Deakin University
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Enhancing the effectiveness of consumer-focused health information technology systems through eHealth literacy: a framework for understanding users' needs

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journal contribution
posted on 2015-01-01, 00:00 authored by L Kayser, A Kushniruk, Richard Osborne, O Norgaard, P Turner
Background: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and
use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective
eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives
of the general population, and developers may have limited understanding about how well they might represent the full range of
intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate
the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may
result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user
attributes has not been adequately considered by health IT designers.
Objective: The objective of this paper is to propose how users’needs and competences can be taken into account when designing
new information and communications technology solutions in health care by expanding the user-task-context matrix model with
the domains of a new concept of eHealth literacy.
Methods: This approach expands an existing method for supporting health IT system development, which advocates use of a
three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and
requirements are under differing contexts of use. The extension of this model involved including knowledge about users’
competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with
computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care.
A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis.
Results: The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the
user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted
in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately
addressing end-users’ needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused
health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring,
and funding of eHealth infrastructure, applications, and services.
Conclusions: Developing effective eHealth products requires complete understanding of the end-users’ needs from multiple
perspectives. In this paper, we have proposed and detailed a framework for modeling users’ needs for designing eHealth systems
that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy,
enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems.



JMIR human factors





Article number



1 - 14


JMIR Publications


Toronto, Ont.





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C Journal article; C1.1 Refereed article in a scholarly journal

Copyright notice

2015, The Authors

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