Notes Persuasive Health Technology
Lectures, book and articles
The notes follow the order of the lectures.
Green= Titles, subtitles
Yellow= definitions/very important concepts
Light blue= lists, sub-categories
Salmon= authors/organisations and dates/time
Lecture 1: Introducing eHealth, the CeHRes roadmap
and the contextual inquiry - Chapter 1,7, 8
Chapter 1 - Introducing eHealth
Introduction to eHealth
SUMMARY
● eHealth is the use of technology to improve health, well-being and healthcare
○ Self-care and prevention
○ Supportive care
○ Social health
● Holistic vision of health is advocated: fit between technology, people (users and
stakeholders) and their context
○ Holistic development, design, implementation, and evaluation can overcome
barriers and achieve benefits
● CeHRes Roadmap - can support holistic development and it’s based on approaches
as participatory development, human-centred design, business modelling and
persuasive design
What is eHealth?
“refers to the use of [information and communication] technologies to support health, well-
being, and healthcare”
Why is important?
- Ageing population → rise of eldelry people, chronic diseases, comorbidity,
participatory health
- Decline in healthcare professionals, budget
➔ The healthcare system is in great need of innovation
,Categorization of eHealth - Based on the involvement of
specific stakeholders
1. Self-care and prevention
Patients or health consumer in the lead → foster self-management
● Decision aids: information and interaction with the system
● Self-monitoring of health-related info → smartwatches
● Online (self-help) interventions
2. Supportive care
More involvement of healthcare professionals → work together with
patient
● Telemedicine → telecommunication to exchange long-distance
medical informationn
● Electronic Personal Health Records (PHRs) → sharing clinical data
between patient and healthcare professional + support self-
management
3. Societal health
→ Involvement of both patients & healthcare professionals
→ The lead is at a societal level: broad health-related issues
→ Government vital role in creating policies and regulations
● Influence the attitude and awareness of individual about societal health
issues
● Support behavior that is compliant with guidelines → technology can
assist in translating policies into action
● Manage the behaviour of individuals during outbreaks of infectious
disease → mobile tracking apps during COVID
● Support communication between health professionals about societal
issues
Benefits of eHealth:
★ Access to care
● Healthcare is available independent of time (24/7) and place (at home)
● Healthcare equity: improved access for more people
- Remove threshold to healthcare: stigmatization (anonymus online
consultations)
★ Empowerment
● Enable people to take more control of their own health and care process
→ Patient-centredness
● Care-professionals: technology supports decision making
★ Innovation
● Sustainable change in health care: i.e. easy communication
● Technology opens up new possibilities, way of thinking →
innovations
★ Quality of care
● Effectiveness: improve traditional treatments → better safey, less
errors
, ● Efficiency: optimize resource use → achieve same results with fewer
resources
Barriers of eHealth
1. Implementation barriers
A lack of:
● Incentives → resistance to use technology
○ Financial incentives
○ Perceived benefits
● Stakeholder support
● Ability or skills to use technology → low health-literacy
● Motivation to start or continue using eHealth
● Trust and confidence in technology → fear
● Standardization - using different softwares and hardares → no
interoperable
● Clear regulations and certification procedures
2. Ethical barriers
● Privacy and security:
- Ownership of data? Who has access to the system and data?
● Transparency & liability:
- Do we understand the decision rules of algorithms that are being
used?
- Technology vs clinical eye: who is liable when things go wrong?
● Reliability & accuracy: quality of information
- To what extent can we trust the information?
- Need of reliable certifications
● Autonomy & trustworthiness:
- Expertise is needed to understand and judge your own health data
- How to ensure that the user remains in control (when alghortism are
not used?)
3. Evidence barriers
● A lack of available evidence on (cost)effectiveness and long-term effects
● Study designs used (Randomize Control Trials - RCTs) are not adequate
○ Need of other more complete evaluation methods
● Information of (non)adherence is lacking
○ Non-adherence: wheter technology is used as intended by the
developers
● Evaluation studies outcome driven: only effectiveness is considered
○ the design & quality of the evaluated technology is often not studied
○ need to ensure replicability of studies and interventions
● Combination of Fundamental and Applied research needed: insight into the
working elements of eHealth interventions
eHealth: Technology
● Technology is essential for eHealth
, ● Technology should fit the way people live and work, their socio-economic
background and the way they make decisions about health and well-being
● Good fit between technology, user and context → more likely the technology
will be used and effective
eHealth: Psychology
● Change in people’s cognition and behaviour is required, but difficult
● eHealth intervention that use psychological behaviour change theories are more
effective
○ Behavioural change techniques + persuasive features
● Co-designing intervention → fit the users/stakeholders perspective
○ methods from human centered design
eHealth: Multidisciplinary approach
● Close interrelationship between creation of the content and technology, its end-users,
stakeholders, and the healthcare context in which they will be used
● Participatory design
○ To ensure that content and design fit stakeholder needs
● Use methods, frameworks and theories from different disciplines
○ to account for all perspectives throught development, implementation and
evaluation
Chapter 7 - The CeHRes Roadmap
5 Pillars of holistic eHealth development, implementation and
evaluation:
eHealth development, implementation, and evalutation process:
1. Are ongoing and intertwined, rather than phases containing separate and
sequential activities
2. Holistic approach: fit between technology, people and context
3. Multi-method, iterative approach with continuous evaluation cycles
4. Constant active involvement of stakeholders
5. Based on an interdisciplinary approach
1. Ongoing and intertwined
Development, implementation and evaluation are intertwined and relevant from the start
● Implementation plays a role from the start
● Development activities can also take place during evaluation
● Evaluation can be initiated during the development
➢ development, implementation and evaluation are never finished
2. Holistic: best fit between technology, people and context
Interrelationship between:
● Design and content of a technology
● Needs and preferences of the people involved
Lectures, book and articles
The notes follow the order of the lectures.
Green= Titles, subtitles
Yellow= definitions/very important concepts
Light blue= lists, sub-categories
Salmon= authors/organisations and dates/time
Lecture 1: Introducing eHealth, the CeHRes roadmap
and the contextual inquiry - Chapter 1,7, 8
Chapter 1 - Introducing eHealth
Introduction to eHealth
SUMMARY
● eHealth is the use of technology to improve health, well-being and healthcare
○ Self-care and prevention
○ Supportive care
○ Social health
● Holistic vision of health is advocated: fit between technology, people (users and
stakeholders) and their context
○ Holistic development, design, implementation, and evaluation can overcome
barriers and achieve benefits
● CeHRes Roadmap - can support holistic development and it’s based on approaches
as participatory development, human-centred design, business modelling and
persuasive design
What is eHealth?
“refers to the use of [information and communication] technologies to support health, well-
being, and healthcare”
Why is important?
- Ageing population → rise of eldelry people, chronic diseases, comorbidity,
participatory health
- Decline in healthcare professionals, budget
➔ The healthcare system is in great need of innovation
,Categorization of eHealth - Based on the involvement of
specific stakeholders
1. Self-care and prevention
Patients or health consumer in the lead → foster self-management
● Decision aids: information and interaction with the system
● Self-monitoring of health-related info → smartwatches
● Online (self-help) interventions
2. Supportive care
More involvement of healthcare professionals → work together with
patient
● Telemedicine → telecommunication to exchange long-distance
medical informationn
● Electronic Personal Health Records (PHRs) → sharing clinical data
between patient and healthcare professional + support self-
management
3. Societal health
→ Involvement of both patients & healthcare professionals
→ The lead is at a societal level: broad health-related issues
→ Government vital role in creating policies and regulations
● Influence the attitude and awareness of individual about societal health
issues
● Support behavior that is compliant with guidelines → technology can
assist in translating policies into action
● Manage the behaviour of individuals during outbreaks of infectious
disease → mobile tracking apps during COVID
● Support communication between health professionals about societal
issues
Benefits of eHealth:
★ Access to care
● Healthcare is available independent of time (24/7) and place (at home)
● Healthcare equity: improved access for more people
- Remove threshold to healthcare: stigmatization (anonymus online
consultations)
★ Empowerment
● Enable people to take more control of their own health and care process
→ Patient-centredness
● Care-professionals: technology supports decision making
★ Innovation
● Sustainable change in health care: i.e. easy communication
● Technology opens up new possibilities, way of thinking →
innovations
★ Quality of care
● Effectiveness: improve traditional treatments → better safey, less
errors
, ● Efficiency: optimize resource use → achieve same results with fewer
resources
Barriers of eHealth
1. Implementation barriers
A lack of:
● Incentives → resistance to use technology
○ Financial incentives
○ Perceived benefits
● Stakeholder support
● Ability or skills to use technology → low health-literacy
● Motivation to start or continue using eHealth
● Trust and confidence in technology → fear
● Standardization - using different softwares and hardares → no
interoperable
● Clear regulations and certification procedures
2. Ethical barriers
● Privacy and security:
- Ownership of data? Who has access to the system and data?
● Transparency & liability:
- Do we understand the decision rules of algorithms that are being
used?
- Technology vs clinical eye: who is liable when things go wrong?
● Reliability & accuracy: quality of information
- To what extent can we trust the information?
- Need of reliable certifications
● Autonomy & trustworthiness:
- Expertise is needed to understand and judge your own health data
- How to ensure that the user remains in control (when alghortism are
not used?)
3. Evidence barriers
● A lack of available evidence on (cost)effectiveness and long-term effects
● Study designs used (Randomize Control Trials - RCTs) are not adequate
○ Need of other more complete evaluation methods
● Information of (non)adherence is lacking
○ Non-adherence: wheter technology is used as intended by the
developers
● Evaluation studies outcome driven: only effectiveness is considered
○ the design & quality of the evaluated technology is often not studied
○ need to ensure replicability of studies and interventions
● Combination of Fundamental and Applied research needed: insight into the
working elements of eHealth interventions
eHealth: Technology
● Technology is essential for eHealth
, ● Technology should fit the way people live and work, their socio-economic
background and the way they make decisions about health and well-being
● Good fit between technology, user and context → more likely the technology
will be used and effective
eHealth: Psychology
● Change in people’s cognition and behaviour is required, but difficult
● eHealth intervention that use psychological behaviour change theories are more
effective
○ Behavioural change techniques + persuasive features
● Co-designing intervention → fit the users/stakeholders perspective
○ methods from human centered design
eHealth: Multidisciplinary approach
● Close interrelationship between creation of the content and technology, its end-users,
stakeholders, and the healthcare context in which they will be used
● Participatory design
○ To ensure that content and design fit stakeholder needs
● Use methods, frameworks and theories from different disciplines
○ to account for all perspectives throught development, implementation and
evaluation
Chapter 7 - The CeHRes Roadmap
5 Pillars of holistic eHealth development, implementation and
evaluation:
eHealth development, implementation, and evalutation process:
1. Are ongoing and intertwined, rather than phases containing separate and
sequential activities
2. Holistic approach: fit between technology, people and context
3. Multi-method, iterative approach with continuous evaluation cycles
4. Constant active involvement of stakeholders
5. Based on an interdisciplinary approach
1. Ongoing and intertwined
Development, implementation and evaluation are intertwined and relevant from the start
● Implementation plays a role from the start
● Development activities can also take place during evaluation
● Evaluation can be initiated during the development
➢ development, implementation and evaluation are never finished
2. Holistic: best fit between technology, people and context
Interrelationship between:
● Design and content of a technology
● Needs and preferences of the people involved
