Chapter 4 72 4.2.2 Procedure and materials 4.2.2.1 Phase 1 – Secondary analysis and development of the content The goal of this phase was to develop the content and information structure of the guide. Activities included secondary analysis with the goal of combining data from previously conducted Delphi and community-based participatory research (CBPR) studies. The Delphi study was performed with professionals and identified their experienced barriers and facilitators regarding eHealth development, reach, adherence, implementation, and evaluation for people with a low SEP (top-down) (Al-Dhahir et al., 2023). The CBPR study was conducted with people with a low SEP and resulted in different profiles of their attitudes toward health, health care, and eHealth (bottom-up) (Faber et al., 2021). Analyzing these studies through a qualitative secondary analysis allowed us to extract, combine, and synthesize insights that we used to develop the content and structure of the guide (Heaton, 2008). The combination of bottom-up and top-down approaches represents an innovative methodology that is not widely used. eHealth interventions exhibit limited alignment with the needs and preferences of people with a low SEP, thereby resulting in their underuse by this target group (Latulippe et al., 2017; Reiners et al., 2019). Professionals are crucial in adjusting these interventions to meet the target population’s needs. By integrating the perspectives of professionals (as guide users) and people with a low SEP who engage with eHealth interventions, we can develop a comprehensive guide that substantially enhances interventions for this group. The secondary analysis embodied the analysis, discussion, and synthesis of data obtained from the previous studies. For the analysis, both first authors (JSF and IAD) independently analyzed the barriers and facilitators of the Delphi study (Al-Dhahir et al., 2023) and considered which profiles of the CBPR study (Faber et al., 2021) could be influenced by them. For example, the Delphi study identified a barrier where professionals lacked sufficient knowledge about the daily lives of people with a low SEP, which aligned with attitude profiles from the CBPR study characterized by difficulty in comprehending written materials and limited digital skills. Another example is provided in Figure 4.2. Both authors independently documented their associations in Microsoft Excel. For the discussion, the first authors discussed their associations and documented their alignment using color coding in Excel, making distinctions between “full alignment,” where both authors found the same association; “to be discussed,” where alignment did not match; and “not applicable,” where both authors did not find an association between the 2 studies. A second discussion round followed, in which both authors discussed the “to be discussed” associations and developed a mutual agreement on the corresponding association. Finally, during synthesis, the first authors developed the association scheme (Appendix 4A).
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