

@mastersthesis {7063,
	title = {Designing task shifting medical devices for low-resource settings},
	year = {2015},
	note = {3701838},
	school = {University of Michigan},
	type = {phdPh.{D}.},
	address = {Ann Arbor},
	abstract = {The availability and acceptability of many medical devices designed for use in low-resource settings is affected by many factors including unreliable energy and water supply, limited distribution and infrastructure, high product costs, and lack of spare parts and required consumable. One study found that 40 percent of medical devices used in low-resource settings were dysfunctional. Further, the limited availability of highly trained health providers is perhaps the most important obstacle to providing care in low-resource settings. For instance, Africa bears more than 24 percent of the global burden of disease, but has access to only 2 percent of the global physician supply. In fact, 47 percent of the World Health Organization{\textquoteright}s member states report having less than 1 physician per 1000 population. These pose a design challenge on how to develop task shifting medical devices that are simple enough to use that lay health providers can deliver or perform some of the more common and urgent health services and tasks previously undertaken by highly trained health providers. This dissertation investigated the perceptions of stakeholders about task shifting and identified the attributes of task shifting medical devices by engaging with a wide range of stakeholders. Also, existing qualitative and quantitative methods for eliciting user requirements from diverse stakeholders were applied and analyzed; the research adopted a statistical approach to identify the requirements common, and conflicting, across stakeholder groups. 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 by our stakeholders 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 from a wide range of stakeholders, and used individual difference scaling analysis to further extend the analysis to further analyze the data from the clustering elicitation method. The requirements categories allowed an objective comparison of the requirements noted by the different stakeholder groups. Design ethnography techniques including focus group discussions, expert interviews, and direct observations were systematically applied to inform the design process of a device to mitigate the adverse events of TMC in Uganda. The device{\textquoteright}s cultural acceptance and fit were measured through preference analysis of stakeholders and a clinical trial, respectively. This dissertation made four contributions to the interdisciplinary field of design engineering, focusing on global health issues. First, it provided an understanding about diverse stakeholders{\textquoteright} 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 thenecessary design requirements essential for designing easy to use mechanical task shifting medical devices. Third, it evaluated qualitative and quantitative user 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, through interactions with local stakeholders based on design ethnography approaches, to make traditional adult male circumcision safer. This work concludes with presenting a set of steps for product requirements elicitation, informed by an inclusive approach of involving multiple stakeholders and based on design ethnography approaches, to develop task shifting medical devices. The steps promote an iterative design process and repeated interactions between design engineers and target stakeholders to identify major categories of requirements, and then break them into measurable, objective sub-requirements. Future work includes the generation of a detailed and analytical user requirements elicitation method to inform a stakeholder-driven design requirements elicitation and engineering specification development process.},
	keywords = {0541:Biomedical engineering, 0548:Mechanical engineering, 0573:Public health, Applied sciences, Biomedical engineering, Design engineering, Global Health, Health and environmental sciences, Mechanical engineering, Medical device design, Public health, Task shifting},
	url = {http://search.proquest.com/docview/1681291957?accountid=14270},
	author = {Sarvestani, Amir Sabet}
}
