2 Attitudes toward health, healthcare, and eHealth of people with a low socioeconomic position 41 2.4.2.2 Doubtfully Disadvantaged The Encumbered, Disadvantaged, and Hesitating profile, that represented this attitude, all embodied a perceived lack of control related to one’s health, healthcare, or eHealth. Various previous studies support this finding. The lack of control over health is attributed to lower problem-solving skills (Mirowsky & Ross, 2017), environmental deprivation (Pepper & Nettle, 2017), and financial, environmental, and social limitations (Cutler & Lleras-Muney, 2006; van Wijk et al., 2019). Therefore, we recommend considering self-efficacy and perceived control enhancing strategies within eHealth interventions. Goal setting has been mentioned as a potentially successful strategy in various studies regarding other low-SEP populations (Bull et al., 2018; Coupe et al., 2018; Michie et al., 2009). A possible implementation is through persuasive game design. Through the game world the user could acquire feelings of competence and transfer these toward the real world (Visch et al., 2013). For example, one could help an avatar to progress through different life goals by earning points based on healthy snack choices (Schaefbauer et al., 2015). In addition, various studies also mention social support as a potentially effective strategy (Bukman et al., 2014; Troelstra et al., 2020). Emotional support could be offered through supportive conversations and buddy systems, informational support from educational information from peers and providers and appraisal could be offered through peers, providers or the eHealth system itself (Vorderstrasse et al., 2016). In addition, designers could think of ways to make technologies and information more accessible and easier to integrate into the persons’ daily life. For example, cardiac telerehabilitation allows to reach patients in their home-environment and motivate them to participate even though they do not have the means (physically as well cognitive) to visit the rehabilitation center (Kraal et al., 2017; Nabutovsky et al., 2020). We found that participants characterized by the Disadvantaged profile were experiencing communication difficulties in the healthcare setting. Especially assessing and applying health knowledge was perceived as problematic. It is striking that this profile only represented a mere 12% of our sample, while these difficulties are widely discussed in previous studies on this topic (Adams et al., 2013; Yin et al., 2012). Since our participants were proficient in the Dutch language, we argue that communication for them was less problematic. Moreover, combatting health literacy is currently high on the agenda (Kickbusch et al., 2013). In fact, in the Netherlands, 60% of healthcare professionals report adapting their communication toward their patients’ needs (Murugesu et al., 2018). Nevertheless, to include this part of the population, eHealth interventions should accommodate for varying literacy levels, for
RkJQdWJsaXNoZXIy MTk4NDMw