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Connected health (CH) technologies have resulted in a paradigm shift, moving health care steadily toward a more patient-centered delivery approach. CH requires a broad range of disciplinary expertise from across the spectrum to work in a cohesive and productive way. Building this interdisciplinary relationship at an earlier stage of career development may nurture and accelerate the CH developments and innovations required for future health care.
This study aimed to explore the perceptions of interdisciplinary CH researchers regarding the design and delivery of an interdisciplinary education (IDE) module for disciplines currently engaged in CH research (engineers, computer scientists, health care practitioners, and policy makers). This study also investigated whether this module should be delivered as a taught component of an undergraduate, master’s, or doctoral program to facilitate the development of interdisciplinary learning.
A qualitative, cross-institutional, multistage research approach was adopted, which involved a background study of fundamental concepts, individual interviews with CH researchers in Greece (n=9), and two structured group feedback sessions with CH researchers in Ireland (n=10/16). Thematic analysis was used to identify the themes emerging from the interviews and structured group feedback sessions.
A total of two sets of findings emerged from the data. In the first instance, challenges to interdisciplinary work were identified, including communication challenges, divergent awareness of state-of-the-art CH technologies across disciplines, and cultural resistance to interdisciplinarity. The second set of findings were related to the design for interdisciplinarity. In this regard, the need to link research and education with real-world practice emerged as a key design concern. Positioning within the program context was also considered to be important with a need to balance early intervention to embed integration with later repeat interventions that maximize opportunities to share skills and experiences.
The authors raise and address challenges to interdisciplinary program design for CH based on an abductive approach combining interdisciplinary and interprofessional education literature and the collection of qualitative data. This recipe approach for interdisciplinary design offers guidelines for policy makers, educators, and innovators in the CH space. Gaining insight from CH researchers regarding the development of an IDE module has offered the designers a novel insight regarding the curriculum, timing, delivery, and potential challenges that may be encountered.
The population of Europe is aging. Life expectancy is estimated to increase by more than a full year between 2016 and 2021—from 73 to 74.1 years—bringing the number of people aged over 65 years to more than 656 million or 11.5% of the total population [
A conceptual model for health management where devices, services or interventions are designed around the person’s needs, and health-related data is shared, in such a way that the person can receive care in the most proactive and efficient manner possible. All stakeholders in the process are “connected” by means of timely sharing and presentation of accurate and pertinent information regarding patient status through smarter use of data, devices, communication platforms and people.
CH can be used by both clinicians and citizens to enable better and more efficient use of scarce health care resources. It promises a paradigm shift with novel technologies being used to create and develop links between individuals and communities, health and disease, and different health actors (eg, citizens, patients, clinicians, and policy makers), thereby enabling citizens and health care practitioners to make better decisions about health care.
CH interventions such as home-based exercise programs can contribute to CH impact via improvement in patient adherence [
Adopting a CH approach to health care could enhance the delivery of a more integrated health care system [
Concepts central to both the connectedness and integration aspects of the CH approach are sharing of information, involvement and collaboration of multiple professions, redesign of care models, temporal and organizational continuum, new care and business models, and leveraging of services via technology. The development of CH technologies, therefore, requires that professionals from across both the health care and technology disciplines work together in a more integrated and cohesive way. This implies a good understanding of the skills each discipline brings to the team and the health needs they intend to address [
Medical students are envisioned as the frontline of
Slovensky et al [
However, CH involves a broad spectrum of disciplines extending beyond those directly associated with traditional health care and health care delivery. Recent studies and research programs have begun to recognize that engineers, computer scientists, information technology designers, and policy makers must together engage in interdisciplinary research to deliver on the promise of CH. Xu et al [
The main premise underpinning this research is that modeling interdisciplinary team working behaviors during the education process is a prerequisite for productive interdisciplinary cooperation in CH research and development as well as practice. Clear understanding of benefits, potential, and relevance of interdisciplinary collaboration must be learned and practiced to yield its full potential in the field. Education of health care professionals should embrace the technological innovation that is empowering the field of medicine today. Engineering curricula, being far more flexible in continuous adaptations to the exponential progress in the field, have already encompassed enabling technology for health. However, only bringing the interdisciplinary teamwork into the classroom will ensure broader acceptance and understanding of the fundamental CH concepts. Investment at the education level will eventually facilitate faster adaptation and implementation of CH technologies. The ENJECT Cooperation in Science and Technology (COST) action [
With some notable exceptions, previously presented, existing literature offers few guidelines as to the design of IDE modules for CH teams, no advice on how much interprofessional education (IPE) or IDE is adequate, and no indication of how its objectives should be defined. The aim of this study was to examine the perceptions of researchers engaged in interdisciplinary research regarding the design and development of CH education modules.
IPE and multiprofessional education are examined in the literature [
An interaction involving collaborations between students from differing subject areas in pooling their disciplinary knowledge in addressing complex and significant, real-world problems [leading to] the ability to understand and be understood by a diverse group of specialists.
Smith and Clouder [
Overall, within an interdisciplinary team,
Indicatively, IPE barriers have been identified in a study by Hall [
Beyond IPE among health professionals, CH training involving all relevant disciplines is not well explored. Attitudes toward interdisciplinary training have been studied where staff and students have been drawn from medical and engineering backgrounds. In a study by Spoelstra et al [
Mountford et al [
From another perspective, the value of interdisciplinarity in research has been critically examined [
These studies introduce descriptors of interdisciplinary research [
IDE assumes innovative teaching methodologies, as it should foster active students’ involvement, exchange of opinions, and cooperation. The most widely used paradigms for IDE include competency-based learning, PBL, project-based learning, and design-based learning. Competency-based learning builds students’ knowledge, one competency at a time. In that sense, it is a natural way to introduce different disciplines from along the continuum of learning into the students’ body of knowledge. The formative method of assessment used in competency-based learning places an emphasis on the application of knowledge in a certain situation (problem), focusing this educational paradigm on the skills acquired by the students [
When considering project-based learning versus PBL, the starting point in both approaches is a problem; however, in PBL, students’ activity is directed to
Design-based learning has recently been proposed [
Project-based learning and design-based learning methods seem to present differences, as discussed in the study by Stokholm [
To address the aim of this work and explore academic IDE toward the evolution of CH, a cross-institutional (Aristotle University of Thessaloniki [AUTH], Greece, and University College Dublin [UCD], Ireland), multistep qualitative approach was defined. Although these institutions are geographically distant, they are similar in many respects. Both universities are state funded, and they both have highly competitive, long-standing, and sought-after professional health education programs (nursing and medicine) and computer science and engineering programs. They also have well-developed collaborative interdisciplinary postgraduate research education programs, which have a CH ethos at their core. The AUTH Lab of Computing and Medical Informatics and Biomedical Imaging Technologies (MI-LAB) and the UCD Insight Centre for Data Analytics are international leaders in CH research and have collaborated in several EU-funded CH projects, for example, the initial training network “Connected Health Early Stage Researcher Support System” and the project “Championing a Multi-Sectoral Education and Learning Experience to Open New Pathways for Doctoral Students.”
The data collection was conducted in two stages:
Stage 1: interviews with CH researchers to explore specific themes
Stage 2: workshops to further examine and elaborate on themes emerging from stage 1
Stage 1 research was undertaken in AUTH, whereas stage 2 data collection was undertaken in UCD.
Interviews were undertaken with researchers in the health informatics sector collaborating with the AUTH MI-LAB, Greece. The purpose of the interviews was to gain insight regarding the views of researchers about the needs for CH education and the ways in which CH education could be best delivered. Ethical review was not required as this study was the evaluation of standard educational practices. All participants consented to participate and were assured of confidentiality and anonymity. The interviews were undertaken by an experienced qualitative researcher who has published several papers that have employed similar research methodologies [
All staff and postdoctoral and doctoral researchers employed in or closely collaborating with AUTH MI-LAB in health informatics research or education were invited to participate in the study. A total of 9 individuals agreed to be interviewed, comprising 2 staff and 7 early-stage researchers (at the postdoctoral or PhD level). The majority of those interviewed were engineers or computer scientists, who had specialized in health informatics. All those interviewed had undertaken their research in an interdisciplinary context and had experience of communicating with a broad range of disciplines. All researchers had contributed to the health informatics module delivered to the undergraduate medical students at Aristotle University. The interview schedule is presented in
This stage included workshops to gain further knowledge and insight. These workshops took place at the Insight Centre for Data Analytics, UCD, Ireland. The method used in both workshops was based on the structured group feedback approach [
Workshop 1 was entitled “Finding our way for interprofessional connected health education” and followed a 3-phase procedure. In phase 1, participants were split into
This workshop had 10 participants, all of them researchers in CH, including postdoctoral researchers (n=3), PhD students (n=4), and professors (n=3), from medicine, physiotherapy, business, social sciences, and ICT backgrounds. The duration of the workshop was 2 hours.
Workshop 2 took place during a full group meeting of CH researchers at the Insight Centre and included 16 participants, including postdoctoral researchers (n=4), PhD students (n=10), and professors (n=2). The disciplines represented were the same as those of the first workshop. The duration of this second workshop was less than 2 hours. Building on the outcomes of workshop 1, the purpose of this workshop was to refine and elaborate on specific points. Therefore, the previous procedure was followed, but with the addition of two new questions that focused on preconceptions in an interdisciplinary team that could be addressed through education and the focus of an interdisciplinary CH course (see
The analysis of the interviews revealed a number of key themes as follows: challenges concerning IDE, recommendations in relation to developing IDE, and positioning of IDE within a curriculum (
Emergent themes and subthemes from the interviews undertaken at the Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University.
Theme | Subthemes |
Challenges identified to interdisciplinary learning | Communication, state-of-the-art knowledge, and resistance to interdisciplinarity |
Recommendations for an interdisciplinary learning environment | Learning environment and link to real-world practice |
Position of the interdisciplinary module within the study program | Need for skills and experience and early integration |
The researchers interviewed in health informatics domain at the Aristotle University identified several key themes in relation to CH and CH education. They identified several challenges that centered on working across and between disciplines. The challenges were frequently associated with communication and the difficulty experienced in communicating their own key disciplinary concepts while also understanding those of an individual from another discipline in an interdisciplinary context. They identified that each discipline perceives ideas and concepts differently and that it can take time to convey these concepts to an individual beyond their own discipline. One researcher commented as follows:
Difficult because we cannot communicate properly our needs both of us...I ask something my own words because I have something on my mind and I say because it is a different way of thinking so we have to sit down and discuss for a long time so that we can understand each other.
The fast pace of technological advancement is beyond doubt; however, some concern was expressed regarding the up-to-date understanding of members of other professions within the team. One participant commented:
The problem is with the older doctors who think technology is not for them and try to put the burden on you...they too must understand things so that they can help me and their selves.
The interview participants frequently referred to their links with health care staff, their need to work together, and the importance of being able to communicate and collaborate as being an essential element of their work:
...constantly in communication with the health care professionals in order to explain to them how to explain to the patients how to use our devices and our applications.
A number of participants raised the possibility of resistance from other disciplines to engage in an interdisciplinary context:
I don’t know the level of willing that’s let’s just say from different departments to join forces.
The staff who were interviewed had considerable experience in terms of education delivery, many of whom had delivered lectures and supported the laboratory lessons for the undergraduate medical program and curriculum. When they were asked to describe how best they thought IDE could be delivered, several critical recommendations for learning emerged.
A number of participants recommended that students should learn to work as part of a multidisciplinary team from early in their education, as they believed this would prepare them to collaborate and communicate with disciplines beyond their own from early in their careers:
...laboratory sessions for students...team orientated...multidisciplinary projects for the students in order to learn from early on how they can collaborate and how they can speak the same language.
A number of participants identified the importance of learning in an enjoyable environment because they believed that this promotes better engagement and an opportunity for students to extend their learning beyond their own disciplinary limits:
...have a little bit of fun a play…play that will turn on your imagination not for hard work…that you are doing daily…let's have fun and be out of the box you know...
One person identified the value of interdisciplinary work as a means of empowering students to link research and clinical outcome:
More practical things how to link the research with the clinical outcome.
Another indicated that interdisciplinary work is an opportunity to innovate in terms of education and enable the introduction of contemporary topics with a view to stimulating student interest in engagement and learning:
...cutting edge and innovations which are currently hot in the science field.
The interview participants made some recommendations in terms of the position of an interdisciplinary module within a program. A number of participants commented that owing to the wide variety of career pathways that can be chosen by electrical engineers and computer scientists, many of which do not involve engagements with health care, it was thought that offering such an opportunity late in an undergraduate program or as part of a master’s degree program would be most appropriate One participant commented as follows:
...only at the last years when you have chosen your faculty...because electrical engineering is versatile...its only one tenth of what engineering can do.
Another participant indicated that introducing such innovations at an early stage within the formalized education cycle might be difficult; however, it could be developed initially as an extracurricular activity:
...in order to include this seminars this lesson in the everyday curriculum of high school or the first semester of college or university I think this is a little bit difficult all this could be in extracurricular.
With respect to existing or potential cases of IDE, quite a few education examples emerged—“Patient care in the long term” or a “CH design project” (similar to a weight management program design). These cases were distinguished from other more clearly multiprofessional education examples such as biotechnology programs, patient care in
With respect to positioning of the module within the program, two levels were identified for CH education with two different aims: (1) at undergraduate level for awareness-raising purposes, not necessarily focusing on interdisciplinarity, and (2) at postgraduate level for actual interdisciplinary research. An alternative idea was to embed elements within different courses at the undergraduate level. At the undergraduate level, it was found essential to inform students about the roles of different actors and to address misconceptions, perhaps by presenting examples of how interprofessional projects worked. To build a common language within an interdisciplinary PBL team, participants believed that some time has to be invested, and each member has to have at least an undergraduate level of proficiency at their discipline. This indicates the master’s level as an appropriate time for achieving the second aim of CH education. At later stages, it was felt that the lack of time, professional duties, and professional bias might hinder the potential involvement in interdisciplinary research teams.
Project-based and problem-based courses were discussed as a means to involve young researchers, with
In general, teamwork learning was placed as the central concept toward better understanding the domain and the team and meeting patient care needs. Learning from experience is important; therefore, an idea offered was to
Our research suggests two areas where improvements can be made in the synthesis and design of new CH education concepts: (1) overcoming disciplinary boundaries and (2) designing for disciplinary interaction. These build into a model for IDE for CH as illustrated in
A model for interdisciplinary education for connected health.
Our research identifies three challenges that must be overcome in the design of new CH education programs to ensure cross-disciplinary engagement: communication challenges, state-of-the-art knowledge, and resistance to interdisciplinarity. We have combined insights from both the literature and the data gathered to develop suggested responses to the challenges identified as outlined below.
In the first instance, our data indicated that difficulties regarding the different perceptions of ideas and concepts were hindering interdisciplinary endeavors. Participants also highlighted the difficulties posed by multiple disciplinary
On the basis of participants’ insistence that understanding alternate perspectives is key, we borrow from design thinking literature to suggest the use of empathy interviews to gain an understanding of multiple viewpoints. Sarasvarthy [
The second major challenge raised throughout our research was the divergence in knowledge across disciplinary boundaries as to the availability of state-of-the-art technologies.
We accept participants’ recommendations from our workshops that students be encouraged to
Our data indicate an unwillingness among some students, researchers, and practitioners to reach across the disciplinary divide.
We recommend iterative processes in the education modules as per the principles of design-based learning discussed in the Introduction section [
Our research indicates two major factors that lead to the successful design of interdisciplinary CH education: (1) the nature of the education module and (2) the positioning of the module within the education program.
Overall, two key issues arose as to the nature of the education experience when seeking to integrate disciplines that may assist in the design of successful CH education going forward. The first is the creation of an enjoyable and challenging educational environment. Our data suggest that innovation and interest are key to the design of such an environment. The second is the necessity to link research and education together with its corresponding outcome, as our study confirms that education recipients wish to map their educational and research activities onto real-world practice. We recommend the use of both problem and project-based learning approaches to address both environment and application needs. Our workshop results suggest that although project-based activities are more suited to health- and well-being–focused challenges and educational outcomes, problem-based learning is more likely to address those that focus on patient care.
Our data suggested a divergence of opinion as to whether these modules and the learning associated should be delivered early or late in the educational life cycle. Arguments for early delivery center on the advantages of early integration and the embedding of interdisciplinary attitudes. Those who advocated later delivery were concerned that the lack of developed skills and knowledge at that point might hinder useful interdisciplinarity. In response to both sets of concerns, we recommend a dual approach suggested by our workshop participants, which sees early awareness-raising activities (at the undergraduate level) followed by later problem- and project-based learning activities (at the master’s level). Introducing interdisciplinary CH learning in this way is supported by Schön’s work in relation to the role of reflection in professional learning discussed by Atkins and Murphy [
The CH ecosystem sets the basis for the investigation and deployment of new care models, leveraged by technology [
This study relied on surveyed opinions and views across multiple disciplines, attempting to provide some insights on the existing challenges and to indicate potential directions for (successful) implementation of CH education. It mainly focused on the inherent interdisciplinarity in the field, explored the interdisciplinary-related barriers, and offered solutions for overcoming interdisciplinary boundaries and designing CH curriculum.
We consider this work as a first step in investigating pathways to successful CH education. Although this work might be limited in terms of number of organizations involved in the workshops used to define the themes and challenges of interdisciplinary education, the number of identified disciplines mentioned in the obtained themes and challenges reassures the quality of achieved results. A wider multicountry mapping of needs and ideas would further contribute in terms of context-related barriers and enablers as well as in the formation of multicultural CH educational networks. To create solid evidence in this area, the work of Car [
This work contributes useful inputs for CH curricula design with a focus on interdisciplinarity, both with regard to the alleviation of barriers and the design of interaction between different stakeholders in CH.
Interview schedule.
Workshop 1 questions.
Workshop 2 questions.
Aristotle University of Thessaloniki
connected health
Cooperation in Science and Technology
European Network for the Joint Evaluation of Connected Health Technologies
European Union
information and communications technology
interdisciplinary education
interprofessional education
mobile health
Lab of Computing and Medical Informatics and Biomedical Imaging Technologies
problem-based learning
University College Dublin
This article is based upon work from COST Action ENJECT TD 1405, supported by COST (European Cooperation in Science and Technology; www.cost.eu). The participants of the two workshops in Dublin and the interview participants in Thessaloniki are especially acknowledged.
IC and TC designed the study. IC conducted the workshops at UCD, with the support of TC, and principally edited the manuscript. NM contributed toward the consolidation of results, synthesis of concepts, and editing of the manuscript. VT and TLT contributed with ideas for the CH education paper, literature enhancement, and editing of the manuscript. TC (corresponding author) coordinated the whole study, conducted the interviews at AUTH with the support of IC, and edited the manuscript.
None declared.