Examining the post-adoptive infusion of mobile technology in a healthcare domain: determinants and outcomes

The healthcare industry is beginning to appreciate the benefits which can be obtained from using Mobile Health Systems (MHS) at the point-of-care. As a result, healthcare organisations are investing heavily in mobile health initiatives with the expectation that users will employ the system to enhance performance. Despite widespread endorsement and support for the implementation of MHS, empirical evidence surrounding the benefits of MHS remains to be fully established. For MHS to be truly valuable, it is argued that the technological tool be infused within healthcare practitioners work practices and used to its full potential in post-adoptive scenarios. Yet, there is a paucity of research focusing on the infusion of MHS by healthcare practitioners. In order to address this gap in the literature, the objective of this study is to explore the determinants and outcomes of MHS infusion by healthcare practitioners. This research study adopts a post-positivist theory building approach to MHS infusion. Existing literature is utilised to develop a conceptual model by which the research objective is explored. Employing a mixed-method approach, this conceptual model is first advanced through a case study in the UK whereby propositions established from the literature are refined into testable hypotheses. The final phase of this research study involves the collection of empirical data from a Canadian hospital which supports the refined model and its associated hypotheses. The results from both phases of data collection are employed to develop a model of MHS infusion. The study contributes to IS theory and practice by: (1) developing a model with six determinants (Availability, MHS Self-Efficacy, Time-Criticality, Habit, Technology Trust, and Task Behaviour) and individual performance-related outcomes of MHS infusion (Effectiveness, Efficiency, and Learning), (2) examining undocumented determinants and relationships, (3) identifying prerequisite conditions that both healthcare practitioners and organisations can employ to assist with MHS infusion, (4) developing a taxonomy that provides conceptual refinement of IT infusion, and (5) informing healthcare organisations and vendors as to the performance of MHS in post-adoptive scenarios.

Reviewing mHealth in developing countries: A stakeholder perspective

Infrastructural deficiencies, limited access to medicare, and shortage of health care workers are just a few of the barriers to health care in developing countries. As a consequence, the burden of disease and its impact on the livelihoods and the economic productivity of people are staggering. mHealth has been extolled as one possible solution to overcoming these challenges, yet discussion of mHealth systems is often limited to specific tasks and user groups. To address this, we adopt a stakeholder perspective and analyze existing research on the mHealth process in developing countries. Specifically, we focus on three key stakeholder groups, i.e. healthcare workers, patients, and system developers. We perform an in-depth analysis of 60 peer-reviewed studies to determine the extent to which different mHealth stakeholder interactions are researched, and to identify high-level themes emerging within these interactions. This analysis illustrates two key gaps in existing mHealth research. First, while interactions involving healthcare workers and/or patients have received significant attention, relatively little research has looked at the role of patient-to-patient interactions. Second, the interactions between system developers and the other stakeholder groups are strikingly under-represented. We conclude by calling for more mHealth research that explicitly addresses these stakeholder interactions.

An energy efficient power controller switching methodology for an ambient healthcare network

A methodology for improved power controller switching in mobile Body Area Networks operating within the ambient healthcare environment is proposed. The work extends Anti-windup and Bumpless transfer results to provide a solution to the ambulatory networking problem that ensures sufficient biometric data can always be regenerated at the base station. The solution thereby guarantees satisfactory quality of service for healthcare providers. Compensation is provided for the nonlinear hardware constraints that are a typical feature of the type of network under consideration and graceful performance degradation in the face of hardware output power saturation is demonstrated, thus conserving network energy in an optimal fashion.

Context-aware real-time assistant architecture for pervasive healthcare

The aging population in many countries brings into focus rising healthcare costs and pressure on conventional healthcare services. Pervasive healthcare has emerged as a viable solution capable of providing a technology-driven approach to alleviate such problems by allowing healthcare to move from the hospital-centred care to self-care, mobile care, and at-home care. The state-of-the-art studies in this field, however, lack a systematic approach for providing comprehensive pervasive healthcare solutions from data collection to data interpretation and from data analysis to data delivery. In this thesis we introduce a Context-aware Real-time Assistant (CARA) architecture that integrates novel approaches with state-of-the-art technology solutions to provide a full-scale pervasive healthcare solution with the emphasis on context awareness to help maintaining the well-being of elderly people. CARA collects information about and around the individual in a home environment, and enables accurately recognition and continuously monitoring activities of daily living. It employs an innovative reasoning engine to provide accurate real-time interpretation of the context and current situation assessment. Being mindful of the use of the system for sensitive personal applications, CARA includes several mechanisms to make the sophisticated intelligent components as transparent and accountable as possible, it also includes a novel cloud-based component for more effective data analysis. To deliver the automated real-time services, CARA supports interactive video and medical sensor based remote consultation. Our proposal has been validated in three application domains that are rich in pervasive contexts and real-time scenarios: (i) Mobile-based Activity Recognition, (ii) Intelligent Healthcare Decision Support Systems and (iii) Home-based Remote Monitoring Systems.

Childhood obesity treatment: integrating mobile health technology into a paediatric obesity service

Background: The management of childhood obesity is challenging. Aims: Thesis, i) reviews the evidence for lifestyle treatment of obesity, ii) explores cardiometabolic burden in childhood obesity, iii) explores whether changes in body composition predicts change in insulin sensitivity (IS), iv) develops and evaluates a lifestyle obesity intervention; v) develops a mobile health application for obesity treatment and vi) tests the application in a clinical trial. Methods: In Study 1, systematic reviews and meta-analyses of the 12‐month effects of lifestyle and mHealth interventions were conducted. In Study 2, the prevalence of cardiometabolic burden was estimated in a consecutive series of 267 children. In Study 3, body composition was estimated with bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA) and linear regression analyses were used to estimate the extent to which each methods predicted change in IS. Study 4 describes the development of the Temple Street W82GO Healthy Lifestyle intervention for clinical obesity in children and a controlled study of treatment effect in 276 children is reported. Study 5 describes the development and testing of the Reactivate Mobile Obesity Application. Study 6 outlines the development and preliminary report from a clinical effectiveness trial of Reactivate. Results: In Study 1, meta--‐analyses BMI SDS changed by -0.16 (-0.24,‐0.07, p<0.01) and -0.03 (-0.13, 0.06, p=0.48). In study 2, cardiometabolic comorbidities were common (e.g. hypertension in 49%) and prevalence increased as obesity level increased. In Study 3, BC changes significantly predicted changes in IS. In Study 4, BMI SDS was significantly reduced in W82GO compared to controls (p<0.001). In Study 5, the Reactivate application had good usability indices and preliminary 6‐month process report data from Study 6, revealed a promising effect for Reactivate. Conclusions: W82GO and Reactivate are promising forms of treatment.

A benchmark comparison between reconfigurable, intelligent and autonomous wireless inertial measurement and photonic technologies in rehabilitation

Advanced sensory systems address a number of major obstacles towards the provision for cost effective and proactive rehabilitation. Many of these systems employ technologies such as high-speed video or motion capture to generate quantitative measurements. However these solutions are accompanied by some major limitations including extensive set-up and calibration, restriction to indoor use, high cost and time consuming data analysis. Additionally many do not quantify improvement in a rigorous manner for example gait analysis for 5 minutes as opposed to 24 hour ambulatory monitoring. This work addresses these limitations using low cost, wearable wireless inertial measurement as a mobile and minimal infrastructure alternative. In cooperation with healthcare professionals the goal is to design and implement a reconfigurable and intelligent movement capture system. A key component of this work is an extensive benchmark comparison with the 'gold standard' VICON motion capture system.

A cycle route planner mobile-app for Dublin city

In a road network, cyclists are the group exposed to the maximum amount of risk. Route choice of a cyclist is often based on level of expertise, perceived or actual road risks, personal decisions, weather conditions and a number of other factors. Consequently, cycling tends to be the only significant travel mode where optimised route choice is not based on least-path or least-time. This paper presents an Android platform based mobile-app for personalised route planning of cyclists in Dublin. The mobile-app, apart from its immediate advantage to the cyclists, acts as the departure point for a number of research projects and aids in establishing some critical calibration values for the cycling network in Dublin. 

The cloud personal assistant for providing services to mobile clients

This paper introduces the original concept of a cloud personal assistant, a cloud service that manages the access of mobile clients to cloud services. The cloud personal assistant works in the cloud on behalf of its owner: it discovers services, invokes them, stores the results and history, and delivers the results to the mobile user immediately or when the user requests them. Preliminary experimental results that demonstrate the concept are included.

User experience of mobile cloud applications - current state and future directions

The increasing penetration rate of feature rich mobile devices such as smartphones and tablets in the global population has resulted in a large number of applications and services being created or modified to support mobile devices. Mobile cloud computing is a proposed paradigm to address the resource scarcity of mobile devices in the face of demand for more computing intensive tasks. Several approaches have been proposed to confront the challenges of mobile cloud computing, but none has used the user experience as the primary focus point. In this paper we evaluate these approaches in respect of the user experience, propose what future research directions in this area require to provide for this crucial aspect, and introduce our own solution.

Mobile cloud application models facilitated by the CPA

This paper describes implementations of two mobile cloud applications, file synchronisation and intensive data processing, using the Context Aware Mobile Cloud Services middleware, and the Cloud Personal Assistant. Both are part of the same mobile cloud project, actively developed and currently at the second version. We describe recent changes to the middleware, along with our experimental results of the two application models. We discuss challenges faced during the development of the middleware and their implications. The paper includes performance analysis of the CPA support for the two applications in respect to existing solutions.

The mobile cloud - more than a cloud

Nearly one billion smart mobile devices are now used for a growing number of tasks, such as browsing the web and accessing online services. In many communities, such devices are becoming the platform of choice for tasks traditionally carried out on a personal computer. However, despite the advances, these devices are still lacking in resources compared to their traditional desktop counterparts. Mobile cloud computing is seen as a new paradigm that can address the resource shortcomings in these devices with the plentiful computing resources of the cloud. This can enable the mobile device to be used for a large range of new applications hosted in the cloud that are too resource demanding to run locally. Bringing these two technologies together presents various difficulties. In this paper, we examine the advantages of the mobile cloud and the new approaches to applications it enables. We present our own solution to create a positive user experience for such applications and describe how it enables these applications.

Designing tools that enhance communication and understanding between multiple stakeholders: the case of mobile payment value networks

The pervasive use of mobile technologies has provided new opportunities for organisations to achieve competitive advantage by using a value network of partners to create value for multiple users. The delivery of a mobile payment (m-payment) system is an example of a value network as it requires the collaboration of multiple partners from diverse industries, each bringing their own expertise, motivations and expectations. Consequently, managing partnerships has been identified as a core competence required by organisations to form viable partnerships in an m-payment value network and an important factor in determining the sustainability of an m-payment business model. However, there is evidence that organisations lack this competence which has been witnessed in the m-payment domain where it has been attributed as an influencing factor in a number of failed m-payment initiatives since 2000. In response to this organisational deficiency, this research project leverages the use of design thinking and visualisation tools to enhance communication and understanding between managers who are responsible for managing partnerships within the m-payment domain. By adopting a design science research approach, which is a problem solving paradigm, the research builds and evaluates a visualisation tool in the form of a Partnership Management Canvas. In doing so, this study demonstrates that when organisations encourage their managers to adopt design thinking, as a way to balance their analytical thinking and intuitive thinking, communication and understanding between the partners increases. This can lead to a shared understanding and a shared commitment between the partners. In addition, the research identifies a number of key business model design issues that need to be considered by researchers and practitioners when designing an m-payment business model. As an applied research project, the study makes valuable contributions to the knowledge base and to the practice of management.

Mobile cloud contextual awareness with the cloud personal assistant

This paper presents our efforts to bridge the gap between mobile context awareness, and mobile cloud services, using the Cloud Personal Assistant (CPA). The CPA is a part of the Context Aware Mobile Cloud Services (CAMCS) middleware, which we continue to develop. Specifically, we discuss the development and evaluation of the Context Processor component of this middleware. This component collects context data from the mobile devices of users, which is then provided to the CPA of each user, for use with mobile cloud services. We discuss the architecture and implementation of the Context Processor, followed by the evaluation. We introduce context profiles for the CPA, which influence its operation by using different context types. As part of the evaluation, we present two experimental context-aware mobile cloud services to illustrate how the CPA works with user context, and related context profiles, to complete tasks for the user.

Integrating mobile and cloud resources management using the cloud personal assistant

The mobile cloud computing model promises to address the resource limitations of mobile devices, but effectively implementing this model is difficult. Previous work on mobile cloud computing has required the user to have a continuous, high-quality connection to the cloud infrastructure. This is undesirable and possibly infeasible, as the energy required on the mobile device to maintain a connection, and transfer sizeable amounts of data is large; the bandwidth tends to be quite variable, and low on cellular networks. The cloud deployment itself needs to efficiently allocate scalable resources to the user as well. In this paper, we formulate the best practices for efficiently managing the resources required for the mobile cloud model, namely energy, bandwidth and cloud computing resources. These practices can be realised with our mobile cloud middleware project, featuring the Cloud Personal Assistant (CPA). We compare this with the other approaches in the area, to highlight the importance of minimising the usage of these resources, and therefore ensure successful adoption of the model by end users. Based on results from experiments performed with mobile devices, we develop a no-overhead decision model for task and data offloading to the CPA of a user, which provides efficient management of mobile cloud resources.

Designing and evaluating an interactive assessment instrument to improve the process for mobile service application innovation

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