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From Testers to Cocreators—the Value of and Approaches to Successful Patient Engagement in the Development of eHealth Solutions

A qualitative study in collaboration with PersonalPulse GmbH and sponsored by Innossuisse

A study conducted by the University of Applied Sciences Northwestern Switzerland, in collaboration with the practice partner PersonalPulse GmbH - whose mission is to empower transformation in citizen-led health care innovation, working together with relevant stakeholders in the healthcare ecosystem to cocreate health care tools that are relevant, usable, and sustainable - was published in the Journal of Medical Internet Research Human Factors (link to the study).

The study findings were featured in the media in an article in ICT and Health magazine, and will be presented in the eHealth Summit in November 2022.

About the Study

Research has shown that patient engagement is most commonly done at the beginning of research or to test readily available prototypes and less commonly done in other phases such as the execution phases. Previous studies have reported that patients are usually assigned a consultative rather than a decision-making role in health service planning and evaluation.


This study had 2 objectives: to better understand the challenges and opportunities in the inclusion of patients in the development of eHealth technologies and ideas on how to overcome the identified gaps and to create a research-based end-to-end practical blueprint that can guide the relevant stakeholders to successfully engage patients as cocreators in all human-centered design phases rather than mere testers of preplanned prototypes.


Key informant interviews were conducted using in-depth semistructured interviews with 20 participants from 6 countries across Europe. This was followed by a focus group to validate the initial findings. Participants encompassed all the relevant stakeholder groups including patient experts, eHealth experts, health technology providers, clinicians, pharma executives, and health insurance experts.


The study shows that engaging patients in eHealth development can help provide different types of value; namely, identifying unmet needs, better usability and desirability, better fit into the patient journey, better adoption and stickiness, better health outcomes, advocacy and trust, a sense of purpose, and better health equity and access. However, the participants agreed that patients are usually engaged too late in the development process, mostly assuming a sounding role in testing a ready-made prototype. The justification for these gaps in engagement is driven by some prominent barriers, notably compliance risks, patient-related factors, power dynamics, patient engagement as lip service, poor value perception, lack of resources, mistrust, and inflexibility. On the positive side, the participants also reflected on facilitators for better patient engagement; for instance, engaging through engagement partners, novel approaches such as the rise of professional patient experts, embedding patients in development teams, expectation management, and professional moderation services.


Overcoming the current gaps in patient engagement in eHealth development requires consolidated efforts from all stakeholders in a complex health care ecosystem. The shift toward more patient-driven eHealth development requires education and awareness; frameworks to monitor and evaluate the value of patient engagement; regulatory clarity and simplification; platforms to facilitate patient access and identification; patient incentivization, transparency, and trust; and a mindset shift toward value-based health care.

This study was sponsored by Innosuisse (Swiss Innovation Agency, grant 60330.1 INNO-ICT).

Please cite as:

Jacob C, Bourke S, Heuss S. From Testers to Cocreators—the Value of and Approaches to Successful Patient Engagement in the Development of eHealth Solutions: Qualitative Expert Interview Study. JMIR Hum Factors 2022;9(4):e41481. doi: 10.2196/41481. PMID: 36102548. PMCID: 9585443

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