Designing Task Shifting Medical Devices for Low-Resource Settings.

Abstract

The availability and acceptability of medical devices designed for use in low-resource settings is affected by factors including unreliable energy supply, limited infrastructure, high product costs, and lack of spare parts. Further, the limited availability of highly trained health providers is another obstacle to providing care in low-resource settings. These pose a design challenge on how to develop task shifting medical devices that are simple to use by lay health providers to perform some of the tasks previously undertaken by highly trained health providers. This dissertation investigated the perceptions of task shifting. Also, existing qualitative and quantitative methods for eliciting user requirements were analyzed. Finally, a systematic design ethnography approach was used to develop an understanding of traditional male circumcision (TMC) in sub-Saharan Africa and inform user requirements for a device aimed at improving the safety of the procedure. Ease of use was identified as the most important characteristic that defines a task shifting medical device. This research also evaluated the effectiveness of open-ended, clustering, and discrete choice methods to elicit user requirements, and used individual difference scaling analysis to further extend the analysis to further analyze the data from the clustering method. Design ethnography techniques were systematically applied to inform the design process of a device to mitigate the adverse events of TMC in Uganda. The device’s cultural acceptance and fit were measured through preference analysis and a clinical trial. This dissertation made four contributions to the interdisciplinary field of design engineering. First, it provided an understanding about diverse stakeholders’ perceptions of task shifting medical devices. Second, it offered a set of methods by which requirements needed to develop a task shifting medical device can be elicited and identified the design requirements essential for designing mechanical task shifting medical devices. Third, it evaluated qualitative and quantitative requirements elicitation and prioritization methods, and presented a methodology that indirectly identified the highest priority user requirement categories. Fourth, it developed a culturally acceptable and appropriate device, based on design ethnography approaches, to make TMC safer. This work concludes with presenting a set of steps for requirements elicitation based on design ethnography principals.