Background Generative participatory design (PD) may help in developing electronic health (eHealth) interventions. PD is characterized by the involvement of all stakeholders in creative activities. This is different from the traditional user-centered design, where users are less involved. When looking at PD from a research through design perspective, it is important to summarize the reasons for choosing a certain form of generative PD to further develop its methodology. However, the scientific literature is currently unclear about which forms of PD are used to develop eHealth and which arguments are used to substantiate the decision to use a certain form of generative PD. Objective This study aimed to explore the reporting and substantiation of generative PD methodologies in empirical eHealth studies published in scientific journals to further develop PD methodology in the field of eHealth. Methods A systematic literature review following the Cochrane guidelines was conducted in several databases (EMBASE, MEDLINE Ovid, Web of Science, and CINAHL EBSCOhost). Data were extracted on the recruitment and management of stakeholders, the use of tools, and the use of outcome measures. Results Of the 3131 studies initially identified, 69 were selected for qualitative synthesis. The reporting was very variable, depending to a large extent on whether the study stated that reporting on the PD process was a major aim. The different levels of reporting and substantiation of the choices of a recruitment strategy, stakeholder management, and tools and outcome measures are presented. Only a few authors explicitly used arguments directly related to PD guiding principles such as democratic, mutual learning, tacit and latent knowledge, and collective creativity. Even though PD principles were not always explicitly discussed in the method descriptions of the studies, they were implicitly present, mostly in the descriptions of the use of PD tools. The arguments used to substantiate the choices made in stakeholder management, PD tools, and the type of outcome measures adopted point to the involvement of PD principles. Conclusions Studies that have used a PD research methodology to develop eHealth primarily substantiate the choice of tools made and much less the use of stakeholders and outcome measures.

During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant (or virtual assistant) with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic.

Purpose: Participatory design (PD) is a collective creative design process involving designers and nondesigners. There is limited reporting on the experience of using PD for adolescent and young adult (AYA) care. This study summarizes lessons from employing PD to develop care for AYAs with cancer. Methods: A qualitative multiple-case study method was conducted of three PD processes addressing food (FfC), intimacy and sexuality (I&S), and integrative medicine (IM) in caring for AYAs with cancer. Results: Local key stakeholders, who were exposed to a problem and had not been successful at solving it individually, were recruited to “dream” together. Through this synergy, a shared understanding of the problem and a joint mission emerged to find a solution. PD tools were used to develop a problem definition. An open mind and explorative research helped to understand the problems, and stakeholders were managed such that idea-sharing and learning were enabled. Designers translated ideas into prototypes. The PD process was prolonged due to the hierarchical hospital environment, business considerations, and additionally required evidence. The FfC program produced an effective new food service for the whole hospital. The I&S initiative developed a podcast, two articles, and a prototype website. The IM project developed a pilot study. Conclusions: For a PD process to successfully develop care for AYAs, one needs to use designers and skilled people, PD tools, and an open-ended approach to visualize and materialize new forms of care. Furthermore, recruitment and facilitation techniques help leverage knowledge and create a synergy in a democratic environment between stakeholders.

BACKGROUND Stakeholder participation is considered to play an important role to develop eHealth. Yet, it remains challenging to effectively involve stakeholders in this process. Participatory design (PD) may help to overcome these challenges, however its methodology is still in development. OBJECTIVE The aim of this study was to explore the use of PD methodology in the field of eHealth and to develop PD methodology in the field of eHealth further. METHODS A systematic literature review following Cochrane guidelines was conducted in several databases (Embase, Medline Ovid, Web of science and CINAHL EBSCOhost). Given the developing nature of PD methodology the focus was broader than methodological reasons stated in each study. Data was extracted regarding the reporting on recruitment and management of stakeholders, the use of tools and the use of outcomes. RESULTS Of the 2260 studies, 39 studies were selected for qualitative synthesis. Overall, there was a lack of reporting on the use of stakeholders and outcomes: 28% studies reported a stakeholder recruitment strategy and 38% studies reported about stakeholder management; 30% reported outcomes to evaluate the eHealth technology under development; 5% reported outcomes to evaluate PD. However, 84% studies reported about PD tools. These tools seem to have been used in line with the aim within the stage of the design process. The methodological considerations about the use of stakeholders, tools and outcomes were underreported in the publications. In addition, because of the lack of reporting about stakeholder strategies or the use of convenience sampling it could be questioned whether some studies were conducted according to the principles of PD. CONCLUSIONS There is insufficient reporting on the use of stakeholders and outcomes in studies which use PD to develop eHealth technology. Furthermore, methodological reasons to support the choice for a type of stakeholder recruitment or management, the choice of tools and the choice of outcomes is underreported. Therefore these studies lack rigor and accountability. PD principles may provide guidance to develop PD methodology further to develop eHealth technology.

Background Diverse knowledge and ways of thinking are claimed to be important when involving stakeholders such as patients, care professionals, and care managers in a generative co-design (GCD) process. However, this claim is rather general and has not been operationalized; therefore, the influence of various stakeholders on the GCD process has not been empirically tested. Objective In this study, we aimed to take the first step in assessing stakeholder diversity by formulating a procedure to assemble a group of diverse stakeholders and test its influence in a GCD process. Methods To test the procedure and assess its influence on the GCD process, a case was selected involving a foundation that planned to develop a serious game to help people with cancer return to work. The procedure for assembling a stakeholder group involves snowball sampling and individual interviews, leading to the formation of 2 groups of stakeholders. Thirteen people were identified through snowball sampling, and they were briefly interviewed to assess their knowledge, inference experience, and communication skills. Two diverse stakeholder groups were formed, with one more potent than the other. The influence of both stakeholder groups on the GCD process was qualitatively assessed by comparing the knowledge output and related knowledge processing in 2 identical GCD workshops. Results Our hypothesis on diverse stakeholders was confirmed, although it also appeared that merely assessing the professional background of stakeholders was not sufficient to reach the full potential of the GCD process. The more potently diverse group had a stronger influence on knowledge output and knowledge processing, resulting in a more comprehensive problem definition and more precisely described solutions. In the less potently diverse group, none of the stakeholders had experience with abduction-2 inferencing, and this did not emerge in the GCD process, suggesting that at least one stakeholder should have previous abduction-2 experience. Conclusions A procedure to assemble a stakeholder group with specific criteria to assess the diversity of knowledge, ways of thinking, and communication can improve the potential of the GCD process and the resulting digital health.

UNSTRUCTURED During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant (or virtual assistant) with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic.

BACKGROUND The involvement of stakeholders such as patients, care professionals and care managers is considered to play an important role in developing digital health. To this end generative co-design (GCD) is widely used to develop digital health. Yet, even though active stakeholder involvement is key in GCD, the justification to involve specific stakeholders is lacking in GCD research to develop digital health. Therefore a generative co-design methodology (GCDM) based on theory has previously been developed to improve the scientific rigor regarding stakeholder involvement. OBJECTIVE In this study, we implement the GCDM recommendations concerning stakeholder involvement in a GCD project to develop a serious game for cancer patients. Here, the stakeholder involvement recommendations are further operationalised as a stakeholder selection procedure. METHODS Snowball sampling was used to identify potential stakeholders, and short interviews involving eight criteria were used to assess their relevant knowledge and abilities. On this basis, those deemed most appropriate as participants in GCD were allocated to Group 1 and those with fewer of the desired skills to Group 2. Both groups participated in identical GCD workshops. The influences of the implemented stakeholder selection procedure and the resulting allocations were qualitatively assessed by comparing the knowledge output and the related knowledge processing in the two workshops. RESULTS We found that the interaction quantities in the two workshops were broadly similar but the Group 1 stakeholders had a stronger and more positive influence on the diversity and density of knowledge processing, which resulted in a better quality of knowledge output than from Group 2. In terms of further developing the theory about the role of stakeholders in the GCDM, we would encourage researchers to explore the role given to abduction-2 inference in the selection procedure, and the role of facilitation with abduction-2 and contextual certainties in the GCD process. CONCLUSIONS We encourage the further validation of our stakeholder selection process in GCD. Ultimately, this will help GCD researchers come to more methodologically sound findings and to further refine the methodological recommendations to involve robust decisions and then report them in a sound way, both of which will improve the scientific rigor of GCD science for digital health.