A framework for cloud-based patient-centred health and wellbeing services in an underserved context : case of maternal health information services in Kenya

Abstract

The United Nation’s (UN) Sustainable Development Goals (SDGs) agenda recognises health as a key pillar for global development, hence the need to reduce health inequalities and inequity. Specifically, the aim of SDG 3 is to oversee the health and wellbeing of all people, and reducing maternal mortality. As part of various strategies to achieve global health reform, the World Health Organisation (WHO) proposes the implementation of an integrated and people-centred health services framework by member states. Consequently, in order to achieve this agenda, Target 9c of the SGDs emphasises the need to increase the use of information and communications technologies (ICTs), particularly in the developing countries. Despite these efforts, health systems continue to face the challenge of persistent failure to satisfy health care demands, hence the need to rethink the design of health care. Existing health care information systems (HISs), particularly in low-income and middle-income countries (LMICs), need to be adequately customised to make these systems more technically sound. However, there is a paucity of research whereby health systems are highly fragmented, while cloud infrastructures have not been utilised sufficiently to support health care integration to promote people-centred care. Furthermore, patients’ voices have not been heard on their own health care, including the designing and development of health information technology (HIT) interventions, thus leading to a lack of meaningful use of HITs. Furthermore, health professionals are unable to make evidence-based decisions at the point of care due to the lack of sufficient patient information, thereby prompting medical mistakes. The need for innovative HIT solutions is therefore just as valid in underserved contexts to improve population health and wellbeing. The aim of this research was to develop a framework for ICT-facilitated patient-centred health and wellbeing information architecture to support maternal health care in an underserved context as a case of Kenya’s health system. While the research adopted an interpretive approach, the lens of both stakeholder theory and co-design-oriented Service Design Research (SDR) were used to create the proposed framework. As representative sample, 47 participants (n=47) were recruited from six public health facilities located in informal settlements within Nairobi City County, Kenya. The research was executed on two levels: the co-analysis phase and the co-design phase. The co-analysis process involved the gathering of data from a social perspective, namely: contextual inquiry using interviews, focus group discussions, and observation. The co-design process entailed interactive co-design activities to gather data about the service as the design object in the form of design concepts and constructs, design principles, architectures, the design process, and proof of concept, which involved the use of various design tools and techniques, including a case scenario, information flow, service blueprint, business modelling diagrams, and service prototyping. The thematic analysis (TA) method was applied to analyse the collected data, whereby manual coding was performed, after which twenty (20) data themes were generated to inform the study. A framework for cloud-based patient-centred health and wellbeing information architecture (CPHIA) was developed to enhance the development of eHealth interventions for maternal health care in an underserved context. A cloud-based mobile web application prototype service (AfyaTab) was developed as proof of concept, and by so doing, the study contributes theoretical, discipline and methodological knowledge to health practice.