A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial

Abstract

Background Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes. Objective This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated. Methods Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies. Results The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean −1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07). Conclusions The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change. Trial Registration ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281

Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

“…The summary of analysis is provided in Table 3, which lists the themes/observations from reviewers that correspond with the objective statement and sorts articles from the most recent to the oldest. [25] Not reported Convenience of telemedicine, increased patientprovider communication, concerns adequately addressed, increased access Strong satisfaction Richards et al [24] Some patients prefer in-person consultations, technical literacy Pandemic created acceptance of technology, past experience with technology Not reported Kurihara et al [23] Technology needs further development, technical literacy Technical literacy, past experience with technology, perceived usefulness, increased patient-provider communication, perceived ease of use Not reported Alkirie et al [26] Technology needs further development Increased connectedness, self-management, flexibility, and access Not reported Ballin et al [27] Health literacy, availability of technology, technical literacy Enabled social interaction; decreased anxiety; increased connectedness, technical literacy, and access; televideo enables reading of body language; education; convenience of telemedicine Not reported Banbury et al [28] Technology needs further development, decrease in patient-provider communication, technical literacy, confidentiality/security Increased efficiency, access, and patient-provider communication, and improved standard of care Not reported Barnett et al [29] Discomfort for wearable monitors, technical literacy, technology needs further development Technical literacy, increased self-management, increased access, increased flexibility Not reported Batalik et al [30] Limits of reimbursement for telemedicine, some patients prefer in-person consultations, connectivity, technical literacy Pandemic created acceptance of technology, availability of technology, fewer miles driven to appointment, convenience of telemedicine, faster initiation of treatment, decreased costs Not reported Beller et al [31] Perceived lack of usefulness, lack of personal desire to get better, some patients prefer inperson consultations Increased connectedness, increased adherence, improved health behaviors Not reported Bernabe-Ortiz et al [32] Not reported Pandemic created acceptance of technology Not reported Bilgrami et al [33] Decrease in quality of life after intervention Perceived usefulness, perceived ease of use, increased adherence Strong satisfaction Broers et al [34] Technical literacy, availability of technology Increased adherence, increased self-management, increased weight loss, technical literacy Not reported Cho et al [35] Technology needs further development Technical literacy, perceived ease of use Not reported Claes et al [36] Lack of personal desire to get better, technology needs further development, technical literacy Increased adherence, increased self-management Not reported Coorey et al [37] Technology needs fur...…”

Effects of eHealth-Based Multiple Health Behavior Change Interventions on Physical Activity, Healthy Diet, and Weight in People With Noncommunicable Diseases: Systematic Review and Meta-analysis

“…For people with NCDs, in addition to obtaining traditional medical treatment, it is essential to adopt a healthy lifestyle through health care intervention in order to avoid further progression and relapse of NCDs [4]. In the recent 15 years, multiple health behavior change (MHBC, namely addressing no less than 2 health behaviors within a limited time period) has demonstrated early success in facilitating a healthy lifestyle among people with NCDs [5][6][7].…”

Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial

“…The Do CHANGE 2 program implemented in this trial was similar to that described by Broers et al for Do CHANGE 1 [ 20 ]. Patients randomized to the intervention group received devices for measuring key clinical parameters needed for monitoring their CVD, such as a BP monitor, weight scale (in HF patients only), and the Careportal, which allowed monitoring of daily symptoms and an electrocardiogram.…”

“…Patients received a total of 32 do’s during the 3-month intervention period (2-3 do’s per week). The program was tailored to the cardiac population with slight differences in the program depending on patients’ primary diagnosis (coronary artery disease, heart failure, and hypertension), as the preferred health behaviors may vary depending on the diagnosis [ 20 ]. In order to obtain objective measures on patients’ physical functioning, all participants received a BP monitor, the Moves app (Facebook Inc; to register GPS location), and the Careportal (Docobo Ltd, home monitoring device measuring daily symptoms and an electrocardiogram).…”

“…Care recipients perceived the Do CHANGE 1 program as helpful and easy to use; however, it failed to prompt relevant lifestyle changes (measured with the Health Promotion Lifestyle Profile-II questionnaire) compared with treatment as usual (TAU) [ 20 ]. The Do CHANGE 2, based on a more personalized approach, resulted in a relevant change in lifestyle behavior over time in the intervention group.…”