The Role and Effectiveness of Collaborative Knowledge Systems in Health Promotion and Health Support
L218 25 2064
The Tavistock Institute, London
Dr Joe Cullen, Dr Richard Piper, Dr Kathryn Ehrich, Ms Judith Corlyon, Ms Sigrun Hardardottir, Ms Claire Sandamas
May 2002 - April 2004
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Abstract
The project addresses issues associated with recent trends in public health and health service delivery policy towards promoting greater involvement by patients and citizens in shaping and managing their own health. It's point of departure is the proposition that there are formidable obstacles militating against this vision of an 'e-health society for all', and that many of these problems stem from 'knowledge sharing' or the lack of it. There is conflicting evidence about the capacity and willingness of patients and citizens to engage in collaboration with health professionals, and about the integrity of concepts and models of 'empowerment' that underpin notions of 'self-management' of health. Against this background, the focus of the project is on innovative health technologies (IHTs) that facilitate knowledge production and knowledge sharing between different stakeholders (for example the 'evidence database' managed by the National Institute for Clinical Excellence; NHS Direct Online and Digital Interactive Television). The overall aim of the project is therefore to assess and enhance the role and effectiveness of these collaborative knowledge systems in health promotion and health support. The project combines interpretative, survey, case study and action research methods involving real IHT users in real world projects to develop and evaluate approaches and methods intended to address motivational and access constraints in the development and implementation of collaborative knowledge production systems.
Summary
Background
Collaborative knowledge tools are central to the vision of a patient-centred National Health Service. The current policy context for healthcare implies a substantial paradigm shift in the ways in which different stakeholders - especially health professionals and lay people - communicate. New policy initiatives are aimed at the decentralisation of healthcare from acute to primary and self-managed service delivery. They place more emphasis on health promotion and disease prevention. They imply a movement away from the 'consultant-driven' model and towards more 'power-sharing', and the involvement of health practitioners and patients in new partnerships. However, the evidence suggests that there are formidable obstacles militating against this vision of an 'e-health society for all', and many of these problems stem from 'knowledge sharing' - or the lack of it. Conflicting (and unreconciled) 'world views' between health professionals; health service users; health service managers, and designers of informatics systems is one example of the issues involved. Another major issue centres on access problems. For many 'socially excluded groups', the 'message' of health promotion never reaches the target audience. In turn, motivation remains something that is not yet fully understood or addressed. Indeed there is some evidence that citizens and patients are reluctant to take responsibility for managing their healthcare decisions even in situations where ICTs (for example on-line chat lines; peer review tools and decision support systems) provide them with opportunities to do so. Against this background, what is needed is a systematic review of 'what works; for whom and under what circumstances'.
Research Design
The research methodology and workplan is comprised of four inter-related sets of activities ('work packages'). The project begins with a review of state of the art (desk-based, focusing on a mapping of the relevant literature; a search of web databases and interviews with key experts). It will include an 'audit' of innovative IHTs providing health information and support services, and involving collaborative knowledge tools. Drawing on the results of this review, the second work package involves intensive case studies, to assess the 'goodness of fit' between the technological metaphors and configurations of IHTs and the socio-cultural and institutional context in which they are used. The methodology proposed for this assessment is 'life world analysis'. It involves ethnographic study of the social and institutional environments of these key stakeholders. Following completion of the case studies, the next key research task involves applying the learning drawn from the results of work package 1 and work package 2 to the enhancement of existing collaborative knowledge systems. We will select two pilot sites from the case studies and develop enhanced functionalities intended to a) decrease 'motivational resistance' to the use of the IHTs in use and b) improve accessibility to the services. The research activity will subsequently evaluate the effects of these refinements in terms of user acceptance; utilisation rates; self-reported health behaviours. The methodology will take an action research approach, involving a sample of users in the design and testing of the enhancements. In addition to these three core research activities, an additional 'work package' - project management and dissemination - is dedicated to the effective implementation of the project and the dissemination of its results.
Policy and Academic Implications
Three main policy and academic impacts are envisaged. Firstly, we would hope to deepen understandings about 'empowerment' and health. The main beneficiaries are likely to be: i) producers of health informatics applications (improving design and evaluation methods) ii) health promotion agencies like HAD (supporting improvements in health and risk behaviour models) iii) health professionals - the results can add value to design of electronic patient records (EPR) and hospital information systems (HIS), and to 'evidence-base' systems like NICE (National Institute for Clinical Excellence) iv) the research community - contributing to state of the art in the field of risk models and conceptions of 'empowerment'; exploring notions of 'dialogic reflexivity'.
Secondly, the project would hope to make a contribution to improving the quality of life and health of the nation. It supports the goals set in the National Health Service Plan and more generally in the vision of an 'e-society for all'. Improving the effectiveness of collaborative knowledge systems can potentially i) reduce the costs and increase the efficiency of health service provision ii) contribute to improving the effectiveness of health promotion initiatives; contribute to the development of community-based health support and promoting better decision-making by patients and citizens.
Thirdly, the project aims to support the broader Programme aim of contributing to UK economic competitiveness. The research outputs are transferable beyond the domain of health informatics to generic knowledge production and content management systems - particularly those involving 'convergence' technologies like digital interactive television (DiTV). The 'action research' element of the project workplan specifically involves working with the new Department of Health DiTV pilot sites in order to learn more about these emergent technologies and their role in healthcare.
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