7 General Discussion 133 participate in health improvement activities and eHealth interventions. This observation challenges the stereotype that low-SEP populations uniformly hold negative attitudes toward health and are less inclined toward future-oriented health planning (Heutink et al., 2010; Wardle & Steptoe, 2003). Although less positive attitudes were present, they represented a minor segment of our sample. Particularly, the “Doubtfully Disadvantaged” group could benefit from eHealth interventions tailored to their specific barriers, such as low self-efficacy and insufficient social support. Adopting strategies like peer support, employing a positive tone, setting short-term, manageable goals, and simplifying information could benefit this group (Bukman et al., 2014; Coupe et al., 2018; Michie et al., 2009; Reiners et al., 2019; Troelstra et al., 2020). Despite the proven effectiveness of these approaches to benefit people with a low SEP, they remain underutilized in digital health interventions (Ronteltap et al., 2022). According to existing literature, in contrast to generally unfavorable attitudes toward health, attitudes toward eHealth are more favorable. For instance, data from the Netherlands reveal that over half of individuals with lower education levels or a migration background are open to using eHealth solutions (Beuningen, 2019). Similarly, another study indicated that interest in personal health records and related platforms is comparable among low-SEP groups and their higher-income counterparts (Patel et al., 2011). These observations are consistent with our study’s findings. However, our research also identified a notable degree of hesitancy toward technology, primarily due to concerns about needing more necessary skills for practical use. This ‘technology anxiety’ is a recognized issue in the literature and represents a significant obstacle to the broader adoption of eHealth solutions (Berner et al., 2023). These digital barriers could be a critical factor in why eHealth interventions have lower adherence rates among individuals with a low SEP despite similar acceptance levels. In Chapter 3, our research supported our initial hypothesis, suggesting that participatory design’s inherent strengths supported the participation of our target group. Admittedly, objectively evaluating the impact of participatory design on engagement levels and project outcomes presents severe challenges. The need for more literature in this area complicates comparing our findings with those of other studies. Despite these challenges, our research offers a compelling demonstration of participatory design’s potential to develop interventions that align with the target group. This underscores the necessity for more detailed guidance on using participatory design in various contexts (Vandekerckhove et al., 2020). This need is particularly acute when involving people with a low SEP in participatory design processes.
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