The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care

Abstract

BackgroundThe use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them.ObjectiveThe two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap).MethodsIn the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method.ResultsInformation on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal.ConclusionsReflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed.

A Perspective on the Integration of eHealth in Treatment of Offenders: Combining Technology and the Risk-Need-Responsivity Model

“…In order to integrate eHealth in treatment guided by the RNR model, thorough development, implementation and evaluation are important (76). Multiple researchers recommended to develop new interventions via a participatory development approach, in which patients, therapists and other stakeholders are actively involved throughout the entire process (77)(78)(79). This approach is used to ensure that the intervention fits the characteristics, wishes, treatment protocols and risk factors (78).…”

“…Multiple researchers recommended to develop new interventions via a participatory development approach, in which patients, therapists and other stakeholders are actively involved throughout the entire process (77)(78)(79). This approach is used to ensure that the intervention fits the characteristics, wishes, treatment protocols and risk factors (78). It is important to note that existing interventions from regular mental healthcare cannot simply be copy-pasted into this complex and unique setting, so they might have to be re-designed to optimally fit forensic psychiatry (14).…”

The development and evaluation of a web-based well-being intervention, for inclusion within an existing health promotion programme, to support and encourage health related lifestyle behaviour change

“…For example, Ethnographic observations; interviews; focus groups; workshops, stories and storytelling (including specific methods: CARD; PICTIVE; CUTA; pictureCARD) end-user photography; videos; games (Muller, 2007) and system design focused techniques including: Mock-ups, Scenarios, Simulations and Prototyping (Kensing & Blomberg, 1998). The choice of tools and techniques applied in each design stage is critical to the establishment of a connected, collaborative design process (Kip et al, 2019). For example, the dynamics of the group interview (focus group), necessitate communication between participants, on equal footing (Kitzinger, 1995).…”

“…Of course, PD is not the only approach available for use in the The key difference between PD and the CeHRes Roadmap approach lies in the exact role of the participants, the latter includes participants in the initial stages i.e. contextual enquiry and value specification however once values are identified they are prioritised and transformed into requirements to inform the later design stages which are led by a project team (Kip et al, 2019).…”

“…'Well-being as balance and 'Wellbeing as an active process' were to key themes reported (the other themes reported by Attwood et al, 2020) External resources which support a pro-active self-management approach over the long term. This approach has received support and is encouraged in early phases of development (Kip et al, 2019;Onken et al, 2014). Not all of the requirements identified were incorporated into the final prototype.…”