Embracing Complexity: Rethinking Culturally Informed Design in Human Factors/Ergonomics and Consumer Health Informatics

ABSTRACT

A basic premise of macroergonomic theory is that better physical and psychological outcomes and reduced unintended consequences are achieved when there is alignment between a technology and the user’s work system. The user’s work system is defined as the social subsystem, technical subsystem, and the external environment within which work is performed. Cultural context has been conceptualized as part of the external environment. Thus, from a theoretical viewpoint, creating technology that is aligned with users’ cultural contexts will result in better performance outcomes. The need to align with cultural context is particularly important for technologies such as consumer health information technology, which are intended for use within the naturalistic spaces of patients’ homes and communities. Traditional means of accounting for cultural context in the human factors and consumer health informatics literatures are narrow and unlikely to capture the potential richness and complexity of patients’ cultural contexts. The case study presented here sought to understand cultural context from a patient perspective. Eighteen patients with type 2 diabetes were engaged in a series of interviews about their health information communication practices, their cultural contexts, and the relationships between these. Participants identified a wide range of cultural identities comprising their cultural contexts, including race, ethnicity, nationality, experience, religion, and socioeconomic status. They also identified multiple ways in which cultural identity may be operationalized; qualitative content analysis was used to group these into three main themes: experience (ways in which culture is learned), manifestation (ways in which culture is exhibited), structure (ways in which culture is a social organization or system). Across participants, each of these operationalizations was perceived as influencing health information communication practices. Consequently, the findings suggest that the fields of human factors and consumer health informatics must reconceptualize users’ cultural contexts as encompassing a wider range of identities and as neither constant nor stable. Rather, cultural contexts are situation dependent, are subject to interpretation, and vary across individuals. Such a conclusion implies that existing approaches of aligning specific technologies with specific cultural identities may no longer be appropriate nor scalable. Instead, a more feasible alternative may be to meet the needs of individuals embedded in multiple cultural contexts simultaneously while also enabling users to self-select salient attributes of the technology.

Acknowledgments

This project was supported by grant number R36 HS18809-01 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors would also like to thank the staff and patients of the Federally Qualified Health Centers where this work was conducted.

Additional information

Notes on contributors

Rupa S. Valdez

Rupa Valdez, PhD, is Assistant Professor of Biomedical Informatics at the University of Virginia. Her research integrates methods from medical informatics, health systems engineering, human factors engineering, and cultural anthropology to characterize patients’ home and community environments and to design and evaluate consumer HIT interventions based upon these assessments.

Patricia Flatley Brennan

In August 2016, Patricia Flatley Brennan, RN, PhD, became the Director of the National Library of Medicine (NLM). At UW Madison she was the Moehlman Bascom Professor at the School of Nursing and College of Engineering. She led the Living Environments Laboratory, developing effective visualizations of high dimensional data.