Augmenting Distributed Cognition analysis for home haemodialysis: from a system of representations to systems of activity-centric interactions

摘要

This thesis investigates the application of Distributed Cognition (DCog) to understand patients’ situated interactions with Home Haemodialysis Technology (HHT). With the anticipated increase in home healthcare, there is a need to understand how Home Medical Devices (HMDs) should be designed so that they are patient-friendly and can be safely used in the home. This implies studying situated interactions with current HMDs and identifying the issues that patients face. Taking HHT as an example of a HMD, this thesis focuses on understanding the contexts in which renal patients interact with HHT, and their interaction strategies and issues, from a DCog perspective. DCog has been a useful theoretical framework for understanding work in clinical settings, but has not previously been applied to the study of interactions with HMDs. Data was gathered during visits to 19 patients through ethnographic observations and semi-structured interviews. 3 renal nurses, 3 renal technicians, and 1 nephrologist were also interviewed. Data was analysed by constructing the representational models of the Distributed Cognition for Teamwork framework (DiCoT) to understand the context of interactions, focusing on system activities, information flows, physical layouts, artefacts, social structures, and system evolution, and by applying the principles associated with these models to identify patients’ interaction strategies and issues. This thesis brings five contributions to the study of situated interactions with HHT. Firstly, it provides an account of patients’ experiences of interacting with HHT. Secondly, it demonstrates the utility of DCog as a theoretical framework for understanding interactions with a HMD such as HHT. Thirdly, it develops new theoretical principles that help to understand how people distribute cognitive processes through time. Fourthly, it develops a Contextual Factors Analysis that facilitates the analysis of complex interaction strategies. Finally, it develops an overarching approach that augments DCog analysis from considering a system of representations to considering systems of activity-centric interactions.