Experiences and Opinions of Adults with Type 2 Diabetes Regarding a Self-Regulation-Based eHealth Intervention Targeting Physical Activity and Sedentary Behaviour

Background: Online interventions targeting a healthy lifestyle in adults with type 2 diabetes are more effective when informed by behaviour change theories. Although these theories provide guidance in developing the content of an intervention, information regarding how to present this content in an engaging way is often lacking. Consequently, incorporating users’ views in the creation of eHealth interventions has become an important target. Methods: Via a qualitative interview study with 21 adults with type 2 diabetes who had completed an online self-regulation-based intervention (‘MyPlan 2.0’), we assessed participants’ opinions regarding the usefulness of the implemented self-regulation techniques, the design of the programme as well as their knowledge regarding physical activity and sedentary behaviour. A directed content analysis was performed to synthesize the interview data. Results: Participants experienced difficulties completing the coping planning component. The simple design of the website was considered helpful, and most participants were aware of the beneficial effects of an active lifestyle. Conclusions: ‘MyPlan 2.0’ was well-accepted by the majority of participants. However, the coping planning component will need to be adapted. Based on these findings, recommendations on how to tailor eHealth interventions to the population of adults with type 2 diabetes have been formulated.

have an influence on data collection and analysis. Nevertheless, we created strict protocols to carry-out the interviews and to analyse the data to minimize bias.

Domain 2: Study design
Theoretical framework 9. Methodological orientation and Theory. What methodological orientation was stated to underpin the study? e.g. grounded theory, discourse analysis, ethnography, phenomenology, content analysis A directed content analysis was conducted. This type of analysis was considered best suited for our purpose because our coding scheme was based upon previous research with 'MyPlan 1.0'

Participant selection
10. Sampling. How were participants selected? e.g. purposive, convenience, consecutive, snowball Participants were recruited via the Diabetes Association Flanders, the Ghent University Hospital and snowball sampling.
11. Method of approach. How were participants approached? e.g. face-to-face, telephone, mail, email Participants were recruited in different ways: face-to-face and via advertisements.
12. Sample size. How many participants were in the study?
Twenty-six participants with T2D volunteered for the study. Five participants dropped out during the study process: 2 participants never started using the programme, 2 participants only completed the first session and one participant completed all sessions but could not be reached for the interview. Consequently, there were interviews from 21 participants.
13. Non-participation. How many people refused to participate or dropped out? Reasons?
Five participants dropped out during the study process: 2 participants never started using the programme, 2 participants only completed the first session and one participant completed all sessions but could not be reached for the interview.

Setting
14. Setting of data collection. Where was the data collected? e.g. home, clinic, workplace The interviews took place at the research department or via a telephone call. The interviews were audio-recorded with permission of the participants.

Presence of non-participants. Was anyone else present besides the participants and researchers?
We asked participants to conduct the interview in a room where they would not be disturbed. However, in some cases we could not prevent that a family member occasionally disturbed the interview.
16. Description of sample. What are the important characteristics of the sample? e.g.

demographic data
The demographic information of the sample is provided in table 1 of the manuscript.

Data collection
17. Interview guide. Were questions, prompts, guides provided by the authors? Was it pilot tested?
All questions are provided in additional file 2.
18. Repeat interviews. Were repeat interviews carried out? If yes, how many?
There were no repeat interviews carried out.
19. Audio/visual recording. Did the research use audio or visual recording to collect the data?
All verbalizations were voice-recorded. 20. Field notes. Were field notes made during and/or after the interview or focus group? No.

Duration. What was the duration of the interviews or focus group?
The average duration of an interview was 30 minutes.

Data saturation. Was data saturation discussed?
When a text fragment of the interview did not fit any of the predefined categories, a new category was created. Themes that did not contain enough data were not withheld.
Coding was done independently by two researchers (CV and LP). A weighted kappa was calculated and showed fair to good inter-rater agreement (weighted kappa: 0.62).
23. Transcripts returned. Were transcripts returned to participants for comment and/or correction? No.

Domain 3: analysis and findings Data analysis
24. Number of data coders. How many data coders coded the data?
Two data coders (LP and CVDM) coded the data.
25. Description of the coding tree. Did authors provide a description of the coding tree? Yes.
26. Derivation of themes. Were themes identified in advance or derived from the data?
The themes were identified in advance. This was based on previous research with "MyPlan 1.0". 27. Software. What software, if applicable, was used to manage the data?
The qualitative data analysis software nVivo 11 (QSR International Pty. Ltd. Version 11, 2015) was used to manage the data.

The interview guide:
• Which module did you select, less sitting or being more physically active?

Perception of the website
• In general, how do you feel about the website? • How did you experience using the website? • To what extent, did you perceive the website as engaging?  To what extent, did you think using the website was a fun thing to do?  Could you easily keep your attention to the website?  Which parts of the website did you like the most?  Which parts of the website did you like the least?
o Did you like the questionnaire and its accompanying feedback? o Did you like creating an action plan? o Did you like searching for barriers and solutions? o Did you like reading the tips (e.g. regarding social support)? o Did you like monitoring your goal?

User-friendliness
• In general, was the website easy or difficult to use? • Which parts of the website did you experience as easy?
• Which parts of the website did you experience as difficult?

Time efficiency
• What do you think about the time you needed to complete the sessions?

Lay-out
• What do you think about the lay-out and the design of the website?

Recommendations
• Do you suggest any adaptations to the website?
• Are there things you would recommend us to change regarding the website?

Stimulating value of the website
• To what extent did the website help you to change your behaviour?
• Which parts of the website helped you the most?
• Which parts of the website helped you the least?
o Was it helpful to create an action plan? o Was it helpful to search for barriers and solutions? o Was it helpful to read the tips (e.g. regarding social support)? o Wat is helpful to monitor your goal?

Awareness
• To what extent did the website make you more aware?

Personal relevance
• Did you perceive the website as personal relevant? • Did you perceive the questionnaire and its accompanying feedback as personal relevant?

Informing value of the website
• To what extent did you learn new things by using the website?
• To what extent did you learn new things regarding behaviour change?
• To what extent did you learn new things regarding being less sedentary or more physically active?