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The demand for increased efficiency and patient-centered care has been influencing the

development of healthcare in Sweden, and information technology has an important role in

that process. Developing and implementing systems for public healthcare have proven to be

a great challenge. One way to address this challenge is open innovation and co-creation.

While there are a lot of studies focusing on innovation processes, there is little research

regarding how technology is presented in the results. We have studied a co-creational

workshop that focused on putting new perspectives on the use of information technology in

healthcare. The workshop resulted in eight concepts which have been analyzed in terms of

how technology is expressed. The results were categorized into implicit and explicit use of

technology and this categorization indicates that the implicit use of technology is of the

bricolage kind. By being both implicit and bricolage-like, the concepts hold qualities that

make them more likely to be integrated into existing workplaces.

This thesis explores the role of technology in digitized life focusing on lived experiences of personal informatics technologies in health and healthcare contexts. The work departs from an interest in how digital technologies affects us as individuals in contemporary life. The use personal informatics and self-tracking technologies are explored both in everyday and healthcare contexts. These technologies are used to support self-monitoring and behavioral change, both to improve general health and for patients with chronic illness. In the thesis, personal informatics technologies are studied in the contextual transition between health to healthcare with the purpose of providing a deeper understanding of how these particular kinds of digital devices affect human experience in everyday life.

This research is based on four empirical studies addressing different aspects of how personal informatics technologies redefine the understanding of self at the intersection between health and healthcare contexts. Data was analysed in two steps: an inductive analysis followed by a deductive analysis based on a postphenomenological framework. Findings from the inductive analysis give support for the existing critique of personal informatics being too much concerned with metrics, behaviour and a simplified understanding of self. Applying a postphenomenological framework to the empirical material demonstrates how personal informatics technologies mediates experiences of self, health and healthcare. The analysis also reveals the bidirectional nature of technological mediation making particular experiences foregrounded and more accessible, while downplaying other experiences as less visible and accessible. This lifeworld perspective opens up for understanding the lived experiences of personal informatics technologies in everyday life. This is a contribution to understanding the role of technology in digitized life. It is also a contribution to user experience design as the lifeworld perspective opens up several design challenges concerning how design of personal informatics can shift its focus from the user to the everyday life of a person.

The design challenges found in this thesis are closely related to fields such as norm-critical design, norm-creative design and speculative design, aspiring beyond normative understandings of technology use and design. The postphenomenological analysis suggest four dimensions for further scrutiny in health and healthcare contexts. The dimensions are ontological, epistemological, practical and ethical. For each of these dimensions there are bidirectional aspects that can be used in order to deliberate on implications for design. It is about what is revealed and concealed, what is magnified and reduced, what is enabled and constrained and finally what involves and alienates when people engage with personal informatics technologies. The thesis concludes that the lifeworld perspective on personal informatics, including the postphenomenological analytical framework, supports further critical examinations of the role of technology in digitized life.

Social work faces challenges from demographic shifts, economic limitations, and a shortage of trained professionals. A solution that has emerged is the integration of digitalization, including the implementation of automated social assistance. It facilitates the automation of repetitive and administrative tasks, minimizing reliance on manual human labor. This shift can cut costs, redistribute workload, as well as enabling social workers to focus more on “real social work”. While there are strong arguments supporting the proposed change, there are also concerns voiced. These revolve around the potential transformation of social work and social workers’ roles, and its implications for beneficiaries of social assistance, specifically in terms of ensuring equality and upholding legal justice.

In this single case study, we delve into the preparations for implementing automated social assistance in a Swedish municipality. Our objective was to scrutinize the national and local policies influencing the implementation process, as well as to identify the barriers and facilitators crucial for achieving a successful implementation. Key actors within the organization, directly involved in the implementation preparations, were interviewed. The focus was particularly on policies, decisions, and preparations leading up to the implementation phase. The data underwent analysis using a directed qualitative content analysis, employing Matland’s ambiguity-conflict model and the Consolidated Framework for Implementation Research. The results reveal that, despite a clear goal for implementation, the organization grapples with unclear decisions, ambiguous policies, and a pervasive sense of uncertainty. We explore these findings and discuss how challenges arise from the inherent ambiguity in the process. 

Background: Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce.

Objective: The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D.

Methods: A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data.

Results: Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service.

Conclusions: A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

‘Autonomous technologies’ refers to systems that make decisions without explicit human control or interaction. This conceptual paper explores the notion of autonomy by first exploring human autonomy, and then using this understanding to analyze how autonomous technology could or should be modelled. First, we discuss what human autonomy means. We conclude that it is the overall space for action—rather than the degree of control—and the actual choices, or number of choices, that constitutes human autonomy. Based on this, our second discussion leads us to suggest the term datanomous to denote technology that builds on, and is restricted by, its own data when operating autonomously. Our conceptual exploration brings forth a more precise definition of human autonomy and datanomous systems. Finally, we conclude this exploration by suggesting that human autonomy can be strengthened by datanomous technologies, but only if they support the human space for action. It is the purpose of human activity that determines if technology strengthens or weakens human autonomy.

Robots and AI are increasingly being introduced in organizations to improve efficiency and replace dull and dangerous work. The implementation of robots and AI will change the way work is organized and managed with consequences for both employees and service users. In this chapter, we critically examine the implementation of robots and AI in human service organizations from work design, management, and ethical perspectives. We propose that the implementation of robots and AI introduces several challenges and risks for both employees and users that need to be addressed. However, we also suggest that these challenges may be overcome if knowledge about work design and user involvement is considered.

BACKGROUND: Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care.

AIM: The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management.

METHODS: Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis.

RESULTS: Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.