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Exploring complexity and learning: insights from the DIBH-app project using NASSS-CAT
Health Sciences Research Unit: Nursing, UICISA: E, Univ Coimbra, Coimbra, Portugal; Nursing School of the University of Coimbra, ESEUC, Univ Coimbra, Coimbra, Portugal.ORCID iD: 0000-0001-5722-5612
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID iD: 0000-0003-0976-531X
Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden; Department of Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden.
2026 (English)In: Health Services & Outcomes Research Methodology, ISSN 1387-3741, E-ISSN 1572-9400Article in journal (Refereed) Epub ahead of print
Abstract [en]

Digital health tools, such as radiotherapy preparation apps, can support person-centred care, though their development is shaped by evolving complexity. This study examined how perceived complexity changed during the development of the Deep Inspiration Breath Hold Preparation App and assessed the utility of the NASSS-CAT. A longitudinal observational study was conducted, with complexity assessed at three development stages using the NASSS-CAT. Stakeholders from clinical, academic, and industry settings completed individual assessments followed by group discussions. Quantitative data were analyzed descriptively; qualitative data provided contextual understanding. Perceived complexity varied by domain and over time. Initially, technical complexity was rated highest. Over time, total complexity declined, especially in strategic and operational domains, reflecting greater integration and shared understanding. The NASSS-CAT supported stakeholder reflection and adaptive decision-making. Integrating complexity-informed evaluation into development processes may improve the scalability, sustainability, and person-centredness of digital health interventions.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2026.
Keywords [en]
Complex systems, Co-creation, Digital health Innovation diffusion, Patient-centered care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-35458DOI: 10.1007/s10742-026-00373-0ISI: 001718237600001Scopus ID: 2-s2.0-105033361748OAI: oai:DiVA.org:hb-35458DiVA, id: diva2:2050882
Note

Fundng: Universidade de Coimbra 10.13039/501100005727

Available from: 2026-04-07 Created: 2026-04-07 Last updated: 2026-04-07Bibliographically approved

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Brovall, Maria

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456789107 of 158
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