title: Understanding safety-critical interactions with a home medical device through Distributed Cognition.
abstract: As healthcare shifts from the hospital to the home, it is becoming increasingly important to understand how patients interact with home medical devices, to inform the safe and patient-friendly design of these devices. Distributed Cognition (DCog) has been a useful theoretical framework for understanding situated interactions in the healthcare domain. However, it has not previously been applied to study interactions with home medical devices. In this study, DCog was applied to understand renal patients' interactions with Home Hemodialysis Technology (HHT), as an example of a home medical device. Data was gathered through ethnographic observations and interviews with 19 renal patients and interviews with seven professionals. Data was analyzed through the principles summarized in the Distributed Cognition for Teamwork methodology. In this paper we focus on the analysis of system activities, information flows, social structures, physical layouts, and artefacts. By explicitly considering different ways in which cognitive processes are distributed, the DCog approach helped to understand patients' interaction strategies, and pointed to design opportunities that could improve patients' experiences of using HHT. The findings highlight the need to design HHT taking into consideration likely scenarios of use in the home and of the broader home context. A setting such as home hemodialysis has the characteristics of a complex and safety-critical socio-technical system, and a DCog approach effectively helps to understand how safety is achieved or compromised in such a system.
authors.affiliation: UCL Interaction Centre, University College London, Gower Street, London WC1E 6BT, United Kingdom.
authors.forename: Atish
authors.initials: A
authors.lastname: Rajkomar
authors.affiliation: Department of Oncology, Royal Free NHS Trust, Pond Street, London NW3 2QG, United Kingdom.
authors.forename: Astrid
authors.initials: A
authors.lastname: Mayer
authors.affiliation: UCL Interaction Centre, University College London, Gower Street, London WC1E 6BT, United Kingdom. Electronic address: a.blandford@ucl.ac.uk.
authors.forename: Ann
authors.initials: A
authors.lastname: Blandford
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000884:Anthropology, Cultural; D016477:Artifacts; D001185:Artificial Intelligence; D003625:Data Collection; D003657:Decision Making; D004864:Equipment and Supplies; D005260:Female; D006437:Hemodialysis, Home / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007374:Interior Design and Furnishings; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy; D012111:Residence Characteristics; D012984:Software; D006113:United Kingdom
keywords: Distributed Cognition; Ethnography; Home hemodialysis; Interaction design; Patient experience; Safety–critical system