64 Chapter 3 3 Video prototype evaluation Paper-based prototypes are a common tool to evaluate design concepts of eHealth interventions (35). Nevertheless, these prototypes often fail to adequately represent the concept’s core functions and interaction scenarios. A combination of paper and video prototypes would be more effective in communicating the concept toward people with LHL than paper-based prototypes alone. (45,49). Videos have proven to be an effective tool in other intervention research and design efforts for asthma patients with LHL (50,51). Participants and recruitment The participants involved in the study included patients with asthma who have LHL and stakeholders. Patients with asthma and with LHL (n = 5) were recruited by the first author and an HCP working in a disadvantaged neighbourhood in The Hague, Netherlands. Qualitative and explorative approaches that aim to develop a pragmatic and in-depth understanding of a small number of participants have been argued to be effective in research approaches where not the generalizability, but the values, beliefs, and attitudes of individuals are central. This benefits the study by allowing for more flexibility and in-depth investigation of the included participants (52,53). The patients were purposively sampled based on a self-reported diagnosis of asthma, being prescribed medication, and a subjective health literacy assessment based on the person’s characteristics (e.g., migration background, occupation, educational level, and cognitive disorder) by the involved HCP. We decided to not objectively assess participants’ health literacy as this was likely to be perceived as stigmatizing and imped building a trustful relationship. The first and second authors also recruited other stakeholders, consisting of respiratory nurses (n = 5), health literacy experts (n = 2), design experts (n = 3, TD, NRH, VTV), and eHealth researchers (n = 4, NHC). These stakeholders were selected because they had long-standing experience with treating asthma, people with LHL, or participatory design methodology. We recruited five “language ambassadors” through an expertise centre in health disparities to evaluate the final concept. Ethics approval The study protocol was cleared by the Ethical Committee of the Leiden University Medical Centre (approval number: P18.158). Informed consent was obtained prior to study participation. If written informed consent could not be given, participants provided verbal informed consent, which was recorded. Results Stage 1: empathize The empathize stage served to understand the thoughts, beliefs, and perceived barriers of patients with asthma and with LHL regarding medication adherence. In this stage, we wanted to validate and discuss literature-based personas (Multimedia
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