This study set out to examine what aspects of an OHPC that are critical for satisfying the needs of user communities and public health goals and service capabilities. The most important observation was that compromises in the OHPC design were needed to resolve conflicts between needs to discuss health issues with domain experts in the end-user population and resources and responsibilities related to online activities in the public health organization. In a comparable OHPC development initiative in Ontario, Canada (http://www.youthspark.ca), a method for systems development and evaluation of an OHPC has been comprehensively documented . The current results add knowledge about the need to negotiate public health interests and end-user needs in the OHPC design process.
Web technology is becoming increasingly prevalent in health services [32, 33]. In a recent review of computer and web-based interventions to increase physical activity among adolescents, most reported interventions had led to a significant increase in physical activity, but the effects were short lived . Experiences from smoking cessation programs suggest that using only Internet initiatives based on social cognitive theory is not effective , but that a combination of cell phone-based “push” technologies, peer-to-peer contact, and web-based information on health and coping strategies can be a promising long-term treatment option . In parallel, online communities providing several of the latter services to users have been used in health services for self-management of health problems  and establishment of communities of practice . An OHPC can be regarded as a community-based, long-term, and inclusive health promotion program , although mediated over the Internet. When such OHPCs are developed on a large scale, the existing models for health promotion program implementation and evaluation must also be extended to fit the virtual setting. The OHPCs have to be evaluated with regard to behavioural patterns and health effects in the intended population. In these evaluations, there is thus a need to measure the outreach, usage, and effectiveness of the online system, using methods ranging from web surveys and focus groups to epidemiological studies. Such large-scale evaluations of OHPC designs in practice settings are much warranted, but also associated with considerable methodological challenges.
Participatory design proponents suggest that because social factors important in the implementation process are highlighted in a participatory approach, the resulting system designs are more sustainable compared with those developed using traditional systems development methods . However, participatory methods have also been criticized for neglecting the later technical development stages  and being unrealistic with regard to the time investments demanded by practitioners . Techniques such as the Voice of the Customer table and House of Quality  are well-established but resource-consuming approaches to the technical system accurateness problem. For instance, a possible problem with an OHPC initiative is that it may encourage young people to post and discuss health issues and problems in a manner that they later may come to regret. Even though it is easy to censor content after the fact, information online tends to persist. The use of design rationales in this study enabled public health practitioners to document this design problem, and analyse their views on the consequences of possible solutions. However, these views needed to be scrutinized also by engineers and legal expert before being implemented. This example illustrates that a participatory design process must be structured to include not only a representative group of end-users, but also the necessary expertise. If the experts not are available in the primary process, they have to be recruited downstream to adjust and approve the final systems design. For less complicated design problems, consultation of the scientific literature may be satisfactory. For the example problem, it is possible that consultation review of privacy guidelines for social media and maturation of online behaviour may have been sufficient to reduce the risks associated with sharing online .
The study has several limitations that need to be taken into account when interpreting the results. Allowing practitioners and the target community to influence the qualitative analysis process may be interpreted as surrendering control of the study. However, in accordance with the suggested increased use of qualitative data from in-depth interviews and observations for evaluating the context, process, impact, and outcome of community-based interventions [21, 44–48], we contend that the participatory method used in this study is adequate for capturing the context and process of the community development. In such interventions, experimental control may be incongruous when taking the different sociopolitical structures of communities into account [44, 46, 49]. To ensure contextual soundness, the practitioners were in this study included in their actual professional roles, and the adolescents were regarded as the primary end-users, rather than merely informants. Also, including adolescents from the end-user community from several municipalities and school programs in the research was an attempt to decrease the threats to soundness that are associated with a convenience sample and that the adolescents would be disingenuous.