18 Chapter 1 1 The dissertation consists of three parts. Part 1 focuses on the challenges in eHealth development (Challenge one, two and three) and demonstrates, through three case studies, how these challenges can be tackled. The first case study showcases how participatory design can be utilized to involve end-users and other stakeholders in designing the innovative game ‘Ademgenoot’ to motivate people with asthma to adhere to their medication regimen (chapter 2). It shows how behaviour change and persuasive game design theory can be combined to create a fun and engaging game. In the second case study we focus our participatory design efforts on people with limited health literacy and provide an approach on how one can design with and for people with asthma and limited health literacy employing participatory design tools (chapter 3). Chapter 4 presents the third case study, the Hospital Hero app, which demonstrates how participatory design can be employed to involve children and other stakeholders in the development of an app aimed at reducing preprocedural stress and anxiety among children visiting the hospital. Part 2 continues with the evaluation of eHealth and addresses challenges related to generating evidence on effectiveness (Challenge four). We do so by presenting a protocol for a real-world pragmatic RCT to assess the effectiveness of a smart asthma inhaler, the ACCEPTANCE study (chapter 5). The protocol demonstrates how real-world evidence can be collected and provides an approach to identify which patients benefit most from the smart inhaler program. We continue our exploration on effectiveness studies by presenting a Cochrane systematic review and metaanalysis on integrated disease management for people with COPD, which are complex interventions that are pooled to generate an overall estimate of effect on multiple clinical and process outcomes (chapter 6). By doing so we touch upon the complexity of systematically pooling and evaluating real-world RCTs of complex interventions, the challenges of heterogeneity and the importance of contextual factors. In Part 3 we provide tools that can be helpful in working towards more equitable eHealth, addressing prerequisites in eHealth development such as understanding people’s eHealth literacy needs (Challenge three) and supporting the translation of knowledge into practice (Challenge five). We present the Dutch version of the eHLQ and discuss its translation, cultural adaption, and validity assessment (chapter 7). In chapter 8 we present a systematic, practical, and easy-to-implement tool for effective knowledge creation, and its use in a case study on chronic respiratory diseases in low- and middle-income countries. A detailed overview of the chapters, study aim and used design or research methods is provided in Table 1. The closing chapter, chapter 9, reflects on the separate studies, places them into a larger context, identifies important lessons learned, and concludes with some final insights.
RkJQdWJsaXNoZXIy MTk4NDMw