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It is very important to recognize the value of their contribution by expressing this repeatedly, in general, but also make sure to be as specific as possible. Show them in follow up sessions what was improved and changed based on their comments. Be very careful and adjust individual co-design steps to the participants, by checking with them and empowering them, to avoid that participants feel overwhelmed. Be open-minded, listen to their experiences and remember that they are experts in their own right.
For more information please refer to ‘recommendations for co-design’ and ‘ethical considerations’.

The prevalence of low eHealth literacy in the EU is at this point unknown, however the prevalence of Health literacy across Europe has been assessed. The European health literacy survey (HLS-EU) was conducted in eight countries within Europe by Sørensen et al. They found that at least 1 in 10 persons have insufficient health literacy in the EU, and almost 1 in 2 have limited health literacy [1].
Read more on eHealth literacy and its impact on ‘eHealth literacy’ and ‘Impact of low eHealth literacy’.

[1] Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M, Mensing M, Tchamov K, van den Broucke S, Brand H; HLS-EU Consortium. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015 Dec;25(6):1053-8. doi: 10.1093/eurpub/ckv043. Epub 2015 Apr 5. PMID: 25843827; PMCID: PMC4668324.

Common mistakes include:

  • Using too many complicated (non-native) words and medical terms
  • Proving a lot of information on one screen
  • A lack of support for the users in using the application, that leads to frustration and abandonment of the eHealth solution
  • The first user experience can be quite bad if lots of information is asked from the user before they even can start using the application and can assess whether the app is of value for them.
  • Lack of explanation of the presented information
  • Use of pop-ups and advertisement
  • Using images and symbols that do not match with the content

For further information on how to prevent these common mistakes, please refer to the ‘checklist’.

Fonts should be a minimum of 16 px. Some sources recommend 12 px, but these were even perceived as too tiny.
For more information, please refer to point 9 of the ‘Checklist’.

A sustainable support system at every stage of the introduction of an eHealth applications is necessary. It should be always clear on where to turn to in order to receive support when needed. The more support, the more confident the user is. There is a certain fear or barrier to engage with new technologies, especially in the case of older or lower eHealth literate users.

Especially when working with these users, their care providers need to be involved in the process of introducing an eHealth application as much as possible for they are the ones who can foster and support peoples’ self-confidence and empower them to familiarize themselves with technology and health information which might be alien to them at first.
For further information please refer to the ‘checklist’ and ‘Recommendations on co-design’.