12 Chapter 1 1 (6,12). Considering this, this dissertation identified five challenges pertaining to the development, implementation and evaluation of eHealth solutions that require attention. These challenges can be metaphorically depicted as gaps that must be bridged to facilitate widespread implementation of eHealth in healthcare settings in order to be meaningful. Challenges Challenge one: misalignment with user needs The limited adoption of eHealth solutions can be partly attributed to the lack of active involvement of end-users, such as patients, during the initial stages of design and development (6, 13). This can result in poor usability, poor user experience and, most importantly, misalignment with user needs (6, 14, 15). Recognizing the importance of end-user engagement in eHealth development, there has been a growing emphasis on co-creation and patient involvement in eHealth development (13, 16). However, in practice, patients are primarily involved during later stages when advanced prototypes or finished products already exist (17). During these stages, users are asked to test the prototypes or products, focusing mainly on usability, userfriendliness, and interaction with the user interface. Although this approach helps refine the eHealth technology and ensures certain aspects, such as understandable information and user-friendly navigation, it does not necessarily guarantee that the prototype effectively addresses users’ problems or fulfils their unmet needs. The initial design phase, often referred to as the “fuzzy front-end” research, aims to uncover the central challenges, understand the context, explore unmet needs in detail to then ideate potential solutions that align with those user needs (18, 19). The ideas generated during this phase are subsequently developed into concepts and prototypes, which are further refined based on user feedback (18) (see Figure 1). Figure 1. Design process adopted from co-design process by Sanders and Stappers (20) One strategy to actively involve users in the design process is known as participatory design. This approach is based on the notion that users are regarded as “experts by experience” or experts of their “lifeworld” (21). It acknowledges that their
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