A qualitative exploration of cardiovascular disease patients’ views and experiences with an eHealth cardiac rehabilitation intervention: The PATHway Project

O'Shea, Orlagh; Woods, Catherine; McDermott, Lauri; Buys, Roselien; Cornelis, Nils; Claes, Jomme; Cornelissen, Véronique; Gallagher, Anne; Newton, Helen; Moyna, Niall M.; McCaffrey, Noel; Суста, Давиде; McDermott, Clare M.; McCormack, Ciara; Budts, Werner; Moran, Kieran

doi:10.1371/journal.pone.0235274

Cited by 18 publications

(45 citation statements)

References 26 publications

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“…Occurrence, n (%) References Themes/observations 12 (9.1) [27,30,35,37,38,40,41,45,46,49,57,58] Increased self-management 11 (8.3) [23,25,31,33,41,43,47,51,52,61,62] Pandemic created acceptance of technology 10 (7.6) [32,34,35,37,38,40,43,46,58,67] Increased adherence 9 (6.8) [24,[27][28][29][30]41,52,53,60] Increased access 8 (6.1) [49,50,54,55,[62][63][64]66] Increased social support 7 (5.3) ...…”

Section: Table 4 Facilitator Themes and Individual Observations (N=132)mentioning

confidence: 99%

“…The remaining five observations made up a total of 6% of the total occurrences: decrease in quality of life after intervention, discomfort for wearing monitors, workflow issues for providers, lack of data infrastructure, and interoperability. [23,25,26,[28][29][30][31]35,37,[41][42][43][44]49,57,60,62,65,66] Technical literacy 12 ( 14) [26,27,29,30,[36][37][38][39]45,49,57,62] Technology needs further development 8 ( 9) [22,28,35,41,43,51,60,62] Availability of technology 7 (8) [38,39,41,43,44,46,59] Cost 7 (8) …”

Section: Table 4 Facilitator Themes and Individual Observations (N=132)mentioning

confidence: 99%

“…Health care administrators can focus on the findings demonstrating that implementation of telemedicine will increase self-management [27,30,35,37,38,40,41,45,46,49,57,58], adherence [32,34,35,37,38,40,43,46,58,67], access [24,27-30, 41,52,53,60], and social support [49,50,54,55,[62][63][64]66]. Telemedicine is shown to be an effective modality of treatment [28,32,35,38,40,41,43,46,[48][49][50][53][54][55][58][59][60]64] at a decreased cost…”

Section: Summary Of Evidencementioning

confidence: 99%

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

Kruse¹,

Heinemann²

2022

J Med Internet Res

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Background The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted.

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Section: Table 4 Facilitator Themes and Individual Observations (N=132)mentioning

confidence: 99%

Section: Table 4 Facilitator Themes and Individual Observations (N=132)mentioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

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

Kruse¹,

Heinemann²

2022

J Med Internet Res

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“…Studies included a recruited total of 296 patients receiving virtual education during CR, with sample sizes ranging between 8 and 60 patients (median = 29; Table 1 ). Studies were performed in 11 countries—Dublin and Belgium ( n = 60 participants in 1 study), 37 China ( n = 48 participants in 1 study), 45 Canada ( n = 43 participants in 2 studies), 36 , 46 New Zealand ( n = 38 participants in 1 study), 38 Sweden ( n = 30 participants in 1 study), 35 Australia ( n = 28 participants in 1 study), 40 , 44 Denmark ( n = 14 participants in 1 study), 42 United Kingdom ( n = 27 participants in 2 studies), 41 , 43 United States of America ( n = 8 participants in 1 study). 39 With regard to country income classification, only one was conducted in a middle-income country 45 and none in a low-income country.…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to virtual education in cardiac rehabilitation: a systematic review of qualitative studies

Vanzella

Pakosh

et al. 2021

European Journal of Cardiovascular Nursing

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Background Due to restrictions imposed by the severe acute respiratory syndrome coronavirus 2 pandemic much attention has been given to virtual education in cardiac rehabilitation (CR). Despite growing evidence that virtual education is effective in teaching patients how to better self-manage their conditions, there is very limited evidence on barriers and facilitators of CR patients in the virtual world. Aims To identify barriers and facilitators to virtual education participation and learning in CR. Methods A systematic review of peer-reviewed literature was conducted. Medline, Embase, Emcare, CINAHL, PubMed, and APA PsycInfo were searched from inception through April 2021. Following the PRISMA checklist, only qualitative studies were considered. Theoretical domains framework (TDF) was used to guide thematic analysis. The Critical Appraisal Skills Program was used to assess the quality of the studies. Results Out of 6662 initial citations, 12 qualitative studies were included (58% ‘high’ quality). A total of five major barriers and facilitators were identified under the determinants of TDF. The most common facilitator was accessibility, followed by empowerment, technology, and social support. Format of the delivered material was the most common barrier. Technology and social support also emerged as barriers. Conclusion This is the first systematic review, to our knowledge, to provide a synthesis of qualitative studies that identify barriers and facilitators to virtual education in CR. Cardiac rehabilitation patients face multiple barriers to virtual education participation and learning. While 12 qualitative studies were found, future research should aim to identify these aspects in low-income countries, as well as during the pandemic, and methods of overcoming the barriers described.

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“…Being discharged from hospital meant a transition from a safe environment at the hospital to an unknown environment at home [ 15 , 21 ]. The transition of people with cardiac conditions from hospital after surgery to their homes is equally likely to create challenges and design opportunities, which this paper seeks to address; there is a need for more participatory and iterative approaches to design patient-centered eHealth systems [ 19 , 22 ]. A qualitative systematic review by Tadas et al [ 11 ] identified the limited use of user-centered design methods and theoretical models to guide the design of technology for cardiovascular care.…”

Section: Introductionmentioning

confidence: 99%

Transitions in Technology-Mediated Cardiac Rehabilitation and Self-management: Qualitative Study Using the Theoretical Domains Framework

Tadas¹,

Pretorius²,

Foster³

et al. 2021

JMIR Cardio

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Background An acute cardiac incident is a life-changing event that often necessitates surgery. Although surgery has high success rates, rehabilitation, behavioral changes, and self-care are critical to long-term health. Recent systematic reviews have highlighted the potential of technology in this area; however, significant shortcomings have also been identified, particularly with regard to patient experience. Objective This study aims to improve future systems and to explore the experiences of cardiac patients during key phases after hospitalization: recuperation, initial rehabilitation, and long-term self-management. The key objective is to provide a holistic understanding of behavioral factors that impact people across these phases, understand how experiences evolve over time, and provide user-centered recommendations to improve the design of cardiac rehabilitation and self-management technologies. Methods Semistructured interviews were conducted with people who attended rehabilitation programs following hospitalization for acute cardiac events. Interviews were developed and data were analyzed via the Theoretical Domains Framework, a pragmatic framework that synthesizes prior theories of behavioral change. Results Three phases that arise posthospitalization were examined, namely, recuperation, rehabilitation, and long-term self-management. Through these phases, we describe the impact of key factors and important changes that occur in patients’ experiences over time, including the desire for and redefinition of normal life, the need for different types of formal and informal knowledge, the benefits of safe zoning and connectedness, and the need to recognize capability. The use of the Theoretical Domains Framework allows us to show how factors that influence behavior evolve over time and to identify potential sources of tension. Conclusions This study provides empirically grounded recommendations for the design of technology-mediated cardiac rehabilitation and self-management systems. Key recommendations include the use of technology to support a normal life, leveraging social influences to extend participants’ sense of normality, the use of technology to provide a safe zone, the need to support both emotional and physical well-being, and a focus on recognizing capability and providing recommendations that are positive and reinforce this capability.

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A qualitative exploration of cardiovascular disease patients’ views and experiences with an eHealth cardiac rehabilitation intervention: The PATHway Project

Cited by 18 publications

References 26 publications

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

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

Barriers and facilitators to virtual education in cardiac rehabilitation: a systematic review of qualitative studies

Transitions in Technology-Mediated Cardiac Rehabilitation and Self-management: Qualitative Study Using the Theoretical Domains Framework

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