Hanneke Kip

Hanneke Kip

My research focuses on the development of eHealth technologies that monitor and coach aggressive behaviour of forensic psychiatric patients. I am a teacher in Health Psychology & Technology as well.

Location University of Twente


  • Thanks, we'll take it into account for the next run!

  • Representativeness is not the most important criteria for usability testing, since the goal is not to generalize the results. Of course, there should be some variety in the participants though.

  • What's going wrong?

  • Dealing with conflicting values/requirements can be tricky, making a decision is often up to the developers. Depends on argumentation and sometimes also practical constraints.

  • Nice example of why the context matters, helpline would be a better fit for African countries but probably not for the Netherlands.
    Posters might be useful as well, maybe also as a way to disseminate the app, as a part of implementation. (more on that in week 5, by the way)

  • Requirements should state what kind of platform should be used, but can also say something about the content of the technology, depends on the type of requirement.

  • Roeland, that was also a step in that research process and we of course conducted a thorough contextual inquiry before diving into the requirements. However, because of the limited scope of this course, we did not include all of that information here as well.

  • Of course the process is a lot more elaborate than described here: we briefly point out some important phases of the development process.
    Since the focus of the MOOC is broader than just human centered design, we chose to not go into depth too much, since that would mean less time to discuss other things that are relevant for eHealth.
    But things like...

  • Thanks for the feedback, we're trying to make the abstract language and terminologie (which is necessary to describe what we want to describe) a bit clearer with examples, so hopefully the next steps made it a bit clearer.

  • Indeed, that's why a thorough analysis of stakeholders is important for both development and implementation.

  • True, that's why a business model and a good implementation - with consideration of the needs and work process of the doctor as well - is very important for eHealth.

  • Using technology as some kind of really basic 'self-monitoring diary' is a really nice idea, it's already being done in the Netherlands as part of a bigger intervention. Clients have to indicate their mood during the day, and can discuss these patterns with their therapist (and also gain more insight themselves, hopefully).

  • Really nice examples of ways to increase his motivation, technology can be really useful for that as well. It overlaps with persuasive features/technology, more on that in week 4.

  • I like how you extracted Dave's priorities and based your idea on that. It's very consistent with what we will do in week 3: finding out what people's values are and basing the technology on those, to make sure that the technology fits the user (in this case: Dave)

  • I agree, but fortunately we can combine the human and the technological touch!

  • Really nice and original ideas, and well-connected! I especially like the VR idea, it's an effective technology, and most people find it fun as well. At this point in time VR is mostly focused on anxiety related disorders, but it has a lot of potential for depression as well.
    Any ideas about how we can use VR in Dave's case?

  • I like the idea of tracking physical activities! In the Netherlands some mental health services are using an app that tracks movement & sleep and provides advice accordingly (site in English: http://www.getgoalie.com/?lang=en).

  • Yes, a really good way to lower the threshold for seeking face-fo-face consultation. eHealth can often be a motivation increasing or threshold-lowering method as well

  • True, it is tricky. But eHealth can also motivate people to search professional health, or lower the threshold a little bit.

  • It's an actor indeed (actually, it's me), and we phrased it like that because we wanted to paint a clear picture of Dave's needs. So don't worry!

  • Interesting discussion, I certainly agree with Jan. I think a possible worrying result should be accompanied by a referral to a doctor, if necessary. We shouldn't of course worry people unneccesarily, but we also should avoid indicating that nothing's wrong, or not referring people who are at risk to professionals. There's a fine line between those two...

  • One example is this site (in Dutch): https://www.alcoholdebaas.nl/default.aspx
    It is aimed to reduce excessive alcohol use, and users can, for example, ask a question about alcohol to a healthcare professional. There's a forum as well, for the social support from peers.

  • I already posted this link before, but these articles on Thuisarts.nl might be interesting: http://bmjopenbeta.bmj.com/content/6/11/e013166 & https://www.lumc.nl/over-het-lumc/nieuws/2016/november/zorggebruik-gedaald-thuisarts/

  • A very common reason to stop using apps! We will provide more info on that in the upcoming weeks. What exactly made the app user unfriendly?

  • Fitbit could have prevented disease on your vacation? Would you perhaps share how?

  • I recently saw this article on Thuisarts (unfortunately in Dutch): http://www.mobiledoctors.nl/2016/11/website-thuisarts-nl-zorgt-afname-huisartsbezoeken/
    It states that the amount of care required of a GP has decreased with 12% after the launch of the website Thuisarts.nl, which means a monthly decrease of 675.000 GP visits!
    Research (in English) on this...

  • Those are really nice goals, technology can really help in reaching people who are difficult to reach in other ways.

  • Thanks! So the marketing of the apps on curing depression was a bit too optimistic? ;)

  • Thanks for your clear answer, so there's definitely room for improvement and a lot of potential!

  • Yes I agree, it is something that we have to keep in mind. Overall, eHealth users are mostly highly educated, middle-aged females. Many people are not reached by eHealth technologies yet, but many initiatives are being undertaken to improve that situation.

  • Interesting perspective! Any ideas about how to achieve that?

  • That is indeed a big barrier, but will hopefully be reduced in the near future, when technology will become more available to more people

  • Thank you, very insightful! eHealth does indeed require a certain amount of customization.

  • Yes, that are some of the issues accompanying the use of technology in general, and especially for sensitive issues like personal health and wellbeing. You might find the video on ethics in Week 4 interesting, since we are addressing those kinds of topics there. They are indeed extremely relevant and might be an important factor that determines the success or...

  • The ethical part of eHealth is indeed very important to consider, but it is not insurmountable. In the Netherlands, we have the rule that companies can not give wearales to their employees, since companies are not allowed to look at the (health) data of their employees. Strict rules & regulations about the use and ownership of data are essential for successful...

  • That's a really good point, and also what we mean by ensuring a fit between the context, person and technology. The kind of technology - and its content - has to fit the user and his or her context. Technology also offers some really exiting possibilities to personalize, to make sure that the content and even design of eHealth are specifically tailored to...

  • Thank you Claire, for your insightful comments! I totally agree with you, as a psychologist myself I know how hard it is to get people to change their behaviour or even opinions. Week 4 is about changing (health) behaviour, and Week 5 about how we can help people and organizations to use eHealth, so those two weeks are especially interesting for these kinds of...

  • Good point, ethics of eHealth are important to consider as well. A bit more on that in Week 4

  • Nice and innovative example, thanks!

  • Interesting! What kind of apps did you include in your thesis? And what were some of the main findings?

  • Week 6 gives a bit more info on evaluation, and week 4 focuses on behaviour change & ensuring that people keep on using technology (persuasive technology to improve adherence and support behaviour change), so that might be interesting with regard to your remarks!

  • Nice! What is the main target group of your first example?

  • Thanks for sharing! Do you by any chance know about any research on that site?

  • Interesting! And really important to consider when developing eHealth technologies: context (culture) is extremely important: what might work really well in the Netherlands, might fail in China. Thanks for sharing

  • That's something we recognize in the Netherlands as well: patients seem to be very open-minded, but professionals are a bit more careful. Maybe because they want to protect their patients, quality of care, or perhaps they don't feel comfortable using technology when doing their job. MIght differ per person, but it's very important to account for these kinds of...

  • It might be, it always depends on culture, but technology definitely has a lot of potential in supporting informal caregivers. Hopefully it will reach this potential soon!

  • Thank you for adding this info! Especially the point on geographical size isn't that relevant for the Netherlands, so thanks for adding that.
    With respect to the last point: definitely true, but we do have some examples on that kind of eHealth technologies throughout the course.

  • Very interesting indeed! Implementation of eHealth can be increadibly difficult, the same goes for the Netherlands. Week 5 focuses on implementation, might be relevant for this!

  • Interesting project, Claire, hopefully this course can give you some concrete tools for the development process! Technology can indeed be a very good way to support individuals with ID, especially the non text-based ones. Visualization and simplification of data and feedback is a really nice way to educate them.

  • That's definitely a challenge. But I'm curious, is eHealth being used in Nigeria? Perhaps via mobile phones, or something like that?

  • Thank you for sharing! eHealth is indeed pretty complex because of all of the involved stakeholders, and issues like privacy and security. We will definitely address some of those issues during this course.

  • Monitoring does indeed provide many opportunities that wouldn't exist without technology. One of the advantages of technology is of course that it can always surround you, and a doctor (probably) not.

  • Exactly, and, as with all things, the adoption of new technologies always takes time. More on that in week 5, which is about (the difficulties of) implementation and continued use of eHealth.

  • Is eHealth already being used over there, or not at all?
    Interesting to see how much difference there is between countries and locations.

  • eHealth is also really about balance, constantly critically thinking about when it could be a replacement of a face-to-face contact, or when it definitely shouldn't be. That's a very interesting point and really depends on the expertise of the healthcare professional working with eHealth. In my opinion, eHealth is always an option, but one should really look...

  • Nice example of how technology can help you in supporting your health! Thank you for sharing Paulene

  • Thanks for sharing, interesting for us to see what's happening in other countries!
    Is eHealth being used a lot in Autralia already?

  • Interesting! What kind of barriers would be relevant, in your opinion?

  • Interesting discussion! In this case it's mostly about the intention/goal of the technology --> is the goal to improve health/wellbeing of the user? Then it is eHealth, regardless of its effectiveness.

  • A good point and definitely a barrier: for eHealth to be used in medical settings, you have to be sure that you are measuring in a valid and reliable way. However, as said by Iain, the relevance of accuracy depends on the goal of the technology. Is it knowing that someone is exercising more (trend), or how much steps one set exactly? But it is indeed a very...

  • Yes, that's a good point, if the results of the MRI would be communicated to the patient - so if the user itself can do something with the results of the scan to improve his health or wellbeing - it certainly would be. But in this case, at least how we intended it, the information is provided to the doctor, so in this case its mere medical technology.
    But I...

  • That's a good point! I think it really depends on the person and the amound of intrinsic motivation he or she has to change behaviour (Transtheoretical Model of Change provides some insight in that). Your remark is related to the tailoring of technology --> fitting it to the needs of the user.

  • It is indeed very hard to find a database with 'good' eHealth technologies. Partly because new technologies are surfacing really quickly, but also because it's really hard to define good eHealth technologies. What defines good, and who should make that decision?
    This means that finding a good eHealth technology to use in practice can be a bit of work, but...

  • That's definitely true, one should always consider the context and user before deciding on whether to use technology in healthcare. In some cases consulting a doctor via computer might be very beneficial (e.g. in case of burns), in other cases, for example when someone has vague complaints that need thorough physical examination, a face-to-face consult might...

  • Dates and other practicalities of the Summer School can be found here: https://www.utwente.nl/en/education/summer-school-curiousu/
    The date of the conference can be found here: http://www.persuasivetechnology.eu/

  • Actually, in the Netherlands, employers are now forbidden to track their employees with wearables, even if the employee agrees to it, their still not allowed to do so. See this article, unfortunatly only in Dutch: http://www.trouw.nl/tr/nl/4492/Nederland/article/detail/4259260/2016/03/08/Baas-mag-werknemer-niet-volgen-met-slimme-armband.dhtml
    So it's good to...

  • Yes, a personal way of approaching people is indeed often used in persuasive technology and I think it often works. But also the other way around (which was not shown in this video, but is also interesting): mails from companies are sometimes send as if they were from a person. I think we all know Lily at FutureLearn...

  • I agree. I think the rewards should be tailored to users. While badges might be motivating to some people, others might require more tangible rewards. When I was 5, a sticker was very motivating, but today it (probably) would not work anymore. I think there's room for improvement there.

  • Yes I also agree, it is also very helpful when determining/analyzing your target group. A technology for people that don't want to stop smoking yet (pre-contemplation phase) should differ from a technology for people that are planning to quit smoking (preparation). I often refer to this theory when students are determining their target group and the...

  • Thank you!

  • Thank you for your comment. I'm particularly interested in using the Fitbit with cancer survivors, what a nice application of wearables! In what way is it used? And what are your main experiences?

  • Very interesting discussion! I think this is also a bit related to tailoring the content of the technology to the user: some people need more sleep than others, or might need to exercise more. I think that the way information is communicated to users should also be tailored: some people can be motivated best by focusing on what can be improved, while others...

  • Marieke, we are of course aware of the somewhat outdated image of the TPB and we're certainly not saying that his is the golden standard. However, our experience in educating psychology has taught us that this is one of the behaviour change theories that is the easiest to grasp for people without much knowledge on psychology and its accompanying theories,...

  • Mark, of course you are completely right. The reason why we put it like this, was that we wanted to explain it as simple as possible, since experience has taught us that behaviour change is a hard concept to grasp for people without a background in psychology. This means that some important nuances are lacking, for example also the role of the environment on...

  • That is true, it offers some very interesting possibilities. However, the main advantage of 2D paper prototyping is that it is very quick and cheap, which matches the early stages of prototyping.

  • Values and requirements are interrelated, but values are a bit 'broader' so to speak than requirements. They state what is valued by the stakeholders with respect to the technology. Requirements state what the technology should entail to achieve these values.

  • eHealth is often developed in multidisciplinary teams, so people that are not that technical are often working together with more technically oriented people. This also ensures that multiple perspectives are accounted for: a designer might focus more on a good design, while a psychologist aims at a technology that is valuable for the human beings that it is...

  • That is true, we are using the word 'value' as derived from business modelling. It's a very broad term and susceptible to trends and different perspectives (e.g. psychologist vs. business consultant may view this term differently). In this case, however, values refer to what should be reflected, improved or maintained by means of an eHealth technology. These...

  • True, in this case the term 'values' has another definition than values that define us as human beings.

  • That's indeed a good point, thank you for raising it. We have chosen for some basic methods that are often being used in current practice, but observation in context can indeed be very useful for some target groups!

  • Thank you for this example, stakeholders often have conflicting values, so that's why a thorough inquiry of the context is so important (and often unfortunately lacking, which also leads to problems with the implementation).

  • You can find some more elaborate information on the salience of stakeholders here: http://www.stakeholdermap.com/stakeholder-analysis/stakeholder-salience.html
    Is this a bit more helpful?

  • Thank you for notifiying us, we added a topic!

  • Thank you for notifiying us, I adapted it in the text that accompanies the video. It was a typo that we oversaw, so in the video we use the term bacteria instead of viruses. Apologies, it's certainly not our intention to spread false myths.

  • Privacy issues are indeed very relevant for eHealth, especially when sensitive information is concerned. We'll focus a bit more on that later, but interesting to read perspectives on data privacy!

  • True. Involving stakeholders can also be beneficial for the implementation: they are and feel involved, and their needs are reflected in the design process. There is an ongoing trend of patients who are becoming more and more assertive and empowered, so hopefully participative development will be a given in the future, and not something unusual.

  • Jan, that's a good question. It really differs per eHealth technology: it might be with governmental subsidies, a hospital might pay for it, innovation budgets from institutions can be used, privately funded, a combination of those, etcetera. A lot of times it is also unclear who has to pay.
    That's why it's important to find out as early as possible who has...

  • Very clear, thank you. I like the way you adress the perceived need and how the technology should address the needs of the users. This is exactly what we aim to achieve during the contextual inquiry and value specification: what are the needs of the stakeholders (so also the users). The fit between the user, context and technology should be optimal in order to...

  • Of course a model is always an ideal representation. The challenge is to make sure models are being more and more used in eHealth development. The trend of, for example, including patients in development, is gradually increasing, so that's a good sign! We hope that practice and models will match each other more closely on the short term.

  • Good to hear that, I'm looking forward to reading your perspective on the material from week 3, which is about design.

  • Good point, pilotting is in our view a part of operationalization, but it is not explicitly mentioned because we wanted to keep this as concise as possible.

  • Thank you Lars for explaining. Stakeholders are in our view people who have a stake in the problem/situation. The same goes for values: it's not (just) about money, although it always plays a big role (unfortunately). We do have to take the financial perspective into account, but certainly not forget about the patients and the healthcare context.

  • Thank you for sharing this perspective. Do you perhaps have any ideas on how to overcome these barriers?

  • Thank you, a very good point!

  • Just a quick thanks for all of the interesting examples! Please keep them coming, they are also very interesting for us as educators.

  • You might consider a simple wearable like the Misfit, they are pretty reliable in counting steps (at least, that's what I read), and also sleep. Probably more reliable than an app, anyway. These kinds of wearables can be synchronized to a smartphone and have an accompanying app.
    But perhaps someone else knows about a reliable pedometer app?

  • Thank you for the nice examples. The ethical issue about data posession is very important, we'll pay attention to it throughout the course, especially at the end of Week 4.

  • Interesting! Can you tell a bit more about this? How is eHealth being used in Tanzania?

  • An interesting way of tailoring feedback... ;) Interesting that the design influenced your experience, we'll go into more detail on the importance of user-centered design in Week 3.

  • Teenagers are of course a bit more accessible as a target group for eHealth technologies, because of their knowledge of and experience with technologies. eHealth and elderly is a challenging but interesting combination. What did you think of the workshop and its focus?