63 Designing with and for people with limited health literacy 3 design activities, with a specific focus on the former to illustrate how people with LHL can be involved in a participatory design process of an eHealth intervention. We specifically chose to embed the participatory activities at the beginning (to develop an understanding) and end (to evaluate this understanding) of the design iterations. Figure 1. Schematic overview of the process, illustrating the different design thinking stages and its iterative character. * Defines a participatory design activity; CS, Co-constructing stories; IM, Intervention Mapping Participatory design methods Overview Within this framework, we integrated three participatory activities deemed specifically effective for people with LHL. These were (1) “co-constructing stories” (43), (2) “experience prototype exhibition” (44), and (3) “video prototype evaluation” (45). These activities were specifically selected as they would allow to effectively engage with the target group and understand their perspective. Co-constructing stories The creation of stories helps to discover users’ thoughts and beliefs regarding a particular phenomenon. In a previous study, for example, co-constructing stories was used to gather insights regarding an interactive system to support collaboration in a meeting room (43). Stories can be presented visually, which decreases the interview’s abstractness and verbality. As such, the use of visuals has been successfully applied in other LHL-related intervention design processes as conversation starters or design tokens (46-48). Apart from the benefits of visuals, using a fictional but relatable character in stories helps to shift the conversational focus from the individual, thereby decreasing possible anxiety-related barriers. Experience prototype exhibition Experience prototypes extend beyond the usability of a product and focus on understanding a person’s attitude toward a product by envisioning what it might be like to engage with it (44). People with LHL have little prior experience regarding the use of technologies for health (41). Using these technologies in an experience prototype evaluation session could, therefore, provoke responses and reveal attitudes toward new technological solutions that would otherwise remain undiscovered. Moreover, the physical and interactive nature of the experience prototypes allows the researcher to describe the concepts non-verbally, thereby increasing the engagement of participants with communication difficulties.
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