Every study has limitations or factors that can influence the results. Within this chapter, these possible influential factors and limitations are presented. In further research regarding this topic, these factors and limitations can be kept in mind whilst analysing the results or they can be overcome when the research itself is conducted again. Moreover, this can provide an understanding of why the results obtained might differ from other researcher’s work.
7.1. Literature and Interviews
The results obtained through the interviews agree with the results obtained through the literature review. In some aspects, the results from the interviews build forth on the literature: some new barriers and facilitators come to light, such as the importance of health risks related to hardware devices, liability issues as well as smooth distribution channels.
Moreover, some barriers and facilitators discussed in literature were not mentioned by interviewees. This could have several reasons. During the interviews, stakeholders are asked to come up with barriers and facilitators. However, this requires them to think of a complete list on the spot. The interviewees are inspired by other things discussed during the interviews, which triggers thoughts about barriers and facilitators. Nonetheless, this means that many facilitators and barriers could be forgotten or overlooked and, therefore, not mentioned during the interview.
For the interviews, semi-structured interviews were chosen since they allow for freedom in answers whilst ensuring the most important topics are covered. However, as the researcher would perform the interviews more often, they were inspired by the answers of the previous interviewees. This means that interviewees would cover a topic not originally addressed in the semi-structured interview questions, but the researcher would cover this topic in the subsequent interviews. Therefore, the participants who were interviewed later on during the research study have answered some slightly different questions than the first interviewees. This is allowed in semi-structured interviews, but it could have influenced or altered the results obtained. This does stress that this research study provides qualitative results, rather than quantitative.
The cost-efficiency of the facilitators are estimated based on the claims obtained. In future research, the actual cost-efficiency of facilitators would need to be tested. Moreover, all the claims obtained are categorised in different barriers and facilitators by the researcher. When categorising results, some claims could have been merged that could also have been identified as separate barriers or facilitators. However, most of the categories had been previously identified by multiple research studies, showing the consistency of the identification of these categories.
7.2. Realisation of Website
The participants who are willing to participate are limited on time. At first, the researcher wanted to have four different interviews per practitioner in order for them to provide feedback on the development of the website within each iteration. Unfortunately, this deemed to take up too much time from the practitioners, who declined the offer to participate. The four interviewees contributing to the website are interviewed twice and they filled in a questionnaire at the end. All the other practitioners are asked to interview only once to obtain information about barriers and facilitators. After the request had changed from four sessions to one interview session, more practitioners wanted to be involved within the research study.
During the development of the website, the researcher has made themselves responsible for the implementation of the general usability heuristics as well as for the accessibility guidelines. The accessibility guidelines are predefined by WCAG 2.1, but the usability heuristics are generic
guidelines. Whilst studying these guidelines, the researcher makes decisions on how the guidelines can be translated into objective requirements and then they decide which requirements are relevant for the website. Another researcher can make different decisions, which can have an influence on the outcome of the design.
Regarding the accessibility guidelines, the researcher does not program the website themselves. Therefore, the guidelines regarding coding issues or features cannot be guarded since the researcher does not have access to the code. This means the researcher guards the usability and accessibility requirements during the development phase on a design level.
During the development of the website, there is a continuous discussion between usability, accessibility and aesthetics. The website developers and the company are eager to include as many accessibility guidelines and usability heuristics as possible. However, at some points during the development, the guidelines and design wishes are conflicting. In the end, compromises are made. This is done in agreement with all parties. In the end, there is always a discussion between design, functionality and accessibility, which requires stakeholders to make decisions that influence the end- result.
The same applies to implementing the different claims obtained through user input: where some prefer option A, others prefer option B. Every functionality and design aspect is thoroughly discussed during the project, and sometimes compromises need to be made or claims need to be discarded altogether. These decisions are dependent on the stakeholders involved in the project and the level of influence they maintain.
7.3. Context of Research Study
First, there are strict time constraints during this research study. Due to the deadlines of the university, there is a set time frame in which the entire research study would need to be performed. Therefore, the interviews regarding the barriers and facilitators on the implementation of virtual reality E-health applications are done simultaneously with the development of the website. Due to this, only the first interviewees could be part of both the user-centred design process performed to realise the website as well as identifying the barriers and facilitators. The subsequent interviews would only contribute to the identification of barriers and facilitators. This means there are only four interviewees involved in the website realisation. All four interviewees do represent a different relevant occupation. If this study would be repeated, it would be advised to involve more users within this process. Also, more input from literature findings, direct observations and user interviews help with the foundation of the website. Therefore, it is advised to complete these steps prior to performing the user-centred design process of realising a website.
Furthermore, additional time would allow the researcher to find and interview more practitioners. In this research study, a high amount of participants would allow the researcher to provide quantitative results as well.
7.4. Limitations
There are several limitations in this research study mentioned above. One limitation continuously present during this research study is the difference in work methods of both the startup company and the university. Whereas the university is focussed on research and allowing time for this research to be done, the culture at a startup is based on getting as many things done as fast as possible. Therefore, there is a tension between time pressure from the company to obtain results for the website development and the desire of the university to spend more time on acquiring user input. In the end, the researcher compromises on this matter, which can have an influence on the results. It should be noted that both the company and the university are supportive of the research performed.
Also, this study is performed in the Netherlands, focussed on Dutch practitioners and the Dutch healthcare system. Therefore, the results can be different depending on the geographic location, the culture differences and differences in healthcare systems. Moreover, all the interviews are performed in Dutch to allow for interviewees to respond in their mother tongue and feel more comfortable answering questions. After, the researcher translates these interviews. In every case where results are translated from their original language into another, some claims or subtle references might have been lost in translation.