71 Designing with and for people with limited health literacy 3 imagining technologies and usage scenarios. “Priming” is a participatory facet that allows participants to immerse themselves in a domain (63). Our use of experience and video prototypes has helped the participants to get a feeling of possible technologies and imagine scenarios of future use. This could be observed, for example, through the responses the augmented reality T-shirt provoked in our participants. Therefore, we propose participatory tools that facilitate interaction and immersion, such as prototypes, mock-ups, and role-play to facilitate priming for technologies. Some aspects of the approach demonstrated in this paper could also be used in practice settings. For example, a practice nurse can use co-constructing stories to discuss multiple aspects of medication use in an easy-to-understand, non-obtrusive, and more concrete way with the patient by presenting and discussing recognizable but fictional situations. Hence, it would be interesting to explore co-constructing stories as a low-cost tool during consultations. Limitations Through the participatory activities, we were able to gather important insights into the needs, skills, and preferences of people with LHL that would otherwise remain unarticulated. However, the findings of this study should be interpreted in the context of its limitations. Like most studies that address LHL, recruitment was challenging. Having practice nurses identify and invite patients for participation was effective. However, it could also have led to selection bias, resulting in, for example, people who were above average engaged with their health. Moreover, recruitment was intensive as it required efforts to build rapport and trust and resulted in a relatively small number of participants. The small sample size should be considered regarding the representativeness of the acquired insights for the adherence intervention for patients with asthma and with LHL. In addition, researchers should be mindful in adapting the practical implications mentioned in this paper to fit their context and target group. While the study provides insight into the practical implications of using participatory methods with people with LHL, we did not thoroughly assess the impact of this approach. Previous research has shown that participatory design can improve the process on many levels. It improves participant advocacy, trust, and sense of purpose; leads to better usability and desirability of the intervention; and achieves better health outcomes, equity, and access (64). Therefore, future researchers could set the next step by studying if a participatory process leads to more desirable and effective health interventions for people with LHL. An important facet of participatory design that was not integrated into our approach is allowing the participants to “make” and embody thoughts in physical artifacts (60). In this study, the “making” stages (i.e., ideating and prototyping) were done without the active involvement of people with LHL. Engaging participants in co-creating prototypes helps to generate ideas for the physical manifestation of the intervention and has been done to align interventions to the needs of disadvantaged groups
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