Methods for Human-Centered eHealth Development: Narrative Scoping Review

Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.


Authors
Year Reference Goal of the study Included methods and products Al-Itejawi et al. 2016 [1] To develop a patient decision aid and to prepare an overview of requirements for implementation. Focus groups, interviews, usability tests Amann et al. 2020 [2] Taking spinal cord injury as a case in point, the overall objectives of this study were to identify the perceived benefits of a co-designed self-management app that could promote its uptake and to explore the factors that may impede adoption.
Interviews, focus group Ammerlaan et al. 2016 [3] To provide a systematic and comprehensive description of the theoretical considerations for building a Web-based, expert, patient-guided, and tailored intervention for adult patients with a rheumatic disease. Also, to present the results of a usability study on the feasibility of this intervention, and its study design in order to measure the effectiveness.
Questionnaire, focus groups Asbjørnsen et al. 2019 [4] This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance.

Literature study
Asbjørnsen et al. 2020 [5] The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs.
Interviews, focus groups, behavior change strategies, values Askedal et al.
2017 [6] This study used a qualitative approach to identify and investigate contradictory stakeholder interests in the early phase of a municipal eHealth project.
Desk research, stakeholder map, focus groups Backere, de et al. 2014 [7] To present the methodologies to develop a cloud-based semantic system, offering valuable information and knowledge-based services.
2013 [8] We aimed to identify the group of individuals within the general Dutch population that are at high risk of being bitten by a tick or developing LD and to describe their characteristics, knowledge, and perceptions.

Interviews
Beerlage-de Jong et al.
2014 [9] Offering a (practical) method for the integration of two eHealth development frameworks (User-Centered Design and Persuasive System Design model) Focus group, questionnaire, interviews, usability tests Beerlage-de Jong et al.
2017 [10] Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of clinical decision support systems (CDSS) in antimicrobial stewardship.
2017 [11] To describe the Roadmap activities that we executed in the eZoon-project in the different phases of the project, and which knowledge they yielded.
2017 [12] In this position paper we describe i) how a socio-technical multidisciplinary approach (based on the CeHRes Roadmap) can be applied in the development and implementation of Antimicrobial Stewardship technologies and ii) how this approach can be of value to support Antimicrobial Stewardship in practice. AND In this position paper Literature study, prototype, usability tests, focus we describe the lessons learned from research and practice to guide future developments of technology based ASP interventions.
groups, card sorting, stakeholder map Belt, van de et al.
2013 [13] To determine the preferences of the general population in the Netherlands regarding the use of the Internet and social media in health care.

Questionnaire
Bernecker et al. 2017 [14] The aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs.

Questionnaire
Boele et al. 2017 [15] We aimed to explore PBT caregivers' satisfaction with the current supportive care provision, as well as their thoughts on monitoring their care issues with both paper-based and digital instruments.

Interviews
Bogza et al. 2020 [16] This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with mild cognitive impairment.
Literature study, prototype, usability tests, questionnaire, focus group Børøsund et al.
2018 [17] To develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination.
Interviews, focus groups, usability tests, prototypes Bossen et al.
2016 [18] The first aim was to develop a blended exercise therapy intervention for patients with knee and hip osteoarthritis that matches the values of the users and that can be implemented in the daily routine of physical therapists. The second aim was to investigate the feasibility through interviews and a pilot study.

Focus groups, interviews
Breeman et al. 2021 [19] The goals of this study were threefold: to uncover stakeholders' needs and preferences, to translate these to core values, and develop eHealth technology based on these core values. Our primary research question is: What type of eHealth application to support healthy living among people with (a high risk of) CVD would provide the greatest benefit for all stakeholders?
2014 [20] The objective of this project was to apply a bottom-up inspired procedure to develop a patient-centered intervention with corresponding evaluation and implementation plan.
Questionnaires, interviews, behavior change strategies, usability tests Carr et al.
2017 [21] To identify the needs and requirements of the end users, to inform the development of a user-interface to translate an existing evidence-based decision support tool into a practical and usable interface for health service planning for osteoarthritis (OA) care.

Focus groups
Cheung et al. 2018 [22] To illustrate a mixed-method usability evaluation of an economic decision-support tool for tobacco control, using the EQUIPT ROI tool prototype as a case study.
2015 [23] To develop a Web-based self-care program for patients after total laryngectomy according to a participatory design approach.
Focus group, prototype, usability test Corbett et al.
2017 [24] What characteristics of business model design in precare contribute to the convenience and quality of eHealth services provided by a health professional to a client?
Literature study, desk research, focus groups, usability tests Crane et al.
2017 [25] The aim of this study is to explore user views toward an app to help people reduce their consumption of alcohol and determine whether the BCTs are acceptable and feasible to users and how they might be improved
2018 [26] To deliver recommendations to further improve the system in preparation for a large scale implementation. Questionnaire, interviews, usability tests, log data analysis, literature study Da Costa et al.
2017 [27] To guide the development of Healthydads.ca, a website designed to enhance mental health and healthy behaviors in expectant fathers, a needs assessment was conducted to identify fathers' perspectives of barriers to seeking help for emotional wellness, informational needs, and factors affecting the decision to visit such a website.
Questionnaire D'adderoi et al. 2020 [28] The aim of this study was to investigate the features that are judged to be important for engagement with a physical activity mobile app and the reasons for their importance.

Focus groups
Derks et al. 2017 [29] Using a modified UXD-framework, we investigated the need amongst BPD-patients and therapists for an ambulatory biofeedback e-coaching app that supports patients in learning to better recognise changes in their arousal level.
Interviews, card sorting, persona Derks et al. 2019 [30] The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness.
Usability tests, questionnaire, interviews, prototypes Dick et al. 2020 [31] This paper describes the process and contributions of a persona-building approach in the development of a digital behaviour change intervention tailored to the needs of third-level students.
Focus groups, personas Dijk, van de et al.
2013 [32] To explore the requirements of older people for eHealth support, and through this to promote self-management and enhance quality of life.
Focus groups, questionnaires Doty et al. 2020 [33] Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP).
Questionnaire, interviews, requirements, prototype Downing et al. 2016 [34] This study investigated views of mothers from disadvantaged urban and regional areas (i.e., beyond major capital cities) as potential end users of child active play and screen time behaviour change interventions, with a focus on text messaging and web-based delivery platforms.
2015 [35] To investigate health care professionals' perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care.
Interviews, prototypes, usability tests Duplaga 2016 [36] To assess nurses' opinions and to analyze the predictors of their acceptance of ehealth features relevant to patient empowerment with a strong focus on chronic care.

Questionnaire
Dyk, van et al. 2012 [37] The purpose of this paper is to analyse the commonalities and differences of two models (CeHRes Roadmap and Telemedicine Maturity Model) , and to explore how they can be used to complement each other.
Literature study, focus groups, requirements, prototypes Ehrler et al.
2019 [38] To present the design, development, and testing of a smartphone app for nurses guided by an adapted software development life cycle model that takes into consideration the complexity and constraints of a health care setting.
Focus group, card sorting, prototypes, usability tests Fico et al.
2015 [39] The work presented in this paper describe the methodologies used in the context of two multidisciplinary research projects, METABO and MOSAIC.
Focus groups, business model Fico et al.
2015 [40] The work presented in this paper describe the methodologies used in the context of a multidisciplinary research project and provides an overview of the preliminary results.
Focus groups, usability tests, prototype Fico et al.
2019 [41] To develop new computer models, and implement them in tools to support the detection and prediction of T2D onset and related complications, in different healthcare settings (e.g. hospitals, clinical centres and health agencies).
2015 [42] In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)-both as a website and as a mobile app-was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs.
Focus groups, interviews, usability tests, prototype Floch et al. 2018 [43] To develop and evaluate an app ecosystem for self-management in systic fibrosis. Interviews, prototypes Galpin et al.
2017 [44] The first objective was to examine the utility of an online user design group for generating insight for the creation of Web-based health resources. We sought to explore the advantages and limitations of this approach. The second objective was to analyze what women want from a Web-based resource for breast cancer screening.
2016 [45] In this chapter we elaborate on the use of the CeHRes roadmap for dementia care. First, we will describe the CeHRes roadmap and its principles for development, then we present a case study to demonstrate how the roadmap was used in practice, and finally we will reflect upon the case study by means of lessons learned.
2011 [46] To investigate the use of a web-based triage system in primary care, and compliance with the medical advice delivered by it.
2014 [47] The aims of this study were (1) to illustrate how log data can be used to understand the uptake of the content of a Web-based intervention that is based on the acceptance and commitment therapy (ACT) and (2) to discover how log data can be of value for improving the incorporation of content in Web-based interventions Log data analysis Geraghty et al. 2016 [48] To develop an unguided e-mental health intervention for distress in primary care patients, drawing on meta-theory of psychotherapeutic change and utilizing the person-based approach (PBA) to guide iterative qualitative piloting with patients.
Interviews, prototypes, usability tests Gilbert et al. 2016 [49] This paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC).
2018 [50] To determine the level of interest in online peer support among infertility patients, factors associated with such interest, and preferences for features of an online peer support network. 2017 [53] The study aim was to develop a mobile application (app) supported by user preferences to optimise selfmanagement of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment.
Focus groups, literature study, usability tests, requirements, Hochstenbach et al.
2017 [54] To describe a co-creative method directed towards the development of na eHealth intervention delivered by registered nurses to support self-management in outpatients with cancer pain.
Literature study, desk research, interviews, focus groups, prototypes, usability tests Honary et al.
2018 [55] The aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder.
Focus groups, requirements, usability tests Hughes et al. 2020 [56] This study explored rehabilitation clinician's preferences for design features to be included in an mHealth-enabled app for post-stroke upper limb rehabilitation.

Questionnaire
Imhemed et al. 2017 [57] To establish the requirements for type-2 diabetes in Malaysia using the user-centered approach. Questionnaire, focus groups, interviews, prototypes, usability tests Imhemed et al.
2017 [58] To leverage user-centered design (UCD), particularly empathy approach to drive the creation of user-personas for type-2 diabetes.
Questionnaire, personas Jansen et al. 2015 [59] To explore the perceived need for supportive care including healthy lifestyle programs among cancer survivors, their attitude towards selfmanagement and eHealth, and its association with several sociodemographic and clinical variables and quality of life.

Questionnaire
Jonathan et al. 2021 [60] This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions.
Interviews, focus groups, prototype, usability tests, Keizer et al. 2020 [61] This study's aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for antimicrobial resistance prevention measures, with needs and expectations of health care workers.

Interviews
Kelders et al. 2013 [62] The current study describes the development of a web-based intervention for the indicated prevention of depression, employing the CeHRes roadmap. The goals are to create a user-friendly application which fits the values of the stakeholders and to evaluate the process of development.
2012 [63] To review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention.

Literature study
King et al. 2018 [64] The purpose of this article is to describe the development and initial usability testing of an eHealth intervention, the Teaching Educators About Chronic Pain Project (TEACh-Pain), designed to increase educator understanding of pediatric chronic pain in the school setting.

Usability tests
Kip et al.
2018 [65] To examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness.
Literature study Kip et al. 2019 [66] This study aimed to identify (1) points of improvements in existing forensic mental health treatment of in-and outpatients, (2) possible ways of using VR that can improve current treatment, and (3) positive and negative aspects of the use of VR for the current treatment according to patients and therapists.
Interviews, prototypes, questionnaire, Kip et al. 2019 [67] In this paper we show how we formulated values during the multi-method, interdisciplinary and iterative development process of a VR application for a complex setting: forensic mental healthcare Questionnaire, values, interviews Kip et al. 2019 [68] The 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)  2019 [69] To develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept.
Focus groups, desk research Kooistra et al.
2016 [70] To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre and to conduct a preliminary evaluation of this bCBT protocol.

Focus groups
Korpershoek et al.
2020 [71] This study aimed to describe in detail the full user-centred design and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD.
Literature study, Delphi study, interviews, focus groups, behavior change strategies, usability tests, prototype, questionnaire, business model Kramer et al. 2020 [72] This review aimed to identify the current practices in designing and evaluating ECAs for coaching people in a healthy lifestyle and provide an overview of their efficacy (on behavioral, knowledge, and motivational parameters) and use (on usability, usage, and user satisfaction parameters).

Literature study
Kristan et al. 2014 [73] To use online crowdsourcing to evaluate young adult attitudes toward expert-authored messages and to collect peer-authored messages.

Questionnaire
Kulyk et al. 2015 [74] The ultimate goal of this study is to gain insights into the special needs of this user group, persuasive features and design factors influencing the use and uptake of applications for sexuality, wellbeing and health behavior support of young adults.

Focus groups
Kulyk et al. 2014 [75] Based on two user studies, we present general guidelines for design and evaluation of lifestyle support systems with personalized virtual coaching. The first field study focuses on design and evaluation of a mobile physical activity coaching system. The second user study focuses on design factors that influence the attitudes of high-risk adolescents towards virtual coaching in mobile eHealth applications and social media.
Questionnaire, interviews, focus group Kuosmanen et al. 2017 [76] This study explored student and staff attitudes toward the use of computerized Cognitive Behavioral Therapy in an alternative education setting.
Questionnaire, focus groups Lambert et al.
2017 [77] This paper describes the development and theoretical framework for a web-based behavioural activation (BA) intervention, which specifically promotes physical activity (eMotion).
Literature study, focus groups, values, usability tests Leafman et al.
2018 [78] To explore potential benefits of TPE and to apply the Community of Inquiry (CoI) framework to examine perceptions of TPE among patients with rare or chronic conditions.

Questionnaire
Lentferink et al. 2017 [79] To identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence.

Literature study
Lentferink et al. 2018 [80] What are the values according to DSE employees and human resource advisors (HR advisors) for self-tracking, persuasive eCoaching, and preconditions of a workplace stress management application?

Interviews
Lentferink et al. 2020 [81] This study aims to identify key stakeholders and work with them to gain an in-depth understanding of the value proposition of this stress-management app.
Literature study, questionnaire, interviews, values, stakeholder map, prototype, focus group, requirements Liao et al.
2017 [82] The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception.

Questionnaire, interviews
Limburg, van et al.
2015 [83] To demonstrate how business modeling, with the focus on stakeholder involvement, is used to co-create an eHealth implementation.
Literature study, stakeholder map, business model, focus group, interviews Limburg, van et al.
2015 [84] This paper focuses on the process of stakeholder involvement to design an implementation strategy for our infectionmanager.com.

Focus group, interviews
Limburg, van et al.
2010 [85] The following paragraphs describe three recent and different cases of business modeling methods done with the involvement of the authors. These three cases show how the required CDIs were synthesized from different sources in different ways, all using the same business model framework (the business model introduced by Osterwalder) as starting point. 2015 [88] This study aimed to (a) explore the feasibility and acceptability of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy and clinicians involved in their care and (b) assess changes in patient outcomes during implementation of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy in clinical practice.

Literature study, focus groups
Marshall et al. 2019 [89] The present study forms part of a larger project, whose ultimate aim is to develop digital technology to support outcomes for LBP.

Interviews
McGrath et al. 2017 [90] In order to help extend coverage to more rural student athletes, we propose designing a telemedicine app following the mHealth development roadmap from the Center for eHealth Research (CeHRes). In this paper we will document contextual inquiry, user requirements capture, design phases, and app evaluation from the targeted user base. 2020 [94] We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program.
Questionnaire, log data analysis, interviews Nijland et al.
2010 [95] We studied a web-based triage system which was accessible to the general public in the Netherlands. In a etrospective analysis we investigated the type of complaints that were submitted and the kind of advice provided.
Log data analysis, questionnaire Nobakht et al.
2018 [96] To develop a user-friendly web based intervention for training parents of children with CP and evaluate the process of development using modified CeHRes roadmap.
Interviews, questionnaire, prototype, focus group Noordman et al. 2019 [97] This study aims to evaluate the usability, perceived usefulness, and actual use of ListeningTime, through the eyes of elderly patients with cancer and their oncological HCPs.
Questionnaires, log data analysis Noordman et al. 2017 [98] To develop ListeningTime in a participatory way to increase uptake and use. Intervies, focus groups, prototype, usability tests Norris et al.
2015 [99] This paper describes the initial stages of a project to develop such a paradigm by scoping and developing the area of disaster e-health.

Literature study
Oberschmidt et al.
2020 [100] In this article, we report on a co-design process with different stakeholders and the negotiation that ensued after the elicitation of their wishes.

Focus groups, prototypes
Organ et al.
2018 [101] With concern growing about the capacity of mHealth interventions to engage users in real world settings, we undertook a systematic review of the implementation and reporting of user-centred design (UCD) practices in the development of illicit substance use behavioural interventions in the higher education context (n=7).

Literature study
Ossebaard et al. 2012 [102] First objective is to examine what usability aspects of the portal kiesBeter.nl matter for chronic patients and their informal carers with regard to information seeking, self-management, decision making, on line health information and other variables. Second objective is to make evidence-based practical recommendations for usability improvement.
Questionnaire, interviews, usability tests, focus group, Pang et al. 2016 [103] The aim of this research was to create a design for consumer health websites by supporting different health information-seeking behaviors. We created a website called Better Health Explorer with the new design. Through the evaluation of this new design, we derive design implications for future implementations.

Log data analysis, interviews
Pearson et al. 2016 [104] The objective of this study was to codesign a Web-based version of ESCAPE-pain that people with chronic joint pain find engaging, informative, and useful.
Questionnaire, focus groups, interviews, prototype, usability test Radomski et al. 2019 [105] The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes.

Literature study
Ragouzeos et al. 2019 [106] We aimed to develop a "dashboard" for RA patients to display relevant PRO measures for discussion during a routine RA clinical visit.
Interviews, focus groups, usability tests Rai et al.
2020 [107] This study aims to develop and investigate the usability of Thinkability, an Individual Cognitive Stimulation Therapy (iCST) app that can be used by people with dementia and carers on touchscreen tablets.
Focus groups, desk research, prototypes, interviews Rai et al. 2020 [108] To test the individual Cognitive Stimulation Therapy (iCST) application with people with dementia and carers in order to modify and refine the application, and improve its usability.
2017 [109] The aim of our study was to provide an example of the application of the Web-based intervention development process using the CeHRes Roadmap for other research teams to follow. In doing so, we are also sharing our pilot work to enhance eSNAP's acceptance and usability for users and the feasibility of its implementation.
Literature study, interviews, focus groups, prototypes Rosen, von et al. 2017 [110] To assess students' preferences when looking for sexual health information online. Questionnaire Rothgangel et al. 2017 [111] To describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain.
Questionnaire, interviews, literature study, prototypes Schmidt et al. 2021 [112] To design and evaluate a mental health treatment program and internet-based delivery platform for patients with ischemic heart disease (IHD) attending cardiac rehabilitation with the aim of reducing the risks associated with anxiety and/or depression.

Focus groups
Scholten et al. 2019 [113] Can we realize user experience improvements on a text-and video-based self-guided e-mental health intervention by adding an ECA that makes users more engaged and motivated? The aim of this study is to investigate the opportunities from within the technology to increase its support level toward the user.

Questionnaire
Scholten et al.
2017 [114] This study aimed to explore supportive capabilities of virtual agents with the potential benefit in mind that users of self-guided eHealth interventions could be better supported.

Literature study
Scholten et al. 2017 [115] The first objective of this paper was to explore what is known in literature about what support a user needs to stay motivated and engaged in an electronic health (eHealth) intervention that requires repeated use. The second objective was to explore the current potential of embodied conversational agents (ECAs) to provide this support.

Literature study
Sewitch et al. 2019 [116] The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments.

Focus groups
Sieverink et al. 2017 [117] To determine the extent to which a participatory development process can be supportive for developing humancentered eHealth technologies as opposed to expert-driven information systems (to improve education for MRSAcarriers in the home situation by developing a web-based communication system that meets both cognitive (practical) and affective (personal) information needs and to provide healthcare providers with information that is easy to access and to use).

Log data analysis
Sjölinder et al. 2014 [118] This work describes a method used in the development of a stroke rehabilitation tool. Focus groups Skjoth et al.
2015 [119] The aim of this study was to develop an eHealth tool that contained accurate and relevant information to allow pregnant women to make an informed choice about whether to accept or reject participation in screening for Down syndrome.
Literature review, focus groups, interviews Solem et al. 2020 [120] To design and develop a user-centered, evidence-based eHealth self-management intervention for people with chronic pain.
Desk research, personas, focus groups, prototypes, usability tests Span et al.
2015 [121] The aim of this study is to identify design issues in developing a user-friendly IT application facilitating Shared decision-making in dementia.
Focus groups, usability tests, prototypes Span et al.
2014 [122] The aim of this study was to gain insight in the user friendliness of the DecideGuide, user acceptance and satisfaction, and participants' opinion of the DecideGuide for making decisions Interviews, log data analysis, Span et al.
2014 [123] The aim of this study is to identify design issues (both weaknesses and strengths) that should be considered for designing a user-friendly design of an interactive web tool that facilitates shares decision making in care networks of people with dementia.
Focus groups, prototypes, usability tests Span et al. 2014 [124] To identify user requirements for an interactive web tool for people with dementia, informal caregivers, case managers and other professional caregivers Interviews, focus groups Spanakis et al. 2016 [125] To identify and discuss the main scientific and engineering challenges that need to be successfully addressed in delivering state-of-the-art, ubiquitous eHealth and mHealth services, including citizen-centered wellness management services, and reposition their role and potential within a broader context of diverse sociotechnical drivers, agents, and stakeholders.

Literature study
Sporrel et al. 2021 [126] In this paper, we describe the design and development of the Playful data-driven Active Urban Living (PAUL): a personalized physical activity application.
Interviews, requirements, behavior change strategies, desk research, focus groups, Stara et al.
2020 [127] This systematic literature review aimed to identify and synthesize published literature focusing on the efficacy of digital health coaching interventions specifically designed for older workers in transition to retirement (or those who just retired) and that used the user-centered design approach.

Literature study
Stuij et al. 2020 [128] We describe the design of a digital communication skills training (CST)-tool for information provision skills that meets oncologists' learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework.
Literature study, focus groups, usability tests, prototype, requirements Stuij et al.
2018 [129] 1) uncover the learning needs of oncological healthcare providers related to information-provision, and 2) explore their training preferences in the context of clinical practice.

Focus groups, interviews
Suffoletto et al. 2017 [130] To explore whether a text message-based relapse prevention intervention (Preventing and Interrupting Early Relapse [PIER]1) is acceptable to treatment-seeking adults with opioid use disorder (OUD) after Emergency Department (ED) discharge using mixed-methods design.
Interviews, log data analysis Teles et al. 2017 [131] Which are the factors supporting and hindering the development and, in the ongoing process, the implementation of the ActiveAdvice platform, regarding user requirements, preferences, acceptances and expectations?

Interviews
Tieman et al. 2014 [132] This study examined the processes involved in developing a prototype telehealth intervention to support palliative care patients involved with a palliative care service living in the community.

Focus groups, prototype
Timmer et al. 2020 [133] The aim of this study was to develop a blended physiotherapy intervention for persons with hemophilic arthropathy.
Literature study, focus groups, Timmerman et al.

2016
[134] 1) to develop a multimodal telehealthcare application that aimed at improving post-surgery rehabilitation and physical activity, in close cooperation with resected NSCLC survivors and their healthcare professionals (HCPs), and 2) to evaluate its usability.
Interviews, focus groups, usability tests, prototypes 2014 [136] The aim of this study was to gain (1) insight into which treatment components are most suitable for online and/or face-to-face sessions, (2) the sequence and ratio the two forms of therapy should be combined in, and (3) [140] To determine the effects of teleconsultation regarding clinical, behavioral, and care coordination outcomes of diabetes care compared to usual care.

Literature study
Verhoeven et al. 2010 [141] With this study, we aim to identify a discount approach for user-centered design of a completely new e-health application (without a prototype being available).
Usability tests, card sorting, prototypes, Verhoeven et al. 2010 [142] In order to enhance the usability of the expert-driven guideline format, we developed a website for the communication of existing guidelines that better fit the practical information needs of health care workers (HCWs).
Usability tests, requirements, Verhoeven et al. 2010 [143] To assess nurses' information-seeking strategies and problems encountered when seeking clinical guidelines on the Internet, and to investigate the criteria they apply when evaluating the guidelines and the websites communicating the guidelines.

Usability tests
Verhoeven et al. 2009 [144] To describe the design process of a web-based tool for compliance with safe work practices in cross-border care settings, focusing on infection control of MRSA.
Desk research, questionnaire, focus group, card sorting, prototypes, interviews Verhoeven et al. 2008 [145] This paper describes the steps that appeared to be crucial for the development of a tool that aims to provide HCWs with acceptable, applicable, user-friendly and high quality MRSA guidelines that enhance the decision making process to deliver safe health care.
Desk research, usability test, questionnaire, prototype, interviews, card sorting Verhoeven et al. 2007 [146] To determine the benefits and deficiencies of teleconsultation and videoconferencing regarding clinical, behavioral, and care coordination outcomes of diabetes care.

Literature study
Vermeulen et al. 2013 [147] To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study.
Literature study, focus groups, usability tests, prototypes Wachtler et al.
2018 [148] In this study, we describe the user-centered design process of an app to assess individual risk of persistent depressive symptoms and recommend individually tailored treatment based on current knowledge about bestevidence treatment for depression.
Focus groups, interviews, prototype, desk research Wahle et al. 2017 [149] Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care.

Literature study
Walters et al. 2018 [150] To identify and define design requirements for the development of a teledermatology scale-up framework (TDSF) Interviews, literature study, requirements Walters et al.
2016 [151] This study reports on the current status of teledermatology services in the public health sector of SA. Literature study Wentink et al.
2019 [152] To identify end-user requirements for a comprehensive eHealth program in stroke rehabilitation. Focus groups, interviews Wentink et al.
2018 [153] To prioritize the requirements for stroke e-rehabilitation according to patients, informal caregivers, and health professionals.

Questionnaire
Wentzel et al.
2016 [154] We describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment.
Literature study, focus groups, interviews Wentzel et al.
2014 [155] In this formative study, we investigate how nurses' can be supported in antimicrobial stewardship by means of an eHealth intervention that targets their information needs.
Focus group, card sorting, desk research, usability tests Wentzel et al.
2011 [156] In sum, we apply the CeHRes roadmap by starting with a summative evaluation of MRSA-net. This evaluation also serves as input for the contextual inquiry phase of Eursafety Health Net and renders input for the eDEHN-platform.

Log data analysis
Whiteside et al. 2014 [157] The aim of this study was to get user input and feedback on acceptability of messaging content intended to engage suicidal individuals.

Questionnaire
Winterling et al. 2016 [158] The study aims to describe the development of a Web-based intervention in long-term collaboration with patient research partners (PRPs).
2016 [159] To develop a guideline to assist developers in tackling wicked problems using co-creation with stakeholders, and to apply this guideline to practice with an example case in the field of infection prevention and control.
2017 [160] In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed.
Literature study, Delphi study, focus groups, usability tests, prototype