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- 1. DOI: 10.4018/JCIT.2020100103 Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 Copyright©2020,IGIGlobal.Copyingordistributinginprintorelect ronicformswithoutwrittenpermissionofIGIGlobalisprohibited. 44 Building a Critical Mass of Users for Digital Healthcare Promotion Programs: A Teaching Case Rennie Naidoo, University of Pretoria, South Africa https://orcid.org/0000-0001-8392-1136 ABSTRACT Despiterecenttechnologicaladvancements,theslowadoptionpatter nofdigitalhealthcarepromotion programscontinuestobeamajorproblemplaguingmanyhealthcareor ganizationstoday.Thehistorical teachingcasestudyisindispensableinimprovingourunderstandingo fthecomplexandmultifaceted natureofcontemporarydigitalhealthcarepromotionprograms.Thish istoricalteachingcasepresents informationaboute-health,thee- commerceunitofalargemultinationalhealthcareinsurancecompany
- 2. . Theteachingcaseshowshowdespitee- health’sabilitytopersuadealargeregisteredbaseofusersto trialitshealthcarepromotionprograms,over90%oftheseregistrants discontinueduseafterashort trialperiodofusingthetechnology.Thishistoricalteachingcasefocus esonthesocialchallenges involved inpersuadingusers to adopt and continueusing e- health’smajor healthcarepromotion innovation:anonlinenutritioncenter.Despiteextensivepromotions andtheuseofincentives,less than10%oftheuserbaseadoptedandcontinuedtousethishealthcarep romotioninnovation.Thecase reportsonthediscontinuanceamongdigitalhealthcarepromotionuse rsdespitetheintensiveefforts toretainthem.Studentsandpractitionerswillgaininsightintothekeys ocialchallengesinvolved inachievingacriticalmassofusersfordigitalhealthcarepromotionin novations.Theteachingcase requiresimportantdecisionstobemadebystudentsandpractitionersa boutpresentdigitalhealthcare promotionprogramsbydrawingon inferences frompastdigitalhealthcarepromotionprograms. Finally,thishistoricalteachingcasestudymakesaconvincingcasefor thevalueofhistoricalinsights ininformingpresentdaychallengesfacingcontemporarydigitalhealt hcarepromotionprograms. KeywoRDS Adoption, Electronic Health, Healthcare Informatics, Healthcare Promotion, Preventative Healthcare INTRoDUCTIoN To DIGITAL HeALTHCARe PRoMoTIoN PRoGRAMS Astheglobalpopulationrisesandlifeexpectancyratesaroundtheworl
- 3. dcontinuetoincreasedueto advancesinscienceandtechnologyandimprovementstosocio- environmentalconditions,healthcare budgetsarefacingenormouspressure.Onthe21stofNovember1986,t heOttawaCharterinitiated theadvocacyofhealthpromotiontoimprovehealthcareglobally(WH O,1986).Healthpromotionis Thisarticle,originallypublishedunderIGIGlobal’scopyrightonSep tember23,2020willproceedwithpublicationasanOpenAccess articlestartingonJanuary18,2021inthegoldOpenAccessjournal,Jo urnalofCasesonInformationTechnology(convertedtogoldOpen AccessJanuary1,2021),andwillbedistributedunderthetermsoftheC reativeCommonsAttributionLicense(http://creativecommons.org/ licenses/by/4.0/)whichpermitsunrestricteduse,distribution,andpr oductioninanymedium,providedtheauthoroftheoriginalworkand originalpublicationsourceareproperlycredited. https://orcid.org/0000-0001-8392-1136 Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 45 basedonthepremisethathealthcarecannotbethesoleresponsibilityo fthehealthsectorandtherefore seekstoprovidepatientswithbettercontrolovertheirhealththroughi nformation,healtheducation, andlifeenhancingskills(Eriksson&Lindström,2008).Thebenefitof empoweringpatientsisnot limitedtothecostreductionofhealthcare,butisalsoariskmitigationfa ctorfordiseaseaswellas
- 4. ahealth-enhancingstrategy. Overtheyears,ICTbegantobeintegratedintohealthsystemsandservi cesworldwide.During the1990s,e-commerceemergedandenablednewways toconduct transactionsvia the Internet. eHealthwasalsoenabledby theInternet.The termeHealthrefers to theuseof informationand communication technologies to improve health and the health care system (Oh, Rizo, Enkin & Jadad,2005).TheInternetreferstothegloballyconnectednetworkofc omputers.Althoughtheterm InternetisusedinterchangeablywithWorldWideWebor‘theWeb’,th eWorldWideWebrefers tomultimedia- baseddocumentsthatcanbeaccessedonline,overtheInternet(Lupton ,2014).This becameknownastheWeb1.0eraortheso- calledbrochurewebera.TheWeb1.0erabeganrapidly in1990sbecauseoftheavailabilityofbrowserswithuser- friendlygraphicalinterfaces.TheWorld Wide Web had become avaluable channel for accessing and seeking health information. Rapid improvementincommunication,hardwareandsoftwaretechnologie salsoledtonewandbetterhealth serviceofferingsviatheInternet.Bytheearly2000s,therewasanotice ableshiftintheuseofthe webandthedevelopmentofweb- basedapplications.ThiswastermedWeb2.0andinvolvesusers creating,organizing,sharing,critiquingandupdatingcontent.Web2. 0connectspeopleandcontent inuniqueways.Web2.0facilitatesan‘architectureofparticipation’– adesignthatencouragesuser interaction,empowermentandcommunitycontributions.PopularW eb2.0applicationsincludeFlickr, Wikipedia,Facebook,MySpace,TwitterandYouTube.Bythemid-
- 6. calhealthcareenvironmentsare alsogeneratingmassivedatasets(NevesStachyra,Rodrigues2008;P anesar,2019).Thesemassive datasetsarereferredtoas‘bigdata’.Cloudcomputingtechnologiesar ebeingusedtofacilitatethe production,storageandsharingofthesebigdatasetstoprovidedigital healthcaresolutions(Darwish, Hassanien,Elhoseny,Sangaiah&Muhammad,2019).Artificialintel ligenceandmachinelearning arebeingused touncoverhiddenconnectionsandpatterns in thesemassivedatasets toprovide evidence- baseddigitalhealthcaresolutions(Panesar,2019).Today’shealthcar eICTecosystemis muchmorecomplexandinvolvesnetworkproviders,networkoperato rs,digitaldevicesuppliers, platform,contentandapplicationsproviders,healthcarecompanies, healthagencies,governments andpatients(Fransman,2007).Theterm‘digital’isnowbeingemploy edtodescribepaper-based elementsthathavebeentransformedintodigitalformats,andthedevic es,communicationnetworks andsoftwareapplicationsthatusetheseformats. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 46 ICTshaveplayedacrucialroleinprovidingadigitalplatformforpubli shinganddisseminating healthalertsandinformationtothegeneralpublic,scientistsandhealt hcareprofessionals.eHealth innovations like electronic health records, computer assisted
- 7. prescription systems, and clinical databases have already directly benefited many patients and holds great promise for the future. Digitalplatformsareplayingandwillcontinuetoplayacrucialroleinh ealthpromotion.eHealth innovationsareexpectedtoempowerandprovidecost- effectiveapproachesforpatientcareandtohelp governmentagenciesandhealthcareorganizationstocopewiththech allengesofincreasinghealthcare costs.However,theevidenceshowsthatthelevelsofuseruptakeforma nyoftheseinnovationsare currentlyverylowandthatthediffusionofmanyoftheseeHealthinnov ationsisbeingimpededby anumberofsignificantbarriers(Oderanti&Li,2018;Gugglberger,20 18;Parasuraman&Colby, 2007).Despitethetechnologicaladvancementsandthepotentialofdi gitalhealthpromotiontotackle theglobalhealthcrisis,someresearchersarguethatthattherecontinue stobeacrisisindigitalhealth promotiondelivery(vanGemert- Pijnen,Nijland,vanLimburg,Ossebaard,Kelders,Eysenbach& Seydel,2011;KeshavarzMohammad,2019).Thekeychallengesaren ottechnologicalbutsocial. Healthcare promotion innovations have earned a reputation for diffusing relatively slowly comparedtootherhealthcareinnovations(Rogers,2002;Rogers,201 0;Greenhalgh,Robert,Bate, Macfarlane&Kyriakidou,2008).Itmaybesimplistictoassumethatst rongmonetary,andother formsofincentivesforprevention,willresolvethecomplexproblemo fconsumerhealth(Reichheld &Schefter,2000;Jost,2007).Despitethemixedviewsabouttheeffica cyofhealthcarepromotion programsintheliterature(Adam&DeBont,2003;Bandura,2004;List er,West,Cannon,Sax&
- 8. Brodegard,2014),informationandcommunicationtechnologiesare deemedtobeimportantenablers inhealthcareservices(Larkin,2001;Schraefel&Churchill,2014;Sul aiman&Wickramasinghe, 2014;Orji&Moffatt,2018).However,healthcarepromotionprogram sarequitecomplex(Solberg, Kottke,Conn,Brekke,Calomeni&Conboy,1997),yettheycontinuet obehandledpoorlyandfail todeliveronanticipatedbenefits(Ward,2013;Ginter,Duncan,&Swa yne,2018;Greenhalgh,2018). Tomanagethiscomplexity,somescholarshavesuggestedthatthesein terventionsneedtoaddress thesocialchallenges(McLeroy,Bibeau,Steckler,&Glanz,1988;Gre en,Richard,&Potvin,1996; Iyengar&Nair,2000;Schlosser,2002;PorterandTeisberg,2006). Thiscaseisaboutthedifficultiesinvolvedindigitalhealthcarepromot ionprogramsattaininga criticalmassofusers.Asstudentsexplorethecasetheywillberequired toaddressthemanysocial challenges raised by digital healthcare promotion programs. This case highlights the challenges experiencedbye-Health,thee- commercechannelforHealthInsuranceCompany(HIC),anditsOnlin e NutritionCenter.AfterabandoningtheOnlineNutritionCenter,some 15yearsago,HICisrevisiting whetherornottopursueadigitalstrategyforthepromotionofnutrition amongitscustomers,given thelatestadvancesintechnology.Beforeproceeding,theExecutiveh asconcludedthatareviewof thepastOnlineNutritionCenterinitiativeisneeded.Theybelievethat suchanassessmentofthe pastcouldprovidevaluableinsightsandlessonslearnedtoinformthei rdecisionaboutthefuture.
- 9. SeTTING THe STAGe Introducing the e-Health Case Study TerryRossiburst intohisoffice,walkeddirectly tohisdeskandslumpedintohischair.Hehad justarrivedfromanother toughExcomeeting.Thecommitteewasconcerned that the“wellness innovations”deliveredontheWebhadsofarappealedtoonlyaminorit yofcustomersandnotthe highnumbersthathadbeenpromisedbye- Health.Atbest,thehealthcarepromotionprogram,the onlinenutritioncenter,wasservingasacomplementarychannelforas mallcaptiveaudience.Terry wonderedhowhewasgoingtoimprovetheperformanceoftheonlinen utritioncenter.Terryknew that ifhewere toconvince theExco that thishealthcarepromotionprogramwasa success, this programwouldhavetoattainacriticalmassofusers.Hewasconsiderin gthestepshecouldtaketo ensurethate-Healthbuiltacriticalmassofusers. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 47 CASe DeSCRIPTIoN e-Health’s Nutrition Centre E- HealthistheindividualbrandnameofthewebsiteforHealthcareInsur anceCompany(HIC)(Figure 1).HICiscomposedoftwootherbusinessunits:WellnessScienceCo
- 11. itionprogrammeusing ‘scientificguidelines,periodicreviews,anddatacollection’.Meanw hiletheclinicalteamwhowere nowdrivingtheprojectselectedapanelthatconsistedofthreenutritio nacademicsfromthevarious UniversitiesaroundSouthAfrica.Thispanelwastaskedtoreviewthed esignoftheapplicationand provideguidance.Theywerealsoinvolvedinanumberofworkshopsw iththesoftwaredevelopment team.Thedesignofthetoolhadtogettheirstampofapprovalspecifical lyonthe“scientificbasis”. Figure 1. HIC’s organisation structure Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 48 Despitethisaim,thereweredifferentopinionsamongthepanelmembe rsaboutcertaintopics,such asthefibrecontentofahealthydiet,andsoon. AtthetimetheNutritionCentrehadnotputinanyspecificprogramstha tinvolvedmembers goingtoconsultregistereddieticians.Whilememberscouldgoandsee adieticiantherewasnothing inplacethat“pushed”memberstodieticians.Sotheonlywaythatmem berscouldgetnutritional informationinitiallywasviacommunicationthroughthemagazine,e mailandtheweighlessprogram. Howevertheweighlessprogramdidnotappealtoeverybodybecauseit wasobviouslyseenmoreas aprogramspecificallyforpeoplewhowantedtoloseweightandtheobj
- 13. bythediffusionofinnovationtheory(Rogers,2010;Ward,2013),and agreementbyusersonthe utilityandeaseofuseasespousedbythetechnologyacceptancemodel (Davis1989;Holden&Karsh, 2010),discontinuanceoftheNutritionCenterremainedextremelyhig h. Figure 2. Screen shot of e-Health’s landing page (2004 website redesign) Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 49 Promoting the Adoption of Healthcare Promotion Programs Terry’sstrategytomarkettheNutritionCentreresultedinenticingma nyuserstoregistertotrial thetechnology.Thecampaignspromotedthecompany’svisionof“im provingpeople’shealth andenhancingtheirlifestyles”inanonlineenvironment.TheNutritio nCentrewaspromoted invariousmediums: • Healthcare Insurance Fact File:TheNutritionCentrewaspromotedinthefirm’sfactfile. The fact filewasabooklet thatprincipalmembers receivedannually toexplainhowtheir healthplanworks. • Healthcare Magazine:TheNutritionCentrewasalsopromotedinahealthcaremag azine.When comparedtothedifferentawarenessmediumsthemagazineappearedt
- 14. obethemosteffectivein promotingtheonlinechannel.Themagazineconsistentlyfeaturedarti clesexplainingthebenefits oftheNutritionCentretomembers. • Email Newsletter Campaigns:Theseemailsweretobecomeavitalcomponentoftheemai l promotioncampaignforpromotingtheNutritionCentre. Other avenues for promoting the Nutrition Centre were employers, brokers and the call centreagents. • Incentive Points:Memberswereremindedthattheycouldearnpointsbyinteract ingwiththe onlinechannelandspecificallytheWellnessapplications.Itwasspeci ficallytheabilitytoreap rewardsfromcertainbehaviour,andgoingonlinetogatherrewards,su chascheapergymnasium fees,cheaperflightsandholidayaccommodations,thatledtoasignific antincreaseinthenumber ofregisteredusers. Figure4showsthatasaresultofthesepromotions,asmanyas60%ofthe registered userbaseregisteredtousetheNutritionCentre.Despiteeffortsatprom otingtheNutrition Centre, However, Figure 5 shows that over a short period of time as many as 90% of registrantsneverreturnedtousetheNutritionCentre.Thisisinstarkco ntrasttothehealth insuredmemberbasechurnor lapse rateof3 to4%.DespiteTerry’sefforts toattaina criticalmassofusers,theNutritionCentrewaseventuallydisbandedb
- 15. ecauseofthehigh userdiscontinuance. Figure 3. Nutrition center survey. Source: Bataleur, Customer Satisfaction Survey. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 50 PoST IMPLeMeNTATIoN ReVIew: LeSSoNS FRoM THe PAST Thefollowingproblemscontributed to theslowuptakeandnegatively impacteddiffusionof the NutritionZone. Lesson 1: The Constraining Role of Broader Socio-economic Structures TheInternethighwayasastopforonlinewellnesstoolsisnowcompeti ngwiththemoreresilient structureofourroadnetworks.Eversincethegrowthofcarsalesandthe subsequentgrowthofsuburbs, growthwhich roadnetworkshadencouraged, fast foodorganisationshavegrown into sprawling multinationalsbyexploitingprimelocationswithin thesehighwaynetworks.Evenindeveloping countries likeSouthAfricaand in factmanyothercountriesaround theglobe,corporations like Figure 4. Share of active nutrition center users. Source: Internal Report - Statistical analysis of retention. Figure 5. Leaky bucket problem – losing users over time.
- 16. Source: Internal Report - Statistical analysis of retention. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 51 McDonaldshaveexportedthevaluesandtastesoftheirlocalculture.W iththishomogenisationof internationalfastfoodculture,countrieshavenotonlylosttheiridenti tyintermsofhow,whereand whattheyeat,buttheyhavealsoexposedthemselvestomajorhealthris ks. Asaresultofthepervasivenessofthesebroadersocialstructuresinmo dernsocietybehavioural changesaredifficulttomakeevenwiththeguidanceofapractitionerle taloneviaadigitalhealthcare promotiontool.ThefollowingexcerptbyoneofHIC’swellnesspractit ionersdescribesthechallenge: Behaviourchangeisanextremelycomplicatedthing.Itis.Imean,ever ybodywhohasbeenon aweightlossprogramknowsthatyoucanbeasdisciplinedand,youkno w,withexerciseaswellfor twoorthreeweeksandifyouskiptheweek,youhavetostartfromscratc h.Imean,peoplegointothe behaviourchangeforsixmonths,andtheyleaveandthentheyhavegott ostart,andthentheyhave lostallthatmotivation.So,ifpeopleloseinterest,thethingis,ifthey,ift heyhadlearnedwhatthey wantedtohere,theywouldactuallycomebacktokeeponmotivating.B ecauseweneedtosustain thatdevotion.Iftheyhavelostinterest,theyarealosstothecause;theya
- 17. rebacktooldbehaviour. That,thatiswhatIhavelearned,youknow,throughexperience. Lesson 2: Intense Competition for the Customer’s Attention Thereareothermarketmechanismsoutsideof thehealth insurancefirmthatarevyingfor the consumer’sattention.Thecontentdeliveredbythemediaplaysacentr alroleinhowconsumers constructtheirvaluesandrulesofbehaviour.Inaneconomicsystemth atfocusesonthenarrow dictatesofprofitability,obesityhasbecomebigbusinessfortheverys ystemthatinfluencedit. Indeed,consumersareoverwhelmedbythevarietyofdietschemesand weight-lossadviceand productsthatareavailableinthemarketplace.Furthermore,foodisani mportantfactorinour day-to-daysocialpractices. Lesson 3: The Relativistic View of Dietary Science Eventhedieteticpracticeitselfissubjectivewithdifferentschoolsoft houghtmakingdissimilarclaims aboutthebestapproachforweightloss.Forinstance,somefocusoncal oriereduction;othersfocus onthetypesoffoodgroups(protein,carbohydrate,fat)suchaslowGI( glycaemicindex),andthe useofsupplementsandsoon,allservingtoconfusetheconsumer.The NutritionExpertdescribed thedifferentperspectivesimplicatedinthedesignoftheonlineNutriti onCentreasfollows. Therewere a lot of challenges Imeanwithin anypanelyouaregoing tohavediffering opinions.Although theyareallexcellentacademics in theirownright therewasofcoursea certaindegreeofnotnecessarilyconflictbutdifferencesofopinions incertainaspects.You
- 18. couldcertainlypickupthedifferentslantsintheirparticularfieldofint erestsandorpassion. Soforexampleonewouldconstantlybeharpingaboutfibreorlentilsan dtheotheronewould beharpingonaboutyouknowvariousdifferentangles.Sotakingthesci enceandtranslatingit intoaninteractivetoolwasquiteachallenge. Lesson 4: Delegating Tacit and Uncodified Knowledge to Technology Havingbeenapracticingdietician,theNutritionExpertsuggestedtha tbecausefoodandeatingisa veryemotiveissue,the“real- world”dieticianoftenhastoplaytheroleofapsychologist,partcoach, partfriend,andpartdietician.Adieticianalsospendsanenormousamo untofeffortinmotivatinga patient.Andevenduringthefollow- upsessions,thedieticianbecomesthemotivatorandthecounsellor. Thelimitationsofdelegatingtheroleofthedieticiantotheself- servicetoolaresuccinctlydescribed bywayofexamplebytheNutritionist. Thosearethekindofthings,thesmallnuancesthatareimportant,tobea rinmindbecauseofthe factthatthiseatingissomethingwealldoeverydayanditishighlyemot iveandsohighlyeffected bythetypeoflifethatyoulead.Sotherearesomanyfactorsandnoteven necessaryreallytobe writtendown.Youknowyoujustpickthesethingsup.It’sreallyaboutg atheringinformationand Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020
- 19. 52 thentailoringit.Becauseweknowwithcompliance,withanykindoflif estylechange,themoreyou personaliseit,themoresuitableitistotheperson’slifestylethemoresu ccessyougoingtohave. Theadvantagesofgoingtoadietician,yougointoaprofessionalenviro nment,youarehaving thatcontactwiththedieticianwhocanreadyouandbuildarelationship withyouandbecomea partnerinthisprocess...Ithinkattheendofthedayit(theonlinetool)isn osubstituteforthathuman contact…WhatImeanisthatthebodylanguageandthepersonalityand yougettoknowtheperson, andyougettounderstandthemandunderstandtheirlifestyles. Lesson 5: Context-Transferability Challenges Therewasincreasingfrustrationamongthedevelopmentteamreprese ntingtheUKpartner,onthe logicofbasingtheUKfunctionalityontheSouthAfricanperspective. OneoftheunhappyBusiness Analystsmadethefollowingcomment: Firstofall,youcan’tjustplugandplayitfromonecountrytothenext... Andalso,whatone marketingteamwanteddifferedfromtheother.So,itstartedoffsaying ,oh,yes,wearegoingtouse thisconcept,andthemoreandmoreyoudelveintoit,themoreandmorei tmovedaway. Forexample,theconceptionsofanonlinenutritiontoolinscribedwith aSouthAfricanperspective requiredmodificationstosuittheUKcontext.Bringingatechnologyt oanewlocalcontextinvolves someexplicitandimplicitelementsofculturaltransferandmutuallear
- 20. ning.Thefollowingcomment byourNutritionExperthighlightshow theUK requirementswereatoddswith the localSouth Africanrequirements: TheUKsystemusestheimperialsystemwhileweusethemetricsystem .Thisaffectedrecipes, portionsizesandbodymeasurements.ThedieticianintheUKhelpedu swithtranslatingtherecipe measurementsandportionsizesfrommetrictotheimperial,whichinv olvedcalculatingtheequivalent ounceswheretherecipesstatedgrams,millimetresorlitresandconver tingkilogramstopounds. Someofthemeasurementslookedridiculousanddidn’tseemtomakes ense,sowehadtotryand converttohouseholdmeasurementswherepossible.Forexample– 1teaspoon,Icupetc.Regarding thebodymeasurements,oneofthetoolsinthenutritionprogrammeinv olvescalculatingyourbody massindex(BMI).Thisrequiresyoutoenteryourheightinmetresandy ourweightinkilograms. NaturallywehadtomodifythistooltoallowfortheUKmarkettoenter metricfriendlydatasuchas feetandpounds.Thiswasn’tdifficultasitwassimplyacaseofapplying conversionfactors. TheUKnutritionistalsorevealedthedifferencesandidiosyncrasiesth atwereconcealedbeneath theapparenthomogeneityoftheUKrequirements.Whileonthesurfac etheUKandSouthAfrican culturemayappeartobesimilar,thisevidenceiscountertotheglobalh omogenisationnotionwith respecttoICTimplementations.TheUKusersappropriatedthetheonl inenutritioncentre,differently asaresultoftheirspecificgeographies,histories,standardsandlangu ages.
- 21. At firstwe thought itwouldsimply involve removing theSouthAfrican foods, forexample biltong3fromtherecipesandmenusonthemealplansandreplacethem withfoodsfamiliartopeople intheUK.Soweneededtofindoutwhatequivalentfoodswouldbeavail ableintheUKtouseas substitutes.Thenwerealisedwealsohadtochangethenamesofcertain foodsthatwerecommonin bothcountries,butthatwerecalledsomethingdifferentintheUK,like eggplantinsteadofbrinjal, whichaffectedrecipesandmenusthatcontainedthesefoods.Wealsoh adtochangethenamesof recipes,suchas‘potjie’tosomethingmoreUKfriendlylikecasserole. Toensurethatallfoodswould berecognisabletoUKconsumers,weenlistedthehelpofaregistereddi eticianintheUK. AmajornutritionalissueintheUKisintoleranceorallergytowheatand therearemanymore vegansthaninSouthAfrica.Wehadnotcateredforwheat- freeandveganmealplansontheSA NutritionCentreandtheUKofficerequestedthatwedesignsuchoptio nstosuittheirmarket.This involvedtheUKdieticiansupplyinguswiththenamesofproductsavai lableintheUKthatcouldbe usedassubstitutesforwheatandanimalproteinfoods Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 53 Lesson 6: The Abuse of Incentives by Consumers
- 24. nessnetworks.HIC’s nutritionexpertusestheYoutubevideo- sharingcommunitytoprovidedietlessons,eventhough theviewsareverylow.Thefirmalsooffersincentivesforphysicalacti vity.Asmartwatchis offered toqualifying customers.The smartwatchmeasures thewearer’s activity levels and setspersonalisedweeklyfitnessgoalsbyconnectingtothefirm’sfitne ssapp.Thecompany claimsthattheyhaveobservedincreasedactivitylevelsamongmanyo ftheparticipantsusing thesmartwatchrewardprogramme.Today,HICoperatesinmorethan 15countriesandhas over10millioncustomers.Thecompanyfocusesonusingsmartphone s,wearabledevicesand gamingelementstopromotehealthcare.Successinthediffusionofthe sedigitalhealthcare promotionprogramscontinuestobemixed. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 54 yoUR CHALLeNGe AND TASKS TheHICexecutiveisreassessingtheirdigitalstrategyfornutrition.Th eyhavereachedouttoyouand yourteamofconsultantstoadvisethefirm.Theoverarchingobjectivei stwofold: 1. Toassesshowwelldigital technologieshaveprogressed todateand towhatextent they canaddresssomeofthesocialchallengesexperiencedinthepastiterati
- 25. onsofthenutrition center(assessment); 2. Toproposewhethertomoveforwardandhowtomoveforwardwiththei rdigitalstrategyregarding nutrition(recommendations). NoTeS Sincetheorganizationpreferredanonymity,allnameshavebeenficti onalised. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 55 ReFeReNCeS Adam,S.A.,&DeBont,A.A.(2003).Notionsofreliability:Consideri ngtheimportanceofdifferenceinguiding patientstohealthcarewebsites.Methods of Information in Medicine,42(4),307–311.doi:10.1055/s-0038-1634223 PMID:14534627 Bandura,A.(2004).Healthpromotionbysocialcognitivemeans.Heal th Education & Behavior,31(2),143–164. doi:10.1177/1090198104263660PMID:15090118 Bert,F.,Giacometti,M.,Gualano,M.R.,&Siliquini,R.(2014).Smart phonesandhealthpromotion:Areview oftheevidence.Journal of Medical Systems,38(9995),1– 11.doi:10.1007/s10916-013-9995-7PMID:24346929
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- 28. driven movement. Duke University Press. doi:10.1215/9780822390541 KeshavarzMohammadi,N.(2019).Onestepbacktowardthefutureof healthpromotion:Complexity-informed healthpromotion.Health Promotion International,34(4),635– 639.doi:10.1093/heapro/daz084PMID:31505649 Larkin,M. (2001).E-health continues tomakeheadway.Lancet,358(9280), 517–517. doi:10.1016/S0140- 6736(01)05615-X http://dx.doi.org/10.1055/s-0038-1634223 http://www.ncbi.nlm.nih.gov/pubmed/14534627 http://dx.doi.org/10.1177/1090198104263660 http://www.ncbi.nlm.nih.gov/pubmed/15090118 http://dx.doi.org/10.1007/s10916-013-9995-7 http://www.ncbi.nlm.nih.gov/pubmed/24346929 http://dx.doi.org/10.1007/s12652-017-0659-1 http://dx.doi.org/10.1007/s12652-017-0659-1 http://dx.doi.org/10.1093/heapro/dan014 http://www.ncbi.nlm.nih.gov/pubmed/18356285 http://dx.doi.org/10.1016/j.jhealeco.2004.11.009 http://www.ncbi.nlm.nih.gov/pubmed/15960993 http://dx.doi.org/10.1136/bmj.39428.494236.BE http://www.ncbi.nlm.nih.gov/pubmed/18156223 http://dx.doi.org/10.4278/0890-1171-10.4.270 http://www.ncbi.nlm.nih.gov/pubmed/10159708 http://dx.doi.org/10.17061/phrp2831815 http://www.ncbi.nlm.nih.gov/pubmed/30406256 http://dx.doi.org/10.1093/heapro/day060 http://www.ncbi.nlm.nih.gov/pubmed/30239777 http://dx.doi.org/10.1016/j.jbi.2009.07.002 http://www.ncbi.nlm.nih.gov/pubmed/19615467 http://dx.doi.org/10.1016/S0048-9697(99)00529-X
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- 32. http://dx.doi.org/10.1093/heapro/dau091 http://www.ncbi.nlm.nih.gov/pubmed/25320120 http://dx.doi.org/10.1177/109019818801500401 http://www.ncbi.nlm.nih.gov/pubmed/3068205 http://dx.doi.org/10.24138/jcomss.v4i3.218 http://dx.doi.org/10.1002/mar.21074 http://dx.doi.org/10.1002/mar.21074 http://dx.doi.org/10.2196/jmir.7.1.e1 http://www.ncbi.nlm.nih.gov/pubmed/15881824 http://dx.doi.org/10.1177/1460458216650979 http://www.ncbi.nlm.nih.gov/pubmed/27245673 http://dx.doi.org/10.1007/978-1-4842-3799-1 http://dx.doi.org/10.1016/S0306-4603(02)00300-3 http://dx.doi.org/10.1016/S0306-4603(02)00300-3 http://www.ncbi.nlm.nih.gov/pubmed/12369480 http://dx.doi.org/10.1109/MC.2014.339 http://dx.doi.org/10.1007/BF02892291 http://dx.doi.org/10.1007/BF02892291 http://www.ncbi.nlm.nih.gov/pubmed/9603701 http://dx.doi.org/10.2196/jmir.1672 http://www.ncbi.nlm.nih.gov/pubmed/22155738 http://dx.doi.org/10.1016/j.hlpt.2013.07.002 http://dx.doi.org/10.1093/heapro/1.1.73 Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 57 APPeNDIX Table 1. Exhibit 1: Summary of key global health statistics Subject Measures
- 34. 68years Source:WHO(2002) Anumberofdeathsordiseasesarerelatedtocausesthatareviewedtobe withinthecontrolofindividuals.Forexample, chronicnon- communicablediseaseswhicharelinkedtofactorssuchassmoking,o besityandasedentarylifestylecause 20%ofthesociety’sdiseaseburden. Figure 6. Exhibit 2: HIC’s rapid health membership growth Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 58 Figure 7. Exhibit 3: WSC’s rapid wellness program membership growth Figure 8. Exhibit 4: e-Health’s user registration growth. Source: eHIC’s Management Reports (totals are as at financial year-end (June) and not calendar year). 2005 shows almost 430,000 registered users. Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020 59 Rennie Naidoo is an associate professor at the School of IT, Department of Informatics, University of Pretoria. He has
- 35. served a number of clients on a number of IT projects in both the public and private sectors over a 20-year period. Naidoo is also an NRF-rated researcher. His research interests are broadly about information systems and organisations with a particular focus on IT value, IT human resources development and end-user issues. He has published articles in leading international outlets such as the Journal of Strategic Information Systems and the Information Society Journal. He lectures topics on IT investment and enterprise systems to postgraduates at the university. Table 2. Exhibit 5: Summary of key user characteristics Subject Measures Registration based on gender Male Female Active use based on gender Male Female Registered User Age Group 20-25 26-30 31-35 36-40 40-45 Greaterthan45 Preferred Language of Registered Users English Afrikaans Wellness Schememembersonwellnessprogram Wellnessmembersaspartofonlineregistereduserbase 53.37%
- 36. 46.63% 48% 52% 21.91% 32.02% 23.60% 6.74% 8.43% 7.30% 56% 44% 70% 92% Source:InternalManagementReport(2004) ThemajorityoftheusersappeartobeyoungerandaffiliatedtotheWell nessprogram. Themeasureofactiveuseisbasedonloginspermonth Special Education 'Issues & Applications Journal' Entry 2 Culturally and Linguistically Diverse Learners For select modules that do not include a 'Building bridges to practice: Reflective log' assignment, you will be asked to write responses to questions that pertain to course topics and readings. You will write your responses to these questions by adding your responses to each set of questions in a given module and submitting that response in the appropriate location (i.e. in module 4 you will add your responses in module 4). Some questions might also refer to a topic and readings from a previous module. You will be asked to come prepared to discuss your responses with your classmates and instructor. Your responses should be clear, detailed, and address all aspects of a given question (see rubric). Questions for Entry 2
- 37. 1. What professional collaborative practices can Mrs. Jacobs use to help her students with special learning, behavior, and language needs succeed in the general education classroom? How can she develop home-school communication effectively? (Chapter 3) 2. Do you agree that Ms. Grelak should refer Allen for a special education evaluation? Why or why not? (Chapter 4) Rubric grades : 3 pts-This criterion is linked to a Learning OutcomeQuality of Content Advanced Candidate’s response is thorough, addressing all points raised in the guiding question 3 pts-Quality of Argument Advanced All of the arguments in the candidate’s response are presented in clear and comprehensible fashion 3 pts-Length of Response Advanced Length of response to each question is 200-250 words Resource’s: 4.1: Culturally and Linguistically Diverse Students(available on page 103 of the Interactive eBook) 4.2: Assessment Challenges(available on page 111 of the Interactive eBook) 4.3: Culturally Responsive Teaching(available on page 118 of the Interactive eBook) Article 1:Parette, H. P., & Petch-Hogan, B. (2000). Approaching families: Facilitating culturally/linguistically diverse family involvement.
- 38. TEACHING Exceptional Children, 33(2), 4–10. doi:10.1177/004005990003300201Links to an external site. Abstract: This article discusses the benefits, supported literature, and best-practice strategies for engaging families from culturally and linguistically diverse backgrounds. A practical set of questioning strategies is provided for enhancing family participation in the decision-making process (p. 6) as well as an overview of family-centered considerations for IEP team members. https://edge.sagepub.com/bryant2e/student-resources-0/chapter- 4/flashcards If you purchased access or redeemed a code for the eBook, you can read Chapter 4 here Links to an external site.. Article 1:Malone, D. M., & Gallagher, P. A. (2010). Special education teachers’ attitudes and perceptions of teamwork. Remedial and Special Education, 31(5), 330–342. doi:10.1177/0741932509338362Links to an external site. Abstract: One hundred and eighty-four special education teachers serving school-based intervention teams completed the Attitudes About Teamwork Survey, the T eam Characteristics Survey, and the Team Process Perception Survey. Respondents’ regard for the team process in planning and implementing supports for children with disabilities was generally favorable. Similarly, respondents’ perceptions of the performance characteristics of the teams on which they served were generally positive.
- 39. Associations among items on the Attitudes About Teamwork Survey and the Team Characteristics Survey are reported. Finally, respondents provided input regarding teamwork benefits and limitations, how teamwork supports their efforts, and recommendations for improving the effectiveness of teamwork. Practical implications of the results and directions for further investigation in this area are discussed. Article 2:Whitbread, K. M., Bruder, M. B., Fleming, G., & Park, H. J. (2007). Collaboration in special education: Parent– professional training. TEACHING Exceptional Children, 39(4), 6–14. doi:10.1177/004005990703900401Links to an external site. Abstract: This article provides a brief overview of literature and studies and a description of a project aimed at fostering relationships between teachers and parents in support of more effective educational planning and implementation. The curriculum, training procedures, and outcomes of the program are discussed. Article 1:Parette, H. P., & Petch-Hogan, B. (2000). Approaching families: Facilitating culturally/linguistically diverse family involvement. TEACHING Exceptional Children, 33(2), 4–10. doi:10.1177/004005990003300201Links to an external site. Abstract: This article discusses the benefits, supported literature, and best-practice strategies for engaging families from culturally and linguistically diverse backgrounds. A practical set of questioning strategies is provided for enhancing family participation in the decision-making process (p. 6) as well as an overview of family-centered considerations for IEP team members.
- 40. Culturally Responsive Education: Addressing DiversityLinks to an external site. Description: This IES webinar video provides information on research-based, culturally responsive practices for students from diverse backgrounds. Identifying and Supporting Students With Learning DisabilitiesLinks to an external site. Description: This video provides an overview of the challenges in and importance of identifying students with learning disabilities. Evaluation of Children With Suspected DisabilitiesLinks to an external site. Description: This video is the first in a multipart presentation on the evaluation and identification of students with disabilities.