title: Considerations for an Access-Centered Design of the Fever Thermometer in Low-Resource Settings: A Literature Review.
abstract: BACKGROUND
  The lack of adequate information about fever in low-resource settings, its unreliable self-assessment, and poor diagnostic practices may result in delayed care and under-or-overdiagnosis of diseases such as malaria. The mismatches of existing fever thermometers in the context of use imply that the diagnostic tools and connected services need to be studied further to address the challenges of fever-related illnesses and their diagnostics.
  
  
  OBJECTIVE
  This study aims to inform a product-service system approach to design a reliable and accessible fever thermometer and connected services, as well as contribute to the identification of innovative opportunities to improve health care in low-resource settings.
  
  
  METHODS
  To determine what factors impede febrile people seeking health care to access adequate fever diagnostics, a literature search was conducted in Google Scholar and PubMed with relevant keywords. Next, these factors were combined with a patient journey model to design a new product-service system for fever diagnostics in low-resource settings.
  
  
  RESULTS
  In total, 37 articles were reviewed. The five As framework was used to categorize the identified barriers. The results indicate that there is a poor distribution of reliable fever diagnostic practices among remote communities. This paper speaks to the global public health and design communities. Three complementary considerations are discussed that support the idea of a more holistic approach to the design of fever diagnostics: (1) understanding of the fever diagnostics patient journey, (2) identifying user groups of the thermometers in a specific health care system, and (3) assessing different needs and interests of the different users.
  
  
  CONCLUSIONS
  Access to basic, primary health care may be enhanced with better information and technology design made through the involvement of system users.
authors.affiliation: Design for Sustainability, Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
authors.forename: Rikako
authors.identifier: http://orcid.org/0000-0003-2410-4907
authors.initials: R
authors.lastname: Iwamoto
authors.affiliation: Design for Sustainability, Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
authors.forename: Ana Laura
authors.identifier: http://orcid.org/0000-0003-3853-2945
authors.initials: AL
authors.lastname: Rodrigues Santos
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, Netherlands.
authors.forename: Niels
authors.identifier: http://orcid.org/0000-0002-8607-9199
authors.initials: N
authors.lastname: Chavannes
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, Netherlands.|Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands.|The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Ria
authors.identifier: http://orcid.org/0000-0001-8249-0856
authors.initials: R
authors.lastname: Reis
authors.affiliation: Design for Sustainability, Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
authors.forename: Jan Carel
authors.identifier: http://orcid.org/0000-0002-4007-2282
authors.initials: JC
authors.lastname: Diehl
keywords: design; fever diagnostics; low-resource settings; patient journey; product-service system; sub-Saharan Africa; thermometer