Creating a Foundation for the Design of Culturally-Informed Health Information Technology

The specific aim of this AHRQ’s Health Services Research Dissertation (R36)-funded project was to create a foundation for a design strategy that leads to culturally-informed consumer health IT. The long-term objective of this project is to reduce racial and ethnic health care disparities by designing culturally-responsive approaches to the design of health information technologies (IT) that patients and members of their social network (e.g., family members, friends, neighbors) can more easily use.

This dissertation took a mixed-methods approach grounded in both cultural anthropological and systems engineering principles to assess patients’ daily routines of health information communication. Eighteen patients who self-identified their racial, ethnic, and national culture participated in the main study. In an effort to understand daily routines of health information communication, patients were asked during two rounds of interviews to create a visual depiction of their social network and were asked if, why, and how s/he would communicate four types of health information with each member of their social network. The four types of health information were: 1) daily observations of health status; 2) test results from clinical visits; 3) information on diabetes self-care and self-management; and 4) time and place of doctor’s appointments. In addition, study patients used journals to keep track of their communication with members of their social network over 5 days: 2 days before a clinical appointment, the day of the appointment, and 2 days after.

The types of people, information, modes, and rationales illustrated the complexity and diversity of participants’ daily routines of health information communication. The study also highlighted challenges of traditional targeted approaches to incorporating cultural considerations in design processes and provided support for a tailored approach. This work informed the creation of three conceptual frameworks related to the design of culturally-informed consumer health IT. The first framework conceptualizes the tensions between using engineering and cultural anthropological approaches to consumer health IT design. The second conceptualizes how cultural factors may be integrated into the design of consumer health IT. The third framework illustrates how cultural factors form part of a larger cohort of factors—such as functional, technical, and affective factors—in the design of consumer health IT.