From European Journal of Information Systems Authors：James Wallace, Matthew T Mullarkey& Alan Hevner (2023) Presenter ：CHEN,YOU-SHENG (Shane) 2023 / 02 / 08

1. Patient health locus of control :
the design of information systems
for patient-provider interactions
European Journal of Information Systems
Authors：James Wallace, Matthew T Mullarkey
& Alan Hevner (2023)
Presenter ：CHEN,YOU-SHENG (Shane)
2023 / 02 / 08

2. JCR For European Journal of Information Systems
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3. Vocabularies 1/4
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3
P. English Chinese
52 locus of control, LOC 控制點
52 clinical research 臨床研究
52 human-computer
interfaces
人機介面
52 interior 內部的
52 exterior 外部的
52 practitioner
organisation
醫學從業人員組織
52 control over 支配
52 accountability 負有責任
52 authority figure 權威人物
P. English Chinese
52 the course of care. 護理過程
52 compliance 依從性
53 peer attitudes 同伴態度
53 expansive 廣泛
53 cutting-edge
technologies
尖端技術
53 pervasive 普遍存在
53 Interdisciplinary 跨學科
53 focuses on 側重於
53 instantiations 實例化
53 distinguishes 區分

4. Vocabularies 2/4
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4
P. English Chinese
53 Prior art 現有技術
53 engagement 參考
53 focus group 焦點小組
54 committed considerable
time
投入大量的時間
54 intervene 干預
54 practice personnel 實習人員
54 gradient 梯度
54 Qualitative 定性
54 comments on 評論
P. English Chinese
54 subsequent 後續
54 well-defined 明確定義
54 At what point 在…時機
54 care sequence 護理順序
54 candour 坦承
54 mutually exclusive 相互排斥
55 proscribes 禁止
55 administering 管理
56 moderator 主持人
56 practitioner 專業人員

5. Vocabularies 3/4
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5
P. English Chinese
56 myocardial infarction 心肌梗塞
56 a hip replacement
surgery patient
髖關節置換手術
56 advocacy 信念
56 Pre-discharge 出院
57 parsimonious
communication
簡要傳達
57 concise 簡潔
57 severity 嚴重程度
57 circumstances 情況
57 negligible impact 微不足道的影響
P. English Chinese
57 drug regimens 藥物療法
57 medication adherence 用藥依從性
57 ordered by 遵循
57 scepticism 懷疑
57 prescribed 規定
57 recurring 反覆
57 vary materially 實質性變化
57 referral patterns 轉診
57 condition severity 病情嚴重程度
57 cognitive dissonance 認知失調

6. Vocabularies 4/4
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P. English Chinese
57 behavioural therapy 行為療法
57 mindfulness 正念
57 passive faith 被動信念
58 pastoral 牧師
59 adherence to 遵循
59 delivery mechanism 交付機制
59 thyroid disease 甲狀腺疾病
59 receptivity 接受度
60 preceding or subsequent
to discharge
出院前與出院後
P. English Chinese
60 arising from 產生於
60 apprised 告知
60 digital presentation 數據化呈現
60 treating physician 主治醫生
60 corresponding to 對應於
60 should be administered 應該被施行
60 incorporation 成立
61 committed to 致力於
61 convincing 令人信服
61 intervention justification 干預正當性
61 contraindications 禁忌症 (醫療上
的禁忌)

7. TABLE OF CONTENTS
Introduction
01.
Design modes
of human-
computer
interactions
03.
02.
Locus of control
in healthcare
information
systems
Action design
research methods
04.
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8. TABLE OF CONTENTS
Diagnosis cycle –
problem space
05.
Design cycle 1 –
LOC identification
and assessment
06.
Design cycle 2 –
patient-provider engagement
with LOC risks
07.
Discussion and
implications
08.
Contributions, limitations
and future directions
09.
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9. Methodology
Apply action design
research (ADR) methods to
build the LOC identification
and treatment systems
To identify and manage a
patient’s LOC to support
improved medical
outcomes across a wide
range of health conditions
Purpose
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10. Findings Originality
Existing research largely
studies the use of emerging
technologies to improve the
medical decisions and
infrastructure
Social issues of human
interactions with healthcare
information systems are
understudied in research
and underserved in practice
Rigorous focus group evaluations
of the systems in treatment plans
are performed and system
refinements are implemented
The practitioner organisation has
future plans for full
implementation of the designed
systems
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Keyword :
Healthcare information systems
locus of control
action design research
clinical research
Introduction
01.

12. locus of control (LOC)
The manner in which an individual frames
accountability and manages a challenge, issue,
or problem.
Internal: accepting personal responsibility for
achieving a desired outcome
External: identifying chance or powerful others
as primarily responsible for their situation
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(Rotter, 1966)

13. Introduction
LOC is such a strong determinant of
outcomes that two patients with the
same condition, acuity, and care plan
can experience very different results
(Norman, 1995)
Most studies identifying the
improved efficacy of internal versus
external LOC (Cvengros et al., 2007; Rajamma
& Pelton, 2010; Richard et al., 2011)
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14. • Few prior studies generalise
or operationalise their
findings to general patient
populations
• The work needed to fully
integrate LOC into clinical
healthcare systems
• build two key health IS for
assessing patient LOC and
for using this information to
structure an efficacious
treatment plan for patients
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15. Locus of control in
healthcare
information systems
02.
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16. /46
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LOC in healthcare information systems
An essential component of all healthcare treatment plans is the individual’s
active participation in the course of care
There exists an expansive research literature on healthcare information
systems and IT solutions (Fichman et al., 2011; Ho et al., 2019; Tortorella et al., 2020) focus on
the use of cutting-edge technologies
Here are few rigorous studies on design of human-computer interactions
between patients and providers to improve the quality of healthcare
(Hevner & Wickramasinghe, 2018)

17. LOC in healthcare information systems
Identifying context-
specific factors that
interact with LOC
age, gender,
clinical condition
Measures of key LOC
determinants
health value, peer attitudes,
learned helplessness, self-
efficacy, socio-economic
background, religiosity
Assessing sub-
components of LOC
internal, chance, powerful
others (e.g., God, a parent, or
other authority figure)
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Key requirements for integrating LOC in clinical healthcare IS

18. Design modes of
human-computer
interactions
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03.

19. Design modes of human-computer interactions
IS technical design
researcher participates in
constructing the artefact
“first-hand”
IS usage design
to support stakeholders in
effectively using the artefacts
as deployed in the field
Interior mode Exterior mode
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HCI is concerning how humans interact with information, technologies, and tasks
in socio-technical systems (Sarker et al., 2019)
The design of HCI can focus on the interior mode of an IS technical design
and/or on the exterior mode of an IS usage design (Adam et al., 2021)
constructs,
models,
methods,
instantiations

20. Action design
research methods
04.
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21. Action design research methods
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Figure 1. ADR cycles in project.
The decision to design,
build, and intervene with
a digital IT-based solution
led the research team to
employ Action Design
Research (ADR) methods
(Mullarkey & Hevner,
2019; Sein et al., 2011).

22. Elaborates action design research methods
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The design of HCI
Fig. A.1. The eADR Cycle
Author expect every cycle to go
through a Problem Formulation,
Artifact Creation, Evaluation,
Reflection, and Learning sequence
of activities. All cycles incorporate
the key activities and principles
described by Sein et al. (2011)

23. Elaborates action design research methods
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The constructs and methods of action design research (ADR) were initially presented in
Sein et al. (2011)
The eADR process model provides a flexible yet disciplined inquiry into the initiation,
conduct, reflection, and presentation of rigorous (Knowledge) and relevant
(Environment) information system solutions
Fig. A.2. eADR Process Model

24. Elaborates action design research methods
Diagnosis
to analyze the importance of the
problem domain and the relevance
of the IT solution class to research
and practice
Implementation
instantiates the artifact
design in context at the
client organization
Design
identification and
conceptualization of the
proposed solution artifact design
(Abstraction principle)
Evolution
may be a long-term
organizational project
and will continue to
generate knowledge
useful to researcher and
practitioner
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25. Diagnosis cycle
– problem space
05.
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26. Diagnosis cycle – problem space
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Figure 2. LOC management protocol.
System2
System1
1. Identification and assessment of
existing patient LOC with
contextual demographic
influences
2. Determination of treatment plans
to manage patient LOC and
clinical interventions to move
patients from external to internal
locus of control
Two key socio-technical systems are determined essential

27. WHO
to encourage candor,
trust, and objectivity
WHEN
to optimize clarity and
avoid bias and optimally
communicated to the
patient
HOW
best communicated to
minimise anxiety and
maximise engagement
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Diagnosis cycle – problem space
healthcare
professionals,
practice personnel,
and patients (n=19)
four physical
locations
St. Petersburg FL;
Boston MA; Bradenton FL;
Newton MA
three virtual
locations
Tampa FL; Jacksonville FL;
Washington DC
The protocol artefact
was evaluated via a
series of interviews

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Design cycle 1 –
LOC identification
and assessment
06.

29. 6.1. Patient LOC identification
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Figure 3. Patient LOC questionnaire.
To adapt a multidimensional LOC scale
(Wallston et al., 1978) as the most widely
applied instrument for measuring LOC
Further segments powerful others into
doctors and other people

30. 6.2. Patient LOC assessment
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Figure 4. Patient LOC risk assessment matrix.
The research team created an
assessment matrix as shown in left
figure which maps the patient’s
external and internal LOC scores as a
relative LOC risk indicator
The risk combined with demographic
information provides the healthcare
organisation the ability to supplement
the patient treatment plan

31. 6.3. Patient-provider interaction process
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Figure 5. LOC identification and assessment interaction process.

32. 6.4. Focus group evaluation
a) myocardial infarction
b) a hip replacement surgery
c) a Type 2 diabetes
10-minute review of literature
and a set of pre-defined
questions addressing the Who,
When, and How
An independent moderator
with substantial healthcare
experience
5 licenced nurse care
managers and 1 Ph.D.
case
protocol
participants
tools
Case (vignettes)
Participants (leader)
Protocol
Participants
IRB-approved
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Tools
Otter.ai , Nvivo software

33. 6.4. Focus group evaluation
Improved belief
and trust
LOC questionnaire was
adequately designed to
impact emotional
investment
Discuss who better
to administer
Nurses were better
positioned to
administer
Impact participation
and engagement
LOC questionnaire was
adequately designed to
impact a patient’s
orientation to action
Optimal method
Digital presentation
for administering
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34. /46
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Design cycle 2 –
patient-provider
engagement with
LOC risks
07.

35. 7. Patient-provider engagement with LOC risks
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Drawing from the patient’s LOC assessment and resulting risk profile,
provides a sampling of nine potential LOC risks
1
2
3
4
5
6
7
8
9

36. 7.1. Patient LOC treatment artefact
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Figure 6. Clinical engagement artefact.
designed a concise
presentation of the
patient’s treatment
options based on their
unique risk profile
2
1
8
6
9
3
5
4
7

37. 7.2. Patient-provider interaction process
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Figure 7. Patient engagement process artefact.
automation and
digitalisation of the
clinical intervention
tool would be beneficial
to the communication
and leverage of patient
engagement
providing the patient a
physical treatment
plan to take with them
after review would
extend the
effectiveness of patient
engagement

38. 7.3. Focus group evaluation
a) myocardial infarction
b) a hip replacement surgery
c) thyroid disease
10-minute review of the first
focus group findings and 6
questions addressing the who,
when, and how of presenting
the clinical interventions
An independent moderator
with substantial healthcare
experience
5 licenced nurse care
managers and 1 Ph.D.
case
protocol
participants
tools
Case (vignettes)
Participants (leader)
Protocol
Participants
IRB-approved
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Tools
Otter.ai , Nvivo software

39. 7.3. Focus group evaluation
The instrument was adequately designed
To improve the effectiveness of patient
involvement by providing information
enhance motivation, willingness, belief,
trust, and emotional investment of patients
direct conversation and face-to-face
reviews are best methods
Doctors would be most
effective in presenting
preceding or subsequent to discharge
was the best time to present the LOC
actions ; optimal utility arising from all
members
would impact their willingness to
perform the recommended actions
Verbal delivery of the
recommended actions
Presenting the information in
a stoplight format
ordering the questions in decreasing
level of impact
Recommended actions
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the importance of education and
training, further research

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Discussion and
implications
08.

41. Practice implications
The healthcare
organisation must
identify a patient’s
baseline LOC
Must assess the patient
LOC information by
building a detailed risk
assessment profile for
each patient
Goal is to better
engage the patient
in understanding
and commitment
to a treatment plan
01. 02. 03.
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42. Patient LOC
manifests across
a continuum
from internal
orientation to
external
orientation
Identified factors can be
influenced to modify the
effects of patient LOC
1.cognitive dissonance
2. receptivity to treatment
3. expectation of health
outcomes
4.adjustment to illness or
recovery
Four factors impact
clinical outcomes：
1)Demographic
2)Personal
3)Environmental
4)Societal
Revealed a
substantial gap in
practitioner
knowledge with
regard to patient
LOC
Research implications
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43. /46
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Contributions,
limitations and
future directions
09.

44. Contributions
1. Evaluate two novel healthcare information systems
2. Discuss the synergies in each of the two systems between
the interior and exterior design modes
3. Provide a rigorous and novel application of ADR methods
4. Two rigorous Focus Group evaluations of the interior and
exterior artefacts were performed
5. Organisation is committed to the next steps of
implementation of proposed system designs
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45. Limitations
Performed this
research with a single
large healthcare
organisation
may not be reflected in
other healthcare
organisations
Use of the same
participants in both
evaluation focus
groups
the selection of only six
focus group members
from a single organisation
is a limitation
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46. Future directions
1. To optimise the effectiveness of the
information presented
2. Additional cycles of artefact designs
and evaluations will create and test
3. Improved LOC education and training
4. A comprehensive human subject study
should be conducted with varying
degrees of clinical and procedural
intensity
5. Interaction SaMD with simultaneous
treatments, contraindications, and other
relevant factors
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47. THANKS!

48. ● James Wallace, Matthew T Mullarkey & Alan Hevner (2023) Patient health
locus of control: the design of information systems for patient-provider
interactions, European Journal of Information Systems, 32:1, 52-63, DOI:
10.1080/0960085X.2022.2088416
● Free Google Slides theme and PowerPoint template - Healthcare Center
Website Presentation
https://slidesgo.com/theme/healthcare-center-website#search-
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● Microsoft Stock images (royalty-free images)
RESOURCES

49. ● MBA-社會技術系統 https://wiki.mbalib.com/zh-
tw/%E7%A4%BE%E4%BC%9A%E6%8A%80%E6%9C%AF%E7%B3%BB%E7%BB%9F
● 依从性，病人按醫生規定進行治療
https://baike.baidu.com/item/%E4%BE%9D%E4%BB%8E%E6%80%A7/1188488
● 習得性無助 https://zh.wikipedia.org/zh-tw/%E7%BF%92%E5%BE%97%E6%80%A7%E5%A4%B1%E5%8A%A9
● 醫學研究倫理委員會 https://highscope.ch.ntu.edu.tw/wordpress/?p=24768
● Otter AI, Save time with an AI assistant in every meeting https://otter.ai/
● NVivo 質性分析軟體 https://www.twnfi.com.tw/psychology-179.html
● 醫療器材軟體之臨床評估 https://www.cde.org.tw/Content/Files/Knowledge/1fd8ea23-044a-4d26-b98d-
a2dfce7c575c.pdf
 SaMD 臨床評估的過程被視為品質管理系統中醫療器材產品生命週期的一部分，不僅限於產品上市前的臨床資料，更結合
上市後蒐集之真實世界數據，透過持續不斷的分析評估，進而確認 SaMD 達到其安全性、有效性和預期用途之目的
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