7 General Discussion 151 interventions, often has limited room for patient input. This leads to less appropriate care for patients who deviate from the norm, such as those with a low SEP. In addition, this can also inadvertently induce feelings of paternalism and infringe upon an individual’s health autonomy, diminishing their motivation to adhere to these interventions (Grunloh et al., 2018). Therefore, it remains crucial to recognize the value of patient input in shaping healthcare interventions. The bottom-up approach to developing eHealth interventions discussed in this dissertation offers promising prospects. It emphasizes the importance of catering to the unique needs of specific groups. By tailoring health interventions to better align with individual needs and circumstances, people can engage with these interventions in a more meaningful way. This empowers them to take control of their own care, enhancing feelings of autonomy and, consequently, their motivation to engage with the intervention and their overall health. Such alignment ensures a better match between the provided and the required care and addresses some of the shortcomings of the one-size-fits-all approach. By focusing on groups for whom standard approaches are less effective, this strategy holds the potential to reduce health disparities. However, the standardization and evidence-based nature inherent in top-down interventions play a crucial role in ensuring improved general public health outcomes and efficient implementation of these interventions (Nys, 2008). Moreover, certain patient groups, such as the “Optimistically Engaged”, may prefer delegating health responsibility to healthcare providers. Therefore, a critical consideration is the potential negative impact of transitioning to a more complex and resource-intensive approach on groups that the existing healthcare system adequately serves. Acknowledging the complexity of integrating these bottom-up approaches, future research should investigate the conditions through which bottom-up approaches to intervention design can enhance the healthcare system. It is essential to clarify that the objective should not be to shift to bottom-up approaches completely but to identify areas where they can augment the existing top-down system (Vansteenkiste et al., 2012). Future research should, for instance, assess the practicality of healthcare professionals’ adoption and application of these interventions effectively and evaluate the scalability of such tailored interventions. 7.7 General conclusion This thesis demonstrated an apparent willingness from the participants with a low SEP to engage with their health through eHealth interventions. However, it also uncovered a mismatch between the current design of eHealth interventions and the diverse needs of the low-SEP demographic. We showed that participatory design offers a promising method for involving people with a low SEP, highlighting the necessity for comprehensive,
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