Chapter 2 40 reason for not visiting a community center (Hooghuis, 2010). Therefore, we argue that some participants in our sample, having the time to visit a community center, also had more time and capacity to think about and act toward a healthy lifestyle. Therefore, we recommend that eHealth researchers and designers should become aware of the person’s life situation and use this knowledge to determine whether the person has the capacity available to fit the intervention into their life. People that do not have this capacity would benefit more from services that deliver support in social or financial aspects (Heutink et al., 2010; Troelstra et al., 2020). We argue that people that do have motivation and consciousness could benefit from being empowered to play a major role in their health management. This could be achieved through shared decision making, providing health information and facilitating self-management (Elwyn et al., 2014). It remains important for healthcare providers to be aware of this attitude as it is known that clinician perceptions of patients with a low SEP have been shown to affect clinical decision making. Based on common beliefs about people with a low SEP, physicians tend to delay diagnostic testing, prescribe more generic medications and avoid referral to specialty care and potentially lifestyle interventions (Arpey et al., 2017). The finding that most of our participants were doctor dependent (Loyal, 60%) conforms to other studies that claim that people with a low SEP are loyal to and rely on their doctor’s advice (Schröder et al., 2018; Yin et al., 2012). Moreover, we found that our participants highly valued a personal interaction with their care provider. The importance of this personal touch is mentioned in various other studies on the interaction between people with a low SEP and healthcare providers (Bull et al., 2018; Latulipe et al., 2015; Schaffler et al., 2018; Troelstra et al., 2020). Since current healthcare systems are moving from a doctor-says, patient-does model toward a model of shared decision making and self-management, we expect that people relying on their doctor’s advice will experience increasing difficulties in their health management. To improve the alignment of eHealth communication to these attitudes, we recommend that professionals should be mindful of ‘dehumanizing’ healthcare, as digital interactions lack the nuances of human interaction (O’Connor et al., 2016). Therefore, eHealth interventions should be designed to incorporate and enhance personal communication, interaction, and relationships with care providers, family members, and peers. This could be done for example by integrating a social role in the intervention through interactive and animated computer characters. Through simple speech, hand gestures and other non-verbal cues, these characters could simulate face-to-face counselling to establish trust and rapport in a virtual environment (Bickmore et al., 2010).
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