User-centred design and collaboration engineering integration to reinforce user involvement in requirements elicitation and analysis tasks: a case of EHIS

Abstract

Requirements elicitation and analysis tasks in User-Centered Design (UCD) are pivotal for assessing digital systems’ quality and costs. However, these tasks often face challenges due to limited user involvement. This stems from unclear guidelines on how to conduct activities and engage users effectively to achieve their goals during the development process. This study explored how the integration of collaboration engineering (CE) principles with UCD approach could address these challenges. The study adopted a pragmatic philosophy aimed at discovering practical solutions to the identified research problem. An abductive approach was utilized to gain new insights by interpreting user needs and experiences, iteratively refining our understanding based on empirical findings. An exploratory survey was conducted to identify the types of users involved in the requirements elicitation and analysis of electronic Health Information Systems (eHIS) and to uncover the challenges they faced during these phases. This survey encompassed both primary and secondary users and assessed their participation through a mix of open-ended and closed-ended questionnaires. A total of 140 respondents were purposively selected from 20 health facilities in northern and central Uganda. The application of CE principles provided essential steps and guidelines for deriving the UCD-CE process requirements. Design Science was employed to develop the study’s artifact (the UCD-CE process), utilizing an Applied Science/Engineering approach to facilitate the integration of CE principles with the UCD process. This integration aimed to enrich the "what" and "how" aspects, enhancing user group involvement during the requirements gathering and analysis phases of eHIS development. To pursue this integration effectively, the Five-ways framework was utilized to delineate the similarities and differences between UCD and CE, addressing the "why," "how," and "what" aspects relevant to their processes. Additionally, we drew on the Six-layer model of Collaboration to illustrate how CE principles address the limitations of UCD and how to derive the work breakdown structure of the UCD-CE process during the eHIS development phase. By applying CE principles and techniques, we designed a structured and collaborative environment that reinforced user involvement in the requirements elicitation and analysis tasks. The collaboration sessions were structured to emulate the first two steps of the UCD process alongside the six steps of the CE approach. Following the design of the UCD-CE process, we implemented this hybrid approach using the Meetingwizard tool to organize and coordinate collaboration sessions across four healthcare facilities in northern and central Uganda: St. Mary's Hospital Lacor, Luwero Hospital, Kisenyi Health Center IV, and the Ugandan Ministry of Health. To ensure participant engagement and alignment with the study goals, we employed a two-pronged sampling strategy. First, purposive sampling targeted specific user categories relevant to the research questions. Second, convenience sampling was used to select participants based on their availability, anticipating that some individuals might not participate due to busy schedules or lack of interest. A total of 57 participants were selected, all possessing adequate knowledge of eHIS and similar backgrounds to foster a shared understanding and provide deeper insights. Their roles included clinicians, doctors, nurses, implementing partners, biostatisticians, counselors, data clerks, lab technicians, quality control officers, IT focal persons, data protection and security specialists, data warehouse architects, health informatics specialists, and monitoring and evaluation officers. The UCD-CE process underwent rigorous Evaluation in three iterations using an action research method, which included both formative and summative evaluations. Data collection tools comprised questionnaires and non-participant observation, supported by techniques such as structured interview guides, user stories, dialogues, ThinkLets, and patterns of collaboration. Both formative and summative evaluations were utilized to validate the UCD-CE process, with data analyzed using SPSS version 25.0 for Likert scale data from the field study. The findings from the exploratory study revealed a predominant use of a top-down approach, favoring the capture of high-level requirements at the Ministry of Health level and among implementing partners. However, less attention was given to gathering and analyzing requirements from facility-level users. Even when collected, primary users reported that their opinions and recommendations were frequently disregarded, leading to eHIS designs with usability-related challenges. Empirical results from evaluating the UCD-CE process highlight its strengths, particularly its efficiency in task completion, reduced cognitive load, and collaborative efforts to achieve common goals (user requirements). The process also demonstrated high user satisfaction, increased creativity and productivity, ease of use, learnability, and completeness of the deliverables in the requirements elicitation and analysis tasks during the development process. This study underscores the critical need for active user involvement in the early stages of eHIS development to ensure alignment with user needs and work practices. Looking ahead, future research should focus on assessing the practicality of the UCD-CE design process in enhancing user involvement during the UCD design phase, as well as exploring the long-term impact of the UCD-CE process on user experiences in developed eHIS systems.