50 Chapter 2 2 and commercial and technical viability of Ademgenoot, making it a strong candidate for future implementation. Our study is subject to several limitations. First, the relatively young participants could have limited the representativeness of our findings and the applicability of the Ademgenoot concept. However, by involving various stakeholders, we were able to achieve a wider perspective. Second, the small number of participants per design phase may have an influence on the study findings. Nonetheless, considering that we were able to involve participants throughout all phases of design and development, involving individuals that had not been involved during the previous phase and iterate on the previous feedback, we believe we were able to capture their needs in a valid way. Third, the formative evaluation of Ademgenoot may also present some limitations as not all components of the Ademgenoot game were tested. In addition, interference by the researcher may have led to changes in behaviour (i.e., improved medication adherence) due to the individual being observed. Finally, the limited duration of the testing period (i.e., five days) calls for caution in drawing conclusions regarding long-term usage. Furthermore, the focus of our study on individuals with mild asthma may limit the generalizability of our findings to other patient groups. Implications for practice Our paper demonstrated how data logging through EDMs can be utilized to provide a fun persuasive game to motivate, in the first place, adults with mild asthma to adhere to their medication regimen. Despite its potential, EMDs have not yet been implemented on a large scale in practice due to, amongst others, the need for evidence on long-term effectiveness and disengagement challenges with existing apps (56). Adoption of EDMs may be facilitated by offering different types of adherence support programs that cater to the needs, reasons for non-adherence, capabilities and preferences of individual patients, in a shared-decision making way (22,58). This requires EMD programs to be compatible with existing inhalers preferably integrated within existing electronic health records. Inquiring into reasons for poor-adherence should be standard practice to provide appropriate adherence support. We observed, in our study, behind the initial answer of “simply forgetting” were several underlying reasons for non-adherence, which should be addressed to support medication adherence effectively. Moreover, to reach its full potential, developments with EMD should focus on providing feedback on inhalation techniques to ensure proper usage. Ademgenoot offers an engaging way to incorporate inhalation techniques into selfmanagement interventions for asthma. Finally, the concept of providing feedback on medication use via automatic logging, such as through electronic pill bottles, may also be applicable to other chronic diseases with medication non-adherence as a common challenge and where there is no direct tangible benefit of being adherent. Implications for research and future directions The evaluation of Ademgenoot through WhatsApp prototype testing provided a lowcost and efficient way to assess people’s perceived impact on medication adherence and motivation. However, further research should focus on a real-world evaluation of
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