Design and development of digital health platforms

Abstract

By providing equitable care, digital health platforms can lessen the pressure on global healthcare systems. Digital platforms are pieces of software that connect users, data, services, and systems. In industry, the use of digital platforms has brought advancements in optimizing and automating processes, which could likewise benefit healthcare. Digital health platforms have been utilized effectively in recent years to connect patients, healthcare experts, researchers, and study participants and provide general care, disease and symptom management, and palliative care. They further allow for the collection of data that enables the monitoring of patients and research participants. In care, sharing patient data between patients and healthcare experts facilitates more effective care, while in research, the data fosters the development of novel diagnostic and predictive algorithms and more effective treatments. For advancing care and research in these ways, a meaningful design of digital health platforms that engages users in the longitudinal collection of reliable data is vital.

Current literature has focused on identifying aspects of meaningful digital health platforms through literature reviews, patient outcome analysis, and surveys with health experts. However, the design of a digital health platform is created during its design and development process. Still, research rarely examines digital health platforms from the insider view of a designer or a developer, and as a result, there is a lack of interpretation of the design and development processes of digital health platforms.

This thesis addresses this gap and contributes to the information system literature by examining the design and development process of the Sleep Revolution digital health platform. The Sleep Revolution digital health platform was designed and developed with the goal of modernizing sleep healthcare and collecting data for the research and development of models and algorithms that have the potential to uncover patterns and provide novel insights. It connects researchers, sleep experts, and study participants to do so. A co-design process has been employed to design and develop the Sleep Revolution digital health platform. Co-design involves stakeholders such as end-users and health experts as active members in the design and development process. Research has highlighted promises and challenges of co-design and has criticized the failure to incorporate it beyond the initial ideation stage of the design of digital health platforms.

Drawing from the experience of designing and developing the Sleep Revolution digital health platform from early ideation stages to active usage in sleep studies in multiple European countries, this thesis documents the learnings and challenges of a four-year action design research project that employed co-design through the insights gained from five papers. The included papers look into the design and development of both a mobile and web application for study participants, which are part of the Sleep Revolution digital health platform. Paper P1 follows the digitization process of an analog sleep diary involving expert and user feedback into a mobile application and derives design guidelines for similar mobile applications to record health-related data from the findings. Building on that research, paper P2 analyses user compliance with the digital sleep diary, and the results contribute to an understanding of improving the challenges associated with the analog version. This paper gives insights into the feasibility of collecting longitudinal sleep-related data with a mobile application and highlights compliance challenges. Paper P3 examines dignity affront responses that users experienced through digital nudging built into the mobile application. Through the formulation of design guidelines, this paper contributes a better understanding of digital nudging and the design of effective and dignity-preserving digital nudges. Concentrating on the technical side of the digital health platform, paper P4 investigates the modularization of its design through a design system, and it presents conclusions about achieving a clear structure of design systems. Paper P5 shifts the focus from the mobile application to the web application by addressing the digitalization of an in-laboratory tool for measuring cognitive functioning into an at-home web tool and frames the learnings from this research as design guidelines. While the five papers focus on different parts of the Sleep Revolution digital health platform, they all reflect various stages of its design and development process.

Based on the findings of these five papers, along with supplementary insights gleaned from the design and development process of the Sleep Revolution platform, the thesis (i) examines how the continuous co-design process of the digital health platform addresses emerging challenges and (ii) presents a framework that conceptualizes three socio-technical key factors for engaging design of digital health platforms for reliable data collection. The thesis also presents the different dimensions of those key factors and how they are interconnected to inform future digital health platforms' design and development. Together, the findings contribute to the discourse on digital health platforms in the information systems literature with the conceptualization of engaging design and the examination of a continuous co-design process.