274 9 Chapter 9 utilization of the co-creating stories method enabled individuals with limited health literacy and asthma to reflect upon their experiences with adhering to their asthma medication regimen. By using relatable fictional stories, participants were able to share their own experiences, connect with different characters, and contemplate their own behaviour and motivations for non-adherence. Experience prototype sessions, involving physical interaction with multiple prototypes, further facilitated the expression of preferences, needs, and attitudes toward the prototypes by endusers. Similarly, the design process involving children (chapter 4) necessitated the customization of participatory design tools. To address children’s difficulty in envisioning the final product, visual elements, such as a colourful animal theme, were incorporated into the prototype and a hospital setting was simulated. While the toolbox for participatory design offers an extensive array of tools and techniques, it is not practical nor comprehensive to provide a complete repertoire in this dissertation. Nonetheless, the studies in this dissertation successfully illustrate several ways in which participatory design tools can be effectively employed for different purposes, within diverse contexts, and involving a range of end-users thereby adding to the knowledge base on the use and application of participatory design tools and methods in eHealth design. Prerequisites for meaningful end-user involvement in design The active involvement of end-users and granting them a voice in the development and evaluation of eHealth solutions, are not only crucial for increasing the likelihood of successful adoption but also aligns with ethical principles of justice and inclusiveness. It is our ethical responsibility to value individuals’ lived experiences, listen to their narratives and involve them in the design process. Also from a societal stance, it can be considered a human right for those affected by the digital transformation now and in the future to have a say in the design solution to the complex issues and societal challenges that awaits us. Consequently, we are obligated to make every effort to include individuals and communities most in need, ensuring that eHealth solutions benefit everyone and do not contribute to widening the digital divide (Challenge three, General introduction). In chapter 3 we concentrated on how to involve people with limited health literacy in the design of eHealth interventions and give them a voice. However, meaningful involvement of people with limited health literacy or lower socio-economic position requires also other important consideration to assure meaningful involvement. Several of these considerations have also been described in the context of including socio-economically disadvantaged population as study participants in randomized controlled trials (15, 16). Firstly, research should be planned and structured in a manner that accommodates the needs of the participants, such as employing a flexible study design and considering participants’ competing demands like childcare or other family responsibilities. In the eHLQ translation study (chapter 7) we included recruitment with posters at various familiar (public) spaces such as sport clubs and community centres to reach
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