A mHealth cardiac rehabilitation exercise intervention: findings from content development studies

Abstract

BackgroundInvolving stakeholders and consumers throughout the content and study design ensures interventions are engaging and relevant for end-users. The aim of this paper is to present the content development process for a mHealth (mobile phone and internet-based) cardiac rehabilitation (CR) exercise intervention.MethodsAn innovative mHealth intervention was developed with patient input using the following steps: conceptualization, formative research, pre-testing, and pilot testing. Conceptualization, including theoretical and technical aspects, was undertaken by experts. For the formative component, focus groups and interviews with cardiac patients were conducted to discuss their perceptions of a mHealth CR program. A general inductive thematic approach identified common themes. A preliminary library of text and video messages were then developed. Participants were recruited from CR education sessions to pre-test and provide feedback on the content using an online survey. Common responses were extracted and compiled. An iterative process was used to refine content prior to pilot testing and conduct of a randomized controlled trial.Results38 CR patients and 3 CR nurses participated in the formative research and 20 CR patients participated in the content pre-testing. Participants perceived the mHealth program as an effective approach to inform and motivate patients to exercise. For the qualitative study, 100% (n = 41) of participants thought it to be a good idea, and 11% of participants felt it might not be useful for them, but would be for others. Of the 20 participants who completed the online survey, 17 out of 20 (85%) stated they would sign up to a program where they could receive information by video messages on a website, and 12 out of 20 (60%) showed interest in a texting program. Some older CR patients viewed technology as a potential barrier as they were unfamiliar with text messaging or did not have mobile phones. Steps to instruct participants to receive texts and view the website were written into the study protocol. Suggestions to improve videos and wording of texts were fed back to the content development team and refined.ConclusionsMost participants thought a mHealth exercise program was an effective way to deliver exercise-based CR. The results were used to develop an innovative multimedia exercise intervention. A randomized controlled trial is currently underway.Trial registrationACTRN12611000117910

Assessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology

“…As noted in earlier studies, the length of time required to develop content, complete usability testing and iteratively refine systems is a barrier to development. [6, 41] Moreover, there are few usability frameworks, which have been developed or evaluated for mHealth technologies, which is an impediment to rigorously evaluating these technologies. Findings from this study fill a gap in the literature by assessing the use of the Health-ITUEM for mHealth technology.…”

“…[2] mHealth interventions are increasingly important instruments in the toolkit of public health professionals and researchers. [3-5] For example, an increasing number of mobile disease management programs for chronic diseases such as diabetes and heart disease [6] are being developed. Additional examples of mobile health apps include interventions that help people quit smoking [7] or lose weight, or mental health apps to address depression, and/or anxieties.…”

Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet

“…21,22,39,40 To our knowledge, only 1 randomized study previously investigated the use of the Internet for cardiac rehabilitation remotely, 23 which comprised online chats between patients and nurses/dietitians, online educational resources, and financial incentives for participation. After 6 months, there was no difference in exercise capacity and the only parameter to improve compared with the control group was weight reduction.…”

“…Despite the enthusiasm for technology supported healthcare services, the evidence to support such use in cardiac rehabilitation is limited to pilot studies. [21][22][23][24] As a result, a recent American Heart Association Presidential Advisory has called for more robust research to test the feasibility and effectiveness of Internet-based CRP. 25 Our goal therefore, was to test the clinical effectiveness of a virtual CRP (vCRP) delivered exclusively using Internet-based technology.…”

Understanding and influencing the maintenance of physical activity and dietary behaviour change in breast cancer survivors

“…Formative research to design interventions is critical, particularly when employing novel ways to deliver behaviour change interventions such as mobile technology (Linde et al, 2014;Pfaeffli et al, 2012;Rogers et al, 2010;Waterlander et al, 2014;Whittaker et al, 2012). The iterative process required to conduct formative research is time consuming but, as outlined in mHealth (i.e., text message) intervention development frameworks, reporting development processes can help design tailored and highly acceptable interventions (Waterlander et al, 2014;Whittaker et al, 2012).…”