Development of interventions for an intelligent and individualized mobile health care system to promote healthy diet and physical activity: using an intervention mapping framework

Abstract

Background The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease. Methods The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels. Results Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications. Conclusions This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease. Trial registration Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx

Contemplation‐action‐maintenance model of behaviour change for persons with coronary heart disease: A qualitative study

“…The contemplation‐action‐maintenance (CAM) model. Reproduced under CCL BY 4.0 from Chen et al (2019) [Colour figure can be viewed at wileyonlinelibrary.com]…”

“…The contemplation-actionmaintenance (CAM) model. Reproduced under CCL BY 4.0 fromChen et al (2019) [Colour figure can be viewed at wileyonlinelibrary.com] to address their sense of control and their beliefs about perceived symptoms management, since high levels of self-efficacy were reported by CHD patients six to twelve months following their diag-…”

Individualized mobile health interventions for cardiovascular event prevention in patients with coronary heart disease: study protocol for the iCARE randomized controlled trial

“…In addition, previous study indicated that the challenges of CHD prevention were the maintenance of healthy behaviors [ 57 ]. The interventions of iCARE study were structured following the CAM model which focused on the moderators and mediators of the action and maintenance stages of behavioral change among patients with CHD [ 42 ]. The utilization of theory-driven interventions in the iCARE study may improve the likelihood of maintaining adherence to health behaviors [ 58 ].…”

“…They can also access individualized interventions with visual formats (such as animation, video, cartoon, and picture) for facilitating their adherence to health behaviors and medications. The interventions of iCARE -1 were developed based on existing evidence-based health behavior change strategies, and the mediators and moderators identified in the CAM model [ 42 ]. Participants in this group can enter their health-related data into the iCARE -1 by manual entry.…”

An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis

“…iCARE was designed to address the gaps in conventional interventions, in which multiple CHD-related risk factors were managed through real-time monitoring, person-centered care, and automatic tailored feedback. Following clinical guidelines on CHD secondary prevention [3,30,31], the interventions of iCARE were developed based on the Intervention Mapping framework [32], and the Contemplation-Action-Maintenance (CAM) model [33,34], which was an integrated behavior change model describing the roles of multiple moderators and mediators during the motivation and volition stages that are essential for healthy behavior change and behavior maintenance in individuals with CHD (Multimedia Appendix 1). In our preliminary study, we generated a set of iCARE interventions along with a set of "IF-THEN" algorithms to improve patients' adherence to health behaviors and medications, and conducted a needs assessment on the use of an mHealth-based system among patients with CHD [33].…”