3 Participatory design for and with patients with low health literacy 57 approximately 1 hour, and were audio recorded. Observations and impressions about reasons for nonadherence and the co-constructed stories were collected in the form of a written report after the sessions. Using the storyboards, we asked nondirective questions such as: “How does this character experience the instructions given by the caregiver?” “How do you experience these instructions?” and “can you relate with the character and why or why not?” The sessions helped to deepen our understanding of the preliminary insights from the initial literature review. For instance, we learned from the literature that an important reason for medication nonadherence in LHL groups is that the patients have misconceptions about the medication (Brown & Bussell, 2011; Federman et al., 2013; Soones et al., 2017). However, through our sessions, we gained a more nuanced view of these beliefs. The participants reported trusting their doctor’s expertise blindly, as they had difficulties understanding the purpose of the maintenance medication. Despite trusting the advice, they used their reliever inhaler instead when they experienced symptoms. When asked, participants indicated not knowing or remembering the explanations given by their HCP: “According to the doctor, I just have to use it [the medication]. That is what I know.” [Male] 3.3.2 Stage 2 – Define We used the intervention mapping approach (Bartholomew et al., 1998) to translate the user insights, through change objectives, toward practical design opportunities. We discussed the 22 identified change objectives with the stakeholders and developed 3 overarching design opportunities (Table 3.1). In a consensus meeting with design experts, we agreed on the most feasible and important design opportunity—creating awareness about the effects of medication on symptoms through patient engagement in logging and monitoring. Table 3.1 Design opportunities Design opportunity Determinant Description Improve the capabilities of patients to understand and organize their medication intake behavior. Capabilities Empower the patient to gain authority and confidence in self-managing their asthma. Create patient awareness about the importance and effect of the medication. Awareness Let the patient see the effect of the medication on the body and the relation between usage and experience of symptoms. Change patients’ attitudes to sustain motivation over a longer period. Attitude Help the patient acknowledge that longterm benefits of a maintenance inhaler are as important as directly noticeable effects of the reliever inhaler.
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