5 Application of the Inclusive eHealth Guide during the development of an eHealth intervention for and with cardiac patients with a low socioeconomic position 103 of Technology (approval numbers 1691 and 2157). Written informed consent was obtained from all study participants prior to their involvement in the study, and they were informed of their right to withdraw at any time. All data were pseudonymized, ensuring that personally identifiable information was replaced with unique identifiers. The study team ensured that all data were handled securely and in accordance with data protection laws and regulations. No conflicts of interest were identified. 5.3 Results 5.3.1 General guide application Out of the 53 recommendations provided in the IeG, we applied 34 (64%) recommendations throughout the intervention design and design process. Nine (17%) recommendations were deemed not applicable as they pertained to the implementation and delivery of an existing intervention, which fell outside the scope of our project. Ten (19%) recommendations were not applied due to resource-related decisions, such as translating research materials into multiple languages or incorporating the social environment into the intervention. Below, we delve into the details of this application of the recommendations. 5.3.2 The design process: Lessons learned In the thematic analysis, four themes emerged regarding challenges and solution strategies in the design process. The first challenge theme, resource management underscored the complexities of balancing the resource-intensive aspects of user involvement— such as logistics and trust-building—with other project requirements. The related efficiency and flexibility solution strategy theme revolves around a counterbalance by optimizing resource use and incorporating flexibility into the study design. For instance, we expanded our recruitment strategies to include former cardiac patients as well. The challenge theme, stakeholder communication, revealed the difficulties of maintaining consistent engagement with stakeholders across multiple locations. This challenge is related to the participatory methods solution strategy theme, which encompasses the involvement of stakeholders in participatory design processes, such as focus groups, to ensure sustained engagement. Two key lessons can be drawn from these themes: (1) Adopting a flexible and resource-efficient approach is essential, especially when the study demands extensive user involvement and (2) Utilizing participatory methods is crucial for sustaining active and consistent stakeholder engagement and shared understanding throughout the project.
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