title: Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs.
abstract: BACKGROUND
  eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers.
  
  
  OBJECTIVE
  The objective of this paper is to propose how users' needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy.
  
  
  METHODS
  This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users' competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis.
  
  
  RESULTS
  The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users' needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services.
  
  
  CONCLUSIONS
  Developing effective eHealth products requires complete understanding of the end-users' needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users' needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems.
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark. lk@sund.ku.dk.
authors.forename: Lars
authors.identifier: http://orcid.org/0000-0002-0909-4088
authors.initials: L
authors.lastname: Kayser
authors.forename: Andre
authors.identifier: http://orcid.org/0000-0002-2557-9288
authors.initials: A
authors.lastname: Kushniruk
authors.forename: Richard H
authors.identifier: http://orcid.org/0000-0002-9081-2699
authors.initials: RH
authors.lastname: Osborne
authors.forename: Ole
authors.identifier: http://orcid.org/0000-0002-1681-4338
authors.initials: O
authors.lastname: Norgaard
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0003-4504-2338
authors.initials: P
authors.lastname: Turner
keywords: eHealth literacy; requirements; user involvement