Wednesday, March 18, 2026
Apps to quit smoking, eat healthier, or exercise more. eHealth-programs are abundant, but they are often not accessible to people with low income and limited education. For her PhD research, Isra Al-Dhahir investigated how this can be improved.
This article previously appeared on Universiteitleiden.nl. Al-Dhahir is one of the PhD candidates and postdocs whose research was funded by the Medical Delta 2019–2024 program. Her research is part of the scientific program Medical Delta eHealth & selfmanagement for a healthy society.
“In our society, technology plays an increasingly important role, and many digital healthcare applications are also being developed,” says health psychologist Dr. Isra Al-Dhahir, now a researcher in the Technology for Healthcare team at The Hague University of Applied Sciences. These applications are often referred to as eHealth interventions. “Through online platforms or apps, people can receive support to lower their blood pressure or work on their mental health, for example via Therapieland.”
Widening health gap
However, Al-Dhahir notes that these applications are often developed based on assumptions about what users can do and the conditions in which they live. “Many eHealth interventions are only easy to use for people who are digitally skilled, have strong literacy skills, and possess certain health competencies.” As a result, people with a lower socioeconomic position (SEP) are less effectively reached.
When digital healthcare does not align with their living conditions, it can widen existing health inequalities. “If we don’t take into account how to make these applications fit into people’s lives, we will only increase the already significant health disparities in society,” says Al-Dhahir. In her dissertation Striving for Equity in eHealth, she therefore examined what is needed to help professionals make digital healthcare more accessible.
Involving the target group
In addition, Al-Dhahir examined the barriers and facilitators that professionals experience when developing, implementing, and evaluating eHealth for people with a lower socioeconomic position (SEP). “We took a broad perspective: looking at all factors involved from development to use and implementation of an application.”
The results show, among other things, that it is crucial to involve the target group from the very beginning. “Only when you understand what is happening in their daily lives can you determine whether eHealth is a suitable solution at all. For example, you might question whether it makes sense to introduce eHealth to a group that is deeply in debt.”
Structural preconditions, such as time and funding, also play an important role in the sustainable implementation of suitable eHealth solutions. “Many researchers, for instance, only receive funding for four years, after which it ends.”
A practical tool for professionals
'Know your target group' is a key message. She emphasizes: “People with less income and education cannot be grouped into a single category.” Based on conversations with people with a lower SEP, she identified different groups with varying attitudes toward eHealth. “One subgroup is enthusiastic, eager to work on their health, and willing to use eHealth for that purpose. Another subgroup wants to improve their health but finds it complex and is afraid of making mistakes. Yet another group is overwhelmed by the stress in their lives and may be less open to eHealth.”
Based on conversations with professionals and people with a lower SEP, Al-Dhahir and her colleagues developed an online guide for inclusive eHealth (in Dutch). This guide supports professionals in making conscious choices during the design, implementation, and evaluation phases.
The guide helps professionals reflect on their assumptions about the target group, on preconditions such as guidance and funding, and on whether eHealth is actually suitable in a specific situation.
Healthcare of the future
Although her PhD has been completed, Al-Dhahir would like to further develop the guide. There is still much to be done. “I would like to make the tips even more practical and concrete.” At The Hague University of Applied Sciences, she is exploring whether the guide can be integrated into education and how students use it when developing assignments and interventions. “After all, they are the healthcare professionals of the future.”
Text: Anne Holleman
