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Positive Design Framework for Carer-eSupport: A Qualitative Study to Support Informal Caregivers of Patients with Head and Neck Cancer in Sweden
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division Vi3.ORCID iD: 0000-0001-6947-9409
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Informatics and Media.ORCID iD: 0000-0003-0732-7009
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine.ORCID iD: 0000-0001-8174-579X
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division Vi3.ORCID iD: 0000-0001-7472-2215
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2023 (English)In: JMIR Cancer, E-ISSN 2369-1999, Vol. 9, article id e45748Article in journal (Refereed) Published
Abstract [en]

Background: Informal caregivers of patients with head and neck cancer (HNC), such as the patient’s spouse, other close relatives, or friends, can play an important role in home-based treatment and health care. Research shows that informal caregivers are usually unprepared for this responsibility and need support with taking care of patients and other daily life activities. These circumstances place them in a vulnerable position, and their well-being may be compromised. This study is part of our ongoing project Carer eSupport, which aims to develop a web-based intervention to facilitate informal caregivers in the home environment.

Objective: This study aimed to explore the situation and context of informal caregivers of patients with HNC and their needs for designing and developing a web-based intervention (Carer eSupport). In addition, we proposed a novel framework for the development of a web-based intervention aimed at promoting the well-being of informal caregivers. Methods: Focus groups were conducted with 15 informal caregivers and 13 healthcare professionals. Both informal caregivers and healthcare professionals were recruited from 3 university hospitals in Sweden. We adopted a thematic data analysis process to analyze the data.

Results: We investigated informal caregivers’ needs, critical factors for adoption, and desired functionalities of Carer eSupport.A total of 4 major themes, including information, web-based forum, virtual meeting place, and chatbot, emerged and were discussed by informal caregivers and health care professionals for Carer eSupport. However, most study participants did not like the idea of a chatbot for asking questions and retrieving information and expressed their concerns such as a lack of trust in robotic technologies and missing human contact while communicating with chatbots. The results from the focus groups were discussed through the lens of positive design research approaches.

Conclusions: This study provided an in-depth understanding of informal caregivers’ contexts and their preferred functions for a web-based intervention (Carer eSupport). Using the theoretical foundation of designing for well-being and positive design in the informal caregiving context, we proposed a positive design framework to support informal caregivers’ well-being. Our proposed framework might be helpful for human-computer interaction and user experience researchers to design meaningful health interventions with a clear focus on users’ well-being and positive emotions, especially for informal caregivers of patients with HNC.

Place, publisher, year, edition, pages
JMIR Publications, 2023. Vol. 9, article id e45748
Keywords [en]
eHealth, subjective well-being, positive design, adaptability, informal caregivers, head and neck cancer, preparedness to care
National Category
Human Computer Interaction
Research subject
Human-Computer Interaction; Health Care Research; Cancer Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-505567DOI: 10.2196/45748ISI: 001021663600001PubMedID: 37252765OAI: oai:DiVA.org:uu-505567DiVA, id: diva2:1771281
Available from: 2023-06-20 Created: 2023-06-20 Last updated: 2026-02-04Bibliographically approved
In thesis
1. Care for Caregivers: Designing IT Applications for Informal Caregivers
Open this publication in new window or tab >>Care for Caregivers: Designing IT Applications for Informal Caregivers
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The role of informal caregivers, who provide essential care and support to their ill or in-need relatives and friends, is crucial but frequently undervalued in the healthcare landscape. Navigating the complexities of caregiving, these individuals encounter numerous challenges that demand a considerable amount of their resources and energy, often without adequate support. Despite these difficulties, caregiving can also be a source of fulfillment and empowerment to some. IT applications can be seen as valuable support tools in the caregiving process. 

This thesis draws on six studies, utilizing semi-structured interviews and focus groups with informal caregivers, alongside discussions with healthcare professionals, to explore the intricacies of informal caregiving. It also includes a heuristic evaluation of an IT application by UI/UX experts. Through thematic analysis, the research delves into the diverse needs of native Swedish caregivers, immigrant caregivers, and caregivers of patients with head and neck cancer. It proposes design solutions tailored to these specific groups, employing persuasive and positive design principles to develop an eCoaching application and a web-based health application named ‘Carer eSupport’, respectively. These applications are designed to address the identified needs, offering support and facilitating the caregiving process.

This thesis contributes to the field of Information Systems (IS) by advancing existing theories and creating adapted frameworks specifically for informal caregiving. It provides a comparative analysis of Persuasive Design (PSD) and Positive Design, detailing their strengths and weaknesses in developing IT applications for caregivers. The research examines the design processes, outcomes, and contextual suitability of each approach, focusing on behavioral psychology in PSD and emotional wellbeing in Positive Design. Practical insights and guidelines for integrating both approaches are offered, ensuring that IT solutions are effective and empathetic. The thesis also adapts and extends these frameworks to better meet the needs of informal caregivers, providing a basis for future research to validate these adaptations. Additionally, it includes the design and evaluation of IT applications like an eCoaching platform and a web-based health application, along with providing systematic design recommendations through a comprehensive literature review.

By focusing on the needs of native Swedish, immigrant, and head and neck cancer caregivers, this research underscores the challenges caregivers face and proposes solutions to manage the caregiving journey while maintaining their well-being. Overall, it emphasizes the necessity of crafting IT applications with empathy and inclusivity, truly embodying the spirit of ‘Care for caregivers.’

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2024. p. 135
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 226
Keywords
Information Systems, Design Science Research, Persuasive Design, Positive Design, Informal Caregiving, Wellbeing, Qualitative
National Category
Information Systems
Research subject
Information Systems
Identifiers
urn:nbn:se:uu:diva-535425 (URN)978-91-513-2189-9 (ISBN)
Public defence
2024-09-13, room B115, Ekonomikum, Kyrkogårdsgatan 10, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2024-08-20 Created: 2024-08-02 Last updated: 2024-08-21
2. Designing for Well-being: A Human-Centred Design Approach to a Web-based Application to Support Informal Caregivers
Open this publication in new window or tab >>Designing for Well-being: A Human-Centred Design Approach to a Web-based Application to Support Informal Caregivers
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare systems worldwide face increasing pressure due to resource limitations and the rising care demands of ageing populations. In cancer care, the shift from hospital-based treatment to home environments has placed much of the daily caregiving on family members. Known as informal caregivers (ICs), these individuals provide unpaid support, often taking on this role out of necessity rather than choice. They frequently lack access to the information and resources required for effective caregiving at home.

These increased responsibilities, combined with insufficient support, have significant implications for ICs’ well-being. Well-being is a multidimensional concept that includes physical health, mental state, and emotional stability. It is particularly vulnerable during major life transitions, such as when a close relative is diagnosed with a severe illness. ICs of individuals with head and neck cancer (HNC) are especially affected. This thesis is part of the Carer eSupport project, which aims to develop and evaluate a web-based application to support ICs.

The thesis aims to provide guidelines for developing and evaluating web-based applications that support the well-being of ICs of individuals with HNC. It also identifies factors that influence the acceptance and use of such applications. In doing so, the thesis highlights the situation of ICs, who play an essential role in cancer care but often receive limited support.

The thesis comprises five journal articles. A human-centred design process guided the overall work. Qualitative methods, including focus groups and interviews, were primarily used. Empirical data were analysed through thematic analysis.

Findings highlight challenges faced by ICs, including exclusion from healthcare processes, disruptions to daily routines, uncertainty about treatment outcomes, and shifts in identity and relationships. The results emphasise the need to address both functional needs, such as tailored information and structured support, and psychosocial challenges.

Acceptance and use depend on usability, trust, emotional relevance, and support from the healthcare system. Web-based applications can strengthen ICs' preparedness and support well-being when they are accessible, credible, and connected to human support. Designing for ICs’ well-being, therefore, requires approaches rooted in their daily routines and backed by healthcare systems that recognise ICs as partners in cancer care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2026. p. 107
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 2639
Keywords
Human-centred design, Designing for well-being, Positive design, UTAUT, Eudaimonic motivation, Head and neck cancer, Informal caregiving, Preparedness for caregiving
National Category
Engineering and Technology
Research subject
Computer Science with specialization in Human-Computer Interaction
Identifiers
urn:nbn:se:uu:diva-578447 (URN)978-91-513-2737-2 (ISBN)
Public defence
2026-03-27, 101195, Heinz-Otto Kreiss, Ångström, Regementsvägen 10, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2026-03-02 Created: 2026-02-04 Last updated: 2026-03-26

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Ahmad, AwaisPremanandan, ShwetaLangegård, UlricaCajander, ÅsaJohansson, BirgittaCarlsson, Maria E.Ehrsson, Ylva Tiblom

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