Chapter 6 126 with a low SEP during their waiting period before starting a CR program. We found good adherence with the participants often using the intervention daily and engaging with 88% of the messages. Most participants (71%) displayed positive overall acceptance of the intervention. However, only 43% were positive about usefulness. The intervention did not affect feelings of certainty and guidance (CGQ) or dropout rate. However, while the length of the waiting period was negatively associated with feelings of certainty and guidance in the control group, no such association was observed in the intervention group. Qualitative feedback suggested that the intervention had helped participants to set expectations and be better informed about their condition and CR journey. Usage data indicated consistent adherence over time, although there was a slight reduction in daily message interactions after the first two weeks. This decrease aligns with the intervention’s dynamic content distribution system, which recalibrates the frequency of messages once participants enter their CR start dates. When the starting date is further in the future, the system automatically reduces the number of messages provided daily to extend the usage period. Despite this, continued message views suggest sustained adherence, which contrasts with the relatively low eHealth adherence often observed in people with a low SEP (Arsenijevic et al., 2020; Reiners et al., 2019). Many participants cited the intervention’s integration into daily routines as crucial. Past studies indicate that individuals with a low SEP often face stressful daily challenges, limiting their time and cognitive capacity for engaging with eHealth interventions (Crielaard et al., 2021). Additionally, curiosity was reported as a key factor in the patient’s adherence to the intervention, aligning with the gamification theory that presents curiosity as a strategy to enhance engagement with a system (Chou, 2015). This facet of the intervention might have been an important contributor to the observed adherence. Regarding acceptance, the intervention’s well-received usability contrasts with findings in existing literature. Typically, individuals with a low SEP encounter more challenges with the usability of eHealth interventions (Choi & Dinitto, 2013; Estacio et al., 2019; Kontos et al., 2014; Yao et al., 2022). The intervention’s consistent adherence and positive overall acceptance could be attributed to its participatory design, which followed the IeG’s recommendations for equitable eHealth development. Failing to achieve adherence and acceptance could negatively influence overall effectiveness, irrespective of any inherent benefits of the intervention (Venkatesh et al., 2003). Given our promising outcomes on adherence and acceptance, we recommend future researchers to apply the IeG and engage in tailored participatory approaches to develop eHealth interventions for individuals with a low SEP in different settings. While we did not find a significant intervention effect in this feasibility study on feelings of certainty and guidance or dropout in subsequent CR, we did find some trends
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