273 General discussion 9 process. In chapter 2, participatory design methods were employed to elicit the needs of people with asthma, which led to the design of a persuasive game to motivate individuals with mild asthma to adhere to their maintenance medication (Challenge two, General introduction). In chapter 3, people with limited health literacy were actively involved, and participatory design tools helped to gain an understanding of their specific needs and preferences. Lastly, chapter 4 demonstrated how participatory design can be used to include children in the design of an app to reduce pre-procedural stress and anxiety. Given the enormous possibilities of participatory design tools and techniques, selection and tailoring of participatory design tools and techniques is a delicate process and should be based on 1) the purpose and 2) the context in which they are utilized (14). Purpose can be priming participants (i.e. immersing participants in the domain of interest), probing (i.e. revealing participants personal perspectives), understanding or generating ideas or design concepts (12, 14). Context can be described along the four dimensions: group size, group composition, face-to-face versus online, venue in which the participator design activity is held, and stakeholder relationship (14). In this dissertation we carefully selected and applied participatory design tools that aligned with the purpose and context of their usage, customizing them accordingly. To prime participants we developed an introduction video featuring the design researcher himself (chapter 3) and providing sensitizing materials to stimulate selfreflection and collection of lived experiences on dealing with asthma (chapter 2). To gain an understanding of end-users’ needs, experiences, and motives we used personas (chapter 2 and 3), co-creating stories (chapter 3) and experience journey mapping (chapter 4). To generate new ideas or design concepts, we employed paper-prototypes (chapter 2 and 4), think aloud exercises and mock-up or clickable prototypes (chapter 2, 3 and 4). Throughout all projects, we opted for a face-toface approach, selected home environments as the preferred venue, and carefully managed stakeholder-participant relationships, incorporating a trust officer (chapter 3) or parents (chapter 4). Furthermore, we made a deliberate effort to tailor our participatory design tools to accommodate the characteristics of the end-users, consider their cognitive abilities, communication skills, and any potential barriers they may face regarding participation (e.g., risk of stigmatization, mistrust, financial barriers). This is especially important when including people who can be considered vulnerable or have difficulties verbalizing their needs, such as those with limited health literacy (Challenge three, General introduction). People with limited health literacy may struggle with abstract thinking or understanding the content of the study, may experience language or literacy problems or feelings of anxiety towards research or the research team. In Chapter 3, we demonstrated the active involvement of individuals with limited health literacy in participatory design. Through the careful selection and tailoring of appropriate participatory design tools and techniques, we effectively engaged these individuals and fostered mutual understanding during the research process. The
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