Jasper Faber

Chapter 2 24 funds, state-funded healthcare, and relatively good public transportation. Consequently, we have a lack of evidence to support the research and design of eHealth interventions that align with the attitudes of people with a low SEP. The rise of eHealth in current healthcare systems opens up exciting new possibilities to improve healthcare quality and efficiency. However, with the increased use of technical innovations and digital systems come unintended, unpredictable, and adverse consequences for individuals. Due to the underrepresentation of these specific societal groups, interventions are minimally aligned toward their attitudes. Consequently, these interventions face the risk of not being adopted and therefore unintentionally contribute to rising health inequalities. Researchers and designers should carry the responsibility to harness the potential of eHealth to create benefit for all groups in society, not merely for those that are motivated to perform a healthy lifestyle (Viswanath & Kreuter, 2007). To engage the target group in the research process, an approach is needed that is comprehensive, culturally sensitive, and builds upon a relationship-based personal approach (Stuber et al., 2020). Community-based participatory research (CBPR), a socio-culturally sensitive approach, which creates a trustful and long-lasting relationship between researcher and participant, has been effectively applied in culturally contrasting contexts (Israel, 2013; Unertl et al., 2016). For example, Henderson et al. (2013) successfully implemented a CBPR approach to develop a tailored web-based diabetes self-management tool in a low-resource setting in the United States. Such an approach can engage hard-to-reach groups in the research process yet has not been applied in the context of attitudes in low-SEP groups. In addition, focusing on a community instead of a person’s individual characteristics is increasingly being recognized as a valuable approach. Studies that focus on these characteristics imply that these are the cause of poor health outcomes, which carries the risk of increasing stigma (Auerswald et al., 2017). It is becoming increasingly known that contextual community factors, such as the availability of healthy food, experiences of discrimination, and neighborhood poverty, also have a significant relation to poor health outcomes (Schüz, 2017; Winkleby & Cubbin, 2003). The resulting knowledge could improve the alignment of health services toward attitudes of low-SEP populations, thereby facilitating their adoption. Currently, eHealth interventions aimed at these populations have only been minimally tailored, for example, by simplifying text and including images and videos (Kock et al., 2019). However, there is currently limited evidence reporting how interventions could be tailored toward psychological characteristics, such as attitudes with regard to eHealth. Although some

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