Nienke Beerlage-de Jong is an Assistant Professor in the Department of Psychology, Health, and Technology at the University of Twente. Her research focuses on infectious diseases and One Health, a field that interconnects the health of humans, animals, and the planet. She works on complex, so-called ‘wicked challenges’ that require interdisciplinary collaboration. In partnership with 8D, she developed the intervention eZoon. Photo: Klaas-Jelmer Sixma
Can you tell us a bit about the eZoon research program? “The eZoon program was initiated to improve preparedness for zoonotic outbreaks: diseases that can spread from animals to humans, like avian flu or Q fever. In these situations, a diverse group of stakeholders – including doctors, veterinarians, policymakers, and public health officials –must collaborate. However, with varied interests, priorities, and limited time, effective teamwork can be challenging. Still, clear communication and collaboration are essential for a successful response. As part of the eZoon program—originally part of Health-i-Care and funded by INTERREG—we explored ways to strengthen communication and teamwork around zoonoses, focusing on persuasive technologies like serious games and other interactive tools.”
Two key outputs of the eZoon program are an informational website for the general public and a serious game designed for professionals. Why did you choose to develop a game? “The advantage of games is their ability to convincingly simulate real situations. In a zoonosis outbreak, professionals must act quickly while handling complex dilemmas. What do you do when there’s a conflict between public health and the livestock sector, and an immediate decision is needed? Creating a sense of time pressure—by incorporating a countdown clock in the scenarios, for example—significantly enhances the learning experience. Moreover, a digital tool helps eliminate logistical and organizational barriers, which is crucial in an already overburdened sector like healthcare.”
How did you approach the process? “We used the CeHRes Roadmap, a methodology we developed for creating eHealth solutions with active stakeholder involvement. This participatory approach was essential to us. Our goal was not just to create a theoretically sound game, but one that genuinely met the needs of the professionals using it. Throughout the project’s various phases, we engaged users—such as veterinarians, GGD doctors, and crisis managers—to gather their insights. In the exploratory phase, we held focus groups with experts and policymakers to better understand their experiences and challenges, which helped shape the content and align it with target group needs. We also tested the game at different stages, refining both content and user experience based on feedback to continuously improve each version.”
How do you reflect on your collaboration with 8D? “It was refreshing to work with a team that truly understands the scope of the innovation process and the importance of a participatory approach. I mainly collaborated with Maarten and Giel and appreciated their constructive, critical feedback. If they felt a particular choice was inefficient—or saw a more impactful way to proceed—they would openly share their thoughts. This made the partnership feel like a true collaboration rather than a client-contractor relationship, which is exactly what you need in complex projects like this.”
‘It was refreshing to work with a team that truly understands the scope of the innovation process and the importance of a participatory approach.’
What are your thoughts on the implementation and sustainability of research outcomes? “It’s more of a priority now than it was a few years ago, but we’re still not there yet. There’s no single right way to ensure the adoption of an e-health innovation. In my research, I focus on studying the various actors involved—what drives them, how to create effective eHealth interventions, and how to measure success. Implementing healthcare innovations is complex because it requires collaboration among businesses, researchers, and the healthcare sector, and these groups don’t always understand each other’s perspectives and challenges. This makes implementation a ‘wicked problem’ of its own, where achieving alignment between the user, technology, and context is essential.”
What are your thoughts on the research field? “The research field can be quite competitive and individualistic. As researchers, we all need to secure funding for our work, which is understandable but can sometimes slow progress and isolate the field. Collaboration is essential to more effectively bring research outcomes to society. This is something I really value in the team at 8D—they have, as I hope I do as well, a healthy dose of self-awareness and don’t claim to have all the answers; they simply want to work toward a shared goal. This approach is essential because if everyone stays within their own silo, implementing interventions only becomes more challenging.”
Has the serious game provided additional benefits for you as a researcher? “I’ve presented and showcased the game at various national and international conferences. It has also been used as a tool for follow-up research and educational purposes, such as graduation projects. For example, we conducted a field study using eye-tracking equipment to examine how players make decisions during gameplay. We held this study in a community setting—the market in Enschede—where anyone interested could participate. Additionally, we apply the lessons learned throughout the game’s development to all our other work, which helps us continue to grow.”
You’ve known us for quite some time now. What do you think of our new business direction? “To me, it’s a very logical step. Even five years ago, when I first worked with you, I already saw you as the free-thinking, creative problem-solvers you’re presenting yourselves as now—unbound by any single form or method, as long as it makes an impact. Dropping ‘games’ from your name perfectly reflects where you are today: working on innovation in the broadest sense, which is a valuable position to take.”
Recommended reading Want to learn more? Check out eHealth Research Theory and Development: A Multidisciplinary Approach by Hanneke Kip, Nienke Beerlage-De Jong, Lisette (J.E.W.C.) van Gemert-Pijnen, Robbert Sanderman, and Saskia M. Kelders. This pioneering book provides a comprehensive overview of the multidisciplinary field of eHealth—a major advancement in modern healthcare. It explores the potential of eHealth across various healthcare sectors, outlines its theoretical foundations and effectiveness, and presents essential models, frameworks, and methods for its development, implementation, and evaluation.
