eHealth interventions such as apps and online programs are increasingly used in healthcare. Although they are often presented as a way to improve access to care, they do not benefit all groups equally. People with a lower socioeconomic position (SEP) often face barriers such as limited digital skills, language difficulties, distrust, and pressures related to daily life. This dissertation explored how eHealth interventions can be developed, implemented, and evaluated in ways that more effectively reach and support people with lower SEP.
The research combined a review of existing literature with studies conducted with researchers and professionals in healthcare, policy, and eHealth development, as well as a community based study with people with lower SEP.
Barriers and facilitators were identified at multiple levels. From the perspective of people with lower SEP, challenges related to digital skills, language, trust, and practical life circumstances shaped how...
Show moreeHealth interventions such as apps and online programs are increasingly used in healthcare. Although they are often presented as a way to improve access to care, they do not benefit all groups equally. People with a lower socioeconomic position (SEP) often face barriers such as limited digital skills, language difficulties, distrust, and pressures related to daily life. This dissertation explored how eHealth interventions can be developed, implemented, and evaluated in ways that more effectively reach and support people with lower SEP.
The research combined a review of existing literature with studies conducted with researchers and professionals in healthcare, policy, and eHealth development, as well as a community based study with people with lower SEP.
Barriers and facilitators were identified at multiple levels. From the perspective of people with lower SEP, challenges related to digital skills, language, trust, and practical life circumstances shaped how accessible and usable eHealth was experienced. From the professional perspective, limited guidance, time pressure, and resource constraints affected the ability to adapt and implement eHealth interventions in practice.
People with lower SEP were not a single group. Some were open to digital care and able to use it with minimal support, while others experienced uncertainty, distrust, or practical difficulties. These differences underline the need for tailored approaches rather than uniform solutions.
Together, these findings show that eHealth interventions are more likely to be accessible and usable when they align with people’s everyday lives and when professionals can realistically deliver them within existing constraints such as limited time, resources, and organizational capacity.
Based on these insights, the Inclusive eHealth Guide was developed and evaluated. The guide provides phase specific recommendations to support professional decision making and was received positively in the Dutch healthcare context, although further testing in diverse settings is needed. This dissertation shows that design alone is insufficient to make eHealth inclusive in practice. Sustainable use requires early planning, continued collaboration with stakeholders, and explicit attention to implementation conditions such as professional workload and available resources. Inclusive digital health therefore depends not only on the intervention itself, but on how it is embedded in everyday practice. Further research and co-creation are needed to strengthen scalability and sustainability, and to prevent digital health from reinforcing existing health inequalities.
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