Chapter 7 150 the intervention accessible and effective for people from various socio-economic backgrounds. Additionally, its scope could be expanded to multiple hospital-rehabilitation care pathways or other conditions (e.g., stroke). 7.6.3 Future research directions For participatory design and its role in designing equitable eHealth interventions, several unanswered questions still merit further investigation. First, it will be important to conduct research to validate the effectiveness of participatory design, specifically in the context of eHealth interventions for low-SEP groups. This should include comparative effectiveness studies that compare eHealth interventions developed through participatory design with those interventions developed using conventional methodologies. The focus should be on evaluating the impact of these approaches on key outcomes, including user adherence, acceptance, and health outcomes. Another valuable avenue for future research involves the development of clear frameworks and guidelines for participatory design (Vandekerckhove et al., 2020). These should detail the participatory design methods and tools that are most effective in engaging individuals from low-SEP backgrounds throughout the research process. There should be an emphasis on distinguishing these recommendations between different target sub-groups, project goals, and phases of project development. Another crucial area in need of further investigation is the long-term maintenance of healthy behavior. This is true for the low-SEP population but notably extends to the entire population as well. For this, it is not only important that an eHealth intervention aligns with the needs of specific populations, but also that they keep being aligned when these needs change over time. Explorative self-experimentation and “behavior crafting” emerge as promising concepts (Fedlmeier et al., 2022). These approaches encourage individuals to actively participate in creating and adjusting their behavior change strategies, fostering a sense of ownership and alignment with personal needs and goals. Yet, it remains to be questioned how such self-directed methods fare among populations with lower levels of self-efficacy, health literacy, or motivation. While these methods offer opportunities to enhance and sustain healthy behavior, they, like eHealth interventions, also risk exacerbating health disparities. Future research could explore how to improve autonomy in the management of health behavior for groups, specifically with low health literacy and self-efficacy. Finally, future research could explore the paradigm shift from top-down healthcare interventions to more nuanced, bottom-up, tailored interventions. The prevailing topdown approach, characterized by one-size-fits-all standardized interventions and eHealth
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