Optimising the implementation of digital-enabled interventions for the secondary prevention of heart disease: A systematic review using the RE-AIM planning and evaluation framework

Abstract

Background Digital-enabled interventions are widely utilised to support the delivery of programs for the secondary prevention of heart disease. They have shown a similar efficacy and safety to centre-based programs and improvements in access and adherence; the key barriers to in-person programs. However, questions remain regarding the successful wider implementation of digital-enabled programs. By applying the RE-AIM framework to a systematic review and meta-analysis, this review aims to evaluate the extent to which these programs report on RE-AIM dimensions and associated indicators. Methods This review extends our previous systematic review and meta-analysis that investigated the effectiveness of digital-enabled programs for coronary artery disease patients after hospitalisation. Citation searches were performed on the 27 studies of the systematic review and meta-analysis to identify linked publications that reported data for RE-AIM dimensions. All included studies and, where relevant, any additional publications, were coded using an adapted RE-AIM extraction tool. Discrepant codes were discussed amongst reviewers to gain consensus. Data were analysed to assess reporting on indicators related to each of the RE-AIM dimensions, and average overall reporting rates for each dimension were calculated. Results Across all 27 studies and nine additional reports, 24 (89%) studies were interventions solely delivered at home. In 11 (46%) of these studies, there were no staff involved in the intervention delivery or staff were only available on request. Ten studies (37%) used a mobile application, and only four (15%) studies did not require access to a smartphone. Across all studies the average reporting rates for RE-AIM dimensions were highest for effectiveness (75%) and reach (67%), followed by adoption (54%), implementation (36%) and maintenance (11%). Conclusions Through the application of the RE-AIM framework to a systematic review, we found most studies failed to report on key indicators. Failing to report these indicators inhibits the ability to address the enablers and barriers required to achieve optimal intervention implementation in wider settings and populations. Future studies should consider indicators in design and report on implementation indicators to improve the translation of research evidence into routine practice, with special consideration given to the long-term sustainability of program effects as well as corresponding ongoing costs. Registration: PROSPERO - CRD42022343030