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Health care is facing challenges: a growing need for care and limited numbers of health care professionals. With an ageing population, growing numbers of people with overweight, increasing numbers of people having one or more chronic disorders, this need for care is expected to grow further in coming years. Also, the differences in (healthy) life-expectation between those with higher versus those with lower social economic status is worrisome. To promote health and continued participation in society, more focus on prevention is essential.


E-health applications are often considered the holy grail in answering the growing needs of an increasing population of patients with chronic diseases. Yet, it is also known that the likelihood that e-health applications reach and support the more vulnerable populations (such as persons with low SES, older people, and persons with different cultural backgrounds) are lower. About 80 percent of technology projects in healthcare fail to be implemented successfully. This can be due to five problems (abbreviated as NASSS): e-health applications are either not adopted or soon abandoned by professionals and/or (subgroups of) their patients and clients; or it succeeds as a small-scale demonstration project but fails to scale up locally, spread to other comparable settings, or be sustained over time. These problems are rooted in many different factors on the micro, meso and macro level. Examples are: vulnerable groups were not involved in the design processes, complex regulatory and safety demands, and limited attention to the overall care process where the application should fit in.


The speed with which new technologies for prevention are developed requires new research methods to enable early identification of technologies that are feasible to scale up, spread and/ or sustain. In the Netherlands, such research methods are currently lacking.



Therefore, we will develop and apply a theory-based and practical framework and Implementation Toolkit, based on the UK-developed NASSS framework. The framework and Toolkit will support the evaluation of e-health applications in different developmental stages (from idea, small-scale demonstration, to implementation). In addition, we will develop a version of the NASSS Implementation Toolkit that can be used by non-academic audiences, in particular designers and software developers. They will support a balanced consideration of the level of complexity of applications, and supports researchers, policymakers and technology developers in deciding which applications can be successfully scaled up, spread and sustained.



An interdisciplinary project group will collaborate in this two year project. The project members have demonstrable expertise in e-health, including the design of applications, software development, small scale evaluation and implementation. In addition, the project group has is experienced in the development and evaluation of new methodologies; validation and (cultural) replication processes and studies; inclusion of vulnerable groups in research and clinical practice (older people, people with lower SES, different cultural background, lower health literacy levels); implementation science; self-management, patient engagement and medical decision-making; and health economics.

Stakeholders and end users will be involved throughout the project, in several invited workshops (“learning labs”). Hard to reach vulnerable groups will be reached through a mobile lab, built into a large van and equipped to bring social science experiments to naturalistic settings.



The project has 6 work packages.

WP 1: Linguistic validation of the NASSS framework and NASSS Implementation Toolkit

WP 2: Development of the Dutch NASSS Implementation Toolkit

WP 3: Refinement of the Dutch NASSS framework and NASSS Implementation Toolkit, based on input from an interdisciplinary one day workshop with invited experts.

WP 4: Evaluation of a diverse set of e-health applications with the Dutch NASSS framework and NASSS Implementation Toolkit. In 5 case studies, we will apply the framework and Implementation Toolkit to 5 e-health prevention applications, that vary with respect to: patient population, stage of development, and preventive e-health modality. We will do this through compiling a dataset with existing data (available datasets, data logs, protocols, reports, correspondence, minutes, business plans, etc), and additional in-depth interviews. This will be followed by in-depth moderated group discussion about complexity and mitigating strategies to reduce complexity in the 7 NASSS domains.

WP 5: Development of a nonacademic version of the NASSS Implementation Toolkit

WP 6: Implementation, integration, and dissemination of the Dutch NASSS framework and NASSS Implementation Toolkit.

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