Annette Cleveland Nielsen

Project Manager, eHealth researcher

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eHealth is a fairly new research area within hearing loss (HL) and this project intends to enlighten the significance of information and communication exchange in living well with HL. The project involves three target groups: elderly persons with hearing impairment, their significant others (family or friends), and audiologists in the research of innovative and empowering eHealth solutions. The three target groups’ perceived problems and their visions for eHealth assisted rehabilitation and living well with HL are the basis for this project. The target groups input and feedback are incorporated in the project through focus group activities with dialogue, debate with the researchers, and by engaging them in the design process.

User-centered design methodologies

  • Users, here the three target groups, will be at the center of our methods.
  • Understanding users is of great importance to design of eHealth solutions (Bélanger et al, 2012).
  • Users can contribute with original innovations of health technology like eHealth solutions (Kanstrup et al, 2014).
  •  We will develop our solutions following
    • The User Innovation Management (UIM) method (Kanstrup & Bertelsen, 2011) and
    • The human-centred design of interactive systems ISO 9241-210:2010 method involving the users in innovation and design of eHealth solutions to hearing health care.
The method is iterative and preliminary prototypes and system architecture of increasing maturity will be produced and evaluated with the target groups in the different focus group activities.

Focus groups activities

Through three rounds of focus group activities, all lasting 2 hours, we will have involved 36 elderly persons with hearing impairment, 10 significant others and 8 audiologists in creating user designed and innovated eHealth solutions for service delivery to elderly persons with hearing impairment:

  • November 2016 Focus groups with hearing aid users, relatives and audiologists
    • Specifying user requirements and visions for a future hearing loss client journey
  • March 2017 Focus groups with hearing aid users
    •  Producing design solutions from the visions and prioritizing them
  • April 2017 Focus groups with hearing aid users
    • Evaluate the designs for specific eHealth solutions

The context of use in the focus group activities in November was within the four-phased hearing loss client journey that all people with hearing loss go through during their hearing loss rehabilitation (Figure 1). Since our attention is on how to design eHealth solutions for hearing health care, we only included the fitting phase (the face-to-face consultation in clinic) in some of the focus group activities

  • Appetite3 The hearing loss client journey
    Figure 1 - The hearing loss client journe
In the second focus group meetings in March, we used large wireframes within the themes “My Information”, “My Hearing”, and “My Development”. The wireframes were illustrating app solutions from the visions from the users in the future hearing loss client journey, as illustrated in the picture below
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    Figure 2. Project researchers showing wireframe “app” solutions. From left to right: Prof. Anne Marie Kanstrup, AAU, Sergi Rotger Griful, Eriksholm Research Centre and Annette Cleveland Nielsen, Project Manager Eriksholm Research Centre.
In the third focus group meetings in April, the participants worked with mock-up “apps” on iPads, as seen in the picture below
  • appetitfg3
    Figure 3Adults with hearing loss using mock-up “apps” on iPads.


Participants were recruited through different means. We had great help in the recruitment process by the partners shown on the right banner. Adults with hearing loss were mainly recruited through local associations of people with HL, social media (i.e., Facebook), and research participants from the database of Eriksholm Research Centre. The latter was also the main recruitment strategy for significant others. Hearing care professionals were recruited through personal networks and communications with public and private hearing clinics.


All focus group meetings were video-recorded and resulted in rich datasets. Findings from November 2016 present 1) insights on the complex interplay related to eHealth assisted hearing rehabilitation (Figure 5), 2) specification of user requirements for eHealth assisted hearing rehabilitation, and 3) an integrated design of a mobile eHealth application with the functionality and interaction defined in cooperation with the key actors.

The complex interplay in hearing rehabilitation is shown in Figure 5. The complex interplay relates for instance to persons with hearing impairment’s requirements for personalised information delivery with the right timing, timely on-demand communication, and ongoing learning about hearing, hearing aids, new available technology and self-management. The participating significant others express requirements for access to the same information as the persons with hearing loss and involvement in the hearing rehabilitation process. The audiologists have requirements for efficient communication with persons with hearing impairment and empowered persons with hearing impairment taking responsibility for their rehabilitation.

From the focus group meetings in March 2017 we learned that adults with hearing loss would like eHealth solutions to enable ongoing personalized

  • Reflections on expectations for living with a hearing loss
  • Learning opportunities and structure for self-learning and self-management
  • Data collection and analyses of my hearing – to share with significant others, mentors, and audiologists

In April, the participants gave further insight and evaluations within the eHealth solutions for “My expectations”, “My personal hearing coach”, and "My development".

Expected outcomes

By involving the user through the entire design process, we expect to develop and design eHealth tools that fulfill the real needs of the people that the tools were designed for. Furthermore, we will end up with a large pool of design concepts and a human-centered design know-how that will be key for developing other eHealth solutions in the future.

Further reading:

European Committee for Standarization. (2010). Ergonomics of human-system interaction - Part 210: Human- centred design for interactive systems (ISO 9241-210:2010).

Bélanger E., Bartlett G., Dawes M., Rodríguez C., Hasson-Gidoni I. (2012). Examining the evidence of the impact of health information technology in primary care: An argument for participatory research with health professionals and patients. International Journal of Medical Informatics, 81(10), 654-661.

Kanstrup, A. M., & Bertelsen, P. (2011). User Innovation Management: a handbook. Aalborg Universitetsforlag.

Kanstrup A. M., Bertelsen P., Nøhr C. (2015). Patient innovation: An analysis of patients’ designs of digital technology support for everyday living with diabetes. Health Information Management Journal, 44(1), 12-20.

Kanstrup, A.M., Rotger-Griful, S., Laplante-Lévesque, A., Cleveland Nielsen, A. (In press). Designing Connections for Hearing Rehabilitation: Exploring future client journeys with elderly hearing aid users, relatives and health care providers. Conference proceedings. Designing Interactive Systems (DIS 2017) Conference, 10-14 June, 2017, Edinburgh, UK

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    Study Partners

    This study is conducted with Professor Anne Marie Kanstrup, Department of Communications and Psychology, Aalborg University.
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    Recruiting Partners

    The following partners are helping us in the recruitment of participants for the focus groups:

    Aleris-Hamlet, Søborg
    Audiologisk afdeling, Bispebjerg Hospital
    Audiologisk afdeling, Nordsjællands Hospital
    Kommunikationscentret Region Hovedstaden, Hellerup
    Regitze Willemoës, Høreklinikken St. Kongensgade
    Videnscenter for Specialpædagogik (VISP), Næstved