Like shouting into the void: Developers’ experiences of end-user participation in health and social care information system development – A survey among vendor personnel in Finland

BACKGROUND: End-user participation in developing health and social care (HSC) information systems (ISs) can improve usability and adoption, but its effect depends on how input is acted upon. Although many clinicians and social care professionals are willing to participate, they report few meaningful opportunities. Developers' perspectives remain underexplored; we examined their experiences. METHODS: In 2024, we conducted a web-based survey in Finland-widely regarded as a forerunner in implementing HSC ISs-among software developers employed by the five largest vendors (n = 266). The questionnaire covered collaboration with end users and client organizations, participation methods, and practices for integrating user perspectives into development. Three researchers thematically analyzed responses to two open-ended questions on reasons for end-user dissatisfaction with HSC IS development. RESULTS: Most respondents (81 %) reported collaborating with end users at least to some extent; those in product management more frequently (77 %) than other roles (41-65 %). While 92 % indicated their organization is interested in end-user feedback, only 44 % believed users know how and to whom to provide it. Common participation methods included online portals (74 %), feedback gathered during training (64 %), requirements workshops (58 %), usability testing (55 %), designated clinician representatives for IS development (54 %), and site visits (44 %). Open-ended responses most frequently attributed end-user dissatisfaction to vendor resource prioritization, national requirements overriding usability improvements, insufficient communication about whether and when suggestions will be implemented, technical constraints, and the absence of established collaboration structures. CONCLUSIONS: HSC IS developers expressed willingness to incorporate end-user needs but perceived constraints from national and organizational priorities that limit usability improvements. To enhance end-user satisfaction, development processes should offer earlier, clearer, and better-targeted opportunities for participation; specify channels and timelines for submitting feedback; explain how input is balanced against competing requirements; and communicate decisions and rationales back to users.