Introduction
As the US healthcare system becomes further impacted by factors such as the oncoming flood of baby boomers, increases in the amount of people uninsured or underinsured, higher occurrences of chronic illnesses (diabetes, hypertension, etc.), and an insufficient pool of incoming healthcare workers, the burden of managing one's own health, therapy, and medical transactions will increasingly fall on the patient and their family. As new systems for personal health management are developed it is critical then that these systems are responsive to the unique and specific needs of underserved populations.

Designing systems that meet the needs of the most disadvantaged users can help to insure wider adoption of that system by providing functionality and resources accessible to the most challenged of users. By conducting interviews with current users, care managers and administrators of personal health record systems a framework for best practices can be created to assist providers and developers as they look to adopt and develop these resources.

The MiVIA Personal Health Information System

Migrant families within the United States are a unique and historically misunderstood population of people. As their name would indicate, migrant workers move continually with the seasons of crops, as they are grown. Migrants straddle a line between the status of documented workers of the U.S. and illegal-aliens. Although they tend to the majority of U.S. agricultural needs, their status as citizens often raises questions regarding their rights to receive education and healthcare. Many complicated issues often surround the lives of migrant families: poverty, low-education, health, housing, language barriers and immigration status.

MiVIA is a web-based personal health record that allows migrant farm workers to update and keep track of their health information. MiVIA provides an opportunity to provide these people with the ability to create a continuous record of their health needs. Each worker's PHR is password protected and is HIPAA compliant providing audit trails, secure messaging and provider entry portals. MiVIA allows patients, or any advocate whom they authorize, to download their information at any time or to have the information downloaded by a health care provider.

The MiVIA program is a customized personal health record application designed within an underlying framework called FollowMe. The FollowMe platform is developed by Access Strategies, Inc., a privately held health information technology firm focused on web-based IT strategies for the healthcare industry. The ability to hold the health information of migrant farm workers in a centralized place through which they can access it no matter where they move is very important to this highly transient and often undocumented population. Of equal importance is the ability to keep track of any medical interactions that might occur throughout several different clinics in several different counties. Many of these field workers do not have medical insurance and so in most cases whenever they go to a clinic doctors often have to start over again and again toward understanding and deciphering the health history of these patients. Not only is this a burden on the provider, but it can also have an impact on one's health (ex. conflicting prescriptions).

Research to support adoption and implementation of systems such as MiVIA has identified that access to health information resources and support can have a positive impact on the health of underserved patients (Chang et al., 2004). Functionality findings have reported that these populations are concerned with their privacy, they want to decide who will access their health information and that all would want it to be portable in some manner of a smart card (Moreno 2007). It would appear that this community has distinct perceptions and insight toward the use of PHRs and yet research literature often focuses on categories common to issues of accessibility (technology and healthcare), usability (including literacy), and education and outreach (Brodie et al., 2000; Martin, 2006; Tang, 2006). There have also been findings that discuss how access to e-health services and resources is further exacerbating digital divide issues across racial and ethnic groups and in relation to socio-economic status (Hsu 2005).

The developers of MiVIA hope that this program can assist in at least providing migrant farm workers with a continuous record of their health information that can be easily accessed from any location. In order to better find out how migrant farm workers are using these systems and how best to address their needs a research project is currently being conducted within this population and is being analyzed to discover overarching issues, insights and experiences from the field that can assist toward future developments and implementations of health information systems within underserved communities.

Case Study Overview

Aguirre International (2006)conducted an evaluation of the MiVIA Program as it began to rollout services into Napa County, California. This evaluation provided an overview of system needs and implementation considerations for the MiVIA program as it continues to expand. Findings from this report indicated that components essential to adoption of the MiVIA program include a strong provider support base, effective outreach efforts and farm worker education opportunities.

Building off of these findings the focus of this report is to understand how qualitative research methods can be used to analyze and assess online health services. Specifically, investigation of the MiVIA program as it is being used within St Joseph Health System and Vineyard Worker Services of Sonoma County will be undertaken in order to better understand the perceptions and experiences of healthcare administrators and care managers who work with migrant farm workers and their families. It is becoming obvious through research and general implementation findings that a better understanding of the unique needs within underserved populations is necessary to effectively utilize personal health information systems within these communities. Furthermore, it is within the details of these unique experiences that the greatest need for research resides. For it is that element, the inimitable difficulties that cannot be easily overcome by these communities, that greatly needs consideration.

Through the use of qualitative research methods such as interviews and focus groups, greater detail can be derived from the experiences of people who work with these systems and within these communities. The study from which this report is derived from investigates three different cases in which PHRs are being implemented or considered for use within the community clinic environment. The first case, the MiVIA program, covers portions of the study discussed within this report. The MiVIA case study most importantly seeks perceptions of patients with experience in working with the MiVIA PHR in hopes of discovering constructs indicative of accessibility, usability and health outcomes. This study is also interested in realizing the experiences of healthcare staff that are promoting and using MiVIA as well. It is this specific aspect, perceptions of community-based healthcare staff and outreach workers that this report focuses on. It is recognized that healthcare is not an isolated experience and that people who use personal health information systems will often be doing so in communication with family members, care managers and physicians.

This report will outline preliminary findings from an interview conducted with the director of St. Joseph Health System for Sonoma County, the director of Vineyard Worker Services and a MiVIA outreach worker. Concepts to be discussed within the interview include aspects of adoption, implementation, usability, access, motivation, and health outcomes. Responses from the interview will be reviewed and coded so that themes or commonalities that surface through the discussion can be identified.

MiVIA Study Setting

These first sets of interviews were conducted during a two-day trip to Sonoma County where the MiVIA program is being implemented. Sonoma County is located a few miles above San Francisco and is most commonly known as a popular wine growing region. Sonoma is highly rural and consists of acres of vineyards used to grow the grapes for wine. Consequently, farm workers are employed throughout the year in order to assist in the growing, harvesting and fermenting of grapes. While this keeps many farm workers employed on a continual basis there are off season times in which farm workers most migrate within and outside of the county in order to find further work.

Two main sites were visited during this two day visit including a community center used as a mobile clinic site for St. Joseph Health System and an outreach center run by the Vineyard Workers Association. The mobile clinic site utilizes an “RV” in order to provide dental services on some days and health services on others. Staffing at these sites usually includes one to two primary physicians, nursing staff and a MiVIA outreach worker. It is the responsibility of the outreach worker to enroll patients into the MiVIA program and assist the physicians in populating the patient’s PHR with updates to their healthcare. The role of the outreach worker is crucial to patient and physician adoption of the MiVIA application. In discussions with the outreach worker it was identified that she often assists and trains patients in tasks which include learning how to use a computer, learning how to navigate the Internet and understanding how to log in and use the MiVIA PHR.

The Vineyard Workers Association (VWA) consists of an office in downtown Sonoma that is used as a drop-in site for migrant farm workers. Case managers there assist workers in a variety of social service tasks including the filling out of general paperwork, finding jobs, finding housing, dealing with social issues and accessing healthcare. Currently located at the VWA is one computer that can be used to train farm workers on computer basics and to enroll and train them in use of the MiVIA PHR. Significantly, VWA received a grant from the California Endowment in 2006 to enroll five hundred workers in the MiVIA program. VWA were able to fulfill their enrollment quota and are now seeking opportunities for continued use and adoption.

Study Design: The Use of Qualitative Research Methods

The use of data collection methods such as observation, interviews and extant documentation can provide extensive data collection opportunities (Creswell, 1998). Use of these types of methods within this research is appropriate since the purpose of this research is to explore and examine general impressions and experiences. An understanding of the perceptions and experiences of healthcare and outreach workers in use of the MiVIA application will be derived from a semi-structured interview conducted with four participants. Participants included the director and an outreach worker of the St. Joseph Health System and an administrator and case worker of the Vineyard Workers Association all of which who are using the MiVIA application within the community health environment. Neuman (2003) advocates the use of such methods when assessing unique populations that may be otherwise difficult to reach.

The use of qualitative research techniques can produce valuable and insightful results that are sometimes unavailable from fixed research methods. Use of qualitative research methods does not mean that the research is non-structured or that you are unable to produce empirical findings that can be generalizable. Yin (1989) stated that general applicability results from the set of methodological qualities of the case, and the rigor with which the case is constructed. In an effort to rigorously analyze interview data this study will use Atlas ti 5.0, the qualitative data analysis software in order to code the interview data received. Atlas ti is a well known tool for the analysis of large sets of textual, graphical, audio and video data and provides a systematic approach to analyzing qualitative data. Coding will be used in order to note when identified concepts (e.g. usability) and unrealized themes within discussions and interviews are encountered.

For example, if during the interviews each of the participants describe in their own way how difficult it is to get to a computer (for some they have to go to the library, for others they have to wait until the mobile van arrives, for others they can't access it at all) then a possible code that could be applied to this would be "difficulty accessing computers" or "access issues". Each time a similar response came up in other participant's interviews we would again code that element. It is possible that this code would come up in several different questions. If we find that throughout the interview this code comes up more frequently than other coded elements then we might surmise that "access to technology" is one of the leading disruptions as to effective use of the MiVIA system. With that knowledge we can make recommendations for system improvements.

Alternatively, we might find many users making comments as to how using MiVIA has allowed them to assist patients in tracking some important element of their children's health (e.g. helps keep track of immunizations, helps manage eye doctor appointments, reminds us of the last flu shot given). These types of comments we might code as "key features" which would provide us clues as to the overall utility of the MiVIA system or suggestions for components that should be included in all PHR systems used within vulnerable populations.

Interview Analysis and Findings

Analysis

The discussion between community clinic and social service administrators, outreach workers, and research staff spanned a time period of approximately forty-five minutes and was conducted using a semi-structured interview schedule that included questions about general experiences and perceptions in use of the MiVIA application (Appendix A).  The full interview was recorded and from this recording a transcript of the discussion was created (Appendix B). This discussion included approximately ninety-seven different communication exchanges between participants. This transcript was imported into Atlas ti for coding and general analysis. A limitation of this initial analysis reporting is that it involves only one interview set. Eventually, Atlas ti will house several primary documents made up of different interviews or pieces of data that can then be used for deeper analysis and defining of correlations between interviews and pertinent themes. A further limitation of this initial analysis is that a demo version was used and therefore only one hundred coded quotations could be stored, however over one hundred- fifty coding associations were identified. It is more than likely that once a full version of Atlas ti is obtained those findings will change or be further supported.

Coding consisted of identifying concepts or terms unique to the research context that arose naturally or through the prompted questions asked of the participants. For example, within the study being analyzed for MiVIA one of the constructs we were interested in identifying was motivation for use of personal health information systems. So as the transcriptions were read through, anytime a quote or phrase implicated some level of motivation this section was tagged with the code "motivation". Many elements were tagged with more than one code depending upon how many different relevant concepts were used within the quotation.

Preliminary Findings

One of the main goals of this study is to determine implementation and adoption issues experienced with the community health setting when using personal health information systems such as the MiVIA program. One way in which this was done was by identifying which coded variables arise within the conversation most often. Chart 1.0 provides a description of the number of times particular codes were found throughout the discussion between directors and outreach workers. Although some concepts were likely triggered from questions asked of participants, the frequency for which they occurred is still indicative of the importance of those concepts as it relates to use of PHRs within vulnerable populations.

From a quick look of these findings we can identify that aspects of education, empowerment, outreach, infrastructure challenges, and the use of health I.D. cards were a frequent part of people's experiences and perceptions. Each of these concepts was found often throughout the discussion and indicate an important aspect of MiVIA use within these communities. Further issues of importance include data accuracy, health record storage, integration issues and staffing challenges.

Chart 1.0 – Frequency of Key Coded Comments

The concept of education, found upwards of seven times, often was referring to training needs in use of the MiVIA program. Expressed often was the idea that you cannot simply hand this community a PHR and think that they will begin managing their health. The only way for it to be effectively used within this group is through continuous trainings and education. This includes trainings about how to use a computer, use the Internet, and how to understand health information. A few examples of these quotes include:

·         “When we started doing MiVIA we discovered that there is no point registering people if they had no education on the program. There was just no use for it. So I started doing training for everybody on how to use the computer, how to use the internet, and how to use the MiVIA program in general.”

·         “Because just having a card is not enough. There is a lot of information to learn if you don’t have computer skills and we do want them to maximize the use of this tool to their benefit and their families benefit. So it does take continued interactions with them. [To Kenny] And I would think that at VWS you tend to follow up with the people after you have given them the card, hold classes…”

Another big issue in use of the MiVIA program with migrants was aspects of empowerment and often tied directly to that was the concept of the health ID card. Although the unintended importance of the health ID card had been related informally, it became obvious from this discussion just how big of an impact the introduction of this card had within the farm worker community. On further reflection this makes sense in that these people primarily consist of undocumented workers (even ones that have been living in the U.S. for up to ten years and more) and consequently obtaining valid identification is very difficult and a great burden. By providing a health id card that includes a picture and physician validated information the MiVIA program significantly empowers farm workers in their ability to legitimately identify themselves. Obviously, of equal importance is the fact that the MiVIA I.D. allows migrants to provide doctors with up to date health information including allergies, prescriptions, and chronic illnesses. These can be hard things to remember for anyone without the added difficulty of being from a population with highly fragmented healthcare.  Below are a couple of the comments made in this regard.

·         “The main motivator is that they get an id card. It says no id card on the bottom of it, but they use it as an id card. So that is one of the main motivators, because you are talking about people who either have a license or they don’t. If they don’t have a license then it is possible that they don’t have any form of ID, but they can go to the library and they can even go to some banks here with a utility bill and an ID and open an account. So that is a great motivator to be able to use it.”

·         “…not only that but even walking down the street and worrying about getting stopped by the police or somebody they are at least able to show that they are a part of Vineyard Worker Services and have recorded health information. Not only that, but without getting into liability issues it provides basic forms of information of what they are allergic to or medications.”

Another potentially interesting element to consider when comparing concepts used three to four times versus those used five or more times is the possible implication of the overarching domains that each of those sets might belong and how that relates to community-based organizations and their underlying priorities.  Other than infrastructure challenges the top elements discussed by directors and outreach workers all had to do with how MiVIA affected the individual. In other words the discussion centered on how MiVIA best supported the needs of the patient. While the primary focus of the study is on how PHRs affect patients, the questions asked of providers were in regards to adoption and implementation factors within the community clinic setting. Even the concept of infrastructure challenges is often related to the needs of patients:

“We are going to get a couple of computers, two Dells, so people can access anything they want in terms of their health records, health information, and we’ll have tutorials on there.”

When we start to look at the second set of concepts, those used three to four times we then seem to find concepts more focused on the needs of the overall clinical system (e.g. data accuracy, staffing issues, integration challenges, etc.).  Outside of any indication as to the unconscious goodwill of community health workers it is possible that this suggests that personal health system success is truly reliant on successful adoption by the patient. 

Conclusion

Preliminary findings indicate the need for patient-centered approaches to personal health information system design and development within vulnerable populations. Importantly, it is through inquiry of healthcare staff that these results are found. It would be expected that a patient’s perspective of personal health systems would center on their specific needs and yet is instructive when administrators of these systems identify the need for patient empowerment as well. Interview data relates that issues of education, empowerment, identification, staffing and integration are all pertinent components to successful implementation within underserved populations. Perhaps most significantly is that these results and the insightful comments elicited from the interviews conducted would not have been realized if not for the use of qualitative research methods. Facets such as the importance of health I.D. cards or the specific tasks that need to be conducted as a MiVIA outreach worker do not come forth within quantitative techniques. It is through the descriptions and personal experiences of users that make possible the ability to identify the unique elements that describe a successful system.

References

Aguirre-International (2006). Case Study: MiVIA Rollout to Napa. Burlingame Aguirre International: 26.

Brodie, M., Flournoy, R. E., Altman, D. E., Blendon, R. J., Benson, J. M., & Rosenbaum, M. D. (2000). Health information, the Internet, and the digital divide. Health Aff, 19(6), 255-265.

Chang, B. L., Bakken, S., Brown, S. S., Houston, T. K., Kreps, G. L., Kukafka, R., et al. (2004). Bridging the Digital Divide: Reaching Vulnerable Populations. J Am Med Inform Assoc, M1535.

Creswell, J. W. (1998). Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Thousand Oaks, CA: SAGE Publications.

Hsu, J., Huang, J., Kinsman, J., Fireman, B., Miller, R., Selby, J., et al. (2005). Use of e-Health Services between 1999 and 2002: A Growing Digital Divide. Journal of the American Medical Informatics Association, 12, 164–171.

Martin, Z. (2006). Underserved clinics collaborate on I.T. Health Data Management, 14(10), 68.

Neuman, W. L. (2003). Social Research Methods: Qualitative and Quantitative Approaches (5th ed.). Boston: Allyn and Bacon.

Tang, P. C., & Lansky, D. (2005). The Missing Link: Bridging the Patient-Provider Health Information Gap. Health Aff, 24(5), 1290-1295.

Yin, R. (1989a). Case study research: Design and methods (Rev. ed.). Beverly Hills, CA: Sage Publishing.

[More]

Introduction
As the US healthcare system becomes further impacted by factors such as the oncoming flood of baby boomers, increases in the amount of people uninsured or underinsured, higher occurrences of chronic illnesses (diabetes, hypertension, etc.), and an insufficient pool of incoming healthcare workers, the burden of managing one's own health, therapy, and medical transactions will increasingly fall on the patient and their family. As new systems for personal health management are developed it is critical then that these systems are responsive to the unique and specific needs of underserved populations.

Designing systems that meet the needs of the most disadvantaged users can help to insure wider adoption of that system by providing functionality and resources accessible to the most challenged of users. By conducting interviews with current users, care managers and administrators of personal health record systems a framework for best practices can be created to assist providers and developers as they look to adopt and develop these resources.

The MiVIA Personal Health Information System

Migrant families within the United States are a unique and historically misunderstood population of people. As their name would indicate, migrant workers move continually with the seasons of crops, as they are grown. Migrants straddle a line between the status of documented workers of the U.S. and illegal-aliens. Although they tend to the majority of U.S. agricultural needs, their status as citizens often raises questions regarding their rights to receive education and healthcare. Many complicated issues often surround the lives of migrant families: poverty, low-education, health, housing, language barriers and immigration status.

MiVIA is a web-based personal health record that allows migrant farm workers to update and keep track of their health information. MiVIA provides an opportunity to provide these people with the ability to create a continuous record of their health needs. Each worker's PHR is password protected and is HIPAA compliant providing audit trails, secure messaging and provider entry portals. MiVIA allows patients, or any advocate whom they authorize, to download their information at any time or to have the information downloaded by a health care provider.

The MiVIA program is a customized personal health record application designed within an underlying framework called FollowMe. The FollowMe platform is developed by Access Strategies, Inc., a privately held health information technology firm focused on web-based IT strategies for the healthcare industry. The ability to hold the health information of migrant farm workers in a centralized place through which they can access it no matter where they move is very important to this highly transient and often undocumented population. Of equal importance is the ability to keep track of any medical interactions that might occur throughout several different clinics in several different counties. Many of these field workers do not have medical insurance and so in most cases whenever they go to a clinic doctors often have to start over again and again toward understanding and deciphering the health history of these patients. Not only is this a burden on the provider, but it can also have an impact on one's health (ex. conflicting prescriptions).

Research to support adoption and implementation of systems such as MiVIA has identified that access to health information resources and support can have a positive impact on the health of underserved patients (Chang et al., 2004). Functionality findings have reported that these populations are concerned with their privacy, they want to decide who will access their health information and that all would want it to be portable in some manner of a smart card (Moreno 2007). It would appear that this community has distinct perceptions and insight toward the use of PHRs and yet research literature often focuses on categories common to issues of accessibility (technology and healthcare), usability (including literacy), and education and outreach (Brodie et al., 2000; Martin, 2006; Tang, 2006). There have also been findings that discuss how access to e-health services and resources is further exacerbating digital divide issues across racial and ethnic groups and in relation to socio-economic status (Hsu 2005).

The developers of MiVIA hope that this program can assist in at least providing migrant farm workers with a continuous record of their health information that can be easily accessed from any location. In order to better find out how migrant farm workers are using these systems and how best to address their needs a research project is currently being conducted within this population and is being analyzed to discover overarching issues, insights and experiences from the field that can assist toward future developments and implementations of health information systems within underserved communities.

Case Study Overview

Aguirre International (2006)conducted an evaluation of the MiVIA Program as it began to rollout services into Napa County, California. This evaluation provided an overview of system needs and implementation considerations for the MiVIA program as it continues to expand. Findings from this report indicated that components essential to adoption of the MiVIA program include a strong provider support base, effective outreach efforts and farm worker education opportunities.

Building off of these findings the focus of this report is to understand how qualitative research methods can be used to analyze and assess online health services. Specifically, investigation of the MiVIA program as it is being used within St Joseph Health System and Vineyard Worker Services of Sonoma County will be undertaken in order to better understand the perceptions and experiences of healthcare administrators and care managers who work with migrant farm workers and their families. It is becoming obvious through research and general implementation findings that a better understanding of the unique needs within underserved populations is necessary to effectively utilize personal health information systems within these communities. Furthermore, it is within the details of these unique experiences that the greatest need for research resides. For it is that element, the inimitable difficulties that cannot be easily overcome by these communities, that greatly needs consideration.

Through the use of qualitative research methods such as interviews and focus groups, greater detail can be derived from the experiences of people who work with these systems and within these communities. The study from which this report is derived from investigates three different cases in which PHRs are being implemented or considered for use within the community clinic environment. The first case, the MiVIA program, covers portions of the study discussed within this report. The MiVIA case study most importantly seeks perceptions of patients with experience in working with the MiVIA PHR in hopes of discovering constructs indicative of accessibility, usability and health outcomes. This study is also interested in realizing the experiences of healthcare staff that are promoting and using MiVIA as well. It is this specific aspect, perceptions of community-based healthcare staff and outreach workers that this report focuses on. It is recognized that healthcare is not an isolated experience and that people who use personal health information systems will often be doing so in communication with family members, care managers and physicians.

This report will outline preliminary findings from an interview conducted with the director of St. Joseph Health System for Sonoma County, the director of Vineyard Worker Services and a MiVIA outreach worker. Concepts to be discussed within the interview include aspects of adoption, implementation, usability, access, motivation, and health outcomes. Responses from the interview will be reviewed and coded so that themes or commonalities that surface through the discussion can be identified.

MiVIA Study Setting

These first sets of interviews were conducted during a two-day trip to Sonoma County where the MiVIA program is being implemented. Sonoma County is located a few miles above San Francisco and is most commonly known as a popular wine growing region. Sonoma is highly rural and consists of acres of vineyards used to grow the grapes for wine. Consequently, farm workers are employed throughout the year in order to assist in the growing, harvesting and fermenting of grapes. While this keeps many farm workers employed on a continual basis there are off season times in which farm workers most migrate within and outside of the county in order to find further work.

Two main sites were visited during this two day visit including a community center used as a mobile clinic site for St. Joseph Health System and an outreach center run by the Vineyard Workers Association. The mobile clinic site utilizes an “RV” in order to provide dental services on some days and health services on others. Staffing at these sites usually includes one to two primary physicians, nursing staff and a MiVIA outreach worker. It is the responsibility of the outreach worker to enroll patients into the MiVIA program and assist the physicians in populating the patient’s PHR with updates to their healthcare. The role of the outreach worker is crucial to patient and physician adoption of the MiVIA application. In discussions with the outreach worker it was identified that she often assists and trains patients in tasks which include learning how to use a computer, learning how to navigate the Internet and understanding how to log in and use the MiVIA PHR.

The Vineyard Workers Association (VWA) consists of an office in downtown Sonoma that is used as a drop-in site for migrant farm workers. Case managers there assist workers in a variety of social service tasks including the filling out of general paperwork, finding jobs, finding housing, dealing with social issues and accessing healthcare. Currently located at the VWA is one computer that can be used to train farm workers on computer basics and to enroll and train them in use of the MiVIA PHR. Significantly, VWA received a grant from the California Endowment in 2006 to enroll five hundred workers in the MiVIA program. VWA were able to fulfill their enrollment quota and are now seeking opportunities for continued use and adoption.

Study Design: The Use of Qualitative Research Methods

The use of data collection methods such as observation, interviews and extant documentation can provide extensive data collection opportunities (Creswell, 1998). Use of these types of methods within this research is appropriate since the purpose of this research is to explore and examine general impressions and experiences. An understanding of the perceptions and experiences of healthcare and outreach workers in use of the MiVIA application will be derived from a semi-structured interview conducted with four participants. Participants included the director and an outreach worker of the St. Joseph Health System and an administrator and case worker of the Vineyard Workers Association all of which who are using the MiVIA application within the community health environment. Neuman (2003) advocates the use of such methods when assessing unique populations that may be otherwise difficult to reach.

The use of qualitative research techniques can produce valuable and insightful results that are sometimes unavailable from fixed research methods. Use of qualitative research methods does not mean that the research is non-structured or that you are unable to produce empirical findings that can be generalizable. Yin (1989) stated that general applicability results from the set of methodological qualities of the case, and the rigor with which the case is constructed. In an effort to rigorously analyze interview data this study will use Atlas ti 5.0, the qualitative data analysis software in order to code the interview data received. Atlas ti is a well known tool for the analysis of large sets of textual, graphical, audio and video data and provides a systematic approach to analyzing qualitative data. Coding will be used in order to note when identified concepts (e.g. usability) and unrealized themes within discussions and interviews are encountered.

For example, if during the interviews each of the participants describe in their own way how difficult it is to get to a computer (for some they have to go to the library, for others they have to wait until the mobile van arrives, for others they can't access it at all) then a possible code that could be applied to this would be "difficulty accessing computers" or "access issues". Each time a similar response came up in other participant's interviews we would again code that element. It is possible that this code would come up in several different questions. If we find that throughout the interview this code comes up more frequently than other coded elements then we might surmise that "access to technology" is one of the leading disruptions as to effective use of the MiVIA system. With that knowledge we can make recommendations for system improvements.

Alternatively, we might find many users making comments as to how using MiVIA has allowed them to assist patients in tracking some important element of their children's health (e.g. helps keep track of immunizations, helps manage eye doctor appointments, reminds us of the last flu shot given). These types of comments we might code as "key features" which would provide us clues as to the overall utility of the MiVIA system or suggestions for components that should be included in all PHR systems used within vulnerable populations.

Interview Analysis and Findings

Analysis

The discussion between community clinic and social service administrators, outreach workers, and research staff spanned a time period of approximately forty-five minutes and was conducted using a semi-structured interview schedule that included questions about general experiences and perceptions in use of the MiVIA application (Appendix A).  The full interview was recorded and from this recording a transcript of the discussion was created (Appendix B). This discussion included approximately ninety-seven different communication exchanges between participants. This transcript was imported into Atlas ti for coding and general analysis. A limitation of this initial analysis reporting is that it involves only one interview set. Eventually, Atlas ti will house several primary documents made up of different interviews or pieces of data that can then be used for deeper analysis and defining of correlations between interviews and pertinent themes. A further limitation of this initial analysis is that a demo version was used and therefore only one hundred coded quotations could be stored, however over one hundred- fifty coding associations were identified. It is more than likely that once a full version of Atlas ti is obtained those findings will change or be further supported.

Coding consisted of identifying concepts or terms unique to the research context that arose naturally or through the prompted questions asked of the participants. For example, within the study being analyzed for MiVIA one of the constructs we were interested in identifying was motivation for use of personal health information systems. So as the transcriptions were read through, anytime a quote or phrase implicated some level of motivation this section was tagged with the code "motivation". Many elements were tagged with more than one code depending upon how many different relevant concepts were used within the quotation.

Preliminary Findings

One of the main goals of this study is to determine implementation and adoption issues experienced with the community health setting when using personal health information systems such as the MiVIA program. One way in which this was done was by identifying which coded variables arise within the conversation most often. Chart 1.0 provides a description of the number of times particular codes were found throughout the discussion between directors and outreach workers. Although some concepts were likely triggered from questions asked of participants, the frequency for which they occurred is still indicative of the importance of those concepts as it relates to use of PHRs within vulnerable populations.

From a quick look of these findings we can identify that aspects of education, empowerment, outreach, infrastructure challenges, and the use of health I.D. cards were a frequent part of people's experiences and perceptions. Each of these concepts was found often throughout the discussion and indicate an important aspect of MiVIA use within these communities. Further issues of importance include data accuracy, health record storage, integration issues and staffing challenges.

Chart 1.0 – Frequency of Key Coded Comments

The concept of education, found upwards of seven times, often was referring to training needs in use of the MiVIA program. Expressed often was the idea that you cannot simply hand this community a PHR and think that they will begin managing their health. The only way for it to be effectively used within this group is through continuous trainings and education. This includes trainings about how to use a computer, use the Internet, and how to understand health information. A few examples of these quotes include:

·         “When we started doing MiVIA we discovered that there is no point registering people if they had no education on the program. There was just no use for it. So I started doing training for everybody on how to use the computer, how to use the internet, and how to use the MiVIA program in general.”

·         “Because just having a card is not enough. There is a lot of information to learn if you don’t have computer skills and we do want them to maximize the use of this tool to their benefit and their families benefit. So it does take continued interactions with them. [To Kenny] And I would think that at VWS you tend to follow up with the people after you have given them the card, hold classes…”

Another big issue in use of the MiVIA program with migrants was aspects of empowerment and often tied directly to that was the concept of the health ID card. Although the unintended importance of the health ID card had been related informally, it became obvious from this discussion just how big of an impact the introduction of this card had within the farm worker community. On further reflection this makes sense in that these people primarily consist of undocumented workers (even ones that have been living in the U.S. for up to ten years and more) and consequently obtaining valid identification is very difficult and a great burden. By providing a health id card that includes a picture and physician validated information the MiVIA program significantly empowers farm workers in their ability to legitimately identify themselves. Obviously, of equal importance is the fact that the MiVIA I.D. allows migrants to provide doctors with up to date health information including allergies, prescriptions, and chronic illnesses. These can be hard things to remember for anyone without the added difficulty of being from a population with highly fragmented healthcare.  Below are a couple of the comments made in this regard.

·         “The main motivator is that they get an id card. It says no id card on the bottom of it, but they use it as an id card. So that is one of the main motivators, because you are talking about people who either have a license or they don’t. If they don’t have a license then it is possible that they don’t have any form of ID, but they can go to the library and they can even go to some banks here with a utility bill and an ID and open an account. So that is a great motivator to be able to use it.”

·         “…not only that but even walking down the street and worrying about getting stopped by the police or somebody they are at least able to show that they are a part of Vineyard Worker Services and have recorded health information. Not only that, but without getting into liability issues it provides basic forms of information of what they are allergic to or medications.”

Another potentially interesting element to consider when comparing concepts used three to four times versus those used five or more times is the possible implication of the overarching domains that each of those sets might belong and how that relates to community-based organizations and their underlying priorities.  Other than infrastructure challenges the top elements discussed by directors and outreach workers all had to do with how MiVIA affected the individual. In other words the discussion centered on how MiVIA best supported the needs of the patient. While the primary focus of the study is on how PHRs affect patients, the questions asked of providers were in regards to adoption and implementation factors within the community clinic setting. Even the concept of infrastructure challenges is often related to the needs of patients:

“We are going to get a couple of computers, two Dells, so people can access anything they want in terms of their health records, health information, and we’ll have tutorials on there.”

When we start to look at the second set of concepts, those used three to four times we then seem to find concepts more focused on the needs of the overall clinical system (e.g. data accuracy, staffing issues, integration challenges, etc.).  Outside of any indication as to the unconscious goodwill of community health workers it is possible that this suggests that personal health system success is truly reliant on successful adoption by the patient. 

Conclusion

Preliminary findings indicate the need for patient-centered approaches to personal health information system design and development within vulnerable populations. Importantly, it is through inquiry of healthcare staff that these results are found. It would be expected that a patient’s perspective of personal health systems would center on their specific needs and yet is instructive when administrators of these systems identify the need for patient empowerment as well. Interview data relates that issues of education, empowerment, identification, staffing and integration are all pertinent components to successful implementation within underserved populations. Perhaps most significantly is that these results and the insightful comments elicited from the interviews conducted would not have been realized if not for the use of qualitative research methods. Facets such as the importance of health I.D. cards or the specific tasks that need to be conducted as a MiVIA outreach worker do not come forth within quantitative techniques. It is through the descriptions and personal experiences of users that make possible the ability to identify the unique elements that describe a successful system.

References

Aguirre-International (2006). Case Study: MiVIA Rollout to Napa. Burlingame Aguirre International: 26.

Brodie, M., Flournoy, R. E., Altman, D. E., Blendon, R. J., Benson, J. M., & Rosenbaum, M. D. (2000). Health information, the Internet, and the digital divide. Health Aff, 19(6), 255-265.

Chang, B. L., Bakken, S., Brown, S. S., Houston, T. K., Kreps, G. L., Kukafka, R., et al. (2004). Bridging the Digital Divide: Reaching Vulnerable Populations. J Am Med Inform Assoc, M1535.

Creswell, J. W. (1998). Qualitative Inquiry and Research Design: Choosing Among Five Traditions. Thousand Oaks, CA: SAGE Publications.

Hsu, J., Huang, J., Kinsman, J., Fireman, B., Miller, R., Selby, J., et al. (2005). Use of e-Health Services between 1999 and 2002: A Growing Digital Divide. Journal of the American Medical Informatics Association, 12, 164–171.

Martin, Z. (2006). Underserved clinics collaborate on I.T. Health Data Management, 14(10), 68.

Neuman, W. L. (2003). Social Research Methods: Qualitative and Quantitative Approaches (5th ed.). Boston: Allyn and Bacon.

Tang, P. C., & Lansky, D. (2005). The Missing Link: Bridging the Patient-Provider Health Information Gap. Health Aff, 24(5), 1290-1295.

Yin, R. (1989a). Case study research: Design and methods (Rev. ed.). Beverly Hills, CA: Sage Publishing.

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I really think this learning studio idea is worthwhile. I liked the custom format I was given based on my own preferences and style that I like to learn from. The content and reading was challenging in the begining, however the reward was after reading and gaining knowledge in qualitative research methods, I was able to apply it directly to a useful project.

This class was interesting in that it gave freedom and flexibility where most all other classes spoon feed a textbook, test on formulas, concepts, etc. and give you a grade. What I liked most about my experience in this class was the 'learn by doing' approach. At the very least I gained experience along with knowledge by taking this course.

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Design Lesson Plan: Angela Chen

Introduction

 The economics pressure of increasing healthcare costs and great healthcare outcome are driving the search of new approaches to health management.  Currently, public policy is attaching importance to the role of consumers in managing their own health while partnership with healthcare providers.  Personal Health Records systems are one of the tools to improve health care through consumer empowerment.  There are quite a few Personal Health Records or health data exchange systems implemented in several cities or counties.  My case analysis will focus on the electronic Personal Health Records on the vulnerable and underserved population-the migrant and seasonal winery worker in Sonoma, California.
 
 The Health Resources Service Administration defines medically underserved populations as those with “economic barriers, or cultural and/or linguistic access barriers to primary medical care services.”  The Advisory Commission on Consumer Protection and Quality in the Health Care Industry consider the vulnerable population are individual who are vulnerable to health care quality problems for one or more underlying reasons including financial circumstances, place of residence, health, age, functional status developmental status, ability to communicate effectively race, ethnicity, and gender (Chang et al, 2004).  The migrant workers often find it difficult to access health care, and even when they are successful, the care they receive is sporadic and fragmented as they move form job to job and community to community.  Due to this nature, migrant workers fall into the categories of vulnerable and underserved group; in addition, they are facing digital divide- has typically been used to describe decreased access to information technologies, particularly the Internet, for racial and ethnic minorities, persons with disabilities, rural populations, and those with low socioeconomic status.
 
 Governmental agencies and cooperative partnership are taking steps to close the gap of access to health care information and communication.  National, regional, state and medical center partnerships are evaluating the effects of information technology use on health and health care outcomes.  In order to minimize the barriers that underserved populations continues to face in accessing or using of health information, the Informatics has been identified a critical role in designing a health system that produces care that is safe, effective, patient centered, timely, efficient, and equitable, as well as a strategy for reducing health disparities in underserved populations.    
    

Background

 MiVIA, which means “my way” in Spanish, is an electronic Personal Health Record designed for the migrant and seasonal workers in Sonoma, California. in 2002 under the collaboration of Vineyard Worker Services, Saint Joseph Health System-Sonoma Country, and Community Health Resource & Development Center.  Migrant and seasonal farm workers suffer disproportionately from undiagnosed and/or unattended chronic medical conditions, poor health outcomes, and increased health costs (duplication of services or tests) for their transient lifestyles.  As they move around the medical records, test results and care plans are usually left behind; thus created increased costs for an already overburdened healthcare system.  MiVIA offers a solution while the purpose of it is to store and download health information and make that information available to multiple doctors and clinics.  In sum, the goal of MiVIA is to prevent unneeded testing and repeat immunizations that delay treatment, crowd waiting rooms and waste taxpayers dollars.  

 In detail, a PHR makes it possible to store critical health information, such as diagnoses, medications, allergies, chronic conditions, treatment plans and test results- in an extremely compact, portable device that workers can easily take with them as they relocate.  The information MiVIA typically stores includes the patient’s medical history, name of doctors and other care providers, and a record of immunizations, hospital visits and any serious conditions.  MiVIA also provides the Service Wheel, which is an Internet portal that leads users to social services.  At security side, MiVIA seeks the balance access and security considerations.  Users, including patients, any health care providers, or advocates can download their information at any time, providing audit trails, secure messaging and provider entry portals.  Each PHR is password protected, using 128 bit encryption, and is HIPAA compliant besides the audit trails and secure messaging.  The MiVIA record is owned by the user or user’s legal representative while allowing user or user’s representative to authorize others to download their information at any time or to have the information downloaded by a healthcare provider.  No one, including the government, can have access to the information without user’s authorization.  Therefore, the fear that the information could be used to deport workers should not exist.  Plus, federal laws prevent immigration officials from looking at medical health records or identification information.     

 There were 1, 092 MiVIA users since January 2005, with the word is spreading through the farmworker community that the service is safe, the number hit impressively to 41,773 at June 2005.  The program proved popular as MiVIA service is getting serious interest from groups in the Napa Valley, the Central Valley, the Pacific Northwest and Texas.     

Learning Objective

 Our learning object is to understand how the narratives can be used to assess online health service. 

 With an increasing focus on developing a theoretical understanding of everyday life information behaviors, researchers need to consider the appropriateness of the methods and techniques utilized in empirical research in this area.  The narrative and episodic interviewing techniques are qualitative research methods that sustain a person-centered paradigm of human information behavior and that provide a particularly useful methodological framework for studies of everyday life information-seeking behavior.  According to Bates, narrative and episodic interviews are best suited to qualitative research and in-depth studies involving a relatively small number of study participants when interviews can be conducted in the interviewees own natural (everyday) environment and where the purpose of the study is to understand the research topic from the perspective of the study participants.  Besides Bates’s study, there are similar studies predominantly emphasize the need to understand everyday information behavior from a person-centered perspective and also reflect a shift towards and increased use of qualitative research methods (Bates, 2003.)   Since using MiVIA is considered as an everyday life information-seeking behavior, narrative approach would be one of the effective tools to assess MiVIA- an online health service.
 First, according to Jovchelovitch and Bauer, narrative interview is described as a qualitative research method used to stimulate interviewees or study participants to express their experiences and view of the topic being studied through telling stories or narratives.  It is believed that the perspective of the interviewee is best revealed in stories where the informant is using his or her own spontaneous language in the narration of events (Jovchelovitch and Bauer, 2000.)  A narrative interview takes the form of a conversation and participants related their experiences, bringing in whatever they consider to be relevant.  The technique of narrative interviewing stimulates storytelling and encourages interviewees to describe an event as they saw it, in their own language, using their own terms of reference, and emphasizing actions or participant which they regard as being significant.  In addition, how study participants report and narrate episodes from their everyday life reflects the factors which influence their behavior.  Because the interviewees will not be restrained by a specific form of answers but an open-end story he/her wants to talk about, it is believed that the use of a narrative approach in social inquiry can overcome barriers that can arise when collecting data from people from relatively disadvantaged backgrounds who may lack educational experience and language or literacy competencies (Bates, 2003.)  Particularly, it is assumed that narrations preserve perspectives of the interviewees in a more genuine form.  As a non-native English speaker, I totally agree with the notion that narrative interview would create a more relax-typed of conversation so that the interviewees who lack language or literacy competencies would be able to open up and disclose more details of his/her perspectives.  Furthermore, storytelling provides researcher with an insight into how the study participants make sense of their everyday lives in relation to the overall research topic.

There are three ways to analyze the data collected through narrative interviews (Bates, 2003.):
•The sequential and temporal structure of narratives (to understand the linear sequencing of actions which comprise the story);
•The focus, or perspective (orientation) of the narrative (to understand the views and perceptions of the interviewee and how they evaluated the situation); and
•How the interviewee tells or reports the narratives or episodes, which includes their use of language, tone, etc. 

The six common elements, according to Labov’s structural approach, which any fully formed narrative should contain, are as follows (Bates, 2003.)  :
•An abstract (a summary of what the narrative is concerned with);
•Orientation (context-time, place, situation, participants);
•Complication action (sequence of events);
•Evaluation (perspective on the event/actions, attitude, significance of the even for narrator);
•Resolution (outcome);
•And coda (related the narrative even back to the present).

Analysis 

In order to learn if the narratives can be used to assess online health service, a semi-structured interview will be conducted in terms of evaluating MiVIA including the aspects of usability, access, outreach, and training.   Specifically, the narratives and analysis from the interview with Jessica Alcanter, the health promoter of MiVIA program, will be presented in the six sections as follows.

Abstract
The purpose of MiVIA is to use technology to improve health for migrant and seasonal workers.  In order to evaluate the MiVIA program, Nathan and I went on a 2-day trip at Sonoma Valley to visit the MiVIA program users, administrators/staffs, physicians and nurses.  During these two days, we visited both Mobile Dental and General clinics at Sonoma and Windsor, Vineyard Worker Service Center, and Mary Issak Center.  However, in this analysis I will focus on the interview with Jessica Alcanter held at Springs Village Apartment recreation center on November 19, 2007.

Orientation 
The interview with Jessica Alcanter, a health promoter of Saint Joseph Health System Mobile Health Clinic, was the very first interview we conducted for the MiVIA project.  We arrived around 9 o’clock in the morning at Springs Village Apartment, a low-income housing, which was one of the sites for Sonoma mobile clinics.  Jessica gave us a tour on the mobile dental clinic parked outside the apartment complex, as well as the apartment recreation center where the MiVIA administrative work is done.  The recreation center is approximately 1000 square feet with one separate room served as a reception room.  There is only one desktop computer used by the receptionist besides Jessica’s laptop on site.  We were introduced to the dentist and several staffs.  Jessica is serving as a MiVIA program coordinator today while at the second day she is a mobile clinic assistant (wearing scrub) at the Windsor mobile clinic site. We were hoping to talk with physician since we prepared a set of questions for them.  However, they have a booked schedule and took emergency patients they have to squeeze in.  Thus, we didn’t get to interview with the dentist.  
 
Description
In order to explicitly present the intrinsic of MiVIA program, the sections of Description and Evaluation use the “narrations” extracted directly from our interview with Jessica.  In the Description section, the narrations will be categorized into four entities as follows with the intention to understand MiVIA from various angles (Please see Appendix for complete Description and Evaluation).   
Jessica Related
•I started to work about a year and half ago, and all I really do is working with MiVIA program and getting it out to the community.  And I go around with both Mobile Health and Mobile dental registering clients into the program.  I also do any types of presentations, to the community and the doctors’ meetings.
•So I started doing the training on how to use the computer and how to use the internet, as far as detail as that possible could, you know, how to turn it on.  It has to be pretty detail. 
•I go to different clinics to explain what is this (MiVIA program) that we have, in case patients come to them with MiVIA card, and you know, how are they gonna access the program and reach anybody to answer their questions about the program or about our patients. 
•My job is specific using MiVIA or enrolling patients or keeping track of the records.  I am pretty much they come to in case they need help with that.

Physician Related
•(Interviewer: when do physicians enter the information? Is that right at the time or the end of the day?)  At the end of the day mostly or whenever they get a chance to. 
•The physicians enter all the record at their offices or homes, and they have to take their personal time to do that. 

Program Work Related
•(Interviewer: Someone wants to come in and use the clinics, how does the enrollment go?  They (patients) get here early in the morning.  I get an hour early before the mobile clinic gets there because as soon as the mobile clinic gets in there’s whole bunch of commotion and switching in and out of patients.  And I’ll have my time with each patient individually so I can talk to them, explain to them about this great program that we offer to all of our patients.  If we got someone who has already enrolled, we offer training for the day, you know either during their wait or we schedule another appointment.  But for people who are just getting enrolled we sit down and show them how the program works, get all the information down, have them log in and give the user name and passwords and take pictures, either giving them the ID card on the spot or send it to them by mail.  And by the time the mobile gets here, my whole thing is to get them enrolled so the doctors can access to that patient as the chart said he’s a MiVIA patient.  (Interviewer: So the chart will say that?)  Yah, hummhum 
•(Interviewer: When the patient return, do physicians pull out the MiVIA record again or do they usually reference their notes first or they go in?) They have to reference their notes first as they don’t have laptops up there (at the mobile clinic), they don’t have room for it so they would have to check their charts, they would access the program as soon as their visit or at the end of the day because of the information they have to input, and because the patients already assume the information they (physicians) input on the day are out there. 
•We are mobile clinic, and we don’t have a phone that they can access us and call us to get a medical chart.  So it’s really good as it (MiVIA card) offering to people to keep in an emergency, they have their cards on them as they have all the immediate information, any medication they currently on, any allergy, any emergency contact, so immediate information you need to know.
•(Interviewer: We heard that MiVIA card is a big deal or something they really like to carry with them? Is that true? ) Yah, one of the favorite things is that ID card.  Most of them don’t have formal IDs, and MiVIA card could be the only ID with photo and immediate information, and on the back it has the medical information.  Yah, people come to enjoy it as it’s the one thing they use it the most.

Context Related
•There are more female users than male users.
•St. Joseph hospital is the only hospital has community service in the area.

Evaluation
•And we came to realize that the patients we were enrolling didn’t have education on the computer or the internet.  So we start thinking maybe we need to go a little bit further, for the user actually to be able to use it.
•(Interview: From the doc’s point of view, is filling out patients’ information on MiVIA web a burden or are they all for it?)  Yah, when we first started it was a burden, we have to write down the charts and we have to go ahead and input into the computer.  You know it was not really having it until we started calling people and doing little survey, you know, asking “Are you using it? How often or how are you comfortable using it and etc?”  And it was until I brought the numbers back to the physicians we are worked with and they were really surprised that how many people were actually using it.
•(Interviewer: Does using the personal health record system make people feel better? They feel more control of their health? Like they actively managing their health? You notice that?)  You know what, it’s funny because before a lot of people don’t remember the whole name of the medication they are currently on.  Now they know how to found out the medication maybe not to spell it, but at least know how to pronounce it.  So they are definitely more active with their health.  And I use it on my grandpa, she lives by herself and she is 75 years old and all of her family are down here and she is in Yucaipa, so I definitely got her enroll because we are all scared what she’s doing by herself, you know, does she have anybody to help her.     
•(Interview: How long it takes for those who don’t know how to get on computer or use mouse to get on computer or comfortable to put information?)  Usually, we do training whenever they have time, I would say anywhere about 7 visits to where I don’t have to say anything at all.  It’s pretty intense pretty long, it’s about 2 hour training, and sometimes I would spend the whole morning with them.  (11:30)And they pretty enjoy using email, it’s cheaper than calling Mexico (laughing).  So, it’s really cute because they will bring camera so they can send pictures, they really enjoy emails.  This is actually one of their first email accounts.

Challenge/Recommendation

Based on the interview, the followings are two main challenges of MiVIA program.
1.It is hard to promote the MiVIA program to the clinics or physician.  Physicians wish to see numbers of enrollment of MiVIA before adopting MiVIA.  In addition, physicians need to spend extra time to enter patients’ health diagnosis to MiVIA.
   
2.Lacking of funds, computer equipment and human resources to support the program. Using quotes from Jessica, “The only other issue will be having the computer.  You know we deal with the less-fortunate population and they just don’t have money to have their computer at home like anybody else.  So you know the access to it, either public library or anywhere like VWS (Vineyard Worker Service) where has little computer lab for whatever need they have,” and “the computer training takes anywhere about seven visits to where I don’t have to say anything at all, and it’s pretty intense pretty long,” I believe time and resources for training on using MiVIA program are the biggest obstacle from her side. 

There followings are findings/ recommendations to the MiVIA program.

•Jessica, seems to me, is a critical bridge in terms of training and promoting between the MiVIA program and the patient.  The MiVIA program is hard to prevail among the underserved populations without the role of Jessica.  Without technical computer knowledge, the underserved population will not know how to get on to computer, not even to mention understanding the benefits of MiVIA.  Without Jessica, there’ll be a technological gap for the MiVIA users.  Jessica’s has been multi-tasking in the roles of health promoter/outreach coordinator, mobile clinic assistant, and computer trainer.  Therefore, it is essential to recruit more staffs to serve Jessica’s multiple roles to make MiVIA program more effective.  

•The number of enrollment of the MiVIA program is a decisive factor for the physicians/clinics to adopt MiVIA program.  Showing good numbers worth more than a thousand words.  Thus, it is recommended that a comprehensive statistics/survey of MiVIA usage be conducted to serve this purpose.  Further, providing physicians statistical benefits of adopting MiVIA, such as improving accuracy of information across the continuum of care, saving redundant paperwork, shortening the wait for obtaining patient’s lab result and etc, to physician/clinics will certainly increase physicians’ interest.   

•In order to avoid double work and increase efficiency (physicians enter patients information in their spare time), it is recommended to provide an on-site laptop for physicians to enter patients’ health information while diagnosis.
 
•Even though MiVIA staffs emphasized on the confidentiality of the personal information to comply with HIPPA regulation, users are still not confident on the confidentiality.  It is critical to gain the trust from users.  Besides continued education, to overcome the obstacles of users’ unwillingness to disclose specific personal information on the MiVIA system, the required information may be redesigned.  Jessica mentioned, “The information we input, a lot of people are uncomfortable with letting us know where they were born because of the whole immigration issue.  They don’t want that to be a question,” hence, some required information may be redesigned or removed according to patients’ concerns to minimize the hesitation and increase the enrollment.
    
•Outreach/marketing plays a significant role for the success of MiVIA program. The followings are various sales pitches can be used to promote the program.

1.Saint Joseph hospital is the only hospital offering community service as well as a catholic organization, MiVIA program should utilize the “brand identity and trust” to promote the program. 

2.The mobile clinic is mobile without a phone number and therefore is hard to reach for medical/health information if emergency happens.  For that reason, MiVIA online record, as an alternative, will be an easy and convenient access for the mobile clinic patients to obtain their health information anytime.
 
3.Enforce the alliance with institutes that migrant workers use or contact frequently, such as Vineyard Worker Service or other social institutes.  Based on the current established relationship with migrant workers, those institutes will be the credible and trustful resources to effectively recommend or promote MiVIA to the workers.

4.Not only apply to the migrant workers, MiVIA program is also suitable for the live-alone elders.  Families of the elders are able to monitor and access the health record of the elders’ while they are hundred miles away.  Consequently, elders could be another target market for the MiVIA program.
   
5.Point 5 and 6 are based on the “customer perceived value” from marketing perspective.  MiVIA card turns out surprisely to be a big hit by serving as an ID card due to most of the migrant workers can not obtain formal ID cards for their illegal immigrant status.  Follow this logic, MiVIA program will be prevailing if MiVIA card or online health record system is designed to suit users’ extra needs.  For instance, according to the cases told by VWS workers, the migrant workers are mostly young, single male.  A lot of them have sexual transmitted disease issue that they are unwilling to share or disclose with.  Therefore, if MiVIA online system supports a medical search function for the non-disclosable diseases in Spanish version as a side benefit besides storing personal health record, the potential clients may be increased as they perceive more values from the system.     

6.Potential users will adopt the product or program depends how much values they perceive from them.  According to Jessica, one of the values users perceive from MiVIA program is they learn how to use computer and obtain more computer/technological knowledge.  With the basic computer training, users can now send their pictures to their families at Mexico as well as calling them through Internet as an added value.  Thus, it is recommended to increase the perceived value of the MiVIA program or other added values to users.  The MiVIA program has to be user-driven.  

Coda and reflection

Through the narrative interviews with a story telling approach, I indeed can immerse myself in the context by picturing the story.  In order to explore how the central topic fits into the interviewee’s everyday life, Flick suggests that the interviewee being asked to recount a day with reference to the issue (Flick, 2000).  While Jessica was asked what her typical day is alike when she is with the mobile clinic, she described how she outreached and enrolled the patients as telling her everyday story.  From that, I thoroughly agree that story telling approach gives me a deeper understanding of interviewee’s perspectives.  For instance, she would be able to open up and disclose more details about how she has to train the patients to use computer from scratch to the point they can use MiVIA program without her help.  Without narrative interview, I would not know what difficulties she needs to go through and how much effort she needs to put on the training session.  Those details definitely will not be presented or disclosed in the context of true/false or Likert-scale survey.  Furthermore, from her narratives I strongly sensed how much she loves her job and enjoys helping MiVIA patients.  From this narrative “there are always little story…..I go to the store and I bump into five people that I know. I work around the Sonoma country so I am just so well-known by everybody (with a pleasant tone),” it is no doubt that Jessica is proud of her job.  I believe her enthusiasm is an inevitable factor for the MiVIA outreach or enrollment to be successful.  Again, this is an additional finding that I may not be able to obtain from other research method.
 
When carrying out the analysis of data from narrative interview, I use Labov’s structural approach with some modifications to identify the story components and select illustrative quotes which highlight any significant parts of the narratives.  Using this structure enable me to observe the MiVIA program at complete angles.  Also, among Bates’s three ways to analyze the data, I chose “perspective/orientation of narratives” by focusing on Jessica’s narrative to understand her view and perceptions and how she evaluated the MiVIA program. As we ask Jessica “how the users feel about the MiVIA?” she described how the MiVIA ID card became a big hit as well as how the users feel excited about seeing their pictures on the card because the illegal immigrants never had a chance to obtain one formal ID.  Flick advises that the interview guide should be sufficiently flexible to accommodate any new aspects that may emerge from the interviewee.  In that nature, Jessica further shared her grandma’s story with MiVIA and that story gave me the insight that MiVIA program should not only be promoted to the migrant workers but other populations.  Further, with the flexibility of storytelling I obtained the valuable stories of STD issues among young male workers.  I would not be able to obtain those without physically going into the field and having conversations with VWS workers.  Various stories led me to a deeper, thorough understanding of the mindset of the MiVIA users.  Those insights are derived from the richer data- narrative interview, as they allow me to assess the MiVIA program comprehensively.

While governmental agencies, medical centers or health organizations are taking steps to empower citizen to access the health care information and communication and evaluating the effects of information technology used on health, this MiVIA program could be a pilot project to assess the electronic health system used by underserved populations. 

Lastly, I am thankful for the opportunity granted by Professor Tom Horan for letting me go to the field to observe and understand various perspectives from MiVIA users.  I indeed get more sense on electronic personal health record, to the point that I plan to have my own one.  After all, how could I get into personal health record field without experiencing in it?       

Evaluation and Extension

In order to ensure we achieve our learning object, we need to understand the two entities in the learning object first, Narratives and Online health service-MiVIA program.  As the reader reads through the learning objective section where I addressed the concepts and techniques of narratives, and analysis section where I included the context of MiVIA program through the perception of MiVIA program promoter, one should be able to answer the following questions.
1.What are the two toughest challenges of Jessica’s job?
2.What the values/benefit of the MiVIA program perceived from the users?
3.Please describe what the training session is alike?
4.List few sales pitches for promoting MiVIA program.
5.Narrative interview is particular useful for what kind of study and why?

 With all the questions correctly answered, the reader should obtain certain level of understanding on how the narratives can be used to assess MiVIA program.  For those who wish to have further study on electronic personal health can work on the issue “a personal health record or a personal health system-a system to facilitate communication on personal health?”
 
  

Related Readings

1.Chang B, Bakken S, Brown S, et al.  Bridging the digital divide: Reaching vulnerable populations.  J Am Med Inform Assoc. 2004;11:448-457.

2.The Aguirre Group.  Case Study: MiVIA Rollout to Napa.  Spring 2006.

3.Migrant workers’ health goes online-MiVIA gives doctors access to farmworkers’ medical records.    Retrieved October 31, 2007, from http://nl.newsbank.com/nl-search/we/Archives?p_action=doc&p_docid=1104003482A381B0&p_docnum=1&s_dlid=DL0107111507061207077&s_ecproduct=SUB-FREE&s_ecprodtype=INSTANT&s_subterm=Subscription%20until%3A%2012%2F14%2F2015%2011%3A59%20PM&s_subexpires=12%2F14%2F2015%2011%3A59%20PM&s_username=santarosa&s_accountid=AC0105061516020614723&s_upgradeable=no

4.About MiVIA.  Retrieved October 31, 2007, from https://www.mivia.org/About_Us.aspx

5.Bates J.  Use of narrative interviewing in everyday information behavior research.  Retrieved October 31, 2007, from http://www.sciencedirect.com/science/journal/07408188

6.Jovchelovitch S, Bauer M.W (2000).  Narrative interviewing.  In: Bauer, M.W. and Gaskell, G., Editors, 2000.  Qualitative researching with text, image and sound, Sage, London, England, pp.57-74
7. Flick U (2000).  Episodic interviewing.  In: Bauer, M.W. and Gaskell, G., Editors, 2000.  Qualitative researching with text, image and sound, Sage, London, England, pp.75-92

 

Appendix

Analysis
Description
 Jessica related 
•(Interviewer: Do you work full time doing this?)  I work 32-40 hours depends on how the week goes.  (Interviewer: Do you have any background in health previous to this?)  I volunteer for a lot of work, but this is pretty much it.  (Interviewer: So what brought you here?)  Hum, I really like people, I definitely look for job that kept me working with the community as closely as possible.  And I work for retail for few years.  I just really want to be in the community where I actually can do more than I was doing in the retail.  I definitely get to do it here and I love it!  It was so much fun.   There are always little story, and all the family and the kids, and I love kids and get to know them.  I go to the store and I bump into 5 people that I know.  I work around the Sonoma county so I am just so well-known by everybody.

•(Jessica actually meets the participants at the library to do the training because it’s different to work on the laptop and the desk top.)  So I would actually meet them at the library to do the training there.  So they know where that (library) is and they know how to use the computer.   (Interviewer: What’s the big difference for them to use laptop versus desktop?)  Hum, one is the Mouse, believe it or not (laughing) it’s just easier to use the mouse.
Program Work Related

•The mobile clinic covers three main sites, Sonoma, Petaluma and Windsor, on weekly basis.  The service charge is free for Mobile general but $55 for Mobile dental.     

Context Related

•65% are Spanish speaking only, and our staffs are pretty much bilingual. 
•There are around 100 clients per year to use the program.

Evaluation
•(Interviewer: Do they distinguish of the difference between Doctors putting their information on the paper or information on the computer?  Is that an issue?)  I think it’s an issue of it is online and government has access to everything and they can get their hands on anything (laughing).  And people are afraid if they have the medication condition that let’s say they don’t want their future workplace to find out or somehow has access to it, so they don’t want that to be an issue.  Again, we did explain the HIPAA compliance rule.

•(Interviewer: As far as other clinics you go to see whether they all adopt MiVIA, what are their biggest issues?)  Same thing with us, I think it’s just all a “time” thing.  If the physician gonna have the time to do it, I think they wonna to do it.  Again, it’s just about the number of people who are interested in doing this program, they are using this program.  The numbers are the main reason they (physicians/clinics) wonna adopt it. 

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Design Lesson Plan: Angela Chen

Introduction  The economics pressure of increasing healthcare costs and great healthcare outcome are driving the search of new approaches to health management.  Currently, public policy is attaching importance to the role of consumers in managing their own health while partnership with healthcare providers.  Personal Health Records systems are one of the tools to improve health care through consumer empowerment.  There are quite a few Personal Health Records or health data exchange systems implemented in several cities or counties.  My case analysis will focus on the electronic Personal Health Records on the vulnerable and underserved population-the migrant and seasonal winery worker in Sonoma, California.  The Health Resources Service Administration defines medically underserved populations as those with “economic barriers, or cultural and/or linguistic access barriers to primary medical care services.”  The Advisory Commission on Consumer Protection and Quality in the Health Care Industry consider the vulnerable population are individual who are vulnerable to health care quality problems for one or more underlying reasons including financial circumstances, place of residence, health, age, functional status developmental status, ability to communicate effectively race, ethnicity, and gender (Chang et al, 2004).  The migrant workers often find it difficult to access health care, and even when they are successful, the care they receive is sporadic and fragmented as they move form job to job and community to community.  Due to this nature, migrant workers fall into the categories of vulnerable and underserved group; in addition, they are facing digital divide- has typically been used to describe decreased access to information technologies, particularly the Internet, for racial and ethnic minorities, persons with disabilities, rural populations, and those with low socioeconomic status. Governmental agencies and cooperative partnership are taking steps to close the gap of access to health care information and communication.  National, regional, state and medical center partnerships are evaluating the effects of information technology use on health and health care outcomes.  In order to minimize the barriers that underserved populations continues to face in accessing or using of health information, the Informatics has been identified a critical role in designing a health system that produces care that is safe, effective, patient centered, timely, efficient, and equitable, as well as a strategy for reducing health disparities in underserved populations.          Background MiVIA, which means “my way” in Spanish, is an electronic Personal Health Record designed for the migrant and seasonal workers in Sonoma, California. in 2002 under the collaboration of Vineyard Worker Services, Saint Joseph Health System-Sonoma Country, and Community Health Resource & Development Center.  Migrant and seasonal farm workers suffer disproportionately from undiagnosed and/or unattended chronic medical conditions, poor health outcomes, and increased health costs (duplication of services or tests) for their transient lifestyles.  As they move around the medical records, test results and care plans are usually left behind; thus created increased costs for an already overburdened healthcare system.  MiVIA offers a solution while the purpose of it is to store and download health information and make that information available to multiple doctors and clinics.  In sum, the goal of MiVIA is to prevent unneeded testing and repeat immunizations that delay treatment, crowd waiting rooms and waste taxpayers dollars.   In detail, a PHR makes it possible to store critical health information, such as diagnoses, medications, allergies, chronic conditions, treatment plans and test results- in an extremely compact, portable device that workers can easily take with them as they relocate.  The information MiVIA typically stores includes the patient’s medical history, name of doctors and other care providers, and a record of immunizations, hospital visits and any serious conditions.  MiVIA also provides the Service Wheel, which is an Internet portal that leads users to social services.  At security side, MiVIA seeks the balance access and security considerations.  Users, including patients, any health care providers, or advocates can download their information at any time, providing audit trails, secure messaging and provider entry portals.  Each PHR is password protected, using 128 bit encryption, and is HIPAA compliant besides the audit trails and secure messaging.  The MiVIA record is owned by the user or user’s legal representative while allowing user or user’s representative to authorize others to download their information at any time or to have the information downloaded by a healthcare provider.  No one, including the government, can have access to the information without user’s authorization.  Therefore, the fear that the information could be used to deport workers should not exist.  Plus, federal laws prevent immigration officials from looking at medical health records or identification information.      There were 1, 092 MiVIA users since January 2005, with the word is spreading through the farmworker community that the service is safe, the number hit impressively to 41,773 at June 2005.  The program proved popular as MiVIA service is getting serious interest from groups in the Napa Valley, the Central Valley, the Pacific Northwest and Texas.        Learning Objective Our learning object is to understand how the narratives can be used to assess online health service.  With an increasing focus on developing a theoretical understanding of everyday life information behaviors, researchers need to consider the appropriateness of the methods and techniques utilized in empirical research in this area.  The narrative and episodic interviewing techniques are qualitative research methods that sustain a person-centered paradigm of human information behavior and that provide a particularly useful methodological framework for studies of everyday life information-seeking behavior.  According to Bates, narrative and episodic interviews are best suited to qualitative research and in-depth studies involving a relatively small number of study participants when interviews can be conducted in the interviewees own natural (everyday) environment and where the purpose of the study is to understand the research topic from the perspective of the study participants.  Besides Bates’s study, there are similar studies predominantly emphasize the need to understand everyday information behavior from a person-centered perspective and also reflect a shift towards and increased use of qualitative research methods (Bates, 2003.)   Since using MiVIA is considered as an everyday life information-seeking behavior, narrative approach would be one of the effective tools to assess MiVIA- an online health service. First, according to Jovchelovitch and Bauer, narrative interview is described as a qualitative research method used to stimulate interviewees or study participants to express their experiences and view of the topic being studied through telling stories or narratives.  It is believed that the perspective of the interviewee is best revealed in stories where the informant is using his or her own spontaneous language in the narration of events (Jovchelovitch and Bauer, 2000.)  A narrative interview takes the form of a conversation and participants related their experiences, bringing in whatever they consider to be relevant.  The technique of narrative interviewing stimulates storytelling and encourages interviewees to describe an event as they saw it, in their own language, using their own terms of reference, and emphasizing actions or participant which they regard as being significant.  In addition, how study participants report and narrate episodes from their everyday life reflects the factors which influence their behavior.  Because the interviewees will not be restrained by a specific form of answers but an open-end story he/her wants to talk about, it is believed that the use of a narrative approach in social inquiry can overcome barriers that can arise when collecting data from people from relatively disadvantaged backgrounds who may lack educational experience and language or literacy competencies (Bates, 2003.)  Particularly, it is assumed that narrations preserve perspectives of the interviewees in a more genuine form.  As a non-native English speaker, I totally agree with the notion that narrative interview would create a more relax-typed of conversation so that the interviewees who lack language or literacy competencies would be able to open up and disclose more details of his/her perspectives.  Furthermore, storytelling provides researcher with an insight into how the study participants make sense of their everyday lives in relation to the overall research topic.  There are three ways to analyze the data collected through narrative interviews (Bates, 2003.):·         The sequential and temporal structure of narratives (to understand the linear sequencing of actions which comprise the story);·         The focus, or perspective (orientation) of the narrative (to understand the views and perceptions of the interviewee and how they evaluated the situation); and·         How the interviewee tells or reports the narratives or episodes, which includes their use of language, tone, etc.   The six common elements, according to Labov’s structural approach, which any fully formed narrative should contain, are as follows (Bates, 2003.)  :·         An abstract (a summary of what the narrative is concerned with);·         Orientation (context-time, place, situation, participants);·         Complication action (sequence of events);·         Evaluation (perspective on the event/actions, attitude, significance of the even for narrator);·         Resolution (outcome);·         And coda (related the narrative even back to the present). Analysis   In order to learn if the narratives can be used to assess online health service, a semi-structured interview will be conducted in terms of evaluating MiVIA including the aspects of usability, access, outreach, and training.   Specifically, the narratives and analysis from the interview with Jessica Alcanter, the health promoter of MiVIA program, will be presented in the six sections as follows. 

AbstractThe purpose of MiVIA is to use technology to improve health for migrant and seasonal workers.  In order to evaluate the MiVIA program, Nathan and I went on a 2-day trip at Sonoma Valley to visit the MiVIA program users, administrators/staffs, physicians and nurses.  During these two days, we visited both Mobile Dental and General clinics at Sonoma and Windsor, Vineyard Worker Service Center, and Mary Issak Center.  However, in this analysis I will focus on the interview with Jessica Alcanter held at Springs Village Apartment recreation center on November 19, 2007. Orientation  The interview with Jessica Alcanter, a health promoter of Saint Joseph Health System Mobile Health Clinic, was the very first interview we conducted for the MiVIA project.  We arrived around 9 o’clock in the morning at Springs Village Apartment, a low-income housing, which was one of the sites for Sonoma mobile clinics.  Jessica gave us a tour on the mobile dental clinic parked outside the apartment complex, as well as the apartment recreation center where the MiVIA administrative work is done.  The recreation center is approximately 1000 square feet with one separate room served as a reception room.  There is only one desktop computer used by the receptionist besides Jessica’s laptop on site.  We were introduced to the dentist and several staffs.  Jessica is serving as a MiVIA program coordinator today while at the second day she is a mobile clinic assistant (wearing scrub) at the Windsor mobile clinic site. We were hoping to talk with physician since we prepared a set of questions for them.  However, they have a booked schedule and took emergency patients they have to squeeze in.  Thus, we didn’t get to interview with the dentist.    DescriptionIn order to explicitly present the intrinsic of MiVIA program, the sections of Description and Evaluation use the “narrations” extracted directly from our interview with Jessica.  In the Description section, the narrations will be categorized into four entities as follows with the intention to understand MiVIA from various angles (Please see Appendix for complete Description and Evaluation).    Jessica Related·         I started to work about a year and half ago, and all I really do is working with MiVIA program and getting it out to the community.  And I go around with both Mobile Health and Mobile dental registering clients into the program.  I also do any types of presentations, to the community and the doctors’ meetings. ·          So I started doing the training on how to use the computer and how to use the internet, as far as detail as that possible could, you know, how to turn it on.  It has to be pretty detail.  ·         I go to different clinics to explain what is this (MiVIA program) that we have, in case patients come to them with MiVIA card, and you know, how are they gonna access the program and reach anybody to answer their questions about the program or about our patients.  ·         My job is specific using MiVIA or enrolling patients or keeping track of the records.  I am pretty much they come to in case they need help with that. Physician Related·         (Interviewer: when do physicians enter the information? Is that right at the time or the end of the day?)  At the end of the day mostly or whenever they get a chance to.  ·         The physicians enter all the record at their offices or homes, and they have to take their personal time to do that.    Program Work Related·          (Interviewer: Someone wants to come in and use the clinics, how does the enrollment go?  They (patients) get here early in the morning.  I get an hour early before the mobile clinic gets there because as soon as the mobile clinic gets in there’s whole bunch of commotion and switching in and out of patients.  And I’ll have my time with each patient individually so I can talk to them, explain to them about this great program that we offer to all of our patients.  If we got someone who has already enrolled, we offer training for the day, you know either during their wait or we schedule another appointment.  But for people who are just getting enrolled we sit down and show them how the program works, get all the information down, have them log in and give the user name and passwords and take pictures, either giving them the ID card on the spot or send it to them by mail.  And by the time the mobile gets here, my whole thing is to get them enrolled so the doctors can access to that patient as the chart said he’s a MiVIA patient.  (Interviewer: So the chart will say that?)  Yah, hummhum  ·         (Interviewer: When the patient return, do physicians pull out the MiVIA record again or do they usually reference their notes first or they go in?) They have to reference their notes first as they don’t have laptops up there (at the mobile clinic), they don’t have room for it so they would have to check their charts, they would access the program as soon as their visit or at the end of the day because of the information they have to input, and because the patients already assume the information they (physicians) input on the day are out there.  ·         We are mobile clinic, and we don’t have a phone that they can access us and call us to get a medical chart.  So it’s really good as it (MiVIA card) offering to people to keep in an emergency, they have their cards on them as they have all the immediate information, any medication they currently on, any allergy, any emergency contact, so immediate information you need to know.·         (Interviewer: We heard that MiVIA card is a big deal or something they really like to carry with them? Is that true? ) Yah, one of the favorite things is that ID card.  Most of them don’t have formal IDs, and MiVIA card could be the only ID with photo and immediate information, and on the back it has the medical information.  Yah, people come to enjoy it as it’s the one thing they use it the most.  Context Related·         There are more female users than male users.·         St. Joseph hospital is the only hospital has community service in the area. Evaluation·         And we came to realize that the patients we were enrolling didn’t have education on the computer or the internet.  So we start thinking maybe we need to go a little bit further, for the user actually to be able to use it.·         (Interview: From the doc’s point of view, is filling out patients’ information on MiVIA web a burden or are they all for it?)  Yah, when we first started it was a burden, we have to write down the charts and we have to go ahead and input into the computer.  You know it was not really having it until we started calling people and doing little survey, you know, asking “Are you using it? How often or how are you comfortable using it and etc?”  And it was until I brought the numbers back to the physicians we are worked with and they were really surprised that how many people were actually using it.·          (Interviewer: Does using the personal health record system make people feel better? They feel more control of their health? Like they actively managing their health? You notice that?)  You know what, it’s funny because before a lot of people don’t remember the whole name of the medication they are currently on.  Now they know how to found out the medication maybe not to spell it, but at least know how to pronounce it.  So they are definitely more active with their health.  And I use it on my grandpa, she lives by herself and she is 75 years old and all of her family are down here and she is in Yucaipa, so I definitely got her enroll because we are all scared what she’s doing by herself, you know, does she have anybody to help her.      ·         (Interview: How long it takes for those who don’t know how to get on computer or use mouse to get on computer or comfortable to put information?)  Usually, we do training whenever they have time, I would say anywhere about 7 visits to where I don’t have to say anything at all.  It’s pretty intense pretty long, it’s about 2 hour training, and sometimes I would spend the whole morning with them.  (11:30)And they pretty enjoy using email, it’s cheaper than calling Mexico (laughing).  So, it’s really cute because they will bring camera so they can send pictures, they really enjoy emails.  This is actually one of their first email accounts.  Challenge/RecommendationBased on the interview, the followings are two main challenges of MiVIA program.

1. It is hard to promote the MiVIA program to the clinics or physician.  Physicians wish to see numbers of enrollment of MiVIA before adopting MiVIA.  In addition, physicians need to spend extra time to enter patients’ health diagnosis to MiVIA.   
2. Lacking of funds, computer equipment and human resources to support the program. Using quotes from Jessica, “The only other issue will be having the computer.  You know we deal with the less-fortunate population and they just don’t have money to have their computer at home like anybody else.  So you know the access to it, either public library or anywhere like VWS (Vineyard Worker Service) where has little computer lab for whatever need they have,” and “the computer training takes anywhere about seven visits to where I don’t have to say anything at all, and it’s pretty intense pretty long,” I believe time and resources for training on using MiVIA program are the biggest obstacle from her side. 

There followings are findings/ recommendations to the MiVIA program.·         Jessica, seems to me, is a critical bridge in terms of training and promoting between the MiVIA program and the patient.  The MiVIA program is hard to prevail among the underserved populations without the role of Jessica.  Without technical computer knowledge, the underserved population will not know how to get on to computer, not even to mention understanding the benefits of MiVIA.  Without Jessica, there’ll be a technological gap for the MiVIA users.  Jessica’s has been multi-tasking in the roles of health promoter/outreach coordinator, mobile clinic assistant, and computer trainer.  Therefore, it is essential to recruit more staffs to serve Jessica’s multiple roles to make MiVIA program more effective.   ·         The number of enrollment of the MiVIA program is a decisive factor for the physicians/clinics to adopt MiVIA program.  Showing good numbers worth more than a thousand words.  Thus, it is recommended that a comprehensive statistics/survey of MiVIA usage be conducted to serve this purpose.  Further, providing physicians statistical benefits of adopting MiVIA, such as improving accuracy of information across the continuum of care, saving redundant paperwork, shortening the wait for obtaining patient’s lab result and etc, to physician/clinics will certainly increase physicians’ interest.    ·         In order to avoid double work and increase efficiency (physicians enter patients information in their spare time), it is recommended to provide an on-site laptop for physicians to enter patients’ health information while diagnosis.   ·         Even though MiVIA staffs emphasized on the confidentiality of the personal information to comply with HIPPA regulation, users are still not confident on the confidentiality.  It is critical to gain the trust from users.  Besides continued education, to overcome the obstacles of users’ unwillingness to disclose specific personal information on the MiVIA system, the required information may be redesigned.  Jessica mentioned, “The information we input, a lot of people are uncomfortable with letting us know where they were born because of the whole immigration issue.  They don’t want that to be a question,” hence, some required information may be redesigned or removed according to patients’ concerns to minimize the hesitation and increase the enrollment.      ·         Outreach/marketing plays a significant role for the success of MiVIA program. The followings are various sales pitches can be used to promote the program.1.      Saint Joseph hospital is the only hospital offering community service as well as a catholic organization, MiVIA program should utilize the “brand identity and trust” to promote the program.  2.      The mobile clinic is mobile without a phone number and therefore is hard to reach for medical/health information if emergency happens.  For that reason, MiVIA online record, as an alternative, will be an easy and convenient access for the mobile clinic patients to obtain their health information anytime.   3.      Enforce the alliance with institutes that migrant workers use or contact frequently, such as Vineyard Worker Service or other social institutes.  Based on the current established relationship with migrant workers, those institutes will be the credible and trustful resources to effectively recommend or promote MiVIA to the workers.4.      Not only apply to the migrant workers, MiVIA program is also suitable for the live-alone elders.  Families of the elders are able to monitor and access the health record of the elders’ while they are hundred miles away.  Consequently, elders could be another target market for the MiVIA program.     5.      Point 5 and 6 are based on the “customer perceived value” from marketing perspective.  MiVIA card turns out surprisely to be a big hit by serving as an ID card due to most of the migrant workers can not obtain formal ID cards for their illegal immigrant status.  Follow this logic, MiVIA program will be prevailing if MiVIA card or online health record system is designed to suit users’ extra needs.  For instance, according to the cases told by VWS workers, the migrant workers are mostly young, single male.  A lot of them have sexual transmitted disease issue that they are unwilling to share or disclose with.  Therefore, if MiVIA online system supports a medical search function for the non-disclosable diseases in Spanish version as a side benefit besides storing personal health record, the potential clients may be increased as they perceive more values from the system.      6.      Potential users will adopt the product or program depends how much values they perceive from them.  According to Jessica, one of the values users perceive from MiVIA program is they learn how to use computer and obtain more computer/technological knowledge.  With the basic computer training, users can now send their pictures to their families at Mexico as well as calling them through Internet as an added value.  Thus, it is recommended to increase the perceived value of the MiVIA program or other added values to users.  The MiVIA program has to be user-driven.    Coda and reflectionThrough the narrative interviews with a story telling approach, I indeed can immerse myself in the context by picturing the story.  In order to explore how the central topic fits into the interviewee’s everyday life, Flick suggests that the interviewee being asked to recount a day with reference to the issue (Flick, 2000).  While Jessica was asked what her typical day is alike when she is with the mobile clinic, she described how she outreached and enrolled the patients as telling her everyday story.  From that, I thoroughly agree that story telling approach gives me a deeper understanding of interviewee’s perspectives.  For instance, she would be able to open up and disclose more details about how she has to train the patients to use computer from scratch to the point they can use MiVIA program without her help.  Without narrative interview, I would not know what difficulties she needs to go through and how much effort she needs to put on the training session.  Those details definitely will not be presented or disclosed in the context of true/false or Likert-scale survey.  Furthermore, from her narratives I strongly sensed how much she loves her job and enjoys helping MiVIA patients.  From this narrative “there are always little story…..I go to the store and I bump into five people that I know. I work around the Sonoma country so I am just so well-known by everybody (with a pleasant tone),” it is no doubt that Jessica is proud of her job.  I believe her enthusiasm is an inevitable factor for the MiVIA outreach or enrollment to be successful.  Again, this is an additional finding that I may not be able to obtain from other research method.  When carrying out the analysis of data from narrative interview, I use Labov’s structural approach with some modifications to identify the story components and select illustrative quotes which highlight any significant parts of the narratives.  Using this structure enable me to observe the MiVIA program at complete angles.  Also, among Bates’s three ways to analyze the data, I chose “perspective/orientation of narratives” by focusing on Jessica’s narrative to understand her view and perceptions and how she evaluated the MiVIA program. As we ask Jessica “how the users feel about the MiVIA?” she described how the MiVIA ID card became a big hit as well as how the users feel excited about seeing their pictures on the card because the illegal immigrants never had a chance to obtain one formal ID.  Flick advises that the interview guide should be sufficiently flexible to accommodate any new aspects that may emerge from the interviewee.  In that nature, Jessica further shared her grandma’s story with MiVIA and that story gave me the insight that MiVIA program should not only be promoted to the migrant workers but other populations.  Further, with the flexibility of storytelling I obtained the valuable stories of STD issues among young male workers.  I would not be able to obtain those without physically going into the field and having conversations with VWS workers.  Various stories led me to a deeper, thorough understanding of the mindset of the MiVIA users.  Those insights are derived from the richer data- narrative interview, as they allow me to assess the MiVIA program comprehensively.While governmental agencies, medical centers or health organizations are taking steps to empower citizen to access the health care information and communication and evaluating the effects of information technology used on health, this MiVIA program could be a pilot project to assess the electronic health system used by underserved populations.  Lastly, I am thankful for the opportunity granted by Professor Tom Horan for letting me go to the field to observe and understand various perspectives from MiVIA users.  I indeed get more sense on electronic personal health record, to the point that I plan to have my own one.  After all, how could I get into personal health record field without experiencing in it?          Evaluation and Extension In order to ensure we achieve our learning object, we need to understand the two entities in the learning object first, Narratives and Online health service-MiVIA program.  As the reader reads through the learning objective section where I addressed the concepts and techniques of narratives, and analysis section where I included the context of MiVIA program through the perception of MiVIA program promoter, one should be able to answer the following questions.1.      What are the two toughest challenges of Jessica’s job?2.      What the values/benefit of the MiVIA program perceived from the users?3.      Please describe what the training session is alike?4.      List few sales pitches for promoting MiVIA program.5.      Narrative interview is particular useful for what kind of study and why? 

           With all the questions correctly answered, the reader should obtain certain level of understanding on how the narratives can be used to assess MiVIA program.  For those who wish to have further study on electronic personal health can work on the issue “a personal health record or a personal health system-a system to facilitate communication on personal health?”

 Related Readings 1.      Chang B, Bakken S, Brown S, et al.  Bridging the digital divide: Reaching vulnerable populations.  J Am Med Inform Assoc. 2004;11:448-457. 2.      The Aguirre Group.  Case Study: MiVIA Rollout to Napa.  Spring 2006. 3.      Migrant workers’ health goes online-MiVIA gives doctors access to farmworkers’ medical records.    Retrieved October 31, 2007, from http://nl.newsbank.com/nl-search/we/Archives?p_action=doc&p_docid=1104003482A381B0&p_docnum=1&s_dlid=DL0107111507061207077&s_ecproduct=SUB-FREE&s_ecprodtype=INSTANT&s_subterm=Subscription%20until%3A%2012%2F14%2F2015%2011%3A59%20PM&s_subexpires=12%2F14%2F2015%2011%3A59%20PM&s_username=santarosa&s_accountid=AC0105061516020614723&s_upgradeable=no 4.      About MiVIA.  Retrieved October 31, 2007, from https://www.mivia.org/About_Us.aspx 5.      Bates J.  Use of narrative interviewing in everyday information behavior research.  Retrieved October 31, 2007, from http://www.sciencedirect.com/science/journal/07408188 6.      Jovchelovitch S, Bauer M.W (2000).  Narrative interviewing.  In: Bauer, M.W. and Gaskell, G., Editors, 2000.  Qualitative researching with text, image and sound, Sage, London, England, pp.57-74

7.       Flick U (2000).  Episodic interviewing.  In: Bauer, M.W. and Gaskell, G., Editors, 2000.  Qualitative researching with text, image and sound, Sage, London, England, pp.75-92

 AppendixAnalysisDescription  Jessica related  ·         (Interviewer: Do you work full time doing this?)  I work 32-40 hours depends on how the week goes.  (Interviewer: Do you have any background in health previous to this?)  I volunteer for a lot of work, but this is pretty much it.  (Interviewer: So what brought you here?)  Hum, I really like people, I definitely look for job that kept me working with the community as closely as possible.  And I work for retail for few years.  I just really want to be in the community where I actually can do more than I was doing in the retail.  I definitely get to do it here and I love it!  It was so much fun.   There are always little story, and all the family and the kids, and I love kids and get to know them.  I go to the store and I bump into 5 people that I know.  I work around the Sonoma county so I am just so well-known by everybody.·         (Jessica actually meets the participants at the library to do the training because it’s different to work on the laptop and the desk top.)  So I would actually meet them at the library to do the training there.  So they know where that (library) is and they know how to use the computer.   (Interviewer: What’s the big difference for them to use laptop versus desktop?)  Hum, one is the Mouse, believe it or not (laughing) it’s just easier to use the mouse.Program Work Related·         The mobile clinic covers three main sites, Sonoma, Petaluma and Windsor, on weekly basis.  The service charge is free for Mobile general but $55 for Mobile dental.      Context Related·         65% are Spanish speaking only, and our staffs are pretty much bilingual.  ·         There are around 100 clients per year to use the program.  Evaluation·         (Interviewer: Do they distinguish of the difference between Doctors putting their information on the paper or information on the computer?  Is that an issue?)  I think it’s an issue of it is online and government has access to everything and they can get their hands on anything (laughing).  And people are afraid if they have the medication condition that let’s say they don’t want their future workplace to find out or somehow has access to it, so they don’t want that to be an issue.  Again, we did explain the HIPAA compliance rule.·         (Interviewer: As far as other clinics you go to see whether they all adopt MiVIA, what are their biggest issues?)  Same thing with us, I think it’s just all a “time” thing.  If the physician gonna have the time to do it, I think they wonna to do it.  Again, it’s just about the number of people who are interested in doing this program, they are using this program.  The numbers are the main reason they (physicians/clinics) wonna adopt it. 

[More]

Introduction

 

e-Government implementations worldwide have gone through several phases since their inception in the late 1990s (Gronlund & Horan, 2004).  The initial stage of e-government initiatives witnessed governments across the globe starting to create their presence on the net through the creation of online services, followed by campaigns to promote the uptake of e-Government online services by the citizens and businesses and then, the thrust of enhancing service delivery (Accenture, 2006; West,2006).

 

With governments being very enthusiastic about providing better service delivery (Accenture, 2006) to the citizen; alongside, the government counterpart, the business sector in attracting more online customers, the advancement of the Information and Communication Technology (ICT) and the Internet have been eminent as the most appropriate channels for the delivery of services.  However, there are factors limiting the utilization of these systems such as the level of trust, system being too complicated as well as the unattractive, cluttered user interface.   Contrary to earlier literature which has focused on the functionality in terms of effectiveness and efficiency of the websites; nowadays, there are many literature being written to address the subject matter of user interface design, particularly addressing the hedonic component of the web machinery.  The aesthetic attribute of the user interface, other than its element of usability, has gained much interest among researchers and practitioners, particularly exploring how this aesthetic attribute can attract the user to utilize the systems (Gait, 1985; Galitz, 1997; Karvonen, 2000; Hong and Kim (2004); Lavie & Tractinsky, 2004; Cyr, Head & Ivanov, 2006).  These research works have been focused predominantly on the online businesses environment, exploring the appealing factor to lure customers to purchase online.  In the public sector landscape, this phenomenon of good design, however, has not been appropriately addressed.  The question of whether e-governmental systems meet the requirements of good user interface design and what the users have to say about e-governmental systems have not been widely highlighted.  

 

This conceptual analysis study draws upon the methodologies of literature review and pilot surveys to address the significance of good design and to assess these characteristics of good design in user interface of e-governmental systems vis-à-vis government websites.  The outcome of this conceptual analysis has shown that literatures in the forms of articles, books and guidelines on good design are plentiful, all addressing how design can elevate the user’s experience with websites. Coupled with a simple pilot survey, this study revealed that the reality of user’s experiences with e-governmental systems via the user interface are not aesthetically luring.

  

Background

e-Government

In this 21st century, the ICT and the Internet have become the delivery channels for government to provide services to the citizens, and this phenomenon has been termed as e-government.  West (2006) has defined e-government as the delivery of government information and services online through the Internet or other digital means.   Governments across the globe have undergone phases of transformation in its endeavor to provide better service delivery.  Accenture (2006) defined the Governments’ progress toward leadership in customer service has been marked by clearly defined stages, beginning with the 1st era (1999-2001) of establishing e-Government with the creation of online services and followed by the 2nd era (2001 – 2005) of ensuring the uptake of e-Government by the citizen and businesses.  The 3rd era (2005-2008) focus on providing Government services delivered cross channel and cross-government for one-stop/end-to-end services, and finally the 4th era (starting 2007) ascertaining citizen trust their government implicitly.  West (2006) depicted the transformation of e-government in four stages : (1) the billboard stage; (2) the partial-service-delivery stage; (3) the portal stage, with fully executable and integrated service delivery; and (4) interactive democracy with public outreach and accountability enhancing features.  The governments’ efforts to improve the presentation of websites are evidenced by the number of online guidelines (Leavitt & Shneiderman, 2006; NHS, 2007; Department of Premier and Cabinet, 2006; Office of the State CIO, 2004; State Services Commission, 2007; National Informatics Center, 2004).  

 

The way forward for government is to reap the benefits of ICT and the Internet by making its presence ubiquitous to the citizens, and the e-Government initiatives have brought about much change in the way government conducts its businesses.  With the advancement of the ICT and the Internet, citizen have rising expectations for government to provide better and quality services, which also signifies fast and efficient and ubiquitous delivery.  Studies have shown that citizens do have the inclination to use e-governmental systems to facilitate the need to get services from the government (Navarrete, 2006; Horan & Abhichandani, 2006).  However, the provision of online services has not been fully taken advantage by the citizen.  The lukewarm response can be due to the feeling of insecurity to use the online services for fear of losing data or information while doing the transaction, the inability to use complex online systems, the slow transmission rate and the poorly designed, unattractive user interface.   The research conducted by Accenture in 2006 highlighted that government must recognized that being true citizen-centric encompasses making the system simple and making the process as painless as possible for the citizen.   Hence, this implies that the system must be appealing as well as meet the user’s need. 

The Aesthetic Values of User Interface Design

The user interface is the component of computer systems or information systems that the user encounters first.   This first impression is critical to the acceptance of the system.  This statement is supported by studies conducted by Lindgaard, Fernandes, Dudek, Brown (2006) to ascertain how quickly people form an opinion about web page visual appeal.   The researchers demonstrated that first impressions form quickly and are consistent.  Their data suggested that a reliable decision can be made in 50 ms and that the notion of visual appeal may be closely related to other concepts concerning overall impressions of design layout and color.  

 

The importance of good design cannot be emphasized enough if the system is to be appealing to the user.  The user interface design is the window to view the capabilities of the system and the screen layout and appearance have an effect on the user in a variety of ways (Galitz, 1997), which can be the determining factors for the user to use or abandon the system.  Hence, the incorporation of human behavior factors into the design process where issues such as user requirements, task analysis, environment analysis and audience analysis were emphasized in the development of system so as to meet both the social and functional standards (Chen, 2001).     It is apparent that user interface design has to cater to users from all walks of life as the users come from many different backgrounds with different capabilities, and this is where a good interface design will have a lasting impact on the user and will increase the utilization rate of the computer or information systems. 

 

Simplicity has been identified as one of the characteristics of good user interface design (Karvonen, 2000; Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006).   According to Jakob Nielsen (in Karvonen, 2000), “simplicity” means, first and foremost, that users on the Web are able to get what they came for, where the users are very much goal-driven, and simplicity, for users signify lack of obstruction and lack of complexity.  Extending this notion of simplicity,  Karvonen (2000) also explored the notion of beauty and its aesthetic characteristic, which in her opinion, is important for understanding just how effective beauty can be for the Web and that beauty may be the decisive factor when wondering whether or not to trust a service enough to conduct business online.  She also pointed out that simplicity, design quality and pleasantness are aesthetic notions and that these aesthetic values have different impacts on novice users and technically experienced users.  Novice users would evaluate the application in its simplest way, of either “likes it” or “dislikes it” without putting much intrinsic meaning to the emotion.  For the technically experienced users, she argued that the beauty of the application is more than just the user interface but how the system functions to deliver its services.    

 

Thüring & Mahlke (2007) has defined aesthetics as the sensual experience a product instills, and to the extent to which this experience fits individual goals and preferences.  This aspect of aesthetic value is further established by the study conducted by Tractinsky, Katz, and Ikar (2000) where there were evidence of tight relationships between users' initial perceptions of interface aesthetics and their perceptions of the system's usability.   This phenomenon further defines the role of aesthetics in Human Computer Interaction (HCI) design and its effects on how users experience their interaction with computerized systems.  They also acknowledged that the facade of an information system is what users experience first and that facade is what cues users about the inside of the system.

 

Hong and Kim (2004) relate the idea of architectural characteristics to that of the websites, where they pointed out that from the aesthetic perspective, a building should be enjoyable enough to provide a pleasant feeling to the inhabitants.  In the same way, they have quoted Moran (1981) in saying that aesthetic appeal in websites refers to the user interface, because the user interface is the aspect of computer systems that users actually see and hear.   Hong and Kim (2004) hypothesized that aesthetic appeal is an important architectural dimension for websites because it enhances a customer’s pleasure.   Another interesting note on the aesthetic values of user design is the ability to create a sense of place, relating to the functions and aesthetic of the place to the user where the design is cognizant of the relationships between physical and virtual space (Horan, 2000), hence instilling the good feeling to use the systems via the interface.

 

Galitz (1997) characterized the graphical computer as an extension of a person where the system should be able to reflect the person’s capabilities and also to respond to the specific need of the user, that is, to be a tool that is useful for providing faster and efficient transactions.   The characteristics of good graphical user interface have been acknowledged in many literatures by researchers and practitioners as the critical requirements for the acceptability criteria of the websites (Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006; Wroblewski & Rantanen, 2001).    Based on the guidelines derived from their research works well as from experience working on the design and development of numerous Web-based applications,  Wroblewski & Rantanen (2001) made 19 recommendations for weblication interface design, which include the aesthetic integrity of the interface that would provide users enjoyment or familiarity, and a sense of trust and professionalism.   With the continuous ignorance of these basic criterions of good user interface design, Jakob Nielsen (through the articles published in his website) revealed  “The Ten Most Violated Homepage Design Guidelines” (Nielsen, 2003) and most recently, “The Top Ten Mistakes In Web Design” (Nielsen, 2007).   The summary of good characteristics and the Jakob Nielsen’s articles are attached in Appendix 1.

 

All the literature is evidently coherent on the role of good design to enhance user’s experience on their encounters with the interface of the systems or websites.   Nielsen & Tahir (2001) alleged that one of the oldest guidelines for usable interaction design is to increase the user's sense of control and freedom, and web sites that provide better user experiences empower their consumers to reap the benefits of the Web.

 

The Instruments for Measuring Aesthetic and Usability Values

The intriguing aspect of aesthetic values in relation to the success of the user interface design in creating a conducive milieu for website users has encouraged researchers to explore and identify suitable constructs as a means to measure the browsing experience of a website.  These aesthetic values relate to the sensual experience of the user with the artifact (Thüring & Mahlke, 2007) and this sensual experience can be described as a sense of pleasure, which connotes a state of gratification or a source of delight or joy (Merriam-Webster Online Dictionary).   Pleasure, according to De Wulf, Schillewaert, Muylle & Rangarajan (2006) is the extent to which the visitor perceives the web site visit to be enjoyable and is considered a prerequisite for a successful site.  In a study conducted to assess the role of pleasure in web site success, De Wulf et al (2006) have identified 15 constructs as the measure for establishing the state of pleasure.   These constructs (relevance, credibility, currentness, sufficiency, design, interactivity, speed, navigation, readability, reliability, progressiveness, pleasure, satisfaction, commitment and trust) share the aspects of good user interface design as recommended by other researchers and practitioners in the same domain (Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006; Wroblewski & Rantanen, 2001).

 

For the measurement of usability attributes, the System Usability Scale (SUS), which is a simple, ten-item Likert scale, which gives a global view of subjective assessments of usability (Brooke, 1996), has been identified as appropriate.  The selected statements in SUS cover a variety of aspects of system usability, such as the need for support, training, and complexity, and thus have a high level of face validity for measuring the usability of a system.  The 10 constructs in SUS are adequate to capture the usability experiences of websites. 

 

Learning Objectives

Our learning objective is to understand how conceptual analysis can be used to access good design of e-governmental systems.   The initial step for this conceptual analysis began with the literature reviews on the subject matters of e-Government, user interface design with reference to the usability and aesthetic values and the instruments for measuring these values.  The next step was identifying the right instruments and using these instruments to rate the aesthetic and usability experiences of different e-government websites.  The government websites were selected based on different layouts as well as services.   The analysis step involved the use of a free online survey application to collect the experiences of participants.  Each participant was assigned a government website to browse and these experiences were evaluated, based on the instruments used to measure the aesthetic and usability values.  The outcomes of this analysis were used to define whether e-governmental systems have met the requirements of good design practice and to advocate a way forward for better utilization of the systems in the future.

 

Analysis and Evaluation

The analysis phase of this study began with the literature review on identifying instruments for measuring the aesthetic and usability values which are to be applied to e-governmental systems.  For the purpose of determining the aesthetic values, the questionnaires composed by De Wulf et al (2006) to assess the role of pleasure in website success, has been identified as being appropriate for this study as the 15 constructs defined were sufficient to address the aesthetic component of the system or website.  As for the measurement of the usability component of the e-governmental system, the 10 constructs of the System Usability Scale (SUS) was used.   Once the instruments had been determined, the next step taken was to identify the government websites to be accessed.  The criteria used to establish the websites were based on the layout as well as the services rendered by the e-governmental system, for the intent of the survey was to gather the different aesthetic and usability experiences of the participant. 

 

For the purpose of analyzing the perception that good design is crucial for e-governmental systems, a pilot survey was conducted among the five course participants.  Each participant was assigned to experience a government website and was required to record their experiences using SurveyMonkey (a free online survey application) based on the 15 item Likert scale for aesthetic values and the 10 item Likert scale for the usability values.  The survey instrument and the URLs of the website are attached as Appendix 2.   

 

The individual evaluations indicated that one participant was more on the strongly disagree and disagree of the scales, while two participants were on the scale of disagree, undecided and agree.  The other two participants were on the scale of undecided and agree.  These findings showed that the aesthetic and usability values experienced by the user are very much influenced by the websites assigned, for some websites will induce good aesthetic and usability values while others will induce otherwise.

 

From the overall summary of the outcome for the pilot survey, the following findings can be deduced based on the percentage of strongly agree and agree, undecided and disagree to strongly disagree.  The overall summary of the outcome of the pilot survey is attached as Appendix 3. 

 

Aesthetic Values

(i)                 None of the participants strongly agree on any of items for the aesthetic values.

(ii)               The participants agree that the information in the web site is relevant, credible, sufficient, easy to navigate and that the surfing time is acceptable.

(iii)             The participants were undecided on whether the web site is up-to-date or the text is presented in an easy-to-read manner.

(iv)              The participants disagree/strongly disagree that the web site has no technical problems, it contains a lot of modern web technology, the web site is visually appealing, it takes into account personal information, and that the web site makes them feel good.

(v)                There were a range of agree, undecided and disagree on the point of whether the web sites give a feeling of satisfaction and trust as well as the high chances of visiting the website again.

Usability Values

(i)                 Only one participant strongly agrees on the inconsistency of the website.

(ii)               The participants agree that it would be quick to learn to use the website.

(iii)             The participants were undecided on whether the web site was cumbersome to use.

(iv)              The participants disagree/strongly disagree that the web site was complex, that there is a need for technical support to use the website, inconsistency of the website and the need to learn before using the website, as well as the frequency of using the web site.

(v)                There were a range of agree, undecided and disagree on the point of whether the web sites were easy to use, the confidence on using the website and the integration of the functions of the website.

 

The above findings showed that none of the participants strongly feel that government websites are aesthetically appealing and that the participants are generally between agreeing and being undecided on the usability of the website.  Hence, on the part of aesthetic values which are relevant for good design, it seems that e-governmental systems have not fully conceptualized the characteristics of good design.

 

Lesson Learnt and Extension

The literature on good design of user interface sets the foundation for the discussion on the subject matter of good design in e-governmental systems. The literature review gave insights into the importance of good design on online systems as well as the works that have been done such as identification of good design characteristics as well as guidelines on implementing good designs. Researchers have also started to view aesthetic values in good design seriously as they believed that these aesthetic values will create a positive impact on the utilization of online systems. However, there is lack of literatures on the measurement of aesthetic values. The instrument used for measuring aesthetic values this study was introduced by De Wulf, Schillewaert, Muylle & Rangarajan (2006) for evaluating the role of pleasure in web site success. The other instrument used was the System Usability Scale (SUS) introduced by Brooke, (1996).

 

The pilot survey was conducted using a free online survey application, SurveyMonkey, which provided the basic to conduct a survey. Having used the application for the first time, there were a few hiccups such as the inability of the participants to enter more than one response per column. This was due to the action of ticking the box for "Allow Only One Response per Column (Forced Ranking)". Since each participant was assigned different website to evaluate, and when they input their evaluations into the survey application, the outcome of that survey was not on individual basis evaluation but the application gave an overall evaluations. It was not possible to get the individual's evaluation, so another paper survey was issued for each participant to fill in so as to gauge the individual's evaluation.

 

The other lesson learnt was the survey instrument. Some of the items in the survey instruments were found to be not appropriate for assessing aesthetic values. The 10-item likert scale used in SUS was having both positive and negative items which created some difficulties in the analysis process.  Overall, the whole process was a good experience in doing a simple conceptual analysis study comprising of literature reviews and a pilot survey. The mistakes made have created awareness to the details and requirements of conducting a conceptual analysis study.

 

Through the literature review and the pilot survey, it is evident that good design interface has been a major issue in the implementation of online services, particularly in the private sector environments.  Good design is essential in creating the right atmosphere and sense of place to empower and engage users to utilize the online systems.  The purpose of this conceptual study was to establish the significance of good design on e-governmental systems, by means of literature review, as well as the implementation of a pilot survey by using the instruments identified, hence, it is fundamental to extend this study to the actual environment, so as to be able to gauge the extent  e-governmental systems meet the characteristics of good design, and this could provide new insights to the e-government implementers to upgrade the existing systems.  However, for future research work on this subject matter, the instruments used in the pilot survey can be further refined so as to capture the precise aesthetic values of website experiences. 

 

Conclusion

The literatures have acknowledged that good design is a significant element of a website that has the capability of creating the aesthetic sense of good feeling which in turn, induces a sense of wanting to use the system within a user.  Through the literature review and the simple pilot survey, this study has established that the user interface of a website can either create a sense of appeal or reject on the part of the user.  Hence, e-Governmental systems should embrace all these characteristics of good user interface design if government implementers are legitimate in their endeavor to provide effective and noteworthy online services and in empowering and engaging the citizens to utilize the systems accordingly. 

 

 

Related Readings

Apple Developer Connection (2006), Human Interface Design Principles.  Retrieved November 14, 2007 from  http://developer.apple.com/documentation/UserExperience/Conceptual/OSXHIGuidelines/XHIGHIDesign/chapter_5_section_2.html#//apple_ref/doc/uid/TP30000353-TPXREF130

Accenture (2006), Leadership in Customer Service : Building the Trust,  Retrieved November 1, 2007 from http://www.accenture.com/xdoc/en/industries/government/can_2006_govt_report_FINAL2.pdf

Brooke, J. (1996) SUS: A "Quick And Dirty" Usability Scale. In P. W. Jordan, B. Thomas, B. A. Weerdmeester & A. L. McClelland (eds.) Usability Evaluation in Industry. London.  Retrieved November 27, 2007 from http://www.usabilitynet.org/trump/documents/Suschapt.doc

Chen, Q. (2001), Human Computer Interaction : Issues and Challenges, Idea Group Publishing.

Cyr, D., Head, M. & Ivanov, A (2006), Design Aesthetics Leading to M-Loyalty in Mobile Commerce, Information & Management, Volume 43, Issue 8, December 2006, Pages 950-963

Department of Premier and Cabinet (2006) Websites Guideline and Standards, Western Australia.  Retrieved on December 3, 2007 from http://www.dpc.vic.gov.au/wovgwebsiteguidelines

De Wulf, K.,  Schillewaert,  N., Muylle, S. & Rangarajan, D. (2006),  The Role Of Pleasure In Web Site Success, Information & Management 43 (2006) 434–446

Gait, J (1985), An Aspect of Aesthetics in Human-Computer Communications : Pretty Windows, Ieee Transactions On Software Engineering, Vol. Se-11, No. 8, August 1985

Galitz, W. O. (1997) The Essential Guide to User Interface Design.  John Wiley & Sons Inc.

Grimsley, M & Meehan, A. (2007) e-Government Information Systems : Evaluation-led Design For Public Value And Client Trust, European Journal Of Information Systems, 16, 134–148

Grönlund, A. & Horan, T.A. (2004) Introducing E-Gov : History, Definitions, And Issues.  Communications of the Association for Information Systems (Volume 15, 2004) 713-729.

Hong, S. & Kim, J. (2004), Architectural Criteria For Website Evaluation – Conceptual Framework And Empirical Validation, Behaviour & Information Technology, September–October 2004, Vol. 23, No. 5, 337–357

Horan, T. A. (2000) Digital Places : Building Our City of Bits. ULI – the Urban Land Institute.

Horan, T. & Abhichandani, T. (2006), Evaluating User Satisfaction In An E-Government Initiatives : Result Of Structural Equation Modeling And Focus Group Discussion, Journal of Information Technology Management, Vol. XVII, Number 4, 2006.

IBM, Ease of Use – Design.  Retrieved on November 14, 2007 from http://www-03.ibm.com/easy/page/6

Karvonen, K (2000), The Beauty Of Simplicity, ACM Conference on Universal Usability, Proceedings on the 2000 conference on Universal Usability.  Retrieved November 23, 2007 from http://www.tml.tkk.fi/Research/TeSSA/Papers/Karvonen/CUU2000_Karvonen_K.pdf

Lavie, T & Tractinsky, N (2004), Assessing Dimensions Of Perceived Visual Aesthetics Of Web Sites, International Journal of Human-Computer Studies,
Volume 60, Issue 3, March 2004, Pages 269-298

Leavitt, M.O.& Shneiderman, B. (2006), Research-based Web Design and Usability Guidelines, US Department of Health and Human Services.  Retrieved on December 3, 2007 from http://www.usability.gov/pdfs/guidelines.html

Lindgaard, G, Fernandes, G., Dudek, C. & Brown, J. (2006), Attention Web Designers: You Have 50 Milliseconds To Make A Good First Impression!, Behaviour & Information Technology, Vol. 25, No. 2, March-April 2006, 115 – 126

Merriam Webster Online, http://www.merriam-webster.com/dictionary/pleasure

Navarrete, C. A. (2006), Utilization of Electronic Government Services in Mexico: A Matter of Trust, School of Information Systems and Technology, Claremont Graduate University.

Nielsen, J (2003), Jakob Nielsen’s Alertbox : The Ten Most Violated Homepage Design Guidelines, Retrieved November 27, 2007 from http://www.useit.com/alertbox/20031110.html

Nielsen, J (2007), Jakob Nielsen’s Alertbox : Top Ten Mistakes in Web Design, Retrieved November 27, 2007 from http://www.useit.com/alertbox/9605.html

National Informatics Center (2004), Management of Government of India Websites – Guidelines for IT Managers.  Retrieved on December 3, 2007 from nicsu.up.nic.in/guidelines.pdf

NHS (2007) Website Guidelines, National Health Service. UK.  Retreived on December 3, 2007 from http://www.nhsidentity.nhs.uk/websites/

Nielsen, J. and Tahir, M. (2001) Building Web Sites With Depth, New Architect Daily, Retrieved November 27, 2007 from http://www.webtechniques.com/archives/2001/02/nielsen/

Office of the State CIO (2004), Website Development Guidelines, State of North Carolina.  Retrieved on December 3, 2007 from http://www.ncsta.gov/docs/White%20papers/general/Web%20Site%20Development%20Guidelines.pdf

State Services Commission (2007), NZ Government Web Standards and Recommendations v1.0.  Retrieved December 3, 2007 from  http://www.e.govt.nz/standards/web-guidelines/

Thüring, M. & Mahlke, S. (2007), Usability, Aesthetics And Emotions In Human–Technology Interaction, International Journal Of Psychology, 2007, 42 (4), 253–264

Tractinsky, N., Katz, A. S., & Ikar, D. (2000). What Is Beautiful Is Usable. Interacting with Computers, 13, 127–145.

West, D. M. (2006) E-Government and the Transformation of Service Delivery and Citizen Attitudes. Public Administration Review January/February 2006/Vol.64 No. 1

Wroblewski, L. & Rantanen, E.M. (2001), Design Considerations For Web-Based Applications, Proceedings of the 45th Annual Meeting of the Human Factors and Ergonomics Society. Santa Monica, CA: Human Factors & Ergonomics Society. 2001.

 

[More]

Introduction

 

e-Government implementations worldwide have gone through several phases since their inception in the late 1990s (Gronlund & Horan, 2004).  The initial stage of e-government initiatives witnessed governments across the globe starting to create their presence on the net through the creation of online services, followed by campaigns to promote the uptake of e-Government online services by the citizens and businesses and then, the thrust of enhancing service delivery (Accenture, 2006; West,2006).

 

With governments being very enthusiastic about providing better service delivery (Accenture, 2006) to the citizen; alongside, the government counterpart, the business sector in attracting more online customers, the advancement of the Information and Communication Technology (ICT) and the Internet have been eminent as the most appropriate channels for the delivery of services.  However, there are factors limiting the utilization of these systems such as the level of trust, system being too complicated as well as the unattractive, cluttered user interface.   Contrary to earlier literature which has focused on the functionality in terms of effectiveness and efficiency of the websites; nowadays, there are many literature being written to address the subject matter of user interface design, particularly addressing the hedonic component of the web machinery.  The aesthetic attribute of the user interface, other than its element of usability, has gained much interest among researchers and practitioners, particularly exploring how this aesthetic attribute can attract the user to utilize the systems (Gait, 1985; Galitz, 1997; Karvonen, 2000; Hong and Kim (2004); Lavie & Tractinsky, 2004; Cyr, Head & Ivanov, 2006).  These research works have been focused predominantly on the online businesses environment, exploring the appealing factor to lure customers to purchase online.  In the public sector landscape, this phenomenon of good design, however, has not been appropriately addressed.  The question of whether e-governmental systems meet the requirements of good user interface design and what the users have to say about e-governmental systems have not been widely highlighted.  

 

This conceptual analysis study draws upon the methodologies of literature review and pilot surveys to address the significance of good design and to assess these characteristics of good design in user interface of e-governmental systems vis-à-vis government websites.  The outcome of this conceptual analysis has shown that literatures in the forms of articles, books and guidelines on good design are plentiful, all addressing how design can elevate the user’s experience with websites. Coupled with a simple pilot survey, this study revealed that the reality of user’s experiences with e-governmental systems via the user interface are not aesthetically luring.

  

Background

e-Government

In this 21st century, the ICT and the Internet have become the delivery channels for government to provide services to the citizens, and this phenomenon has been termed as e-government.  West (2006) has defined e-government as the delivery of government information and services online through the Internet or other digital means.   Governments across the globe have undergone phases of transformation in its endeavor to provide better service delivery.  Accenture (2006) defined the Governments’ progress toward leadership in customer service has been marked by clearly defined stages, beginning with the 1st era (1999-2001) of establishing e-Government with the creation of online services and followed by the 2nd era (2001 – 2005) of ensuring the uptake of e-Government by the citizen and businesses.  The 3rd era (2005-2008) focus on providing Government services delivered cross channel and cross-government for one-stop/end-to-end services, and finally the 4th era (starting 2007) ascertaining citizen trust their government implicitly.  West (2006) depicted the transformation of e-government in four stages : (1) the billboard stage; (2) the partial-service-delivery stage; (3) the portal stage, with fully executable and integrated service delivery; and (4) interactive democracy with public outreach and accountability enhancing features.  The governments’ efforts to improve the presentation of websites are evidenced by the number of online guidelines (Leavitt & Shneiderman, 2006; NHS, 2007; Department of Premier and Cabinet, 2006; Office of the State CIO, 2004; State Services Commission, 2007; National Informatics Center, 2004).  

 

The way forward for government is to reap the benefits of ICT and the Internet by making its presence ubiquitous to the citizens, and the e-Government initiatives have brought about much change in the way government conducts its businesses.  With the advancement of the ICT and the Internet, citizen have rising expectations for government to provide better and quality services, which also signifies fast and efficient and ubiquitous delivery.  Studies have shown that citizens do have the inclination to use e-governmental systems to facilitate the need to get services from the government (Navarrete, 2006; Horan & Abhichandani, 2006).  However, the provision of online services has not been fully taken advantage by the citizen.  The lukewarm response can be due to the feeling of insecurity to use the online services for fear of losing data or information while doing the transaction, the inability to use complex online systems, the slow transmission rate and the poorly designed, unattractive user interface.   The research conducted by Accenture in 2006 highlighted that government must recognized that being true citizen-centric encompasses making the system simple and making the process as painless as possible for the citizen.   Hence, this implies that the system must be appealing as well as meet the user’s need. 

The Aesthetic Values of User Interface Design

The user interface is the component of computer systems or information systems that the user encounters first.   This first impression is critical to the acceptance of the system.  This statement is supported by studies conducted by Lindgaard, Fernandes, Dudek, Brown (2006) to ascertain how quickly people form an opinion about web page visual appeal.   The researchers demonstrated that first impressions form quickly and are consistent.  Their data suggested that a reliable decision can be made in 50 ms and that the notion of visual appeal may be closely related to other concepts concerning overall impressions of design layout and color.  

 

The importance of good design cannot be emphasized enough if the system is to be appealing to the user.  The user interface design is the window to view the capabilities of the system and the screen layout and appearance have an effect on the user in a variety of ways (Galitz, 1997), which can be the determining factors for the user to use or abandon the system.  Hence, the incorporation of human behavior factors into the design process where issues such as user requirements, task analysis, environment analysis and audience analysis were emphasized in the development of system so as to meet both the social and functional standards (Chen, 2001).     It is apparent that user interface design has to cater to users from all walks of life as the users come from many different backgrounds with different capabilities, and this is where a good interface design will have a lasting impact on the user and will increase the utilization rate of the computer or information systems. 

 

Simplicity has been identified as one of the characteristics of good user interface design (Karvonen, 2000; Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006).   According to Jakob Nielsen (in Karvonen, 2000), “simplicity” means, first and foremost, that users on the Web are able to get what they came for, where the users are very much goal-driven, and simplicity, for users signify lack of obstruction and lack of complexity.  Extending this notion of simplicity,  Karvonen (2000) also explored the notion of beauty and its aesthetic characteristic, which in her opinion, is important for understanding just how effective beauty can be for the Web and that beauty may be the decisive factor when wondering whether or not to trust a service enough to conduct business online.  She also pointed out that simplicity, design quality and pleasantness are aesthetic notions and that these aesthetic values have different impacts on novice users and technically experienced users.  Novice users would evaluate the application in its simplest way, of either “likes it” or “dislikes it” without putting much intrinsic meaning to the emotion.  For the technically experienced users, she argued that the beauty of the application is more than just the user interface but how the system functions to deliver its services.    

 

Thüring & Mahlke (2007) has defined aesthetics as the sensual experience a product instills, and to the extent to which this experience fits individual goals and preferences.  This aspect of aesthetic value is further established by the study conducted by Tractinsky, Katz, and Ikar (2000) where there were evidence of tight relationships between users' initial perceptions of interface aesthetics and their perceptions of the system's usability.   This phenomenon further defines the role of aesthetics in Human Computer Interaction (HCI) design and its effects on how users experience their interaction with computerized systems.  They also acknowledged that the facade of an information system is what users experience first and that facade is what cues users about the inside of the system.

 

Hong and Kim (2004) relate the idea of architectural characteristics to that of the websites, where they pointed out that from the aesthetic perspective, a building should be enjoyable enough to provide a pleasant feeling to the inhabitants.  In the same way, they have quoted Moran (1981) in saying that aesthetic appeal in websites refers to the user interface, because the user interface is the aspect of computer systems that users actually see and hear.   Hong and Kim (2004) hypothesized that aesthetic appeal is an important architectural dimension for websites because it enhances a customer’s pleasure.   Another interesting note on the aesthetic values of user design is the ability to create a sense of place, relating to the functions and aesthetic of the place to the user where the design is cognizant of the relationships between physical and virtual space (Horan, 2000), hence instilling the good feeling to use the systems via the interface.

 

Galitz (1997) characterized the graphical computer as an extension of a person where the system should be able to reflect the person’s capabilities and also to respond to the specific need of the user, that is, to be a tool that is useful for providing faster and efficient transactions.   The characteristics of good graphical user interface have been acknowledged in many literatures by researchers and practitioners as the critical requirements for the acceptability criteria of the websites (Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006; Wroblewski & Rantanen, 2001).    Based on the guidelines derived from their research works well as from experience working on the design and development of numerous Web-based applications,  Wroblewski & Rantanen (2001) made 19 recommendations for weblication interface design, which include the aesthetic integrity of the interface that would provide users enjoyment or familiarity, and a sense of trust and professionalism.   With the continuous ignorance of these basic criterions of good user interface design, Jakob Nielsen (through the articles published in his website) revealed  “The Ten Most Violated Homepage Design Guidelines” (Nielsen, 2003) and most recently, “The Top Ten Mistakes In Web Design” (Nielsen, 2007).   The summary of good characteristics and the Jakob Nielsen’s articles are attached in Appendix 1.

 

All the literature is evidently coherent on the role of good design to enhance user’s experience on their encounters with the interface of the systems or websites.   Nielsen & Tahir (2001) alleged that one of the oldest guidelines for usable interaction design is to increase the user's sense of control and freedom, and web sites that provide better user experiences empower their consumers to reap the benefits of the Web.

 

The Instruments for Measuring Aesthetic and Usability Values

The intriguing aspect of aesthetic values in relation to the success of the user interface design in creating a conducive milieu for website users has encouraged researchers to explore and identify suitable constructs as a means to measure the browsing experience of a website.  These aesthetic values relate to the sensual experience of the user with the artifact (Thüring & Mahlke, 2007) and this sensual experience can be described as a sense of pleasure, which connotes a state of gratification or a source of delight or joy (Merriam-Webster Online Dictionary).   Pleasure, according to De Wulf, Schillewaert, Muylle & Rangarajan (2006) is the extent to which the visitor perceives the web site visit to be enjoyable and is considered a prerequisite for a successful site.  In a study conducted to assess the role of pleasure in web site success, De Wulf et al (2006) have identified 15 constructs as the measure for establishing the state of pleasure.   These constructs (relevance, credibility, currentness, sufficiency, design, interactivity, speed, navigation, readability, reliability, progressiveness, pleasure, satisfaction, commitment and trust) share the aspects of good user interface design as recommended by other researchers and practitioners in the same domain (Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006; Wroblewski & Rantanen, 2001).

 

For the measurement of usability attributes, the System Usability Scale (SUS), which is a simple, ten-item Likert scale, which gives a global view of subjective assessments of usability (Brooke, 1996), has been identified as appropriate.  The selected statements in SUS cover a variety of aspects of system usability, such as the need for support, training, and complexity, and thus have a high level of face validity for measuring the usability of a system.  The 10 constructs in SUS are adequate to capture the usability experiences of websites. 

 

Learning Objectives

Our learning objective is to understand how conceptual analysis can be used to access good design of e-governmental systems.   The initial step for this conceptual analysis began with the literature reviews on the subject matters of e-Government, user interface design with reference to the usability and aesthetic values and the instruments for measuring these values.  The next step was identifying the right instruments and using these instruments to rate the aesthetic and usability experiences of different e-government websites.  The government websites were selected based on different layouts as well as services.   The analysis step involved the use of a free online survey application to collect the experiences of participants.  Each participant was assigned a government website to browse and these experiences were evaluated, based on the instruments used to measure the aesthetic and usability values.  The outcomes of this analysis were used to define whether e-governmental systems have met the requirements of good design practice and to advocate a way forward for better utilization of the systems in the future.

 

Analysis and Evaluation

The analysis phase of this study began with the literature review on identifying instruments for measuring the aesthetic and usability values which are to be applied to e-governmental systems.  For the purpose of determining the aesthetic values, the questionnaires composed by De Wulf et al (2006) to assess the role of pleasure in website success, has been identified as being appropriate for this study as the 15 constructs defined were sufficient to address the aesthetic component of the system or website.  As for the measurement of the usability component of the e-governmental system, the 10 constructs of the System Usability Scale (SUS) was used.   Once the instruments had been determined, the next step taken was to identify the government websites to be accessed.  The criteria used to establish the websites were based on the layout as well as the services rendered by the e-governmental system, for the intent of the survey was to gather the different aesthetic and usability experiences of the participant. 

 

For the purpose of analyzing the perception that good design is crucial for e-governmental systems, a pilot survey was conducted among the five course participants.  Each participant was assigned to experience a government website and was required to record their experiences using SurveyMonkey (a free online survey application) based on the 15 item Likert scale for aesthetic values and the 10 item Likert scale for the usability values.  The survey instrument and the URLs of the website are attached as Appendix 2.   

 

The individual evaluations indicated that one participant was more on the strongly disagree and disagree of the scales, while two participants were on the scale of disagree, undecided and agree.  The other two participants were on the scale of undecided and agree.  These findings showed that the aesthetic and usability values experienced by the user are very much influenced by the websites assigned, for some websites will induce good aesthetic and usability values while others will induce otherwise.

 

From the overall summary of the outcome for the pilot survey, the following findings can be deduced based on the percentage of strongly agree and agree, undecided and disagree to strongly disagree.  The overall summary of the outcome of the pilot survey is attached as Appendix 3. 

 

Aesthetic Values

(i)                 None of the participants strongly agree on any of items for the aesthetic values.

(ii)               The participants agree that the information in the web site is relevant, credible, sufficient, easy to navigate and that the surfing time is acceptable.

(iii)             The participants were undecided on whether the web site is up-to-date or the text is presented in an easy-to-read manner.

(iv)              The participants disagree/strongly disagree that the web site has no technical problems, it contains a lot of modern web technology, the web site is visually appealing, it takes into account personal information, and that the web site makes them feel good.

(v)                There were a range of agree, undecided and disagree on the point of whether the web sites give a feeling of satisfaction and trust as well as the high chances of visiting the website again.

Usability Values

(i)                 Only one participant strongly agrees on the inconsistency of the website.

(ii)               The participants agree that it would be quick to learn to use the website.

(iii)             The participants were undecided on whether the web site was cumbersome to use.

(iv)              The participants disagree/strongly disagree that the web site was complex, that there is a need for technical support to use the website, inconsistency of the website and the need to learn before using the website, as well as the frequency of using the web site.

(v)                There were a range of agree, undecided and disagree on the point of whether the web sites were easy to use, the confidence on using the website and the integration of the functions of the website.

 

The above findings showed that none of the participants strongly feel that government websites are aesthetically appealing and that the participants are generally between agreeing and being undecided on the usability of the website.  Hence, on the part of aesthetic values which are relevant for good design, it seems that e-governmental systems have not fully conceptualized the characteristics of good design.

 

Lesson Learnt and Extension

The literature on good design of user interface sets the foundation for the discussion on the subject matter of good design in e-governmental systems. The literature review gave insights into the importance of good design on online systems as well as the works that have been done such as identification of good design characteristics as well as guidelines on implementing good designs. Researchers have also started to view aesthetic values in good design seriously as they believed that these aesthetic values will create a positive impact on the utilization of online systems. However, there is lack of literatures on the measurement of aesthetic values. The instrument used for measuring aesthetic values this study was introduced by De Wulf, Schillewaert, Muylle & Rangarajan (2006) for evaluating the role of pleasure in web site success. The other instrument used was the System Usability Scale (SUS) introduced by Brooke, (1996).

 

The pilot survey was conducted using a free online survey application, SurveyMonkey, which provided the basic to conduct a survey. Having used the application for the first time, there were a few hiccups such as the inability of the participants to enter more than one response per column. This was due to the action of ticking the box for "Allow Only One Response per Column (Forced Ranking)". Since each participant was assigned different website to evaluate, and when they input their evaluations into the survey application, the outcome of that survey was not on individual basis evaluation but the application gave an overall evaluations. It was not possible to get the individual's evaluation, so another paper survey was issued for each participant to fill in so as to gauge the individual's evaluation.

 

The other lesson learnt was the survey instrument. Some of the items in the survey instruments were found to be not appropriate for assessing aesthetic values. The 10-item likert scale used in SUS was having both positive and negative items which created some difficulties in the analysis process.  Overall, the whole process was a good experience in doing a simple conceptual analysis study comprising of literature reviews and a pilot survey. The mistakes made have created awareness to the details and requirements of conducting a conceptual analysis study.

 

Through the literature review and the pilot survey, it is evident that good design interface has been a major issue in the implementation of online services, particularly in the private sector environments.  Good design is essential in creating the right atmosphere and sense of place to empower and engage users to utilize the online systems.  The purpose of this conceptual study was to establish the significance of good design on e-governmental systems, by means of literature review, as well as the implementation of a pilot survey by using the instruments identified, hence, it is fundamental to extend this study to the actual environment, so as to be able to gauge the extent  e-governmental systems meet the characteristics of good design, and this could provide new insights to the e-government implementers to upgrade the existing systems.  However, for future research work on this subject matter, the instruments used in the pilot survey can be further refined so as to capture the precise aesthetic values of website experiences. 

 

Conclusion

The literatures have acknowledged that good design is a significant element of a website that has the capability of creating the aesthetic sense of good feeling which in turn, induces a sense of wanting to use the system within a user.  Through the literature review and the simple pilot survey, this study has established that the user interface of a website can either create a sense of appeal or reject on the part of the user.  Hence, e-Governmental systems should embrace all these characteristics of good user interface design if government implementers are legitimate in their endeavor to provide effective and noteworthy online services and in empowering and engaging the citizens to utilize the systems accordingly. 

 

 

Related Readings

Apple Developer Connection (2006), Human Interface Design Principles.  Retrieved November 14, 2007 from  http://developer.apple.com/documentation/UserExperience/Conceptual/OSXHIGuidelines/XHIGHIDesign/chapter_5_section_2.html#//apple_ref/doc/uid/TP30000353-TPXREF130

Accenture (2006), Leadership in Customer Service : Building the Trust,  Retrieved November 1, 2007 from http://www.accenture.com/xdoc/en/industries/government/can_2006_govt_report_FINAL2.pdf

Brooke, J. (1996) SUS: A "Quick And Dirty" Usability Scale. In P. W. Jordan, B. Thomas, B. A. Weerdmeester & A. L. McClelland (eds.) Usability Evaluation in Industry. London.  Retrieved November 27, 2007 from http://www.usabilitynet.org/trump/documents/Suschapt.doc

Chen, Q. (2001), Human Computer Interaction : Issues and Challenges, Idea Group Publishing.

Cyr, D., Head, M. & Ivanov, A (2006), Design Aesthetics Leading to M-Loyalty in Mobile Commerce, Information & Management, Volume 43, Issue 8, December 2006, Pages 950-963

Department of Premier and Cabinet (2006) Websites Guideline and Standards, Western Australia.  Retrieved on December 3, 2007 from http://www.dpc.vic.gov.au/wovgwebsiteguidelines

De Wulf, K.,  Schillewaert,  N., Muylle, S. & Rangarajan, D. (2006),  The Role Of Pleasure In Web Site Success, Information & Management 43 (2006) 434–446

Gait, J (1985), An Aspect of Aesthetics in Human-Computer Communications : Pretty Windows, Ieee Transactions On Software Engineering, Vol. Se-11, No. 8, August 1985

Galitz, W. O. (1997) The Essential Guide to User Interface Design.  John Wiley & Sons Inc.

Grimsley, M & Meehan, A. (2007) e-Government Information Systems : Evaluation-led Design For Public Value And Client Trust, European Journal Of Information Systems, 16, 134–148

Grönlund, A. & Horan, T.A. (2004) Introducing E-Gov : History, Definitions, And Issues.  Communications of the Association for Information Systems (Volume 15, 2004) 713-729.

Hong, S. & Kim, J. (2004), Architectural Criteria For Website Evaluation – Conceptual Framework And Empirical Validation, Behaviour & Information Technology, September–October 2004, Vol. 23, No. 5, 337–357

Horan, T. A. (2000) Digital Places : Building Our City of Bits. ULI – the Urban Land Institute.

Horan, T. & Abhichandani, T. (2006), Evaluating User Satisfaction In An E-Government Initiatives : Result Of Structural Equation Modeling And Focus Group Discussion, Journal of Information Technology Management, Vol. XVII, Number 4, 2006.

IBM, Ease of Use – Design.  Retrieved on November 14, 2007 from http://www-03.ibm.com/easy/page/6

Karvonen, K (2000), The Beauty Of Simplicity, ACM Conference on Universal Usability, Proceedings on the 2000 conference on Universal Usability.  Retrieved November 23, 2007 from http://www.tml.tkk.fi/Research/TeSSA/Papers/Karvonen/CUU2000_Karvonen_K.pdf

Lavie, T & Tractinsky, N (2004), Assessing Dimensions Of Perceived Visual Aesthetics Of Web Sites, International Journal of Human-Computer Studies,
Volume 60, Issue 3, March 2004, Pages 269-298

Leavitt, M.O.& Shneiderman, B. (2006), Research-based Web Design and Usability Guidelines, US Department of Health and Human Services.  Retrieved on December 3, 2007 from http://www.usability.gov/pdfs/guidelines.html

Lindgaard, G, Fernandes, G., Dudek, C. & Brown, J. (2006), Attention Web Designers: You Have 50 Milliseconds To Make A Good First Impression!, Behaviour & Information Technology, Vol. 25, No. 2, March-April 2006, 115 – 126

Merriam Webster Online, http://www.merriam-webster.com/dictionary/pleasure

Navarrete, C. A. (2006), Utilization of Electronic Government Services in Mexico: A Matter of Trust, School of Information Systems and Technology, Claremont Graduate University.

Nielsen, J (2003), Jakob Nielsen’s Alertbox : The Ten Most Violated Homepage Design Guidelines, Retrieved November 27, 2007 from http://www.useit.com/alertbox/20031110.html

Nielsen, J (2007), Jakob Nielsen’s Alertbox : Top Ten Mistakes in Web Design, Retrieved November 27, 2007 from http://www.useit.com/alertbox/9605.html

National Informatics Center (2004), Management of Government of India Websites – Guidelines for IT Managers.  Retrieved on December 3, 2007 from nicsu.up.nic.in/guidelines.pdf

NHS (2007) Website Guidelines, National Health Service. UK.  Retreived on December 3, 2007 from http://www.nhsidentity.nhs.uk/websites/

Nielsen, J. and Tahir, M. (2001) Building Web Sites With Depth, New Architect Daily, Retrieved November 27, 2007 from http://www.webtechniques.com/archives/2001/02/nielsen/

Office of the State CIO (2004), Website Development Guidelines, State of North Carolina.  Retrieved on December 3, 2007 from http://www.ncsta.gov/docs/White%20papers/general/Web%20Site%20Development%20Guidelines.pdf

State Services Commission (2007), NZ Government Web Standards and Recommendations v1.0.  Retrieved December 3, 2007 from  http://www.e.govt.nz/standards/web-guidelines/

Thüring, M. & Mahlke, S. (2007), Usability, Aesthetics And Emotions In Human–Technology Interaction, International Journal Of Psychology, 2007, 42 (4), 253–264

Tractinsky, N., Katz, A. S., & Ikar, D. (2000). What Is Beautiful Is Usable. Interacting with Computers, 13, 127–145.

West, D. M. (2006) E-Government and the Transformation of Service Delivery and Citizen Attitudes. Public Administration Review January/February 2006/Vol.64 No. 1

Wroblewski, L. & Rantanen, E.M. (2001), Design Considerations For Web-Based Applications, Proceedings of the 45th Annual Meeting of the Human Factors and Ergonomics Society. Santa Monica, CA: Human Factors & Ergonomics Society. 2001.

 

 

 

[More]

Introduction

 

e-Government implementations worldwide have gone through several phases since their inception in the late 1990s (Gronlund & Horan, 2004).  The initial stage of e-government initiatives witnessed governments across the globe starting to create their presence on the net through the creation of online services, followed by campaigns to promote the uptake of e-Government online services by the citizens and businesses and then, the thrust of enhancing service delivery (Accenture, 2006; West,2006).

 

With governments being very enthusiastic about providing better service delivery (Accenture, 2006) to the citizen; alongside, the government counterpart, the business sector in attracting more online customers, the advancement of the Information and Communication Technology (ICT) and the Internet have been eminent as the most appropriate channels for the delivery of services.  However, there are factors limiting the utilization of these systems such as the level of trust, system being too complicated as well as the unattractive, cluttered user interface.   Contrary to earlier literature which has focused on the functionality in terms of effectiveness and efficiency of the websites; nowadays, there are many literature being written to address the subject matter of user interface design, particularly addressing the hedonic component of the web machinery.  The aesthetic attribute of the user interface, other than its element of usability, has gained much interest among researchers and practitioners, particularly exploring how this aesthetic attribute can attract the user to utilize the systems (Gait, 1985; Galitz, 1997; Karvonen, 2000; Hong and Kim (2004); Lavie & Tractinsky, 2004; Cyr, Head & Ivanov, 2006).  These research works have been focused predominantly on the online businesses environment, exploring the appealing factor to lure customers to purchase online.  In the public sector landscape, this phenomenon of good design, however, has not been appropriately addressed.  The question of whether e-governmental systems meet the requirements of good user interface design and what the users have to say about e-governmental systems have not been widely highlighted.  

 

This conceptual analysis study draws upon the methodologies of literature review and pilot surveys to address the significance of good design and to assess these characteristics of good design in user interface of e-governmental systems vis-à-vis government websites.  The outcome of this conceptual analysis has shown that literatures in the forms of articles, books and guidelines on good design are plentiful, all addressing how design can elevate the user’s experience with websites. Coupled with a simple pilot survey, this study revealed that the reality of user’s experiences with e-governmental systems via the user interface are not aesthetically luring.

  

Background

e-Government

In this 21st century, the ICT and the Internet have become the delivery channels for government to provide services to the citizens, and this phenomenon has been termed as e-government.  West (2006) has defined e-government as the delivery of government information and services online through the Internet or other digital means.   Governments across the globe have undergone phases of transformation in its endeavor to provide better service delivery.  Accenture (2006) defined the Governments’ progress toward leadership in customer service has been marked by clearly defined stages, beginning with the 1st era (1999-2001) of establishing e-Government with the creation of online services and followed by the 2nd era (2001 – 2005) of ensuring the uptake of e-Government by the citizen and businesses.  The 3rd era (2005-2008) focus on providing Government services delivered cross channel and cross-government for one-stop/end-to-end services, and finally the 4th era (starting 2007) ascertaining citizen trust their government implicitly.  West (2006) depicted the transformation of e-government in four stages : (1) the billboard stage; (2) the partial-service-delivery stage; (3) the portal stage, with fully executable and integrated service delivery; and (4) interactive democracy with public outreach and accountability enhancing features.  The governments’ efforts to improve the presentation of websites are evidenced by the number of online guidelines (Leavitt & Shneiderman, 2006; NHS, 2007; Department of Premier and Cabinet, 2006; Office of the State CIO, 2004; State Services Commission, 2007; National Informatics Center, 2004).  

 

The way forward for government is to reap the benefits of ICT and the Internet by making its presence ubiquitous to the citizens, and the e-Government initiatives have brought about much change in the way government conducts its businesses.  With the advancement of the ICT and the Internet, citizen have rising expectations for government to provide better and quality services, which also signifies fast and efficient and ubiquitous delivery.  Studies have shown that citizens do have the inclination to use e-governmental systems to facilitate the need to get services from the government (Navarrete, 2006; Horan & Abhichandani, 2006).  However, the provision of online services has not been fully taken advantage by the citizen.  The lukewarm response can be due to the feeling of insecurity to use the online services for fear of losing data or information while doing the transaction, the inability to use complex online systems, the slow transmission rate and the poorly designed, unattractive user interface.   The research conducted by Accenture in 2006 highlighted that government must recognized that being true citizen-centric encompasses making the system simple and making the process as painless as possible for the citizen.   Hence, this implies that the system must be appealing as well as meet the user’s need. 

The Aesthetic Values of User Interface Design

The user interface is the component of computer systems or information systems that the user encounters first.   This first impression is critical to the acceptance of the system.  This statement is supported by studies conducted by Lindgaard, Fernandes, Dudek, Brown (2006) to ascertain how quickly people form an opinion about web page visual appeal.   The researchers demonstrated that first impressions form quickly and are consistent.  Their data suggested that a reliable decision can be made in 50 ms and that the notion of visual appeal may be closely related to other concepts concerning overall impressions of design layout and color.  

 

The importance of good design cannot be emphasized enough if the system is to be appealing to the user.  The user interface design is the window to view the capabilities of the system and the screen layout and appearance have an effect on the user in a variety of ways (Galitz, 1997), which can be the determining factors for the user to use or abandon the system.  Hence, the incorporation of human behavior factors into the design process where issues such as user requirements, task analysis, environment analysis and audience analysis were emphasized in the development of system so as to meet both the social and functional standards (Chen, 2001).     It is apparent that user interface design has to cater to users from all walks of life as the users come from many different backgrounds with different capabilities, and this is where a good interface design will have a lasting impact on the user and will increase the utilization rate of the computer or information systems. 

 

Simplicity has been identified as one of the characteristics of good user interface design (Karvonen, 2000; Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006).   According to Jakob Nielsen (in Karvonen, 2000), “simplicity” means, first and foremost, that users on the Web are able to get what they came for, where the users are very much goal-driven, and simplicity, for users signify lack of obstruction and lack of complexity.  Extending this notion of simplicity,  Karvonen (2000) also explored the notion of beauty and its aesthetic characteristic, which in her opinion, is important for understanding just how effective beauty can be for the Web and that beauty may be the decisive factor when wondering whether or not to trust a service enough to conduct business online.  She also pointed out that simplicity, design quality and pleasantness are aesthetic notions and that these aesthetic values have different impacts on novice users and technically experienced users.  Novice users would evaluate the application in its simplest way, of either “likes it” or “dislikes it” without putting much intrinsic meaning to the emotion.  For the technically experienced users, she argued that the beauty of the application is more than just the user interface but how the system functions to deliver its services.    

 

Thüring & Mahlke (2007) has defined aesthetics as the sensual experience a product instills, and to the extent to which this experience fits individual goals and preferences.  This aspect of aesthetic value is further established by the study conducted by Tractinsky, Katz, and Ikar (2000) where there were evidence of tight relationships between users' initial perceptions of interface aesthetics and their perceptions of the system's usability.   This phenomenon further defines the role of aesthetics in Human Computer Interaction (HCI) design and its effects on how users experience their interaction with computerized systems.  They also acknowledged that the facade of an information system is what users experience first and that facade is what cues users about the inside of the system.

 

Hong and Kim (2004) relate the idea of architectural characteristics to that of the websites, where they pointed out that from the aesthetic perspective, a building should be enjoyable enough to provide a pleasant feeling to the inhabitants.  In the same way, they have quoted Moran (1981) in saying that aesthetic appeal in websites refers to the user interface, because the user interface is the aspect of computer systems that users actually see and hear.   Hong and Kim (2004) hypothesized that aesthetic appeal is an important architectural dimension for websites because it enhances a customer’s pleasure.   Another interesting note on the aesthetic values of user design is the ability to create a sense of place, relating to the functions and aesthetic of the place to the user where the design is cognizant of the relationships between physical and virtual space (Horan, 2000), hence instilling the good feeling to use the systems via the interface.

 

Galitz (1997) characterized the graphical computer as an extension of a person where the system should be able to reflect the person’s capabilities and also to respond to the specific need of the user, that is, to be a tool that is useful for providing faster and efficient transactions.   The characteristics of good graphical user interface have been acknowledged in many literatures by researchers and practitioners as the critical requirements for the acceptability criteria of the websites (Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006; Wroblewski & Rantanen, 2001).    Based on the guidelines derived from their research works well as from experience working on the design and development of numerous Web-based applications,  Wroblewski & Rantanen (2001) made 19 recommendations for weblication interface design, which include the aesthetic integrity of the interface that would provide users enjoyment or familiarity, and a sense of trust and professionalism.   With the continuous ignorance of these basic criterions of good user interface design, Jakob Nielsen (through the articles published in his website) revealed  “The Ten Most Violated Homepage Design Guidelines” (Nielsen, 2003) and most recently, “The Top Ten Mistakes In Web Design” (Nielsen, 2007).   The summary of good characteristics and the Jakob Nielsen’s articles are attached in Appendix 1.

All the literature is evidently coherent on the role of good design to enhance user’s experience on their encounters with the interface of the systems or websites.   Nielsen & Tahir (2001) alleged that one of the oldest guidelines for usable interaction design is to increase the user's sense of control and freedom, and web sites that provide better user experiences empower their consumers to reap the benefits of the Web.

 

The Instruments for Measuring Aesthetic and Usability Values

The intriguing aspect of aesthetic values in relation to the success of the user interface design in creating a conducive milieu for website users has encouraged researchers to explore and identify suitable constructs as a means to measure the browsing experience of a website.  These aesthetic values relate to the sensual experience of the user with the artifact (Thüring & Mahlke, 2007) and this sensual experience can be described as a sense of pleasure, which connotes a state of gratification or a source of delight or joy (Merriam-Webster Online Dictionary).   Pleasure, according to De Wulf, Schillewaert, Muylle & Rangarajan (2006) is the extent to which the visitor perceives the web site visit to be enjoyable and is considered a prerequisite for a successful site.  In a study conducted to assess the role of pleasure in web site success, De Wulf et al (2006) have identified 15 constructs as the measure for establishing the state of pleasure.   These constructs (relevance, credibility, currentness, sufficiency, design, interactivity, speed, navigation, readability, reliability, progressiveness, pleasure, satisfaction, commitment and trust) share the aspects of good user interface design as recommended by other researchers and practitioners in the same domain (Galitz, 1997; IBM, 2007; Apple Developer Connection, 2006; Wroblewski & Rantanen, 2001).

 

For the measurement of usability attributes, the System Usability Scale (SUS), which is a simple, ten-item Likert scale, which gives a global view of subjective assessments of usability (Brooke, 1996), has been identified as appropriate.  The selected statements in SUS cover a variety of aspects of system usability, such as the need for support, training, and complexity, and thus have a high level of face validity for measuring the usability of a system.  The 10 constructs in SUS are adequate to capture the usability experiences of websites. 

 

Learning Objectives

Our learning objective is to understand how conceptual analysis can be used to access good design of e-governmental systems.   The initial step for this conceptual analysis began with the literature reviews on the subject matters of e-Government, user interface design with reference to the usability and aesthetic values and the instruments for measuring these values.  The next step was identifying the right instruments and using these instruments to rate the aesthetic and usability experiences of different e-government websites.  The government websites were selected based on different layouts as well as services.   The analysis step involved the use of a free online survey application to collect the experiences of participants.  Each participant was assigned a government website to browse and these experiences were evaluated, based on the instruments used to measure the aesthetic and usability values.  The outcomes of this analysis were used to define whether e-governmental systems have met the requirements of good design practice and to advocate a way forward for better utilization of the systems in the future.

 

Analysis and Evaluation

The analysis phase of this study began with the literature review on identifying instruments for measuring the aesthetic and usability values which are to be applied to e-governmental systems.  For the purpose of determining the aesthetic values, the questionnaires composed by De Wulf et al (2006) to assess the role of pleasure in website success, has been identified as being appropriate for this study as the 15 constructs defined were sufficient to address the aesthetic component of the system or website.  As for the measurement of the usability component of the e-governmental system, the 10 constructs of the System Usability Scale (SUS) was used.   Once the instruments had been determined, the next step taken was to identify the government websites to be accessed.  The criteria used to establish the websites were based on the layout as well as the services rendered by the e-governmental system, for the intent of the survey was to gather the different aesthetic and usability experiences of the participant. 

 

For the purpose of analyzing the perception that good design is crucial for e-governmental systems, a pilot survey was conducted among the five course participants.  Each participant was assigned to experience a government website and was required to record their experiences using SurveyMonkey (a free online survey application) based on the 15 item Likert scale for aesthetic values and the 10 item Likert scale for the usability values.  The survey instrument and the URLs of the website are attached as Appendix 2.   

 

The individual evaluations indicated that one participant was more on the strongly disagree and disagree of the scales, while two participants were on the scale of disagree, undecided and agree.  The other two participants were on the scale of undecided and agree.  These findings showed that the aesthetic and usability values experienced by the user are very much influenced by the websites assigned, for some websites will induce good aesthetic and usability values while others will induce otherwise.

 

From the overall summary of the outcome for the pilot survey, the following findings can be deduced based on the percentage of strongly agree and agree, undecided and disagree to strongly disagree.  The overall summary of the outcome of the pilot survey is attached as Appendix 3. 

 

Aesthetic Values

(i)                 None of the participants strongly agree on any of items for the aesthetic values.

(ii)               The participants agree that the information in the web site is relevant, credible, sufficient, easy to navigate and that the surfing time is acceptable.

(iii)             The participants were undecided on whether the web site is up-to-date or the text is presented in an easy-to-read manner.

(iv)              The participants disagree/strongly disagree that the web site has no technical problems, it contains a lot of modern web technology, the web site is visually appealing, it takes into account personal information, and that the web site makes them feel good.

(v)                There were a range of agree, undecided and disagree on the point of whether the web sites give a feeling of satisfaction and trust as well as the high chances of visiting the website again.

Usability Values

(i)                 Only one participant strongly agrees on the inconsistency of the website.

(ii)               The participants agree that it would be quick to learn to use the website.

(iii)             The participants were undecided on whether the web site was cumbersome to use.

(iv)              The participants disagree/strongly disagree that the web site was complex, that there is a need for technical support to use the website, inconsistency of the website and the need to learn before using the website, as well as the frequency of using the web site.

(v)                There were a range of agree, undecided and disagree on the point of whether the web sites were easy to use, the confidence on using the website and the integration of the functions of the website.

 

The above findings showed that none of the participants strongly feel that government websites are aesthetically appealing and that the participants are generally between agreeing and being undecided on the usability of the website.  Hence, on the part of aesthetic values which are relevant for good design, it seems that e-governmental systems have not fully conceptualized the characteristics of good design.

 

Lesson Learnt and Extension

The literature on good design of user interface sets the foundation for the discussion on the subject matter of good design in e-governmental systems. The literature review gave insights into the importance of good design on online systems as well as the works that have been done such as identification of good design characteristics as well as guidelines on implementing good designs. Researchers have also started to view aesthetic values in good design seriously as they believed that these aesthetic values will create a positive impact on the utilization of online systems. However, there is lack of literatures on the measurement of aesthetic values. The instrument used for measuring aesthetic values this study was introduced by De Wulf, Schillewaert, Muylle & Rangarajan (2006) for evaluating the role of pleasure in web site success. The other instrument used was the System Usability Scale (SUS) introduced by Brooke, (1996).

 

The pilot survey was conducted using a free online survey application, SurveyMonkey, which provided the basic to conduct a survey. Having used the application for the first time, there were a few hiccups such as the inability of the participants to enter more than one response per column. This was due to the action of ticking the box for "Allow Only One Response per Column (Forced Ranking)". Since each participant was assigned different website to evaluate, and when they input their evaluations into the survey application, the outcome of that survey was not on individual basis evaluation but the application gave an overall evaluations. It was not possible to get the individual's evaluation, so another paper survey was issued for each participant to fill in so as to gauge the individual's evaluation.

 

The other lesson learnt was the survey instrument. Some of the items in the survey instruments were found to be not appropriate for assessing aesthetic values. The 10-item likert scale used in SUS was having both positive and negative items which created some difficulties in the analysis process.  Overall, the whole process was a good experience in doing a simple conceptual analysis study comprising of literature reviews and a pilot survey. The mistakes made have created awareness to the details and requirements of conducting a conceptual analysis study.

 

Through the literature review and the pilot survey, it is evident that good design interface has been a major issue in the implementation of online services, particularly in the private sector environments.  Good design is essential in creating the right atmosphere and sense of place to empower and engage users to utilize the online systems.  The purpose of this conceptual study was to establish the significance of good design on e-governmental systems, by means of literature review, as well as the implementation of a pilot survey by using the instruments identified, hence, it is fundamental to extend this study to the actual environment, so as to be able to gauge the extent  e-governmental systems meet the characteristics of good design, and this could provide new insights to the e-government implementers to upgrade the existing systems.  However, for future research work on this subject matter, the instruments used in the pilot survey can be further refined so as to capture the precise aesthetic values of website experiences. 

 

Conclusion

The literatures have acknowledged that good design is a significant element of a website that has the capability of creating the aesthetic sense of good feeling which in turn, induces a sense of wanting to use the system within a user.  Through the literature review and the simple pilot survey, this study has established that the user interface of a website can either create a sense of appeal or reject on the part of the user.  Hence, e-Governmental systems should embrace all these characteristics of good user interface design if government implementers are legitimate in their endeavor to provide effective and noteworthy online services and in empowering and engaging the citizens to utilize the systems accordingly. 

 

 

Related Readings

Apple Developer Connection (2006), Human Interface Design Principles.  Retrieved November 14, 2007 from  http://developer.apple.com/documentation/UserExperience/Conceptual/OSXHIGuidelines/XHIGHIDesign/chapter_5_section_2.html#//apple_ref/doc/uid/TP30000353-TPXREF130

Accenture (2006), Leadership in Customer Service : Building the Trust,  Retrieved November 1, 2007 from http://www.accenture.com/xdoc/en/industries/government/can_2006_govt_report_FINAL2.pdf

Brooke, J. (1996) SUS: A "Quick And Dirty" Usability Scale. In P. W. Jordan, B. Thomas, B. A. Weerdmeester & A. L. McClelland (eds.) Usability Evaluation in Industry. London.  Retrieved November 27, 2007 from http://www.usabilitynet.org/trump/documents/Suschapt.doc

Chen, Q. (2001), Human Computer Interaction : Issues and Challenges, Idea Group Publishing.

Cyr, D., Head, M. & Ivanov, A (2006), Design Aesthetics Leading to M-Loyalty in Mobile Commerce, Information & Management, Volume 43, Issue 8, December 2006, Pages 950-963

Department of Premier and Cabinet (2006) Websites Guideline and Standards, Western Australia.  Retrieved on December 3, 2007 from http://www.dpc.vic.gov.au/wovgwebsiteguidelines

De Wulf, K.,  Schillewaert,  N., Muylle, S. & Rangarajan, D. (2006),  The Role Of Pleasure In Web Site Success, Information & Management 43 (2006) 434–446

Gait, J (1985), An Aspect of Aesthetics in Human-Computer Communications : Pretty Windows, Ieee Transactions On Software Engineering, Vol. Se-11, No. 8, August 1985

Galitz, W. O. (1997) The Essential Guide to User Interface Design.  John Wiley & Sons Inc.

Grimsley, M & Meehan, A. (2007) e-Government Information Systems : Evaluation-led Design For Public Value And Client Trust, European Journal Of Information Systems, 16, 134–148

Grönlund, A. & Horan, T.A. (2004) Introducing E-Gov : History, Definitions, And Issues.  Communications of the Association for Information Systems (Volume 15, 2004) 713-729.

Hong, S. & Kim, J. (2004), Architectural Criteria For Website Evaluation – Conceptual Framework And Empirical Validation, Behaviour & Information Technology, September–October 2004, Vol. 23, No. 5, 337–357

Horan, T. A. (2000) Digital Places : Building Our City of Bits. ULI – the Urban Land Institute.

Horan, T. & Abhichandani, T. (2006), Evaluating User Satisfaction In An E-Government Initiatives : Result Of Structural Equation Modeling And Focus Group Discussion, Journal of Information Technology Management, Vol. XVII, Number 4, 2006.

IBM, Ease of Use – Design.  Retrieved on November 14, 2007 from http://www-03.ibm.com/easy/page/6

Karvonen, K (2000), The Beauty Of Simplicity, ACM Conference on Universal Usability, Proceedings on the 2000 conference on Universal Usability.  Retrieved November 23, 2007 from http://www.tml.tkk.fi/Research/TeSSA/Papers/Karvonen/CUU2000_Karvonen_K.pdf

Lavie, T & Tractinsky, N (2004), Assessing Dimensions Of Perceived Visual Aesthetics Of Web Sites, International Journal of Human-Computer Studies,
Volume 60, Issue 3, March 2004, Pages 269-298

Leavitt, M.O.& Shneiderman, B. (2006), Research-based Web Design and Usability Guidelines, US Department of Health and Human Services.  Retrieved on December 3, 2007 from http://www.usability.gov/pdfs/guidelines.html

Lindgaard, G, Fernandes, G., Dudek, C. & Brown, J. (2006), Attention Web Designers: You Have 50 Milliseconds To Make A Good First Impression!, Behaviour & Information Technology, Vol. 25, No. 2, March-April 2006, 115 – 126

Merriam Webster Online, http://www.merriam-webster.com/dictionary/pleasure

Navarrete, C. A. (2006), Utilization of Electronic Government Services in Mexico: A Matter of Trust, School of Information Systems and Technology, Claremont Graduate University.

Nielsen, J (2003), Jakob Nielsen’s Alertbox : The Ten Most Violated Homepage Design Guidelines, Retrieved November 27, 2007 from http://www.useit.com/alertbox/20031110.html

Nielsen, J (2007), Jakob Nielsen’s Alertbox : Top Ten Mistakes in Web Design, Retrieved November 27, 2007 from http://www.useit.com/alertbox/9605.html

National Informatics Center (2004), Management of Government of India Websites – Guidelines for IT Managers.  Retrieved on December 3, 2007 from nicsu.up.nic.in/guidelines.pdf

NHS (2007) Website Guidelines, National Health Service. UK.  Retreived on December 3, 2007 from http://www.nhsidentity.nhs.uk/websites/

Nielsen, J. and Tahir, M. (2001) Building Web Sites With Depth, New Architect Daily, Retrieved November 27, 2007 from http://www.webtechniques.com/archives/2001/02/nielsen/

Office of the State CIO (2004), Website Development Guidelines, State of North Carolina.  Retrieved on December 3, 2007 from http://www.ncsta.gov/docs/White%20papers/general/Web%20Site%20Development%20Guidelines.pdf

State Services Commission (2007), NZ Government Web Standards and Recommendations v1.0.  Retrieved December 3, 2007 from  http://www.e.govt.nz/standards/web-guidelines/

Thüring, M. & Mahlke, S. (2007), Usability, Aesthetics And Emotions In Human–Technology Interaction, International Journal Of Psychology, 2007, 42 (4), 253–264

Tractinsky, N., Katz, A. S., & Ikar, D. (2000). What Is Beautiful Is Usable. Interacting with Computers, 13, 127–145.

West, D. M. (2006) E-Government and the Transformation of Service Delivery and Citizen Attitudes. Public Administration Review January/February 2006/Vol.64 No. 1

Wroblewski, L. & Rantanen, E.M. (2001), Design Considerations For Web-Based Applications, Proceedings of the 45th Annual Meeting of the Human Factors and Ergonomics Society. Santa Monica, CA: Human Factors & Ergonomics Society. 2001.

 

 

 

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Outcome of Usability Values

 

SD – Strongly Disagree

D – Disagree

U – Undecided

A – Agree

SA – Strongly Agree

 

#	Usability Values	SD	D	U	A	SA
1	I think I would like to use this website frequently.	40%	20%	40%
2	I found the website unnecessarily complex.	20%	60%		20%
3	I thought the website was easy to use.		20%	40%	40%
4	I think I need technical support to be able to use this website.	20%	60%	20%
5	I found the various functions in this website, were well integrated.	20%		40%	40%
6	I thought there was too much inconsistency in this website.		60%	20%		20%
7	I would imagine that most people would learn to use this website very quickly.			40%	60%
8	I found the website very cumbersome to use.	20%	20%	60%
9	I felt very confident using the website.		20%	40%	40%
10	I need to learn a lot about this website before I could effectively use it.	20%	40%		40%

 

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Outcome of Aesthetic Values

 

SD – Strongly Disagree

D – Disagree

U – Undecided

A – Agree

SA – Strongly Agree

 

#	Aesthetic Values	SD	D	U	A	SA
1	The information in the web site is relevant.			20%	80%
2	The information in the web site is credible.			20%	80%
3	The information in the web site is up-to-date.			60%	40%
4	The web site provides sufficient information.		20%		80%
5	The graphical illustrations (colors, pictures) in the web site are visually appealing.	20%	40%	40%
6	The web site takes into account the personal information of the visitor.	20%	40%	20%	20%
7	Surfing this web site does not require long waiting times.				100%
8	The web site is easy to navigate.		20%	20%	60%
9	The text in the web site is presented in an easy-to-read manner.			60%	40%
10	The web site has no technical problems.	20%	60%	20%
11	The web site contains a lot of modern web technology.	20%	60%	20%
12	This web site makes me feel good.	20%	40%	20%	20%
13	This web site gives me a feeling of satisfaction.		40%	20%	20%
14	There is a high chance that I will visit this web site again.	20%	20%	40%	20%
15	This website gives me a feeling of trust.	20%	20%	20%	40%

 

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