3. RESEARCH METHODOLOGY

This chapter covers the details of the research design, encompassing the methodology and

procedures employed to conduct this research. Over the last few decades, qualitative research is

getting very popular in the fields of Computer Information Systems. Implementation of computer

application systems can significantly change the situation dramatically, for the good or

sometimes, even worse. Many systems do not achieve the goals they had been built for. This is

because the needs of the stake holders had not been completely accounted for. The Information

Systems discipline today is considered, a socio-technical discipline, founded on the need to

reconcile technological solutions with the social and human dimensions of business and the

organizational reality Bonnie K & Joseph A M (2005). As the IT industry has grown into a

service oriented industry, the focus has shifted to building software applications based on the

usability of the software by human interaction and behavior. There is now a branch of study

called the Information technology in a global society (ITGS) where the focus of the study is the

study of the impact of information technology on the people and society for the better or worse.

This approach ensures that users do not just use a technology, but the users are provided with an

enhanced experience of living with it. This has given rise to the evolution of software

development approaches like Agile Programming, RAD and Extreme Programming, over the

years, where the development process centrally involves incorporating user requirements at

every stage. As a result, the final product is usable by the end user. The main focus of this

research is to understand the needs of the senior citizens and then design a software application

to cater to their requirements. The work flow for collecting and consolidating the user

requirements has been designed on the lines of Agile software development. This software

development method is based on repetitive and accumulative advancement, where requests and

elucidations progress by teaming and association with the end users. This approach was adapted

here as it would help in adaptive planning, evolutionary design of the interface, and decision of

business model, development and implementation based on an iterative approach. It promotes

rapid and flexible response to change. This model involves the active involvement of the user

throughout the entire lifecycle thus ensures that user expectations are clearly understood.

Prototyping is used to help users for visualization and collect the changes to the system as it is

being built, ensuring that the system being built is what the users really need. This type of

qualitative research method is called design-based technique for exploration here, facts are

collated by consequent estimation during the process of devising, constructing, and testing an

object of importance. The object in focus could be anything like any apparatus, an application

that is developed from IT, the product to solve a cause that is technical and social in nature, a

structure that is theoretically defined, or just a sum up of a theory. In our case the artifact is the

system or model proposed for the social cause of the senior citizens. In summation, it comprises

of a successive iterations of a phase:

Awareness of Problem Suggestion Development Evaluation Conclusion

The consequent progress attained in the artifact or needs of the senior citizens as it is evaluated

depict the possibilities for unifying the facts that evolves from its schematic planning and

development Bonnie K & Joseph A M (2005), Figueiredo & Dias De A (2010).

The steps in Agile Development Model are:

1. Requirements Planning: Defining the concept, the business functions and data, and the

scope of the system.

2. User Interface Design: Proposal of the functional design, specification of system work

flow and processes.

3. Construction: Building a working prototype of main basic features of the system

components, demonstration of prototype with the users and collecting feedback.

Refining the design based on feedback from the users. Development of the final

prototype.

4. Implementation: Deployment stage, this stage again involves demonstration of the

system to the end users who give the final feedback after which the system requirements

are deployed this completes the implementation of the application system.

The research work flow is designed in two main phases- Research Stage I and Research Stage II.

Research stage I focuses in executing the first two steps mentioned above namely, Requirements

planning and user requirements gathering and specification of a functional model. The Research

Stage II would focus in executing the step 3 that would help in finalizing the final user

requirements. Step 4 would cover modelling research that would include technical architecture

design, development and implementation. The deliverable after every state of the research design

is as shown in figure 3.1.

Figure Error! No text of specified style in document..1 Steps of Research Design

3.1 Research Stage I

Research Stage I pertains to requirements planning and functional design. The research

execution plan comprises of a combination of explorative and survey research. The explorative

part involves review of pertinent literature and the survey; this is aimed at requirements

gathering from domain experts, end users and other beneficiaries. This depicted in figure 3.2.

The primary data from survey and the secondary data from the reports both will be analyzed to

understand the requirements in order to design the system.

Literature Review The details of literature review are elaborated in chapter 2. The following are the details of the

reports referenced.

1. Research Reports of NGOs Agencies working for the Social Cause.

a. Study of proprietary research reports published by Agewell. This Delhi based

NGO established in 1999 and has been working for the cause of senior citizens in

order to empower them and provide the necessary care and welfare of older

persons since the time of its inception. Agewell has a network of over 1500 NGOs

over 6500 volunteers and 70000+ sub-volunteers spread across 540 districts of

India. Agewell interacts with over 2500 older persons and other concerned people

on daily basis through its nationwide network of volunteers.

Figure Error! No text of specified style in document..2 Research Stage I

b. Study of proprietary research reports published by Helpage India. This is another

NGO, that has been actively participating in the Age Demands Action Campaign

of HelpAge International since 2007, they organize different activities for the

underlying theme of assertion of rights and entitlements of older persons in the

country.

2. Research Reports of Government of India for Senior Citizens to understand the

initiatives taken by them.

3. Research Reports of Health issues of Senior citizens published by International

agencies like WHO. This will help to understand the common health problems faced

by the senior citizens.

3.1.1. Analysis Report of Secondary Data from Literature

Analysis of secondary data from the proprietary reports of Agewell and Helpage India revealed

the results shown in fig 3.3

Figure Error! No text of specified style in document..3 Secondary Data Analysis

3.1.1.1 User Requirements Gathering The requirements of the senior citizens have been consolidated based on secondary data from the

proprietary research reports. To validate these requirements a survey was conducted with Senior

citizens in the Navi Mumbai area. This would help in deducing if these requirements from the

secondary sources are sufficient or are there any additional requirements?

3.1.1.2 Sampling Jyeshta Nagrik Association consists of members who are senior citizens of India. The Navi

Mumbai wing has a membership base of nearly 1000 in the Nerul suburb alone. Most of them are

active and well informed and are working for the cause of serving towards the wellbeing of the

senior citizens community. This organization is run by the senior citizens themselves and they

have the involvement with many more of them, this organization was chosen as the best place to

conduct the survey in order to assess the needs of the senior citizens. A convenience sample was

used in this study. The inclusion criteria were: voluntary participant in this study, being 55 years

or older. Apart from this a survey was also conducted among 100 random samples like senior

citizens living in the vicinity, building etc. A questionnaire was designed and distributed among

the senior citizens to be completed by them. This was distributed to all the members of the senior

citizens association in 3 different suburbs in the Navi Mumbai Area, Nerul, Kharghar and Vashi.

Each of these centers has about 1000 members each.

Table Error! No text of specified style in document.-1 Sampling Details for Primary Research

3.1.1.3 Design of Data Collection Instrument A survey form was designed and distributed among the senior citizens to be completed by them.

This was distributed to all the members of the senior citizens association in three different

suburbs in the Navi Mumbai Area, Nerul, Kharghar and Vashi. Each of these centers have about

1000 members each. The survey form was distributed to other senior citizens living in the

vicinity also and they were asked to fill it up at leisure. The final number of forms collected back

with survey completed was 456. The research instrument is given in the Appendix A [Form - A].

Association/Building Locality Approx. Sample Size

Jeshta Nagrik Association Nerul 1000

Jeshta Nagrik Association Kharghar 580

Jeshta Nagrik Association Vashi 1500 Jimmy Park Co-operative Housing Society (Building inhabited by many Senior Citizens)

Nerul 30

3.1.1.4 Primary Data Analysis The primary data collected from the survey was analyzed to understand the following points:

Validation of the requirements that have been identified from the secondary data.

Identifying new requirements

Identifying requirements that can be dropped.

Willingness to adapt and use an Internet based technology, for their health care, essential care

and social interaction with their peers.

The primary data analysis is depicted in figure 3.4.

Figure Error! No text of specified style in document..4 Primary Data Analysis

3.1.1.5 Discussions with Domain Experts – Health Practitioners and NGOs

Discussions with Health Practitioners

Discussions were held with health practitioners to understand, their requirements to help them

serve the senior citizens better. The steps to store medical records and also to understand

regulations to be followed for the same were discussed. The following health practitioners were

interviewed:

Dr.(Mrs.) P. R Chakra- MBBS General Physician

Dr. (Mrs.) Gaiki MD (E & T Specialist)

Dr. (Mrs.) Aruna Mayank MBBS General Physician

Dr. Sundaram MD Surgeon

Dr. Ramani MD

Dr. (Mrs.) Kinjewadekar MD Gynecologist

Dr. G. Padmanabhan M B B S General Physician

Dr. (Mrs.) Hema Anand MD

Dr. P Padmanabhan MD

Dr. (Mrs.) Ratna Pedhamkar MD

Dr. Pedhamkar MD

Dr. (Mrs.) Jyothi Prabhakar MD

Consolidation of Points Discussed

Common health issues with senior citizens: Mainly NCDs like diabetes, hypertension

(BP), dementia, knee problems, heart diseases, frequent fractures, eye problems, and

hearing problems.

One of the doctors stated that out of the diseases mentioned above, the main disease that

India will have to deal in the coming years is diabetes and if technology can be used to

analyse the data so that the cause to fight it can be determined, then it will be a great idea.

The doctor also mentioned that they have been told that India was expected to be the

country with the top most number of cases and that too it will occur with the younger age

group1. Research with data mining tools can be undertaken and the lifestyle of the people

can be analyzed. The system that is being designed should contain the following features:

o Health Monitor

Diabetic blood sugar monitor

Sleep hours monitor

Fitness monitor

Pressure monitor

1 http://www.emedicinehealth.com/diabetes, http://diabetes.co.in/

Diet monitor

o Online Counseling with doctors

o Prediction based on health conditions whether a person is prone to diabetes

o News about drugs

o Tutorial about self-administering insulin

o Reminders to administer insulin

About health records being maintained online, two of doctors opined that this will add

work for the doctors, but may be if the format is standardized, they can be given a

softcopy that can be automatically uploaded into the system. Others felt that this is a good

feature, as most of the patients do not know anything about their records, and it would be

not an issue to enter the details into the system.

Many of the seniors do not realize that they need to visit the doctors, so a little bit of

online counselling would help them to understand and overcome their inhibitions. They

can also be convinced that the best way to address the issue is by going to the doctor.

Most of them need to be made to understand the need for following a good exercise

routine, reduce intake of coffee, sweets and smoking. Their awareness about fitness

should be improved with the help of the system.

The awareness about the NCDs itself can help them to understand why they have to come

for treatment, how could they prevent the incidence of the NCDs.

Regarding the regulations for medical records, the doctors suggested that many

applications based on EMR or EHR are already available, these systems will ensure that

the standards are in place; many of them are free of charge and can be reused so that it

can be used for a large database of users.

Discussions with NGOs Associated with the Social Cause

Discussions were held with social organizations working for the cause of senior citizens, to

understand the needs of the senior citizens from their own experience.

1. Jyeshta Nagarik Association President Mr. Kinjewadekar

2. Jyeshta Nagarik Association – Mr. Chapke

3. Silver Innings – Mr. Bhavesh

Consolidation of Points Discussed About Requirements for Senior Citizens

The senior citizens should be made to get actively involved in volunteering activities to

help each other.

Most the senior citizens require assistance at home to do regular check-ups, in case of

emergency they need to be able to contact local doctors who are willing to come for

urgent care.

Many health check-up camps are being held but, there should be a way to network

different health service providers to organize more camps.

Many of the seniors do not get the message about these camps and even if they get, they

do not have any awareness so they don’t attend these camps. We should help them to

improve their awareness.

Information about the schemes given by insurance companies and the Government

benefits should reach the senior citizens.

They should be able to network on online forums among others.

Many of them want financial assistance, part time jobs, some of them want to study, and

access to such opportunities could be provided.

Many of the seniors do not understand how to use the health devices like glucometer,

video tutorials in the local language should be uploaded in the site.

Shopping for medical supplies like adult diapers, strips for blood sugar tests etc would be

convenient if it can be delivered to their doorstep.

Many of the senior citizens want assistance at home; they need people who can do day-

to-day jobs, some of them need nurses, or people to attend bedridden patients.

Some of them want to sell property, and need assistance for the same.

Consolidation of Points Discussed About System Requirements

The NGOs welcomed the idea about designing and developing a system to help them to manage

the services for senior citizens. But they had three key concerns:

1. Capital investment: Implementation of any system that would cater to the needs of a

huge community definitely calls for a huge investment of capex for infrastructure. As the

number of users begins to grow, additional infrastructure has to be added.

2. IT operations and training of staff: The management and control of the administrative

functions, and customer support would require investment for training their existing staff;

it would also involve a huge shift in terms of work culture. Additional expenditure would

be to hire IT experts to handle maintenance operations. As a consequence, the focus of

the NGOs gets diverted to handling the IT operations rather than their core task.

3. Application flexibility and sustainability: The system should be user friendly for the

end users to use without much training, the billing and administrative operations should

be easy to handle, the system should be flexible for new add-ons. It should have the

potential to sustain the operations of a huge customer base with a good processing speed,

and efficiently utilize the infrastructure.

3.1.2. Requirements Analysis Summary The study of data from secondary sources, facts from the proprietary reports, and some more

requirements from the survey which is the data from the primary sources showed that the

problems of the elders in the country of India pertain to social set up, legal issues, facilities for

health care, conditions pertaining to psychology, financial needs and relations with other people

in the society. It is also evident that the major areas which they need care is more related to

health. The senior citizens have opined that they are willing to adapt to the changes in social

environment and medical aid Agewell (2010). They are also open to adapt to the use of the

internet technology, for social interaction with their peers. Health is a by-product of emotional

well-being; the objective is to help the senior citizens to have a high wellness quotient by the

following the approach shown in figure 3.5.

The system will help to build their overall wellness by the innovative use of information

technology so that their

Awareness about healthy lifestyle, fitness, disease prevention is improved.

Access to Health care services, home health care services, essential service and

information is established.

Assistance to manage health, wealth and personal portfolio is given.

This will promote their wellness and lead to healthy ageing.

Figure Error! No text of specified style in document..5 Final Requirements Analysis

Summary

3.1.3. Technical Feasibility Study

3.1.3.1 Technical Literature Review The review was covered in Chapter 2 in section 2.3. This was aimed to understand the following

details.

a. Existing technical options available in health care.

b. Requirements of Health care organizations in India,

c. The barriers for the adoption of Information technology in health care in India

d. The Federal regulations imposed.

e. Limitations of existing options.

3.1.3.2 Technical Options for design of SCWM The review of literature on covered in Chapter 2 section 2.3 helped in identifying the technical

requirements for developing a model for catering to the senior citizen’s needs. The details are

discussed in chapter 4.

3.1.3.3 Software Requirements Specification The outcome of the Technical feasibility study is the software requirement specification this is

also covered in chapter 4.

3.1.4. Proposal of Functional Model The outcome of the primary research is the functional model. However the design details of the

functional model are covered under modeling research in chapter 5.

3.2 Research Stage II

Figure Error! No text of specified style in document..6 Research Stage II

The Research stage II as shown in the figure 3.6 would involve design of the prototype,

demonstration of the prototype to the end users, collecting end user response, analysis of the end

user response, and adding the additional requirements to the prototype. This cycle will continue

till the user requirements are finally refined and the deliverable at the end of the research stage II

is the final prototype. The prototype will be implemented and tested for deployment. This will be

followed by the feedback from the end user, NGOs and health practitioners about the final

prototype.

3.2.5. Design of Prototype Based on the functional model proposed for SCWM, a prototype to demonstrate the basic

features of the system interface was designed for presentation at Senior Citizens Associations.

This was designed based on the primary requirements gathered from the user and analysis of

secondary data from proprietary reports. The prototype was created using Wordpress, a blogging

software. A wire frame for the menu and interface screens was created on the internet. The

openEMR software was integrated in the interface and other health care services were added

with sample data. Health tracker was created using PHP and Mysql.

3.2.6. Demonstration of Prototype at Senior Citizens Associations The demo of the prototype along with a story board, poster and PowerPoint presentation was

done at the following centres. The details of the type and size of sample is mentioned in table

3.2.

Table Error! No text of specified style in document.-2 Sample Details for Secondary Research

3.2.7. End User Survey About Prototype Design

A feedback form with questions pertaining to the broad area of services proposed in the

prototype, this instrument can be found in the Annexure A [Form – B]

Questions to judge the user’s comfort level in using a web based system and mobile based

system.

Overall rating, about the system whether it would serve the needs and promote wellness.

3.2.8. Analysis of Survey Results This demonstration was well received at all the associations. A survey was conducted among the

senior citizens after the presentation to get their opinion and feedback about the system. The

demo at Silver Innings, Mumbai – an NGO working for the cause of Senior Citizens, was also

well received and some additional requirements were suggested. These results are consolidated

and presented in figures 3.7 to 3.11.

Name of the Organization Type of User Sample Size

Jyeshta Nagarik Navi Mumbai- Nerul Phase I

Jyeshta Nagarik Navi Mumbai- Nerul Phase II

Jyeshta Nagarik Navi Mumbai- Vashi

End User 88

Kanchan Foundation, Vashi NGO Administrator 3

Silver Innings, Mumbai NGO Administrator 2

Health Services: Do you suffer from any of the following health problems?

Figure Error! No text of specified style in document..7 Survey Results of Current Health

Problems in Senior Citizens

Figure Error! No text of specified style in document..8 Survey Results of the Health Services

Offered

Figure Error! No text of specified style in document..9 Survey Results of the Additional

Services Recommended/Needed

Figure Error! No text of specified style in document..10 Survey Results of the Essential

Services Recommended/Needed

Figure Error! No text of specified style in document..11 Survey Results of Information and

Consultation Services

3.2.9. Additional Requirements Identified New Essential Services Requested

Personal Care/ beauty services

House maintenance and designing make it safe and comfortable for seniors

Shopping- medical supplies

Tutorial of medical devices in local language

3.2.10. Additional Services Requested

Insurance

Government scheme information

Forum for interaction with peers

Personal portfolio

Jobs- part time

Training opportunities

Shopping of medical supplies

Finding a partner

Entertainment events

Gaming

Buying /Selling

3.3 Modeling Research

The modeling research would focus on designing and development of a prototype to serve the

needs of the senior citizens community. The steps in the Modeling Research Plan are shown in

figure 3.12.

Figure Error! No text of specified style in document..12 Steps for Modeling Research

The Modeling Research would be detailed in the Chapter 5.

3.4 Summary of Research Methodology

Research stage I involved the requirements planning and functional design. The approach was a

combination of explorative and survey research. The explorative part involved review of

pertinent literature and requirements gathering from end users by survey, discussions with

domain experts, and other beneficiaries. The primary data from survey and the secondary data

from the reports both were analyzed to establish the needs for enabling the system design

process.

In the research stage II the prototype was designed and demonstration of the prototype to the end

users was conducted, response was collected, analysis of the end user response, was done. This

helped in identifying the additional requirements to the prototype. This cycle continued till all

the user requirements were consolidated. This development would be repetitive and done in

small increments that would eventually enable the inclusion of and refinement of solutions by the

involvement of the end users at all the steps . This approach was adapted here as helped in

adaptive planning, design of the interface, decision of business model, development and

implementation based on an iterative approach. It also enables rapid and flexible response to

change. This model involved the active involvement of the user throughout the entire lifecycle

thus; it ensured that user expectations were clearly understood. Prototyping helped the users

visualize and request changes to the system as it is being built, this ensured that the system being

built is according to the users need.

The details of the technical feasibility study would be detailed in chapter 4 and modeling

research involving the final prototype design would be covered in chapter 5. User Opinion about

the final prototype will also be taken and the details can be found in chapter 6.