Abstract
The present paper aims to review the value of Action Research (AR) in the evolution of sustainable mHealth. On the one hand, mHealth is a medically and economically massively expanding domain. On the other hand, the mHealth development suffers from a serious lack of sustainability, which has become particularly evident through the concept of “pilotitis.” The proposed methodological remedy shows a high congruence to the principle of AR. A quantitative and qualitative literature research is performed. Each result from the qualitative literature research is analyzed with regard to aim, main focuses of AR methodology, study results and AR contribution to mHealth development. The principles of AR with regard to mHealth development are described, showing a strong connection between corresponding methodology and effects in health care. We analyze the quantitative contribution of AR to health care in general and show the typical phases of AR healthcare implementation. Furthermore, a quantitative literature research reveals that AR contributes to 6 % of mHealth publications. Our qualitative literature research discovers 27 studies dealing with AR contributions (54 % direct, 46 % methodological) to mHealth. Main subjects of the direct contributions are Health Information Systems (38 %), Surgery (23 %), Conservative/internal medicine (15 %), Self-help (15 %) and Medical Education (8 %). In summary, our review shows that AR contributes qualitatively and quantitatively to the mHealth development and that AR has a special potential to generate sustainable mHealth solutions.
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Aanestad M, Joliffe B, Mukherjee A, Sahay S (2014) Infrastructuring work: building a State-Wide Hospital information infrastructure in india information systems research online publication 17 November. doi:10.1287/isre.2014.0557
Ahari SS, Habibzadeh S, Yousefi M, Amani F, Abdi R (2012) Community based needs assessment in an urban area: a participatory action research project. BMC Publ Health 12(1):161
Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50(2):179–211
Asangansi I, Braa K (2010) The emergence of mobile-supported national health information systems in developing countries. Stud Health Technol Inform 160(Pt 1):540–544
Baskerville RL (1999) Investigating information systems with action research. Communications of the Association for Information Systems 2, Article 19
Beijma H (2011) Pilotitis, the biggest disease in mhealth. http://de.slideshare.net/texttochange/pilotitis-the-biggest-disease-in-mhealth. Accessed 31 Mar 2015
Braa K, Sanner T (2011) Making mHealth happen for health information systems in low resource contexts. Proceedings of the 11th International Conference on Social Implications of Computers in Developing Countries, Kathmandu, Nepal: 530–541
Braa K, Monteiro E, Sahay S (2004) Networks of action: sustainable health information systems across developing countries. MIS Q 28(3):337–362
Braa K, Hanseth O, Heywood A, Mohammed W, Shaw V (2007) Developing health information systems in developing countries: the flexible standards strategy. MIS Q 31(August):1–22
Braa K, Heywood A, Sahay S (2012) Improving quality and use of data through data-use workshops: Zanzibar, United Republic of Tanzania. Bull World Health Organ 90(5):379–384
Carlozzi NE, Tulsky DS, Kisala PA (2011) Traumatic brain injury patient-reported outcome measure: identification of health-related quality-of-life issues relevant to individuals with traumatic brain injury. Arch Phys Med Rehabil 92(10 Suppl):S52–S60
Chaiyachati KH, Loveday M, Lorenz S, Lesh N, Larkan L-M, Cinti S, Friedland GH, Haberer JE (2013) A pilot study of an mHealth application for healthcare workers: poor uptake despite high reported acceptability at a rural South African community-based MDR-TB treatment program. PLoS ONE 8(5):e64662
Charupash R, Taksinajenkit K, Somjaipen S (2010) Applying the sufficient economical theory in personal money planning: a class room action research at Sirindhron Public Health College Khon Kaen Province, Thailand. Proc Soc Behav Sci 2(2):3792–3795
Checkland P, Holwell S (2007) Action Research. In: Kock N (ed) Information systems action research. Springer, Boston, pp 3–17
Chiasson M, Reddy M, Kaplan B, Davidson E (2007) Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics? Int J Med Inf 76(Suppl 1):89–97
Cintra RF, Vieira SFA, Hall RJ, Fernandes CR (2013) Information from the invoicing sector as support for decision-making: a case study at the University Hospital of the Federal University of Grande Dourados (UFGD). Ciência and saúde coletiva 18(10):3043–3053
Courtney-Pratt H, Cummings E, TurnerP Cameron-Tucker H, Wood-Baker R, Walters EH, Robinson AL (2012) Entering a world of uncertainty: community nurses’ engagement with information and communication technology. Comput Inf Nurs: CIN 30(11):612–619
Cuisance D, Rioux J-A (2004) Current status of medical and veterinary entomology in France: endangered discipline or promising science? Comp Immunol Microbiol Infect Dis 27(5):377–392
Davison R, Martinsons MG, Kock N (2004) Principles of canonical action research. Inf Syst J 14(1):65–86
Delf P (2013) Designing effective eLearning for healthcare professionals. Radiography 19(4):315–320
Divakaran PKP (2013) Pre-release member participation as potential predictors of post-release community members’ adoption behaviour: evidence from the motion picture industry. Behav Inf Technol 32(6):545–559
Ehde DM, Wegener ST, Williams RM, Ephraim PL, Stevenson JE, Isenberg PJ, Mackenzie EJ (2013) Developing, testing, and sustaining rehabilitation interventions via participatory action research. Arch Phys Med Rehabil 94(1 Suppl):S30–S42
Ekberg J, Gursky EA, Timpka T (2013) Pre-launch evaluation checklist for online health-promoting communities. J Biomed Inf Online Publ. doi:10.1016/j.jbi.2013.10.004
Fiordelli M, Diviani N, Schulz PJ (2013) Mapping mHealth research: a decade of evolution. J Med Internet Res 15(5):e95
Hallberg N, Timpka T, Eriksson H (1999) The medical software quality deployment method. Methods Inf Med 38(1):66–73
Henderson BD (1970) The product portfolio. http://www.bcg.de/documents/file52312.pdf. Accessed 31 Mar 2015
Ho K, Marsden J, Jarvis-Selinger S, Novak Lauscher H, Kamal N, Stenstrom R, Sweet D, Goldman RD, Innes G (2012) A collaborative quality improvement model and electronic community of practice to support sepsis management in emergency departments: investigating care harmonization for provincial knowledge translation. JMIR Res Protoc 1(2):e6
Janssen J, Hale L, Mirfin-Veitch B, Harland T (2013) Building the research capacity of clinical physical therapists using a participatory action research approach. Phys Ther 93(7):923–934
Jinks C, Ong BN, O’Neill TJ (2009) The Keele community knee pain forum: action research to engage with stakeholders about the prevention of knee pain and disability. BMC Musculoskelet Disord 10:85
Jonker J, Pennink B (2009) The essence of research methodology. Springer, Berlin
Joyner K, Mash B (2012) A comprehensive model for intimate partner violence in South African primary care: action research. BMC Health Serv Res 12(1):399
Källander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, Ten Asbroek AHA, Conteh L, Kirkwood BR, Meek SR (2013) Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review. J Med Internet Res 15(1):e17
Kanfer FH, Reinecker H, Schmelzer D (2012) Selbstmanagement-therapie, 5th edn. Springer, Berlin
Kant I (1986) Kritik der reinen Vernunft (1st edition in 1781). Reclam Verlag, Ditzingen
Kimaro HC, Twaakyondo HM (2005) Analysing the hindrance to the use of information and technology for improving efficiency of health care delivery system in Tanzania. Tanzania Health Res Bull 7(3):189–197
Kohli R, Hoadley ED (2007) Healthcare: fertile ground for action research. In: Kock N (ed) Information systems action research. Boston, Massachusetts, Springer science and Business Media, pp 241–254
Kohli R, Kettinger WJ (2004) Informating the clan: controlling physicians’ costs and outcomes. MIS Q 28(3):363–394
Kotter J (1996) Leading change. Harvard Business Press, Boston
Kuipers P, Humphreys JS, Wakerman J, Wells R, Jones J, Entwistle P (2008) Collaborative review of pilot projects to inform policy: a methodological remedy for pilotitis? Aust New Zealand Health Policy 5(1):17
Kyhlbäck H, Sutter B (2007) What does it take to replace an old functioning information system with a new one? A case study. Int J Med Inform 76(Suppl 1):S149–S158
Lalonde L, Goudreau J, Hudon É, Lussier M-T, Duhamel F, Bélanger D, Lévesque L, Martin É (2012) Priorities for action to improve cardiovascular preventive care of patients with multimorbid conditions in primary care–a participatory action research project. Fam Pract 29(6):733–741
Lemaire JL (2011) Scaling up mobile health elements necessary for the mHealth in developing countries. http://www.adaorganization.net/uploads/2/3/7/1/23713723/scaling_up_mobile_health_elements_necessary_for_the_successful_scale_up_of_mhealth_in_developing_countries.pdf. Accessed 31 Mar 2015
Lewin K (1948) Action research and minority problems. In: Lewin GW (ed) Resolving social conflicts. Harper, New York, pp 34–36
Menschner P, Leimeister JM (2012) Devising a method for developing knowledge-intense, person-oriented services—results from early evaluation. 45th Hawaii International Conference on System Sciences (HICSS). Maui, USA, pp 1502–1511
Meyer J (2000) Qualitative research in health care. Using qualitative methods in health related action research. BMJ 320(7228):178–181 (Clinical research ed.)
Olvingson C, Hallberg N, Timpka T, Lindqvist K (2002) Requirements engineering for inter-organizational health information systems with functions for spatial analyses: modeling a WHO safe community applying use case maps. Methods Inf Med 41(4):299–304
Peters M, Robinson V (1984) The Origins and Status of Action Research. J Appl Behav Sci 20(2):113–124
Petrocelli J (2002) Processes and stages of change: counseling with the transtheoretical model of change. J Couns Dev 80:22–30
Pilemalm S, Timpka T (2008) Third generation participatory design in health informatics–making user participation applicable to large-scale information system projects. J Biomed Inform 41(2):327–339
Puri SK, Sahay S, Lewis J (2009) Building participatory HIS networks: a case study from Kerala, India. Inf Organ 19(2):63–83
Purkayastha S, Manda TD, Sanner TA (2013) A post-development perspective on mhealth—an implementation initiative in malawi. 46th Hawaii international conference on system sciences (HICSS). Maui, USA, pp 4217–4225
Robertson JM (1995) Principals’ partnerships: an action research study on the professional development of New Zealand school leaders. Ph.D. Thesis. University of Waikato, Hamilton
Robertson J (2000) The three Rs of action research methodology: reciprocity, reflexivity and reflection-on-reality. Educ Act Res 8(2):307–326
Rudtanasudjatum K (2008) Road traffic accidents management model: The successful application of stakeholder involvement in Chon Buri, Thailand. In 2008 8th International Conference on ITS Telecommunications, pp 195–198
Sanner TA, Roland LK, Braa K (2012) From pilot to scale: towards an mHealth typology for low-resource contexts. Health Policy Technol 1(3):155–164
Shahar S, Adznam SN, Rahman SA, Yusoff NAM, Yassin Z, Arshad F, Sakian NIM, Salleh M, Samah AA (2012) Development and analysis of acceptance of a nutrition education package among a rural elderly population: an action research study. BMC Geriatr 12(1):24
Skinner H, Maley O, Norman CD (2006) Developing internet-based eHealth promotion programs: the Spiral Technology Action Research (STAR) model. Health Promot Pract 7(4):406–417
Solomon BS, Duce D, Harrison R, Boness K (2012) Modeling social media collaborative work. In 2012 4th International Workshop on Modeling in Software Engineering (MISE), pp 43–49
Stringer ET (2013) Action Research. Sage, Thousand Oaks
Susman G, Evered RD (1978) An assessment of the scientific merits of action research. Adm Sci Q 23(4):582–603
Tanasugarn C, Thongbunjob K (2012) Human capital identification process: linkage for family medicine and community medicine to mobilize the community. J Med Assoc Thai Chotmaihet Thangphaet 95(Suppl 6):S94–S101
Terazzi A, Giordano A, Minuco G (1997) An example of usability measurement in clinical software procedures. Stud Health Technol Inform 43(B):736–740
Terazzi A, Giordano A, Minuco G (1998) How can usability measurement affect the re-engineering process of clinical software procedures? Int J Med Inform 52(1–3):229–234
Thompson MP (2002) Cultivating meaning: interpretive fine-tuning of a South African health information system. Inf Organ 12(3):183–211
Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC (2013) Scaling up mHealth: where is the evidence? PLoS Med 10(2):e1001382
Waterman H, Tillen D, Dickson R, De Koning K (2001) Action research: a systematic review and guidance for assessment. Health Technol Assessment 5(23): iii–157
Weick KE, Quinn RE (1999) Organizational change and development. Annu Rev Psychol 50:361–386
Winkelman WJ, Leonard KJ (2004) Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework. J Am Med Inform Assoc JAMIA 11(2):151–161
Wise M, Pulvermacher A, Shanovich KK, Gustafson DH, Sorkness C, Bhattacharya A (2010) Using action research to implement an integrated pediatric asthma case management and eHealth intervention for low-income families. Health Promot Pract 11(6):798–806
Ziegenfuss JT (1987) Research information systems are path to high-quality healthcare. Health progress (Saint Louis, Mo.) 68(8): 50–3, 82
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The present review is part of the PhD thesis of the first author. He introduced the original research idea into the research group, worked out the overview of AR, performed the qualitative and quantitative literature review and contributed decisively to the discussion. The other two authors acted as scientific supervisors, supplemented the literature selection with respect to the scholarly basket and revised the manuscript.
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Gerhardt, U., Breitschwerdt, R. & Thomas, O. Engineering sustainable mHealth: the role of Action Research. AI & Soc 32, 339–357 (2017). https://doi.org/10.1007/s00146-015-0640-5
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DOI: https://doi.org/10.1007/s00146-015-0640-5