70 Chapter 3 3 Discussion Principal findings This paper demonstrates a participatory design approach of a medication adherence intervention for patients with asthma and LHL. We explored the potential of applying several participatory design techniques in health intervention design for a LHL population. These consisted of co-constructing stories, an experience prototype exhibition, and a video prototype evaluation. The demonstrated activities provide novel insight in the practical use and implications of participatory design activities with people with LHL and have positive indicative value for supporting their participation in the design process. There is a need for more insight into new and adapted methods to effectively reach and engage disadvantaged groups. Current approaches are insufficient in reaching and retaining undeserved populations (36,59). While participatory design is increasingly receiving more attention, it is still seldom applied by designers with people with LHL. Models, approaches, and guidelines for participatory design do exist; yet, they do not provide concrete steps that fit specific contexts and people. A previous study suggests there is a need for a broad range of methods that facilitate the practical application of these models (30). The demonstration of these methods in specific contexts and target groups (i.e., patients with psychiatric illness (30) and LHL could severely improve the alignment of interventions with disadvantaged populations. Indeed, we believe that some of the reasoning behind the activities will also apply to other disadvantaged groups. First, our activities are aimed at facilitating our participants to “tell” their stories using probes of visual scenarios and story elements (60). Several sources on this topic state that groups experiencing communication barriers, such as people with low (health) literacy, learning difficulties, and cultural differences have difficulties understanding the purpose and contents of participatory research activities and vocalizing their thoughts and experiences (36,37). Using scenarios and story elements as a “probe” has helped our participants in telling their stories without relying merely on verbal communication skills. In addition, the probes helped to shift the focus from the individual. This has helped our participants to become more at ease with the research setting, which could be observed based on the extensiveness of their responses. This is deemed especially helpful for groups at risk of stigmatization (i.e., LHL, obesity, and mental illness) (38-40). We propose that the non-verbal and low-threshold nature of such probes positively impacts collaboration with disadvantaged groups. Besides storyboarding and scenarios, other non-verbal participatory probing tools, such as cards, artifacts of discussion, taking pictures, and using emoticons could be equally useful (35,61,62). Second, another facet of participatory design we applied in this project was allowing our participants to “enact” future scenarios by physically trying out new concepts (60). Age and education are associated with having limited knowledge of and experience with health technologies (41). Therefore, we expect that societal groups, such as people with low socio-economic status or the elderly, could experience barriers in
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