JMIR Publications

ABSTRACT

Background:

In order for eHealth technologies to be of added value for patients and healthcare, a thorough, systematic development process is pivotal. There are multiple papers that present frameworks, models and theories for eHealth development. In order to support developers and researchers in applying models and choosing suitable research methods, it is important to show how these abstract models can be operationalized in different contexts. Also, critical reflections on the development process are necessary to further improve models. Consequently, in this study we used the CeHRes Roadmap for the development of a virtual reality application in a complex setting: forensic mental healthcare.

Objective:

First, we demonstrate how we applied the contextual inquiry and value specification phases of the CeHRes Roadmap to eHealth development in practice. Second, we critically reflect on the participatory, iterative development process to increase knowledge on useful development methods and approaches.

Methods:

The development process started with the contextual inquiry, in which the current situation is analysed. Multiple methods were used to do this: we identified stakeholders, searched for relevant literature and composed a multidisciplinary project team. Also, focus groups and interviews with forensic in- and outpatients and therapists were held. The value specification phase aims to investigate what a technology should add to the existing situation according to stakeholders. In order to achieve this, six ideas for VR applications were generated by the project team. These ideas were presented to stakeholders in an online questionnaire. Next, values were formulated and used to create one idea for a VR application. This idea was presented to patients and therapists in an interview to examine their opinions and preferences.

Results:

The project team was composed of therapists, patients, a manager and researchers. Although few studies on VR in forensic mental healthcare were identified, the focus groups and interviews showed that patients and therapists saw a broad range of promising avenues for VR in treatment. The quantitative results of the questionnaire showed that all six ideas were evaluated positively by the stakeholders. The qualitative results provided more insight into their preferences and helped in formulating values. Using these values, the project team created one idea called ‘Triggers and helpers’. Interviews with patients and therapists showed that they positively evaluated this idea and that it was in line with their values.

Conclusions:

The CeHRes Roadmap proved to be a valuable framework for eHealth development in a complex context. To ensure that the process remained structured and coherent, we found that it was essential to use specific, concrete research questions which should be based on outcomes of earlier research activities. A strength of the Roadmap was the constant involvement of stakeholders. However, developers should make sure that the used methods fit the participants’ characteristics. This proved to be especially challenging in the case of a forensic patient population, partly because of their often low motivation, short attention span and lower literacy levels. We conclude that eHealth development requires a sound scientific foundation, thorough research, structured project coordination, a flexible mind-set and the inclusion of multiple perspectives in every decision. This increases the chances on a good fit between the technology, people and their context.