Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach

Introduction

Online community-based exercise (CBE) is a digital health intervention and rehabilitation strategy that promotes health among people living with HIV. Our aim was to describe the factors influencing initial implementation of a pilot online CBE intervention with adults living with HIV using a systems approach, as recommended by implementation science specialists.

Methods

We piloted the implementation of a 6-month online CBE intervention and 6-month independent exercise follow up, in partnership with the YMCA in Toronto, Canada. We recruited adults living with HIV who identified themselves as safe to engage in exercise. The intervention phase included personalized exercise sessions online with a personal trainer; exercise equipment; access to online exercise classes; and a wireless physical activity monitor. Two researchers documented implementation factors articulated by participants and the implementation team during early implementation, defined as recruitment, screening, equipment distribution, technology orientation, and baseline assessments. Data sources included communication with participants; daily team communication; weekly team discussions; and in-person meetings. We documented implementation factors in meeting minutes, recruitment screening notes, and email communication; and analyzed the data using a qualitative descriptive approach using a systems engineering method called Cognitive Work Analysis.

Results

Thirty-three adults living with HIV enrolled in the study (n = 33; median age: 52 years; cis-men: 22, cis-women: 10, non-binary: 1). Fifty-five factors influencing implementation, spanned five layers: (i) Natural, including weather and the COVID-19 virus; (ii) Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups); (iii) Organizational, including information dissemination (e.g. tech support) and logistics (e.g. scheduling); (iv) Personal, including physical setting (e.g. space) and digital setting (e.g. device access); and (v) Human, including health (e.g. episodic illness) and disposition (e.g. motivation). The implementation team experienced heightened needs to respond rapidly; sustain engagement; and provide training and support. Additional organizational factors included a committed fitness training and research team with skills spanning administration and logistics, participant engagement, technology training, physical therapy, and research ethics.

Conclusion

Fifty-five factors spanning multiple layers illustrate the complexities of online CBE with adults living with HIV. Initial implementation required a dedicated, rehabilitation-centred, multi-skilled, multi-stakeholder team to address a diverse set of factors.

Development of Rasmussen's risk management framework for analysing multi-level sociotechnical influences in the design of envisioned work systems

Besides radically altering work, advances in automation and intelligent technologies have the potential to bring significant societal transformation. These transitional periods require an approach to analysis and design that goes beyond human-machine interaction in the workplace to consider the wider sociotechnical needs of envisioned work systems. The Sociotechnical Influences Space, an analytical tool motivated by Rasmussen's risk management model, promotes a holistic approach to the design of future systems, attending to societal needs and challenges, while still recognising the bottom-up push from emerging technologies. A study explores the concept and practical potential of the tool when applied to the analysis of a large-scale, 'real-world' problem, specifically the societal, governmental, regulatory, organisational, human, and technological factors of significance in mixed human-artificial agent workforces. Further research is needed to establish the feasibility of the tool in a range of application domains, the details of the method, and the value of the tool in design. Practitioner summary: Emerging automation and intelligent technologies are not only transforming workplaces, but may be harbingers of major societal change. A new analytical tool, the Sociotechnical Influences Space, is proposed to support organisations in taking a holistic approach to the incorporation of advanced technologies into workplaces and function allocation in mixed human-artificial agent teams.

Identifying Constraints on Everyday Clinical Practice: Applying Work Domain Analysis to Emergency Department Care

BACKGROUND

Emergency departments (EDs) are complex socio-technical work systems that require staff to manage patients in an environment of fluctuating resources and demands. To better understand the purpose, and pressures and constraints for designing new ED facilities, we developed an abstraction hierarchy model as part of a work domain analysis (WDA) from the cognitive work analysis (CWA) framework. The abstraction hierarchy provides a model of the structure of the ED, encompassing the core objects, processes, and functions relating to key values and the ED's overall purpose.

METHODS

Reviews of relevant national and state policy, guidelines, and protocol documents applicable to care delivery in the ED were used to construct a WDA. The model was validated through focus groups with ED clinicians and subsequently validated using a series of WDA prompts.

RESULTS

The model shows that the ED system exhibits extremely interconnected and complex features. Heavily connected functions introduce vulnerability into the system with function performance determined by resource availability and prioritization, leading to a trade-off between time and safety priorities.

CONCLUSIONS

While system processes (e.g., triage, fast-track) support care delivery in ED, this delivery manifests in complex ways due to the personal and disease characteristics of patients and the dynamic state of the ED system. The model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety.

APPLICATION

The model identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.

Human Factors and Ergonomics and the management of existential threats: A work domain analysis of a COVID-19 return from lockdown restrictions system

Following strict "lockdown" restrictions designed to control the spread of the COVID-19 virus, many jurisdictions are now engaged in a process of easing restrictions in an attempt to stimulate economic and social activity while continuing to suppress virus transmission. This is challenging and complex, and in several regions, new outbreaks have emerged. We argue that systems Human Factors and Ergonomics methods can assist in understanding and optimizing the return from lockdown. To demonstrate, we used work domain analysis to develop an abstraction hierarchy model of a generic "return from lockdown restrictions" system. The model was assessed to identify (a) issues preventing a successful return from lockdown; and (b) leverage points that could be exploited to optimize future processes. The findings show that the aim of continuing to suppress virus transmission conflicts with the aims of returning to pre-virus economic and social activity levels. As a result, many functions act against each other, ensuring that the system cannot optimally achieve all three of its primary aims. Potential leverage points include modifying the goals and rules of the system and enhancing communications and feedback. Specifically, it is argued that moderating economic aims and modifying how social and community activities are undertaken will result in longer term suppression of the virus.

Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting

BACKGROUND

A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals.

OBJECTIVE

We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service.

METHODS

We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative "discovery and modeling" approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened.

RESULTS

We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure.

CONCLUSIONS

The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment.

Determining the prerequisites for effective workplace inspection by the occupational safety and health regulatory authority using cognitive work analysis

Objectives. Earlier attempts to understand inspection work and improve inspection effectiveness are based on how controls are conducted and the interactions between the inspectors and inspection subjects. This study aimed to determine workplace occupational safety and health inspection effectiveness prerequisites using cognitive work analysis, an approach for design and evaluation of work domains, focusing on activities and work constraints. Methods. Data were collected through semi-structured interviews and a survey with labour inspection authority inspectors, and by reviewing inspection reports and earlier studies on workplace inspections. These were used in the first three cognitive work analysis phases to identify the prerequisites of effective workplace inspection and designing inspection strategies. Results. An abstraction hierarchy showing the affordances was prepared, with purpose-related functions identified as the inspection effectiveness prerequisites. A contextual activities template and a decision ladder for inspection work were prepared. Strategy maps for on-site control were created, allowing design of structured and organized workplace inspection strategies supporting the work domain's purposes. Conclusion. The analysis dimensions served the study sufficiently, providing the purpose-related functions with their respective subgoals and subsidiary functions that provided the prerequisite for effective workplace inspections and allowed for designing structured and organized strategies for on-site workplace inspection.

With Crisis Comes Opportunity: Redesigning Performance Departments of Elite Sports Clubs for Life After a Global Pandemic

The suspension of major sporting competitions due to the global COVID-19 pandemic had a substantial negative impact on the sporting industry. As such, a successful and sustainable return to sport will require extensive modifications to the current operations of sporting organizations. In this article we argue that methods from the realm of sociotechnical systems (STS) theory are highly suited for this purpose. The aim of the study was to use such methods to develop a model of an Australian Football League (AFL) club's football department. The intention was to identify potential modifications to the club's operations to support a return to competition following the COVID-19 crisis. Subject Matter Experts from an AFL club participated in three online workshops to develop Work Domain Analysis and Social Organization and Cooperation Analysis models. The results demonstrated the inherent complexity of an AFL football department via numerous interacting values, functions and processes influencing the goals of the system. Conflicts within the system were captured via the modeling and included pursing goals that may not fully reflect the state of the system, a lack of formal assessment of core values, overlapping functions and objects, and an overemphasis on specialized roles. The current analysis has highlighted potential areas for modification in the football department, and sports performance departments in general.

Sports Organizations as Complex Systems: Using Cognitive Work Analysis to Identify the Factors Influencing Performance in an Elite Netball Organization

There is increasing interest in the adoption of a complex systems thinking approach when attempting to understand and optimize sports performance. Despite this, few studies have attempted to model elite sports organizations. The aim of this study was to use methods from the Cognitive Work Analysis (CWA) framework to develop a model of an elite netball organization and identify wider organizational functions and constraints influencing performance. Two phases of CWA were used: (i) Work Domain Analysis (WDA); and, (ii) Social Organization and Co-operation Analysis (SOCA). A WDA model of the elite netball organization was developed via subject matter expert (SME) workshops, and a SOCA was undertaken to identify the different functions, roles, and responsibilities of key actors within the organization. The findings identify various factors that influence performance. Functions that appear to provide a competitive edge are discussed, including a strong club ethos, a shared responsibility for performance, and a focus on player and staff health and well-being. Factors that potentially have a negative impact on performance include organizational priorities not related to playing netball, and additional coach and athlete roles beyond coaching, training, and playing. The implications for understanding and optimizing elite sports organizations are discussed.

Accounting for memes in sociotechnical systems: extending the abstraction hierarchy to consider cognitive objects

Work domain analysis (WDA) is used to model the functional structure of sociotechnical systems (STS) through the abstraction hierarchy (AH). By identifying objects, processes, functions and measures that support system purposes, WDA reveals constraints within the system. Traditionally, the AH describes system elements at the lowest level of abstraction as physical objects. Multiple analyses of complex systems reveal that many include objects that exist only at a conceptual level. This paper argues that, by extending the AH to include cognitive objects, the analytical power of WDA is extended, and novel areas of application are enabled. Three case studies are used to demonstrate the role that cognitive objects play within STS. It is concluded that cognitive objects are a valid construct that offer a significant enhancement of WDA and enable its application to some of the world's most pressing problems. Implications for future applications of WDA and the AH are discussed. Practitioner summary: Some sociotechnical systems include memes as part of their functional structure. Three case studies were used to evaluate the utility of introducing cognitive objects alongside physical ones in work domain analysis, the first phase of cognitive work analysis. Including cognitive objects increases the scope and accuracy of work domain analysis.

Examining Cybersecurity of Cyberphysical Systems for Critical Infrastructures Through Work Domain Analysis

OBJECTIVE

The aim of this study was to apply work domain analysis for cybersecurity assessment and design of supervisory control and data acquisition (SCADA) systems.

BACKGROUND

Adoption of information and communication technology in cyberphysical systems (CPSs) for critical infrastructures enables automated and distributed control but introduces cybersecurity risk. Many CPSs employ SCADA industrial control systems that have become the target of cyberattacks, which inflict physical damage without use of force. Given that absolute security is not feasible for complex systems, cyberintrusions that introduce unanticipated events will occur; a proper response will in turn require human adaptive ability. Therefore, analysis techniques that can support security assessment and human factors engineering are invaluable for defending CPSs.

METHOD

We conducted work domain analysis using the abstraction hierarchy (AH) to model a generic SCADA implementation to identify the functional structures and means-ends relations. We then adopted a case study approach examining the Stuxnet cyberattack by developing and integrating AHs for the uranium enrichment process, SCADA implementation, and malware to investigate the interactions between the three aspects of cybersecurity in CPSs.

RESULTS

The AHs for modeling a generic SCADA implementation and studying the Stuxnet cyberattack are useful for mapping attack vectors, identifying deficiencies in security processes and features, and evaluating proposed security solutions with respect to system objectives.

CONCLUSION

Work domain analysis is an effective analytical method for studying cybersecurity of CPSs for critical infrastructures in a psychologically relevant manner.

APPLICATION

Work domain analysis should be applied to assess cybersecurity risk and inform engineering and user interface design.

Modeling Automation With Cognitive Work Analysis to Support Human-Automation Coordination

Cognitive work analysis is useful to develop displays for complex situations, but it has not been well explored in providing support for human-automation coordination. To fill this gap, we propose a degree of automation (DOA) layering approach, demonstrated by modeling an automated financial trading domain, with a goal of supporting interface design in this domain. The abstraction hierarchy and the decision ladder each adopted an additional layer, mapping functions allocated to the trader and to the automation. In addition to the mapping, we marked the four stages of automation on the decision ladder to provide guidance on representing the function allocation at the task level. Next, we compared the DOA layering approach to how automation was represented in the cognitive work analysis literature. We found that a DOA-layered decision ladder, which included well-developed knowledge of the stages and levels of automation, can be suited to modern automated systems with different DOAs. This study suggests that the DOA layering approach has important implications for designing automation displays and deciding stages and levels of automation and may be a useful approach for modeling adaptive automation.

Interactive mechanism of working environments and construction behaviors with cognitive work analysis: an elevator installation case study

Unsafe behavior is a leading factor in accidents, and the working environment significantly affects behaviors. However, few studies have focused on detailed mechanisms for addressing unsafe behaviors resulting from environmental constraints. This study aims to delineate these mechanisms using cognitive work analysis (CWA) for an elevator installation case study. Elevator installation was selected for study because it involves operations at heights: falls from heights remain a major cause of construction worker mortality. This study adopts a mixed research approach based on three research methodology stages. This research deconstructs the details of the working environment, the workers' decision-making processes, the strategies chosen given environmental conditions and the conceptual model for workers' behaviors, which jointly depict environment-behavior mechanisms at length. By applying CWA to the construction industry, environmental constraints can easily be identified, and targeted engineering suggestions can be generated.

Implementation of a novel taxonomy based on cognitive work analysis in the assessment of safety performance

PURPOSE

The aim of this study was to examine how the developed taxonomy of cognitive work analysis (CWA) can be applied in combination with statistical analysis regarding different sociotechnical categories.

MATERIALS AND METHODS

This study applied a combination of quantitative and qualitative methodologies. Workers (n = 120) and managers (n = 85) in the chemical industry were asked in a questionnaire how different occupational safety and health (OSH) measures were being implemented. The exploration of the qualitative CWA taxonomy consisted of an analysis of the following topics: (a) work domain; (b) control task; (c) strategies; (d) social organization and cooperation; (e) worker competencies.

RESULTS AND CONCLUSIONS

The following hypotheses were supported - activities of the management had positive impacts on the aggregated variables: near-accident investigation and instructions (H₁); OSH training (H₂); operations, technical processes and safe use of chemicals (H₃); use of personal protective equipment (H₄); measuring, follow-up and prevention of major accidents (H₅). The CWA taxonomy was applied in mixed methods when testing H₁-H₅. A special approach is to analyze the work demands of complex sociotechnical systems with the taxonomy of CWA. In problem-solving, the CWA taxonomy should seek to capitalize on the strengths and minimize the limitations of safety performance.

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity. The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design.

Integrated System Design: Promoting the Capacity of Sociotechnical Systems for Adaptation through Extensions of Cognitive Work Analysis

This paper proposes an approach for integrated system design, which has the intent of facilitating high levels of effectiveness in sociotechnical systems by promoting their capacity for adaptation. Building on earlier ideas and empirical observations, this approach recognizes that to create adaptive systems it is necessary to integrate the design of all of the system elements, including the interfaces, teams, training, and automation, such that workers are supported in adapting their behavior as well as their structure, or organization, in a coherent manner. Current approaches for work analysis and design are limited in regard to this fundamental objective, especially in cases when workers are confronted with unforeseen events. A suitable starting point is offered by cognitive work analysis (CWA), but while this framework can support actors in adapting their behavior, it does not necessarily accommodate adaptations in their structure. Moreover, associated design approaches generally focus on individual system elements, and those that consider multiple elements appear limited in their ability to facilitate integration, especially in the manner intended here. The proposed approach puts forward the set of possibilities for work organization in a system as the central mechanism for binding the design of its various elements, so that actors can adapt their structure as well as their behavior—in a unified fashion—to handle both familiar and novel conditions. Accordingly, this paper demonstrates how the set of possibilities for work organization in a system may be demarcated independently of the situation, through extensions of CWA, and how it may be utilized in design. This lynchpin, conceptualized in the form of a diagram of work organization possibilities (WOP), is important for preserving a system's inherent capacity for adaptation. Future research should focus on validating these concepts and establishing the feasibility of implementing them in industrial contexts.

Designing a ticket to ride with the Cognitive Work Analysis Design Toolkit

Cognitive work analysis has been applied in the design of numerous sociotechnical systems. The process used to translate analysis outputs into design concepts, however, is not always clear. Moreover, structured processes for translating the outputs of ergonomics methods into concrete designs are lacking. This paper introduces the Cognitive Work Analysis Design Toolkit (CWA-DT), a design approach which has been developed specifically to provide a structured means of incorporating cognitive work analysis outputs in design using design principles and values derived from sociotechnical systems theory. This paper outlines the CWA-DT and describes its application in a public transport ticketing design case study. Qualitative and quantitative evaluations of the process provide promising early evidence that the toolkit fulfils the evaluation criteria identified for its success, with opportunities for improvement also highlighted.

PRACTITIONER SUMMARY

The Cognitive Work Analysis Design Toolkit has been developed to provide ergonomics practitioners with a structured approach for translating the outputs of cognitive work analysis into design solutions. This paper demonstrates an application of the toolkit and provides evaluation findings.

Designing sociotechnical systems with cognitive work analysis: putting theory back into practice

Cognitive work analysis (CWA) is a framework of methods for analysing complex sociotechnical systems. However, the translation from the outputs of CWA to design is not straightforward. Sociotechnical systems theory provides values and principles for the design of sociotechnical systems which may offer a theoretically consistent basis for a design approach for use with CWA. This article explores the extent to which CWA and sociotechnical systems theory offer complementary perspectives and presents an abstraction hierarchy (AH), based on a review of literature, that describes an 'optimal' CWA and sociotechnical systems theory design system. The optimal AH is used to assess the extent to which current CWA-based design practices, uncovered through a survey of CWA practitioners, aligns with sociotechnical systems theory. Recommendations for a design approach that would support the integration of CWA and sociotechnical systems theory design values and principles are also derived.

Using team cognitive work analysis to reveal healthcare team interactions in a birthing unit

Cognitive work analysis (CWA) as an analytical approach for examining complex sociotechnical systems has shown success in modelling the work of single operators. The CWA approach incorporates social and team interactions, but a more explicit analysis of team aspects can reveal more information for systems design. In this paper, Team CWA is explored to understand teamwork within a birthing unit at a hospital. Team CWA models are derived from theories and models of teamwork and leverage the existing CWA approaches to analyse team interactions. Team CWA is explained and contrasted with prior approaches to CWA. Team CWA does not replace CWA, but supplements traditional CWA to more easily reveal team information. As a result, Team CWA may be a useful approach to enhance CWA in complex environments where effective teamwork is required.

PRACTITIONER SUMMARY

This paper looks at ways of analysing cognitive work in healthcare teams. Team Cognitive Work Analysis, when used to supplement traditional Cognitive Work Analysis, revealed more team information than traditional Cognitive Work Analysis. Team Cognitive Work Analysis should be considered when studying teams.