Chapter 6 128 6.4.2 Strengths and limitations This feasibility study lays the groundwork for designing effective interventions for patients with a low SEP during their waiting period before starting CR. Such studies are essential for refining intervention designs to improve impact when scaled up (Skivington et al., 2021). A strength of our research is the mixed-methods approach, which offered insightful explanations for our findings and laid a foundation for future research and development. Additionally, it is noteworthy that we have maintained a participant retention rate similar to other trials conducted at Capri Cardiac Rehabilitation (den Uijl et al., 2023; Ter Hoeve et al., 2018), despite our emphasis on people with a low SEP, who are typically underrepresented in these earlier trials. While our study provides important exploratory insights, the results should be approached with caution and seen as suggestive rather than conclusive. It is important to consider the small sample size and single-center data collection when interpreting these findings, as the limited sample size particularly affects the robustness of the p-values. While our use of a self-designed questionnaire may have affected validity, we mitigated this by basing our questions on established instruments and employing a mixed-methods approach to triangulate the quantitative data with qualitative data (Moon, 2019). Additionally, excluding a participant who dropped out from the analysis could further limit our study’s integrity. We recommend validating our results in a larger, more robust trial, with validated instruments, conducted across multiple rehabilitation centers. Another potential limitation of our study lies in the composition of our participant sample, which, due to neighborhood-level sampling, possibly included individuals with higher SEP. Although our data indicate a low percentage of highly educated individuals within our sample, this metric alone may not provide a comprehensive picture of SEP. SEP is a multi-faceted concept influenced by various factors beyond formal education levels. Additionally, our recruitment approach might have favored those more experienced with digital tools and comfortable in their current situation. Additionally, the interpretability of our results may have been affected by technical difficulties encountered during the early phase of the study, resulting in some participants not receiving messages for a few days. While this issue was promptly resolved, it might have influenced acceptance and adherence scores. As we plan for a larger, more robust trial, it is crucial to thoroughly test the intervention’s technical functionality before its commencement. Finally, a notable limitation of our study concerns the interpretability of the CGQ scores, particularly due to the timeframe of the intervention and its overlap with interactions (e.g., scheduling appointments and intake sessions) in both the intervention
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