used to support the leaders to reach all levels of government. Aside from that, the effectiveness of the information system's preparation and the role of the surveillance system are critical in the early stages of resilience.  All of the detail from the HIT recommendation strategies will be explained in chapter 5.

The relationship between training intensities and fitness gains was selected as a topic for analysis in this study. Forty-six college men served as subjects in one of three groups: a jogging, or moderate intensity, training group, a running, or high intensity, training group, or a control group. All subjects were pre- and post-tested on the Astrand Bike Ergometer Work Test where working heart rates were measured and recorded. The two training groups participated in at least thirteen training sessions between these testing days, in which two miles were covered at the correct intensity level for each subject at each training session. A review of the literature revealed that most researchers embraced the concept of a minimal threshold of training stimulus needed to be met or exceeded by subjects for significant cardiovascular fitness gains to occur. Conclusions about the absolute level of this threshold varied from a low of 120 heartbeats per minute to at least 150 heartbeats per minute, depending apparently upon the experimental evidence each researcher had gathered. The author hypothesized that there existed a continuum of training stimuli such that training at higher intensities would produce larger heart rate decrements (a cardiovascular fitness index) than at moderate training intensities, but that moderate intensities would also produce significant gains. Furthermore, wide variations in heart rate decrements were expected to be observed within any one group, possibly indicating differences in initial fitnesses of subjects. The factual results of the study were: Both experimental groups and the control group exhibited significant decrements in heart rates from pre-test to post-test although the experimental groups' gains were significant at a higher confidence level. Explanations were posited about the possible factors which might have unpredictably caused the control group to have shown significant improvement. The moderate intensity training group exhibited a larger decrement in heart rate than the high intensity training group, although the difference was not statistically significant. There, indeed, was a wide variation of heart rate responses among individuals within any one group, possible indicating initial fitness differences. In light of the results derived from this study, the author can only conclude: Significant decreases in submaximal workload heart rates may be expected to be observed in American college men after training at moderate to high intensity levels (150 beats per minute or higher) for relatively short training periods (two days per week for eight weeks). Large fluctuations in fitness responses among subjects within any one training group can be expected, due probably to individual differences in initial fitnesses. The task of training large numbers of subjects at specified intensity levels within a fairly realistic physical education setting seems to have been a fruitful approach.

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Objective: To determine if a personal digital assistant (PDA) with drug and evidence-based disease information software programs and with librarian training and follow-up can adequately meet at low cost the information needs of clinicians in rural areas with low information availability. Methods: A randomized clinical trial methodology was used. Eight hospitals were selected in rural Appalachia based on accepted definitions of rurality. The hospitals were randomized into two groups of four hospitals with forty PDA users in each group. Both groups were treated equally, except the information needs of one group were measured using a validated instrument before the intervention and in the other group several months later. The survey instrument measured factors such as level of satisfaction with information retrieved in the clinic, required time to find an answer, and frequency of answers found for clinical questions.