296 10 Chapter 10 Summary The Dutch healthcare system is facing multiple challenges which have put a strain on the healthcare system in terms of finances and workforce shortages. eHealth offers innovative and promising ways of providing healthcare, including remote and digital care. However, despite the potential of eHealth to transform healthcare and improve patient outcomes, its wide-spread adoption and implementation have been limited. In the general introduction of this dissertation, five challenges in the development, implementation and evaluation of eHealth were identified: 1. Misalignment with end-user needs due to the lack of active involvement of end-users in the design process. 2. Non-adherence caused by a lack of user engagement to the eHealth solution. 3. Missing those who benefit most in the development and evaluation of eHealth, risking a widening of the digital divide. 4. Limited real-world evidence on the effectiveness of eHealth and the need for alternative study designs. 5. Disconnection between evidence and its application, and the need for a practical guide to translate knowledge into practice. Targeting and overcoming the above-mentioned challenges is essential to work toward meaningful eHealth that benefits patient, healthcare professionals and the healthcare system as whole. By addressing these challenges, eHealth has the potential to revolutionize healthcare and improve health outcomes for individuals and populations. This dissertation addressed the above-mentioned challenges by presenting and discussing real-world case studies on the development and evaluation of various eHealth technologies using participatory design tools and generating real-world evidence, respectively. It also presented a study on the translation and validity assessment of the Dutch version of the eHealth Literacy questionnaire, and a stepby-step approach to guide the translation of research to inform evidence to inform decision-making. Part 1 – Participatory design In the first part of this dissertation, we demonstrated how participatory design can be used to actively involve end-users and other stakeholders in early stages of eHealth development). Chapter 2 described the design of the persuasive game design ‘Ademgenoot’ to motivate people with asthma to be medication adherent. Through early involvement of end-users and use of participatory design tools we were able to identify several reasons for non-adherence and needs which led to the design of ‘Ademgenoot’. User testing showed that Ademgenoot was engaging and has the potential to influence inhaler use behaviour by fostering motivation and
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