Dunja Dreesens

77 A potential weakness was the extent to which the participants are involved in this subject. We tried to counteract this by having a group consisting of participants with different expertise and from various backgrounds, and by providing descriptions of the discussed tools before the meeting. Also, the group was limited in its size. Therefore, the framework was not presented as finished but as a draft framework. Another risk of the group composition and size could be that it obscured tools as not being within scope. There were no patient representatives present during the face-to-face meeting; however, two participants (SH and RR) with extensive experience in health consumer participation and patient-centred care commented and added to the work of the group at the end of day 1. Having (most of) the participants together for a prolonged time in one room, contributed to enhanced participation, open discussions and the liberty to ask each other questions, making it possible to respond to non-verbal communication, and leading to a first draft of the conceptual framework. Implications for practice Our working framework on different types of patient-directed knowledge tools is aimed at developers, and possibly at those who commission the development of tools, healthcare professionals and policy makers, and hopefully adds to clarity on the different knowledge tools by stating the purpose(s) they serve and which core elements they should include. The ambition is that tool types are no longer developed without a clear definition and use. This framework will make it easier for developers to identify when to develop which patient-directed knowledge tool and what core elements to include, and to help patients and professionals to understand when to use which tool type. Chapter 4