title: Patient-Centred Culturally-Aware Design Approach for e-Health Acceptance
Creators: name: Mohamed, AHHM
Publisher: name: University of Liverpool Repository
Year: 2017

description: The importance of information and communication technology in healthcare has recently grown to an unprecedented dimension as more people are empowered by technology to participate more actively in their healthcare processes. New online applications for accessing healthcare information and for self-diagnosis have become increasingly available to diverse patient groups of different languages, educational backgrounds, and cultural orientations. However, the design of these applications typically follows Western cultural orientations. This approach has created a gap, which makes it difficult for users, who use the systems within their own cultural contexts, to derive maximum benefits from such use. As a result, the gap impedes the uptake, market success, and effective adoption of these e-Health applications in various cultural contexts. Moreover, as healthcare organisations increasingly seek to interact with patients, often in real-time, through enhanced web-based services, patient experiences often become tied to a largely ‘Western-driven’ style of patient interfaces, interaction, and look and feel that negatively impact the overall acceptance of these services across different cultures. This poses a tremendous challenge to technology adoption, in particular with regard to how to design culturally-aware and patientcentred e-Health applications that reflect the cultural diversity of today’s users and meaningfully empower them to better utilise such tools to enhance their day-to-day life. This research proposes to investigate the impact of a patient-centred culturally-aware design approach on the patient acceptance of e-Health web-based services, in particular, how e-Health web-based applications can be designed in a way that maximises their usability and ‘fits’ them into the cultural fabrics of individuals in different cultural contexts. To address this challenge, this research work examined existing literature in the fields of culture, technology acceptance and HCI, and identified relevant constructs that were used to develop a culturally-aware technology acceptance model for electronic health. Subsequently, the model provided a means for understanding the influence of different factors affecting patient acceptance and usage which were used as a foundation to inform the design of the Patient-Centred Culturally-aware e-Health Design Approach (PCCeDA) framework for e-Health web-based services developments. The novelty in PCCeDA is the notion of cultural awareness, which allows systems to personalise themselves according to a patient’s cultural profile while adhering to usability principles. As a result, the interface and contents presented to a patient are both dynamically tailored to better suit that patient’s cultural preferences, thereby increasing patient adoption. Based on PCCeDA, a proof of concept prototype called i-Diagnose was developed primarily to assess the validity of the framework and to answer the central questions of this research study. Evaluation results show that a patient-centred culturally-aware design approach enhances the effectiveness, usefulness and patient acceptance of e-Health web-based services in different cultural contexts. The main contributions of this work include: (i) a culturally sensitive technology acceptance model for e-Health (‘e-HTAM’) where both technology acceptance model and cultural dimensions are integrated to develop the e-HTAM model. The model highlighted various issues that need to be taken into consideration when designing patient-centred culturally-aware e-Health Design Approach applications; and (ii) a patient-centred Culturally-aware e-Health Design Approach framework that allows systems to personalise both the patient interface and the contents provided to a patient to better suit that patient’s cultural background. The research also includes a number of other minor contributions such as: (i) an approach for solving the static nature of Hofstede’s dimensions’ indexation, through the use of cultural parameters to dynamically model users’ cultural states, (ii) the introduction of personalisation based on cultural factors into the e-Health web-based services domain, and (iii) shed light on the electronic health acceptance state in the UAE as compared to the UK.