Darcy Ummels

General discussion | 151 7 their education programmes since the use of eHealth in healthcare is rising, and the subject is given limited attention in the current curricula for healthcare professionals. 42 ‐ 44 To implement more eHealth in these curricula, a first step might be to teach educators about the meaningful use of eHealth and the similarities with ‘regular’ measurement tools. Implementation in daily practice is challenging but important During this PhD trajectory, the research team learned that healthcare professionals need more support in implementing activity trackers than was foreseen. Several reports on the implementation of eHealth explain that the bottleneck is the transition from the pilot phase to implementation and upscaling in daily clinical practice. 45,46 For an innovation to be successfully implemented, the eHealth tool should fit the daily clinical practice, but healthcare professionals should also be open to change. 45 To achieve these goals, a systematic implementation approach is recommended, such as that of Grol et al., 47 the Consolidated Framework For Implementation Research (CFIR) 48 and user ‐ centred design. 49 Important features of these approaches are the thorough problem analyses (Grol et al.) and the use of an iterative approach (user ‐ centred design). However, there is a range of implementation methods and strategies. Therefore, it is important but difficult to choose a method that fits the implementation phase, context and stakeholders. 50 Moreover, there are several barriers to and facilitators of implementation that must be considered, 48 some specific to the implementation of eHealth. 51,52 To embed all of these aspects in one implementation design is challenging, which was evident during this study’s action research design. It is important to maintain a balance between support from the research team and time for healthcare professionals to experience the use of activity trackers. On the one hand, healthcare professionals can learn from good examples and studies showing that they need help to understand how to use eHealth and recognise its benefits. 51,53,54 On the other hand, to sufficiently implement an activity tracker, healthcare professionals must experience what works and what does not work in their own daily clinical routines. This team learned that dialoguing with healthcare professionals about their theoretical frameworks, routines, and dilemmas, including examples, helps professionals understand how and when to use the activity trackers. By using an action research design and including both healthcare professionals and patients, the implementation of the activity tracker had a better chance of succeeding. 55,56 A limitation within our action research design might be that we did not base the approach on existing theories such as behaviour change theories.