Jasper Faber

Chapter 3 52 Within the design domain, it is acknowledged that involving users in the design of eHealth interventions facilitates alignment with their needs and preferences. Besides action- and community-based approaches (Faber et al., 2021), participatory design and its methods are increasingly receiving more attention. These approaches are based on the notion that when users are involved in the design and development of interventions, they are more likely to be successfully adopted (Neuhauser, 2017; Van Dooren et al., 2016; van Gemert-Pijnen et al., 2011). Participatory design could uncover potential reasons for nonuse and allow designers to discover, through their participants, how technologies could be acceptable and engaging (van Gemert-Pijnen et al., 2018). Participatory design is human centered and especially useful in the context of LHL. First, participatory methods are visual, interactive, and concrete. This benefits people who have difficulties thinking in abstract terms (Neuhauser, 2017) or who have language barriers to understand and engage with the process (Kip et al., 2019; Neuhauser, 2017). The flexibility of a participatory approach also allows to adapt and align research methods if judged inappropriate. Second, participatory methods can also bridge the gap between researchers and participants by creating a more equal and collaborative environment. This can help reduce distrust, friction, and misunderstanding that can arise due to differences in social, cultural, and economic backgrounds. Finally, a participatory design approach is iterative, which allows multiple engagements with the end user. This benefits the development of rapport and mutual trust between researcher and participant, which is known to be a strong facilitator for participant retention (Mancuso & Rincon, 2006). Nevertheless, participatory design is still seldom applied in intervention design among people with LHL. Only a few examples exist of participatory design studies on people with LHL (Davis et al., 2018; Salim et al., 2021). The time, resource, and skill intensity of such a process in combination with its results being difficult to generalize, decrease the attractiveness of the approach (Altman et al., 2018) and evidence regarding why and how to conduct such an approach in intervention design is falling short (Vandekerckhove et al., 2020). In addition, effectively involving disadvantaged groups, such as people with LHL, in research efforts is challenging. It has been marked by several barriers, such as participants having difficulties understanding the content of the study (Bonevski et al., 2014), finding it difficult to think in abstract terms (Nind, 2008), language or literacy problems (Bonevski et al., 2014), anxiety toward research or the research team (Birks et al., 2007), feelings of stigmatization (Auerswald et al., 2017; Millum et al., 2019), and limited exposure to technology and internet (Hofstede et al., 2014). While participatory design methods have the potential to overcome these barriers, scientific

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