297 Summary 10 combining personal goal setting and continuous direct visual feedback on medication use with game elements such as narrative and rewards. In chapter 3 we focused our participatory design efforts on people with limited health literacy and delved deeper into the application and tailoring of participatory design methods for people with limited health literacy. Through a study aimed at enhancing medication adherence, we presented strategies to overcome challenges specific to working with individuals with limited health literacy and asthma. We demonstrated how participatory design tools can be carefully selected, tailored, and applied to actively involve people with limited health literacy in eHealth design, identify their needs and foster mutual understanding during the design process. In chapter 4 we presented a multiple study report in which we described the development and pilot study of the ‘Hospital Hero’ app, an app aimed to reduce pre-procedural stress and create a more positive hospital experience for children. In the first study we employed participatory design, taking the experience of the user (child) as starting point to develop an application that supports children in their entire hospital journey, by providing preparation and distraction. A first version of the Hospital Hero app was subsequently evaluated in practice. Using a mixedmethod approach, we evaluated the Hospital Hero app on use, usability, and userexperience. As such, we were able to demonstrate how children, as end-users, can be actively involved in the development of eHealth and emphasized the importance of evaluating eHealth solutions in practice to assess their value for children, parents, and healthcare providers. Part 2 – Effectiveness assessment Chapter 5 continued on the significance of evaluating eHealth interventions in real-world settings. It presented a protocol for a cluster RCT to evaluate a smart inhaler asthma self-management programme. The study aimed to provide real-world evidence on clinical outcomes, acceptance, and usability, while also considering patient characteristics such as beliefs about medication and eHealth literacy. The chapter also highlighted how patients can be involved in the design and execution of clinical trials, and ways to overcome limitations of traditional RCTs in studying effectiveness of eHealth. The equivalent of the RCT as golden-standard study design for the evaluation of effectiveness, is the meta-analysis for the overall the effectiveness of multiple studies. Chapter 6 presented a meta-analysis and systematic review on the effectiveness of integrated disease management programmes (IDM) for people with chronic obstructive pulmonary disease (COPD). The review pooled fifty-two studies on IDM interventions, performed across 19 different countries, and compared these with usual care on a number of health-related and clinical outcomes. The findings indicated that IDM programs probably improve disease-specific quality of life, exercise capacity, respiratory-related hospital admissions, and hospital days per person. No significant differences were found for mortality, courses of antibiotics/ prednisolone, dyspnoea, and depression and anxiety scores.
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