270 9 Chapter 9 General discussion In accordance with the adage, “with the wisdom of hindsight”, a consistent observation emerges: embarking on the same journey for a second time is invariably easier. This dissertation encompasses a collection of distinct studies, each presenting a unique journey, involving different contexts, disciplines, approaches, and methodologies. While some journeys were pre-defined, others were discovered along the way, making this dissertation a co-production between different disciplines, following different paths, and offering different perspectives. As such, our journey has yielded several new insights and helped us gain new knowledge along the way. Knowledge and insights that reinforce our decisions made and provide alternative perspectives when considering the broad context of eHealth development, evaluation, implementation, and sustainment. This closing chapter serves as a reflection on the road travelled, the knowledge acquired along the way and the lessons learned by embarking on this journey with designers, behavioural change experts, persuasive game design experts, various healthcare developers, patient advocates, app developers and statistical advisors. Drawing inspiration from the words “the journey matters more than the destination” we believe that these journeys were necessary to acquire these lessons on development, evaluation, and implementation of eHealth. The lessons learned tap into the five challenges presented in the introduction, thereby offering a wider perspective on the intricate relationship between patient empowerment and eHealth literacy, meaningful patient and public involvement, the road toward sustainable implementation, the challenges and implication of evaluation of eHealth and the importance of creating a favourable academic climate in creating societal impact with eHealth. These lessons learned have been clustered into five themes, each of which concludes with key messages intended for fellow (prospective) eHealth researchers, healthcare professionals and academic institutions who play a vital role as knowledge brokers in the field of knowledge dissemination. THEME 1 – SELF MANAGEMENT, PATIENT EMPOWERMENT AND eHEALTH LITERACY Within the ongoing transformation and digitalisation of healthcare in the Netherlands, people are expected to participate in and take responsibility for their own health (1). This entails fostering shared decision making and empowering patients to participate in their healthcare choices (2). Patient empowerment focuses on increasing a patient’s capacity to think critically and make autonomous, informed decisions about their health and has been associated with improved health outcomes, greater healthcare satisfaction, better treatment adherence and reduced healthcare costs (3, 4). This is particularly of importance for individuals with chronic conditions, who continuously self-manage their health regardless of their interaction with the healthcare system or specific professionals (5). Recognizing the significance of patient empowerment and self-management, numerous eHealth interventions for chronic diseases, such as asthma and COPD, focus on empowering patients to enhance their self-management
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