3 Participatory design for and with patients with low health literacy 61 were asked about their opinion and if they had any questions. Subsequently, the interface screens were presented and discussed following an interview topic guide. Interview questions included “what do you think they mean with this?” or “what do you think is presented here?” Whenever an element was unclear, we asked the participant to provide suggestions for improvement. The representative of Pharos provided a summary with recommendations for improvement after the last session. In addition, observations and participant responses by the investigator were collected in a written report. Overall, the participants were positive about the concept as they felt that it would help them gain awareness of being nonadherent to their maintenance medication and the consequences for their lungs. The visual presentation style was understood, and the overall system was perceived as useful and innovative. However, some interface details were unclear, confusing some of the participants. For example, colors were deemed confusing when they were unrealistic (e.g., a blue lung). In addition, a color-coded performance bar was suggested to visualize the improvement of the cilia. 3.4 Discussion 3.4.1 Principal findings This paper demonstrates a participatory design approach of a medication adherence intervention for patients with asthma and LHL. We explored the potential of applying several participatory design techniques in health intervention design for a LHL population. These consisted of co-constructing stories, an experience prototype exhibition, and a video prototype evaluation. The demonstrated activities provide novel insight in the practical use and implications of participatory design activities with people with LHL and have positive indicative value for supporting their participation in the design process. There is a need for more insight in new and adapted methods to effectively reach and engage disadvantaged groups. Current approaches are insufficient in reaching and retaining underserved populations (Bonevski et al., 2014; Janson et al., 2001). While participatory design is increasingly receiving more attention, it is still seldom applied by designers with people with LHL. Models, approaches, and guidelines for participatory design do exist; yet they do not provide concrete steps that fit specific contexts and people. A previous study suggests there is a need for a broad range of methods that facilitate the practical application of these models (Kip et al., 2019). The demonstration of these methods in specific contexts and target groups (e.g., patients with psychiatric illness (Kip et al., 2019) and LHL) could severely improve the alignment of interventions with disadvantaged populations. Indeed, we believe that some of the reasoning behind the activities will also apply to other disadvantaged groups. First, our activities are aimed at facilitating our participants to
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