Darcy Ummels

132 | Chapter 6 experienced therapists might have integrated the activity trackers faster or differently. On the other hand, it might be possible that younger therapists are more open to working with eHealth. Second, by using convenience sampling, there might have occurred selection bias for the therapists. As mentioned above, the selected therapists might be already more open to working with eHealth in comparison to their colleagues. This is an advantage for participation in action research because active participation is required. In future studies, other therapists should be involved in using the developed manual. Convenience sampling was also applied for the recruitment of the patients; however, this could also be beneficial for the action research design since therapists were free in choosing the patients, based on their clinical expertise, who might benefit from the use of the activity tracker, a situation that is closely related to the situation in daily healthcare. Thereby, they had the opportunity to formulate exclusion criteria for patients based on their experiences during this study. But we cannot rule out selection bias. Third, due to the COVID ‐ 19 outbreak, the study had to be ended after the third iteration. In the third iteration, therapists expressed additional new methods to support their clinical reasoning with the use of the activity tracker. One more iteration would have allowed for the evaluation of these planned changes in their clinical reasoning and to facilitate the engagement of patients. Fourth, the therapists experienced that patients did not always show up at the therapy meetings, which potentially affected their own and patients’ experiences with the activity tracker. It is known that missing therapy meetings happens regularly in long ‐ term treatments, 69 and thus the use of an activity tracker was not likely to be the reason for the current compliance of the patients in this study. A strength of this study was the use of a draft manual based on earlier research and the use of the coding framework (see Appendix 6.1). The draft manual gave guidance during the implementation process and could be tailored during the reflection sessions to the specific context. The framework was based on an earlier framework developed to gain insight into the important concepts of experiences with an activity tracker. 28 However, not all (sub)categories were used during this study because some did not fit within the scope of this study. Another strength of this study is the use of the MISS Activity that anticipated formerly mentioned important implementation barriers, such as complexity, technical problems, and concerns about validity. By eliminating those barriers, this study allows for a more in ‐ depth study of the use of the activity tracker in daily clinical practice, and more genuine experiences could be collected. To ensure the quality and trustworthiness of this study, credibility and transferability were checked in several ways. 70 Method, investigator, and data triangulation were used to ensure credibility. Multiple methods of data collection were used (audio recordings of conversations, reflection sessions, and interviews); all authors reflected on the design,