{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T02:07:35Z","timestamp":1775268455375,"version":"3.50.1"},"reference-count":73,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2018,11,9]],"date-time":"2018-11-09T00:00:00Z","timestamp":1541721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Informatics"],"abstract":"<jats:p>Background: The WHO framework on integrated people-centred health services promotes a focus on the needs of people and their communities to empower them to have a more active role in their own health. It has advocated five strategies including: Engaging and empowering people and communities; co-ordinating services within and across sectors; and, creating an enabling environment. Any implementation of these strategies needs to occur at individual, community, and health service levels. Useful steps to reorganising health service provision are already being guided by existing models of care linked to increased adoption and use of digital technologies with examples including: Wagner\u2019s Chronic Care Model (CCM); Valentijn\u2019s Rainbow Model of Integrated Care (RMIC); and Phanareth\u2019s et al.\u2019s Epital Care Model (ECM). However, what about individuals and the communities they live in? How will strategies be implemented to address known inequities in: the social determinants of health; access to, and use of digital technologies, and individual textual, technical, and health literacies? Proposal of a matrix framework: This paper argues that people with complex and chronic conditions (PwCCC) living in communities that are at risk of being under-served or marginalised in health service provision require particular attention. It articulates a step-by-step process to identify these individuals and co-produce mechanisms to engage, empower and ultimately emancipate these individuals to become activated in living with their conditions and in their interactions with the health system and community. This step-by-step process focuses on key issues related to the design and role of digital services in mitigating the effects of the health service inequity and avoiding the creation of an e-health divide amongst users when advocating digital behaviour change initiatives. This paper presents a matrix framework providing a scaffold across three inter-related levels of the individual; the provider, and the health and care system. The matrix framework supports examination of and reflection on the design and role of digital technologies in conjunction with pre-existing motivational instruments. This matrix framework is illustrated with examples from practice. Conclusion: It is anticipated that the matrix framework will evolve and can be used to map and reflect on approaches and practices aiming to enrich and stimulate co-production activities supported by digital technology focused on enhancing people-centred health services for the marginalised.<\/jats:p>","DOI":"10.3390\/informatics5040041","type":"journal-article","created":{"date-parts":[[2018,11,13]],"date-time":"2018-11-13T03:27:31Z","timestamp":1542079651000},"page":"41","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Theory and Practice in Digital Behaviour Change: A Matrix Framework for the Co-Production of Digital Services That Engage, Empower and Emancipate Marginalised People Living with Complex and Chronic Conditions"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0909-4088","authenticated-orcid":false,"given":"Lars","family":"Kayser","sequence":"first","affiliation":[{"name":"Health Informatics &amp; Innovation, University of Copenhagen, DK-1353 Copenhagen, Denmark"}]},{"given":"Christian","family":"N\u00f8hr","sequence":"additional","affiliation":[{"name":"Maersk Mc-Kinney M\u00f8ller Institute, University of Southern Denmark, DK-5230 Odense, Denmark"}]},{"given":"Pernille","family":"Bertelsen","sequence":"additional","affiliation":[{"name":"Danish Centre for Health Informatics, Aalborg University, DK-9000 Aalborg, Denmark"}]},{"given":"Lars","family":"Botin","sequence":"additional","affiliation":[{"name":"Danish Centre for Health Informatics, Aalborg University, DK-9000 Aalborg, Denmark"}]},{"given":"Sidsel","family":"Villumsen","sequence":"additional","affiliation":[{"name":"Maersk Mc-Kinney M\u00f8ller Institute, University of Southern Denmark, DK-5230 Odense, Denmark"}]},{"given":"Chris","family":"Showell","sequence":"additional","affiliation":[{"name":"eHealth Services Research Group (eHSRG), University of Tasmania, Tasmania TAS-7001, Australia"}]},{"given":"Paul","family":"Turner","sequence":"additional","affiliation":[{"name":"eHealth Services Research Group (eHSRG), University of Tasmania, Tasmania TAS-7001, Australia"}]}],"member":"1968","published-online":{"date-parts":[[2018,11,9]]},"reference":[{"key":"ref_1","first-page":"139","article-title":"Participatory Design, User Involvement and Health IT Evaluation","volume":"222","author":"Kushniruk","year":"2016","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1136\/bmjqs-2015-004315","article-title":"Coproduction of healthcare service","volume":"25","author":"Batalden","year":"2016","journal-title":"BMJ Qual. Saf."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"May, C.R., Eton, D.T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S., Mair, F.S., May, C.M., Montori, V.M., and Richardson, A. (2014). Rethinking the patient: Using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Serv. Res., 14.","DOI":"10.1186\/1472-6963-14-281"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Michie, S., van Stralen, M.M., and West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement. Sci., 6.","DOI":"10.1186\/1748-5908-6-42"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.2196\/jmir.1376","article-title":"Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy","volume":"12","author":"Webb","year":"2010","journal-title":"J. Med. Internet Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S0140-6736(12)61228-8","article-title":"WHO European review of social determinants of health and the health divide","volume":"380","author":"Marmot","year":"2012","journal-title":"Lancet"},{"key":"ref_7","unstructured":"Coulter, A., Parsons, S., Askham, J., and World Health Organization (2018, September 10). Regional Office for Europe, European Observatory on Health Systems and Policies. Where Are the Patients in Decision-Making about Their Own care?. Available online: www.who.int\/management\/general\/decisionmaking\/WhereArePatientsinDecisionMaking.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e264","DOI":"10.2196\/jmir.6349","article-title":"Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide","volume":"18","author":"Mackert","year":"2016","journal-title":"J. Med. Internet Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.actaastro.2009.03.059","article-title":"Technology readiness and risk assessments: A new approach","volume":"65","author":"Mankins","year":"2009","journal-title":"Acta Astronaut."},{"key":"ref_10","unstructured":"Kierkegaard, S., Hong, E.H., and Hong, H.V. (2009). Kierkegaard\u2019s Writings, XXII: The Point of View, Princeton University Press."},{"key":"ref_11","first-page":"276","article-title":"The PLU problem: Are we designing personal ehealth for people like us?","volume":"183","author":"Showell","year":"2013","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S0140-6736(71)92410-X","article-title":"The inverse care law","volume":"1","author":"Hart","year":"1971","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.2196\/jmir.3951","article-title":"Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review","volume":"17","author":"Hamine","year":"2015","journal-title":"J. Med. Internet Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1123\/jpah.2012-0152","article-title":"The Effectiveness of Self-Guided Web-Based Physical Activity Interventions among Patients with a Chronic Disease: A Systematic Review","volume":"11","author":"Bossen","year":"2014","journal-title":"J. Phys. Act. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1093\/geronb\/gbt109","article-title":"Predictors of Older Adults\u2019 Technology Use and Its Relationship to Depressive Symptoms and Well-being","volume":"69","author":"Elliot","year":"2014","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_16","first-page":"158","article-title":"Steps toward Technology Design to Beat Health Inequality\u2014Participatory Design Walks in a Neighbourhood with High Health Risks","volume":"233","author":"Bertelsen","year":"2017","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kanstrup, A.M., Bertelsen, P., and Madsen, J.\u00d8. (2014, January 4\u201310). Design with the feet: Walking methods and participatory design. Proceedings of the 13th Participatory Design Conference, Windhoek, Namibia.","DOI":"10.1145\/2661435.2661441"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., and Brown, A. (2015). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-0854-8"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ijmedinf.2016.02.005","article-title":"Persuasive user experiences of a health Behavior Change Support System: A 12-month study for prevention of metabolic syndrome","volume":"96","author":"Karppinen","year":"2016","journal-title":"Int. J. Med. Inf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3414\/ME09-02-0044","article-title":"Pervasive Healthcare: Paving the Way for a Pervasive, User-centered and Preventive Healthcare Model","volume":"49","author":"Arnrich","year":"2010","journal-title":"Methods Inf. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Fogg, B. (2009, January 26\u201329). A behavior model for persuasive design. Proceedings of the 4th International Conference on Persuasive Technology, Claremont, CA, USA.","DOI":"10.1145\/1541948.1541999"},{"key":"ref_22","unstructured":"Halpern, D., Service, O., and Thaler, R. (2016). Inside the Nudge Unit: How Small Changes Can Make a Big Difference, WH Allen."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"130","DOI":"10.12968\/bjhc.2015.21.3.130","article-title":"\u201cNudging\u201d behaviours in healthcare: Insights from behavioural economics","volume":"21","author":"Voyer","year":"2015","journal-title":"Br. J. Healthc. Manag."},{"key":"ref_24","first-page":"389","article-title":"Pokemon Go: Ubiquitous Computing Delivering Better Health or Co-Incidental Health Benefits from Technology Use? A Participatory Observational Study","volume":"234","author":"Yee","year":"2017","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Glasemann, M., Kanstrup, A.M., and Ryberg, T. (2010, January 16\u201320). Making chocolate-covered broccoli: Designing a mobile learning game about food for young people with diabetes. Proceedings of the Conference on Designing Interactive Systems, Aarhus, Denmark.","DOI":"10.1145\/1858171.1858219"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: An updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.2196\/humanfactors.3696","article-title":"Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users\u2019 Needs","volume":"2","author":"Kayser","year":"2015","journal-title":"JMIR Hum. Factors"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.puhe.2016.01.001","article-title":"Health literacy: Applying current concepts to improve health services and reduce health inequalities","volume":"132","author":"Batterham","year":"2016","journal-title":"Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Osborne, R., and Kayser, L. (2018). Skills and characteristics of the e-health literate patient. BMJ, k1656.","DOI":"10.1136\/bmj.k1656"},{"key":"ref_30","unstructured":"Morison, E.E. (2008). Men, Machines, and Modern Times, M.I.T. Press."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.joep.2009.02.004","article-title":"An exploration of consumer resistance to innovation and its antecedents","volume":"30","author":"Kleijnen","year":"2009","journal-title":"J. Econ. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1111\/j.1083-6101.2009.01514.x","article-title":"The Assessment of User Engagement with eHealth Content: The eHealth Engagement Scale1","volume":"15","author":"Tada","year":"2010","journal-title":"J. Comput. Mediat. Commun."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Elwyn, G., Taubert, M., and Kowalczuk, J. (2007). Sticky knowledge: A possible model for investigating implementation in healthcare contexts. Implement. Sci., 2.","DOI":"10.1186\/1748-5908-2-44"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1001\/archinte.164.15.1641","article-title":"Self-management education programs in chronic disease: A systematic review and methodological critique of the literature","volume":"164","author":"Warsi","year":"2004","journal-title":"Arch. Intern. Med."},{"key":"ref_35","unstructured":"Singh, D., and Ham, C. (2005). Improving Care for People with Long-Term Conditions: A Review of UK and International Frameworks, University of Birmingham, Health Services Management Centre."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wodchis, W.P., Dixon, A., Anderson, G.M., and Goodwin, N. (2015). Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis. Int. J. Integr. Care, 15.","DOI":"10.5334\/ijic.2249"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/109019816800102604","article-title":"Psychosocial and Cultural Factors Influencing Patient Education","volume":"1","author":"Scott","year":"1968","journal-title":"Health Educ. Monogr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/109019816300101602","article-title":"Simonds Health education and medical care: Focus on the patient","volume":"1","author":"Scott","year":"1963","journal-title":"Health Educ. Monogr."},{"key":"ref_39","first-page":"188","article-title":"Patients at the centre: Methodological considerations for evaluating evidence from health interventions involving patients use of web-based information systems","volume":"4","author":"Cummings","year":"2010","journal-title":"Open Med. Inform. J."},{"key":"ref_40","unstructured":"Kayser, L., Karnoe, A., Duminski, E., Somekh, D., and Vera-Munoz, C. (2018). A new understanding of empowerment in a health context, submitted."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1080\/0284186X.2016.1267402","article-title":"Patient empowerment: A systematic review of questionnaires measuring empowerment in cancer patients","volume":"56","author":"Eskildsen","year":"2017","journal-title":"Acta Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1037\/0003-066X.55.1.68","article-title":"Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being","volume":"55","author":"Ryan","year":"2000","journal-title":"Am. Psychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1037\/0022-3514.76.3.482","article-title":"Goal striving, need satisfaction, and longitudinal well-being: The self-concordance model","volume":"76","author":"Sheldon","year":"1999","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4278\/0890-1171-12.1.38","article-title":"The transtheoretical model of health behavior change","volume":"12","author":"Prochaska","year":"1997","journal-title":"Am. J. Health Promot."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.pec.2015.10.015","article-title":"Translating person-centered care into practice: A comparative analysis of motivational interviewing, illness-integration support, and guided self-determination","volume":"99","author":"Zoffmann","year":"2016","journal-title":"Patient Educ. Couns."},{"key":"ref_46","first-page":"1","article-title":"An online self-management intervention for young adults with type 1 diabetes: Guided Self-Determination program","volume":"20","author":"Rasmussen","year":"2017","journal-title":"Aust. Diabetes Educ."},{"key":"ref_47","unstructured":"Habermas, J., and Shapiro, J.J. (1971). Knowledge and Human Interests, Beacon Press."},{"key":"ref_48","unstructured":"Botin, L., Bertelsen, P., and N\u00f8hr, C. (2015). Techno-Anthropology in Health Informatics: Methodologies for Improving Human-Technology Relations, IOS Press. Studies in health technology and informatics."},{"key":"ref_49","first-page":"28","article-title":"How Can Health Information Technologies Contribute to Improve Health Care Services for High-Need Patients?","volume":"241","author":"Nohr","year":"2017","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e12131","DOI":"10.1111\/nup.12131","article-title":"Between exclusion and emancipation: Foucault\u2019s ethics and disability","volume":"18","author":"Pezdek","year":"2017","journal-title":"Nurs. Philos."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s11213-016-9376-5","article-title":"Intersections of Critical Systems Thinking and Community Based Participatory Research: A Learning Organization Example with the Autistic Community","volume":"29","author":"Raymaker","year":"2016","journal-title":"Syst. Pract. Action Res."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Showell, C., Cummings, L., and Turner, P. (2017). The Invisibility of Disadvantage: Why Do We Not Notice?. Stud. Health Technol. Inform., 388\u2013392.","DOI":"10.3233\/978-1-61499-753-5-388"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.pec.2016.07.014","article-title":"Shared decision-making as an existential journey: Aiming for restored autonomous capacity","volume":"99","author":"Gulbrandsen","year":"2016","journal-title":"Patient Educ. Couns."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Fredriksson, M., Eriksson, M., and Tritter, J. (2018). Who wants to be involved in health care decisions? Comparing preferences for individual and collective involvement in England and Sweden. BMC Public Health, 18.","DOI":"10.1186\/s12889-017-4534-y"},{"key":"ref_55","unstructured":"Medibank (2018, September 10). Australians Giving up on Living in Good Health. Available online: https:\/\/www.medibank.com.au\/content\/about\/media-centre\/2014\/07\/australians-giving-up-on-a-healthy-life\/jcr%3acontent\/par\/download\/file.res\/MED14005_HEALTH_CHECK_2_FINAL.pdf."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1177\/1049732311405216","article-title":"Participating in Research: Exploring Participation and Engagement in a Study of Self-Management for People with Chronic Obstructive Pulmonary Disease","volume":"21","author":"Willis","year":"2011","journal-title":"Qual. Health Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0140-6736(07)60318-3","article-title":"Patient empowerment and the dilemmas of late-modern medicalisation","volume":"369","author":"Tomes","year":"2007","journal-title":"Lancet"},{"key":"ref_58","unstructured":"Kelder, J., and Turner, P. (2005, January 23\u201325). Lost in Translation? Critical Reflection on Qualitative Approaches for Informing Information Systems Design. Proceedings of the QuallIT2005: Challenges for Qualitative Research, Brisbane, Australia."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e010","DOI":"10.5334\/ijic.886","article-title":"Understanding integrated care: A comprehensive conceptual framework based on the integrative functions of primary care","volume":"13","author":"Valentijn","year":"2013","journal-title":"Int. J. Integr. Care"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"\u00c5berg, A., Halvorsen, K., From, I., Bruhn, \u00c5., Oestreicher, L., and Melander-Wikman, A. (2017). A Study Protocol for Applying User Participation and Co-Learning\u2014Lessons Learned from the eBalance Project. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14050512"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1123\/jpah.2013-0180","article-title":"The Fun Integration Theory: Toward Sustaining Children and Adolescents Sport Participation","volume":"12","author":"Visek","year":"2015","journal-title":"J. Phys. Act. Health"},{"key":"ref_62","first-page":"128","article-title":"Pok\u00e9mon-Go: Why Augmented Reality Games Offer Insights for Enhancing Public Health Interventions on Obesity-Related Diseases","volume":"241","author":"Wong","year":"2017","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1093\/eurpub\/ckx085","article-title":"A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice","volume":"27","author":"Broers","year":"2017","journal-title":"Eur. J. Public Health"},{"key":"ref_64","unstructured":"VicHealth (2018, September 10). Behavioural Insights and Healthier Lives, Available online: https:\/\/www.vichealth.vic.gov.au\/media-and-resources\/publications\/behavioural-insights-and-healthier-lives."},{"key":"ref_65","first-page":"8","article-title":"Avoiding Failure for Australia\u2019s Digital Health Record: The Findings from a Rural E-Health Participatory Research Project","volume":"227","author":"Almond","year":"2016","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_66","unstructured":"(2017, May 11). WHO Framework on Integrated People-Centred Health Services, a Report by the Secretariat. Available online: http:\/\/www.who.int\/servicedeliverysafety\/areas\/people-centred-care\/en\/."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/j.1475-6773.2004.00269.x","article-title":"Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers: Development of the Patient Activation Measure (PAM)","volume":"39","author":"Hibbard","year":"2004","journal-title":"Health Serv. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.pec.2006.12.002","article-title":"The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions","volume":"66","author":"Osborne","year":"2007","journal-title":"Patient Educ. Couns."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Osborne, R.H., Batterham, R.W., Elsworth, G.R., Hawkins, M., and Buchbinder, R. (2013). The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-658"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.2196\/jmir.8371","article-title":"A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ)","volume":"20","author":"Kayser","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.2196\/resprot.6506","article-title":"The Epital Care Model: A New Person-Centered Model of Technology-Enabled Integrated Care for People with Long Term Conditions","volume":"6","author":"Phanareth","year":"2017","journal-title":"JMIR Res. Protoc."},{"key":"ref_72","unstructured":"Lindskrog, S., Christensen, K.B., Osborne, R.H., Vingtoft, S., Phanareth, K., and Kayser, L. How patient reported outcome measures from heiQ, HLQ and SF-36 can be used to follow people with COPD in an ehealth based 24\/7 service, the \u2018Epital Care Model\u2019. J. Med. Internet Res., under review."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"McCabe, C., McCann, M., and Brady, A.M. (2017). Computer and mobile technology interventions for self-management in chronic obstructive pulmonary disease. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD011425.pub2"}],"container-title":["Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9709\/5\/4\/41\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T01:35:05Z","timestamp":1775266505000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9709\/5\/4\/41"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,9]]},"references-count":73,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["informatics5040041"],"URL":"https:\/\/doi.org\/10.3390\/informatics5040041","relation":{},"ISSN":["2227-9709"],"issn-type":[{"value":"2227-9709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,9]]}}}