66 Chapter 3 3 The sessions helped to deepen our understanding of the preliminary insights from the initial literature review. For instance, we learned from the literature that an important reason for medication non-adherence in LHL groups is that the patients have misconceptions about the medication (14,15,56). However, through our sessions, we gained a more nuanced view of these beliefs. The participants reported trusting their doctor’s expertise blindly, as they had difficulties understanding the purpose of the maintenance medication. Despite trusting the advice, they used their reliever inhaler instead when they experienced symptoms. When asked, participants indicated not knowing or remembering the explanations given by their HCP: “According to the doctor, I just have to use it (the medication). That is what I know”. (Male) Stage 2: define We used the intervention mapping approach (57) to translate the user insights, through change objectives, toward practical design opportunities. We discussed the 22 identified change objectives (Multimedia Appendix 2) with the stakeholders and developed three overarching design opportunities (Table 1). In a consensus meeting with design experts, we agreed on the most feasible and important design opportunity—creating awareness about the effects of medication on symptoms through patient engagement in logging and monitoring. Table 1. Design opportunities Design opportunity Determinant Description Improve capabilities of patients to understand and organize their medication intake behaviour. Capabilities Empower the patient to gain authority and confidence in selfmanaging their asthma. Create patient awareness about the importance and effect of the medication. Awareness Let the patient see the effect of the medication on the body and the relation between usage and experience of symptoms. Change patients’ attitudes to sustain motivation over a longer period. Attitude Help the patient acknowledge that long term benefits of maintenance inhaler are as important as directly noticeable effects of the reliever inhaler. Stages 3 and 4: ideation and prototyping The ideation and prototyping stages were directed at developing ideas and concepts that could be used to reach the design objective that resulted from the first two phases. To achieve this, the first author executed a brainstorming session with industrial design students to explore engagement strategies for the monitoring process (i.e., monitor asthma symptoms and monitor inhaler use) and how the data can be presented to patients with LHL to promote awareness.
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