Who's users? Participation and empowerment in socio-technical approaches to health IT developments

Health informatics researchers advocating socio-technical approaches to the design, implementation and evaluation of health information technology (HIT) consistently promote the important role of users. Aside from conventional ethical and legal considerations around their involvement, there are a number of philosophical and methodological issues that have received less attention because of the tendency for researchers to assume the term 'user' is well defined and understood. It is however, evident that there are significant differences amongst users, and differences in how researchers engage, involve and interact with them during health IT developments. Failure to acknowledge these differences and their impact on Health IT developments makes comparisons across different studies problematic and raises fundamental questions about participation and empowerment of end-users in our developments. This paper re-examines the term user in the context of socio-technical approaches to HIT and presents a preliminary approach to differentiating between types of users and our changing expectations of their roles in enhancing different HIT projects across design, implementation and evaluation.