Chapter 1 12 remain largely ineffective for people with a low SEP (Veinot et al., 2018). Multiple key factors must be in place for an eHealth intervention to be effective. First, accessibility is crucial; the intervention should reach its intended audience and be supported by the necessary technological infrastructure and device availability. Second, the target group must find the intervention acceptable, indicating willingness and ability to use it. Finally, adherence is essential; the target group should consistently engage with the intervention throughout its intended duration. Currently, eHealth interventions need to catch up in reaching and retaining adherence among individuals with a low SEP (Reiners et al., 2019; Yamin et al., 2011). Additional barriers that could account for this include inadequate digital (health) literacy (Cashen et al., 2004; Estacio et al., 2019), skeptical or less confident attitudes toward technology (Choi & Dinitto, 2013) and lack of resources (Cashen et al., 2004). Bottom-up, participatory approaches serve as a transformative lens to address the challenges, needs, skills, and preferences of the target group by actively involving them in the design process of eHealth interventions (van Gemert-Pijnen et al., 2011). Essentially, participatory approaches shift the paradigm from designing “for” to designing “with” the target group. This orientation is deeply rooted in human-centered design and design research, as it prioritizes the lived experiences, insights, and contextual nuances of the users (Sanders & Stappers, 2008; Spinuzzi, 2016). Given the complex interplay of factors contributing to low uptake and engagement of eHealth interventions in low-SEP groups, tailored participatory approaches are recommended above top-down, one-size-fits-all strategies (Braveman et al., 2005). Indeed, participatory approaches have shown success in ensuring the intervention is aligned with the specific challenges, skills, and needs of the target group and may facilitate the uptake of the developed interventions (Lee et al., 2022; Neuhauser, 2017). Therefore, integrating participatory design in developing eHealth lifestyle interventions for low-SEP groups could be a crucial strategy to reach equitable eHealth interventions. However, these approaches can be challenging when working with hard-to-reach groups, such as those with a low SEP. eHealth professionals (e.g., designers, developers, researchers, and care providers) often face practical challenges in reaching these groups for participatory design, including low health literacy, distrust toward the research team, cultural differences, and stigmatization (Bonevski et al., 2014; Stowell et al., 2018). These barriers can be time-consuming and challenging to overcome, especially under tight budgets and timelines. While the body of scientific knowledge on addressing the barriers related to the participatory design for and with groups with a low SEP is growing (Bonevski et al., 2014; Stowell et al., 2018), there has been limited effort to translate this knowledge into practical guides that specifically aid in the design of eHealth interventions for and
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