Table 3.

Suggested enablers to support meaningful PPI in digital health innovation, implementation and evaluation

Suggested enablers	Supporting quotes
Commit to sharing power, working in equal partnerships that treat insights equally, irrespective of their source	Specifically ‘better balancing the power relations that exist’ 71 ; ‘a democratic partnership with appropriate distribution of power’, 76 or ‘in bidirectional equitable partnerships’. 77 Similarly, ‘the methods for the design expressly included patients and staff with all voices treated equally and regarded as key contributors to design’. 49
Involve patients early on	‘Findings from this study confirm the importance of including PPI at the early design stage of medical devices’. 59
Work in an interactive, open‐minded and adaptive manner	‘The whole process required flexibility, an open mind, and a willingness to revise material iteratively’. 78 Similarly, ‘it was necessary to take a highly iterative approach’. 75
Work to establish trust	‘It was critical to ensure timely and consistent follow‐up in response to any technical or personal issues that are reported by the participants. This is an important part of building participants' trust in the intervention and the staff. Trust of the programme and trust of outreach workers was a priority issue, which needed to be addressed during all aspects of the programme roll‐out. It was helpful to brand the Mobile Link programme and have Cambodian government buy‐in so that women know that the programme they are signing up for is medically accurate and trustworthy’. 74
Be sensitive to people's spiritual, religious and cultural beliefs/values	Considering peoples ‘spiritual, religious and families values when designing digital health innovations’ 63 is imperative, particularly when working with indigenous and Hispanic communities.
Create engaging activities	‘It is important to ensure that the methods and user activities fully engage the participants’ 71
Communicate clearly, regularly and inclusively in an age‐appropriate and developmentally appropriate way, including the perceived benefits of taking part	‘A developmental or age‐appropriate approach is needed regarding the content and design of a programme, and accounting for the range of interests and tastes’. 76 Suggested use of ‘glossaries, use of visual aids/picture topic clues, and videos to facilitate understanding of information’. 79 ‘Full commitment requires motivating the participants and convincing them about the usefulness of the project, which proved to be more complicated than we thought. The primary motivating factor was their feeling of participating in the creation of services for the future’. 69
Offer people involved a choice of communication methods	For example, ‘WhatsApp was a significant production asset, useful in soliciting feedback from community members who did not regularly use email and did not feel comfortable editing scripts using Google Drive’. 58
Clarify people's roles, decision‐making processes and manage expectations	Creating a ‘memorandum of understanding’ 77 and generating ‘ground rules’ 80 or ‘rules of conduct’ 81 were identified as helpful ways to clarify roles and manage expectations. Other suggestions included ‘knowing each others role in the relationship’ 82 and clarifying to partners involved ‘that their individual wishes will not always be met’ (83).
Provide clear instructions, tech support and relevant device access	‘The elderly can be insecure because they are afraid of doing something wrong, so giving clear directions and affirmation is important. They also often need repeated explanations and daily training or courses in learning how to use a tablet for instance’. 69
	‘Members of the research team set up patients' phones and supported them throughout the study. Phones with the app pre‐loaded were available on loan for people without an Android phone’ (84).
	‘Provide a hotline in case of technical difficulties’ (85).
Allow time for people to become familiar with the tech	‘Given access for a minimum of 2 months to allow sufficient time to work through the programme’. 76
Work with local organizations to facilitate recruitment	‘One of the core principles of patient participation relates to ensuring that engagement is made as easy, feasible and as flexible as possible… With these goals in mind, it was deemed that participant recruitment through a familiar agency… would be optimal’. 59 Other ways of facilitating recruitment included recruiting through existing patient lists or ‘established patient groups’ (86).
Acknowledge people's time	Articles described a range of ways to acknowledge peoples time including prize draws, certificates of attendance/achievement, education credit, gift cards (ranging from $5–$100 depending on time spent and level of activity), shopping vouchers and grocery cards.
Encourage developers and patients to work together in the same room	‘We also recommend organizing meetings between developers and users, like test sessions during which the developers would be present to see for themselves the ways in which end‐users actually use the technology. Another option would be to use video in order to show developers the reactions of the end‐users when interacting with the devices and application’. 69
Create a safe space for people to share their thoughts and ideas	‘We put the primary focus on ensuring all stakeholders felt a part of the process and opened up about their experiences without feeling judged. During all phases, we highlighted the importance of anonymity for this purpose and thus did not collect the demographic information of the participants’ (87); ‘Each session took place at a convenient venue (e.g., community clinic) on weeknights, ranged from 90 to 120 min, and was audio recorded. Before each session, participants shared a meal and informally discussed community health and events. All meetings began with an opening prayer by church leadership to set an atmosphere of creativeness, inspiration, and togetherness among the attendees’ (88).
Hold activities in suitable locations	‘Interviews were held either at Cardiff University or a location convenient for the participant (e.g., home and school). During the interviews, young people stated they were able to discuss the programme openly and appreciated that they could choose the location, and whether they were seen with their parents or carers’. 76
Provide people with a choice of how and who they would like to be involved	‘Young people were asked whether they would like to be interviewed alone or with a parent or carer. The parent or carer was also asked whether they would like to be interviewed separately’. 76