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      Understanding the Acceptance of an eHealth Technology in the Early Stages of Development: An End-User Walkthrough Approach and Two Case Studies

      , PhD , 1 , 2 , , MSc 1 , , MSc 1 , , PhD 1 , 2 , , MSc 1 , , Prof Dr 1 , 2

      (Reviewer), (Reviewer)

      JMIR Formative Research

      JMIR Publications

      eHealth, acceptance, design, walkthrough, agile design

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          Studies that focus on the acceptance of an electronic health (eHealth) technology generally make use of surveys. However, results of such studies hold little value for a redesign, as they focus only on quantifying end-user appreciation of general factors (eg, perceived usefulness).


          We present a method for understanding end-user acceptance of an eHealth technology, early in the development process: The eHealth End-User Walkthrough.


          During a walkthrough, a participant is guided by using the technology via a scenario, a persona, and a low-fidelity protoype. A participant is questioned about factors that may affect acceptance during and after the demonstration. We show the value of the method via two case studies.


          During the case studies, participants commented on whether they intend to use a technology and why they would (not) use its main features. They also provided redesign advice or input for additional functions. Finally, the sessions provide guidance for the generation of business models and implementation plans.


          The eHealth End-User Walkthrough can aid design teams in understanding the acceptance of their eHealth application in a very early stage of the design process. Consequently, it can prevent a mismatch between technology and end-users’ needs, wishes and context.

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          Most cited references 27

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          Factors influencing acceptance of technology for aging in place: a systematic review.

          To provide an overview of factors influencing the acceptance of electronic technologies that support aging in place by community-dwelling older adults. Since technology acceptance factors fluctuate over time, a distinction was made between factors in the pre-implementation stage and factors in the post-implementation stage.
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            User involvement: A review of the benefits and challenges

             Sari Kujala (2003)
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              Design and Evaluation in eHealth: Challenges and Implications for an Interdisciplinary Field

              Much has been written about insufficient user involvement in the design of eHealth applications, the lack of evidence demonstrating impact, and the difficulties these bring for adoption. Part of the problem lies in the differing languages, cultures, motives, and operational constraints of producers and evaluators of eHealth systems and services. This paper reflects on the benefits of and barriers to interdisciplinary collaboration in eHealth, focusing particularly on the relationship between software developers and health services researchers. It argues that the common pattern of silo or parallel working may be ameliorated by developing mutual awareness and respect for each others’ methods, epistemologies, and contextual drivers and by recognizing and harnessing potential synergies. Similarities and differences between models and techniques used in both communities are highlighted in order to illustrate the potential for integrated approaches and the strengths of unique paradigms. By sharing information about our research approaches and seeking to actively collaborate in the process of design and evaluation, the aim of achieving technologies that are truly user-informed, fit for context, high quality, and of demonstrated value is more likely to be realized. This may involve embracing new ways of working jointly that are unfamiliar to the stakeholders involved and that challenge disciplinary conventions. It also has policy implications for agencies commissioning research and development in this area.

                Author and article information

                JMIR Form Res
                JMIR Form Res
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                Jan-Jun 2018
                15 June 2018
                : 2
                : 1
                1 Telemedicine Cluster Roessingh Research and Development Enschede Netherlands
                2 Biomedical Signals and Systems Group University of Twente Enschede Netherlands
                Author notes
                Corresponding Author: Lex van Velsen l.vanvelsen@
                ©Lex van Velsen, Mirka Evers, Cristian-Dan Bara, Harm Op den Akker, Simone Boerema, Hermie Hermens. Originally published in JMIR Formative Research (, 15.06.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on well as this copyright and license information must be included.

                Original Paper
                Original Paper

                agile design, ehealth, walkthrough, design, acceptance


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