Using multi-perspective methodologies to study users' interactions with the prototype front end of a guideline-based decision support system for diabetic foot care

Mor Peleg, Aviv Shachak, Dongwen Wang, Eddy Karnieli

Research output: Contribution to journalArticlepeer-review


Purpose: Clinical practice guidelines are important instruments for improving the quality of care; in paper form, however, they are not used as effectively as possible. In order to develop a guideline-based decision support system (DSS) prototype to help clinicians deal with diabetic patients' foot problems, we drew on methodologies from qualitative research, cognitive science, and information systems. This multi-perspective approach was intended to facilitate user-centered design and evaluation. Methods: We employed field observations, structured interviews, and document analyses to collect and analyze users' workflow patterns, decision support goals, and preferences regarding interactions with a DSS. Next, we aligned their requirements with sequence diagrams and followed Nielsen's heuristics to develop a DSS prototype. We then performed think-aloud analyses and used the technology acceptance model to direct our evaluation of users' perceptions of the prototype. Results: Users had a positive response to the DSS prototype in terms of its clarity of design and ease of use. They expressed a high intention of using the system in the future. Conclusion: Applying multi-perspective methodologies is an effective way to study and design user interactions with the front end of a guideline-based DSS.

Original languageEnglish
Pages (from-to)482-493
Number of pages12
JournalInternational Journal of Medical Informatics
Issue number7
StatePublished - Jul 2009

Bibliographical note

Funding Information:
We would like to thank Dr. Adriana Fodor Aharon Kulater, Sagi Keren, Hana Sender, Shiri Shenhav, Miri Naim, and Gali Feder for their contributions to the design and implementation of the system; and the nurses Tsvia and Varda Swager and Drs. Shmuel Reis, Ramon, Shaul Barak, Avinoam Markowitz, Yaakov Fogelman, Shifrin, Deeb Daoud, Ehud Har-Shemesh, Mordechai Alperin, Adnan Zaina, and Yaron Denekamp for their instrumental suggestions and evaluation of this project. We would also like to thank Peter Elkin and Christian Nøhr for their helpful comments. Our study was supported in part by the Galil Center for Telemedicine and Medical Informatics at the Technion, and the Israel National Institute for Health Policy and Health Services Research (NIHP). A version of this paper was presented at the Conference on Human Factors Engineering and Usability in Aarhus, Denmark, 7–8 June 2007.


  • Clinical decision support systems
  • Clinical practice guidelines
  • Sequence diagrams
  • Technology acceptance
  • Usability heuristics

ASJC Scopus subject areas

  • Health Informatics


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