282 9 Chapter 9 TAKE HOME MESSAGES | THEME 3 • Stakeholders, such as healthcare professionals and developers, and their needs should be identified and considered early in the eHealth development process, in order to ensure that the intervention aligns with existing work processes and thinking, and to support its implementation. • Incorporating business development exploration early in the eHealth development process is crucial for finding sustainable funding models, addressing implementation challenges, and ensuring the technology brings value to payers and other stakeholders. • The CeHRes framework can be used to identify and address questions on implementation, value proposition and the underlying business case early in the process. • Funding bodies can facilitate sustainable implementation by providing funding schemes aimed at validating the business model and investigating commercial feasibility. THEME 4 – SUMMATIVE AND FORMATIVE EVALUATION OF EHEALTH In previous themes we focused on the development process of eHealth and emphasized the importance of involving end-users and stakeholders in the developmental process of eHealth. In the following theme we address the need for proper evaluation, present various evaluation methodologies, and discuss the challenges associated with applying traditional research designs like RCT and metaanalysis in the context of eHealth (Challenge Four, General introduction). This dissertation includes several eHealth evaluation studies that employ different methodologies based on what is being evaluated and the purpose of the evaluation (39). Evaluation can be categorized into three types: process evaluation, impact evaluation and outcome evaluation (39). In chapter 2 and 3 we performed multiple small scale evaluation studies (process evaluation) to assess whether the prototype of the eHealth solution met the design requirements (e.g., does the design visualise the effect of inhaler use in a compelling way? Does the participant feel motivated to perform the desired behaviour?). Based on the findings, adjustments were made to improve the design. In chapter 4 we performed a pilot study (impact evaluation) to assess the Hospital Hero app on use, user-experience, and usability. Chapter 5 presented a study protocol for evaluating a smart asthma inhaler program, focusing on multiple clinical and patient outcomes (outcome evaluation), while in chapter 6 we performed a meta-analysis to examine the overall effect of different integrated disease management programs, including eHealth-based programs, on clinical outcomes (outcome evaluation). Clearly, the evaluation studies had different objectives. Chapter 2, 3 and 4 aimed to gain understanding of user experience and user-interactions with the digital health technology to inform design improvements and implementation. This type
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