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Table 3 Coding schedule

From: The experience of participating in an internet-based cognitive behavioral therapy program among patients with cardiovascular disease and depression: a qualitative interview study

Meaning unit Code Category Theme
“Realizing that it’s up to me how I deal with life. Perhaps you can get that out of such a program. Not believing that the healthcare service should help me with everything. I’m not a child who needs their mom and dad to help, I’m an adult and I have to take charge of my life, and it’s up to me what I make of it.”
“I really… that I made the effort to do those things that I wanted to do… that I know, that I knew before that it was good, but that I didn’t do it anyway for various reasons”
“Really see yourself from outside, and how you feel and so on. You’re open in some way, and, like, want an improvement”
Being driven to change
Working towards change
Interest in their health
Internal motivation
External motivation
Being one’s own guide Taking control of the disease
“You had that realization, and that you sometimes plan afterwards not to take on too many things and so one thing at a time”
“Should it be like this? Shouldn’t there be more demands? And so, I gradually came to understand that that was the point”
” Because there’s a fear linked to this issue of the heart not behaving. But the fear disappeared, and I learnt that the heart can cope with much more than you think”
Changed thinking
New knowledge as part of improving health
Using the program to help control the disease
New insights  
“So, the realization I had that it was OK to change my strategy, to change my personal strategy.”
“I also felt in some way that what I was trying to convey, that came out in the e-mail. I got feedback on what I wanted”
“I wrote based on how I felt. Yes, now there was, like, no time limit”
“The advantage here was that you worked with the program during this time”
“And there are painful things that affect me deeply, so in any case I sit there in peace and quiet, and I can go away if I can’t continue”
Experienced freedom working in the program
Flexibility in program motivates
Freedom  
“Yes, it’s more… cognitive behavioral therapy is more work, but it also produces results”
“Sometimes maybe you felt that, shit, perhaps I haven’t done as much as I should have with this homework this week”
“I have what they call procrastination behavior, and that meant that I felt I was always slightly behind. And that I then got reminders, and it was good that I got reminders, because I needed that kick, as it were”
Experiences requirements in the program as difficult
The program is perceived as demanding
Requires your own work effort
Demanding work Not just a walk in the park
“You try to repress things sometimes, unfortunately. Yes, it’s both good and bad, but eventually it re-emerges then, but no, I think what’s worth most is that you have to, err… think about it and above all look forward. That’s what has helped most, that there’s a change for the better in everything, both physically and mentally. That’s what I think has been sensible.”
“Yes, then I cried and had… because there were questions that I just felt, ow, now you’re pushing with all your might, and then I started crying. That was sensitive”
“There was a lot of these, that you were forced to reflect on things that you didn’t have. That you’d buried a bit”
“Too often, perhaps, people feel so excluded and lonely with those worries they have in connection with these things”
Uncertainty
Anxiety associated with heart disease
Feeling betrayed
Evoking emotions  
“I perceived it almost as if perhaps it wasn’t designed for a… someone who works, like, and has a lot of different types of activities”
“It meant that these final modules, where you had to weigh up your various activities over the days, for example, they became a little hard to deal with, I would say. I gave up a little bit there. It became a bit complex to sit down and do it”
Wrong perspective on the disease
Uncertainty about the content of the program
Not my cup of tea  
“You can communicate with someone about the problems that you might recognize”
“And it can be good to have the chance to express your feelings and so on, even if it’s online in the form of… You still get an answer from somewhere”
Getting to communicate with someone about how you feel
Getting to express their feelings
Being heard
Being seen Being recognized and having support
“I saw other ways to behave, that I made sure that I went out, in particular. Not sitting at home all the time. I signed up for a reading group, which I’m still actually a member of. And then I signed up voluntarily, yes, voluntarily of course, for a new gymnastics troop”
“I think a lot of it was the insight that, yes several insights actually not to set goals that are too high.”
Organizing a health plan as a contribution to improvement
Clear goals as a contribution to improvement
Support and structure  
“The direct contact you can have with a treatment provider or a therapist. And what I found absolutely wonderful, what… perhaps now I’m saying something that, I don’t know if I can say it, but I found what… what gave me a completely different… expectation or understanding”
“I really think that’s a criterion for someone who can understand the patient who is sitting on the other end of the computer”
Strong alliance with the therapist
The therapist as a listener
Understanding of the patient
Perceived as close and personal
The therapist was an important support