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

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. (C) 2009 Elsevier Ireland Ltd. All rights reserved.