298 10 Chapter 10 Integrated disease management programmes (IDM) are complex interventions, consisting of multiple components. Since eHealth interventions are also often also multi- component these can be considered complex health interventions as well. Consequently, challenges in meta-analysis of IDM programs can provide important insights and considerations in the evaluation of eHealth. Part 3 – Tools and instruments The third part of this dissertation presented two different tools. The first tool is a Dutch version of the eHealth Literacy Questionnaire (eHLQ) (Chapter 7). The tool can be used by researchers, eHealth developers and policy makers to identify eHealth literacy needs and inform the development of eHealth interventions to ensure that people with limited digital access and skills are not overlooked. Chapter 7 described the translation, cultural adaptation, and validity assessment of the Dutch eHLQ using a validity-driven and multi-study approach. Validity was assessed on test content, response process and internal structure performing cognitive interviewing, confirmatory factor analysis, invariance testing and multi-group comparison. The Dutch version of the eHLQ showed strong properties for assessing eHealth literacy in the Dutch context. However, ongoing collection of validity evidence was recommended as validity should not be considered a characteristic of the instrument but depends on the context and purpose of use. The second tool, a tool to facilitate effective knowledge creation towards decisionmakers in healthcare to help bridge the knowledge-to-action gap, was presented in Chapter 8. By integrating principles of science communication, data visualisation and user-centred design, a step-by-step process was outlined for translating scientific research into actionable messages, focusing on ‘how something is said’ and ‘how it is communicated.’ General discussion In the closing chapter we reflected on the separate studies, placing them in a wider perspective on the development, evaluation and implementation of eHealth and sharing our lessons learned. We discussed the importance of empowering patients to participate in their healthcare choices but emphasized that differences in patients’ eHealth literacy needs should be taken into account (Theme 1). Moreover, we discussed conditions that should be met when involving socio-economically disadvantaged groups in the development and evaluation of eHealth (Theme 2). We tapped into the importance of early stakeholder involvement, as stakeholders are important actors within the development and sustained use and implementation of eHealth technologies (Theme 3) and presented ways to identify stakeholders, their needs and how to create value, including taking a more business viewpoint on value. We furthermore discussed why evaluation of eHealth should be considered a continuous process, including formative (i.e., to gain understanding for improvements) and summative (i.e., to measure performance or specific endpoints) evaluation moments (Theme 4). By doing so we touched upon the need to create a more favourable
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