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Digital solutions – what does it mean and cost to be inclusive? Lessons learned from three Large-Scale Pilots

EHTEL’s hybrid model of care track is one of EHTEL’s prime activities in its Imagining 2029 work programme. This report outlines the content of the first webinar of EHTEL’s 2023 work programme, on hybrid models of care, held on 24th February 2023. (The webinar was also associated with EHTEL’s work on developing synergies).

In the webinar, representatives from three European Large-Scale Pilots – members of the European Health and Care Cluster – shared their experiences, methodologies, and recommendations.

Close to 75 people attended the webinar which was geared to the EHTEL community and all Health and Care Cluster of Large-Scale Pilots members.

The webinar presentations, videos, and this short report, are now available online.

Imagining 2029: Hybrid models of care

While there is growth in the range of digital health solutions available to older adults, significant segments of the targeted population find these solutions difficult to use. Therefore, some assumptions about the availability of digital solutions need to be revisited. The “one fits all” approach followed by many developers needs to be reassessed in light of individual users’ personal profile and environment.

This webinar enabled participants to learn about what needs to be done at different steps of the innovation cycle to develop digital solutions which can actually be used by older people and people with disabilities.


Three presentations focused on how three of the projects from among the Health & Care Cluster of Large-Scale Pilot perceive the meaning and costs of being inclusive when using digital solutions with older adults. Overall, the presenters and panellist placed considerable emphasis on the importance of European Large-Scale Pilots being able to exchange and share their experiences and their lessons learned.

A pre-validation methodology for developing and selecting digital solutions for older people

Laura FIORINI of the University of Firenze (Italy) introduced the pre-validation methodology applied by the Italian pilots of the Pharaon project, a Large-Scale Pilot.

Laura especially outlined a set of lessons learned on making technologies more reliable; improving training; encouraging balance; exploring return-on-investment; and – of course – reducing techno-stress.

“We have a dream!” Laura concluded: it is to enable lots of European large-scale pilots to be able to share their experiences and to compare and contrast their lessons learned on inclusiveness and usability.

What does inclusiveness mean concretely?

The SHAPES Large Scale Pilots Project has emphasised the notion of inclusiveness. In this presentation, Lucia D’ARINO went beyond the general focus of the project to explain, more precisely, how the project – with the support of the World Federation of deafblind – has concentrated on good practice in introducing accessible technology.

Lucia particularly explained what can be the perceived barriers to involving people with disabilities in projects; she also exposed what obstacles the SHAPES pilot itself had experienced. She emphasised the importance therefore of involving people with disabilities at an early stage in any project, accompanied by appropriate budgets and resources.

When Lucia drew to a close, she highlighted a dozen recommendations that can ensure that accessibility/inclusion become, and remain, key components in initiatives like European projects.

As she summed up, “Inclusion and accessibility are a shared responsibility.”

Why dealing with cultural aspects is important to engage citizens

Gokce B. LALECI and Nerea GONZALEZ, from the ADLIFE project showed that while collecting information from citizens or patients is not a trivial issue it can bring huge benefits.

ADLIFE has developed a methodology which ensures that any digital questionnaires used to collect data are fully understood in different cultural contexts: here the focus was on Patient Reported Experience and Outcomes (PROMS). PROMS are increasingly considered essential as a measurement. In ADLIFE, the PROMS tool used was translated into seven different languages. PROMS were viewed as being more than a form of quantitative evaluation. Instead, they were used in a way that permits cross-country, cross-cultural, and cross-language approaches.

Last but not least, during the project, ADLIFE project participants have found the W3C guidelines extremely useful.


Three questions or statements were introduced to the webinar attendees through live polls.

  • How often has the question of digital inclusiveness been discussed in your organisation?
  • Inclusiveness criteria need to be part of the selection criteria when you select a digital solution.”
  • The costs of embedding inclusiveness criteria into digital solutions need to be supported by all users.”

Several observations were the result. People tend to discuss digital inclusion regularly. Projects need to involve end-users in concrete ways. The costs of ensuring inclusiveness should be shared costs.

Overall, an approach should be used that is based on social justice (involving fairness and equity).


Luc NICOLAS of EHTEL moderated a brief panel conversation. The panel provided an opportunity for an invited guest and the speakers to explore some aspects of inclusive usability in more depth.

Panellist, Claudia LOURO of the PROCare4Life project, which is coordinated by Kinetikos of Portugal, reinforced the importance of holding events like this webinar, where projects can share the results, challenges, and knowledge that they acquire throughout their innovation processes.

Two key ideas arose from the lessons learned in PROCare4Life – flexibility and simplicity. Indeed, the PROCare4Life consortium came up with solutions that made methodologies more flexible and focused on technological simplification. Overall, this meant that the pilot project achieved more user engagement and promoted consistent and helpful adoption of the proposed solutions.

When asked what else is needed to make activities successful, the three pilot representatives had this to say:

  • Remember throughout that these initiatives are “preparing the older adults of the future”. The current approach therefore needs to be changed. (Today, there is a tendency to use with older adults techniques that have been designed by and for young people.)
  • First, plan early. The earlier you plan, the better. For the plan, bring people with different voices to the table, set out clear objectives with regard to who to include and why. Also, work out why inclusion is important to you, and the extent to which it forms part of your organisation’s or your project’s core values.
  • Second, include end-users from the very beginning of the initiative/project. Gather together the end-users’ ideas on what is most important for them. Collect data.
  • Third, use a variety of techniques like story-boards, mock-ups, early demos, and even meetings. (Do not just expect to run questionnaires.)

Other questions: Among other questions posed by attendees during the course of the webinar, for which clarifications were sought, were such issues as:

  • Are presentations of project information is often too complex for people with specific impairments?
  • What is the range of disabilities covered in the projects?
  • What about the detail involved in various questionnaires used in the three pilots?


Luc NICOLAS summarised the webinar’s main results.

The highlights of the webinar included a focus on the availability of the key resources proposed by the three Large-Scale Pilots and other attendees.

Overall, the webinar showed that qualitative approaches need to be used when working on digital health initiatives. There should not be a simple reliance on using questionnaires to find out the needs and opinions of end-users.

Hence, the recommendations made both in the presentations as well as the results of the rapid polls undertaken and the outcomes of the ensuing discussions were all especially useful.

Last but not least was the webinar’s overall focus on social justice.


This webinar was organised with the support of EURAHL.




  • Dr. Gokce Banu Laleci Erturkmen & Dr. Nerea González - Why dealing with cultural aspects is important to engage citizens | ADLIFE project 03 March 2023 Dr. Gokce Banu Laleci Erturkmen & Dr. Nerea González PDF*
  • Lucía D’ARINO - What does inclusiveness mean concretely? | SHAPES project 03 March 2023 Lucía D’ARINO PDF*
  • Laura FIORINI - A pre validation methodology for developing and selecting digital solutions for older people | Pharaon project 03 March 2023 Laura FIORINI PDF*