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Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: Qualitative process evaluation of a randomized controlled trial

Published:October 17, 2022DOI:https://doi.org/10.1016/j.hrtlng.2022.10.005

      Highlights

      • Patients’ preferences should be considered in designing eHealth platforms to enhance user engagement.
      • Professional assessment and goal setting at program entry is crucial to initiate eHealth use.
      • Enabling self-monitoring and self-evaluation are critical in real-world usage.
      • Patients required multimedia chats with professionals and peers for reliable information exchange to guide symptom management at home.

      Abstract

      Background

      A previous randomized controlled trial (NeCR) has indicated the effectiveness of nurse-led eHealth cardiac rehabilitation (CR) on modifying the behaviors of patients with coronary heart disease. However, limited qualitative studies explore the experiences of using eHealth CR that led to such benefits.

      Objective

      The study aimed to explore the experiences of patients who participated in the NeCR program.

      Methods

      A descriptive qualitative study was employed among 20 intervention group patients who used the eHealth CR website and ranked differently (0-35th percentile, >35th percentile, and > 70% percentile) in the improvement of health-promoting behaviors.

      Results

      Five themes emerged: the NeCR program has promoted behavior change and mitigated emotional distress post-CHD. Patients described how the NeCR influenced cognitive determinants (knowledge and skill acquisition, having a roadmap, self-monitoring, and self-evaluation and resolution) and offered social support (professional counseling and peer interaction via multimedia chat) toward such change. Patients also appreciated the high affordability, accessibility, reliability of the NeCR, and expressed psychological, contextual, and technical barriers.

      Conclusions

      Providing eHealth CR during patient discharge is warranted as an affordable, accessible, and reliable alternative to obtain health benefits. Extensive behavior change techniques, actionable CR guidance, and increased awareness are widely perceived enablers. Offering professional support and moderation is critical for early post-discharge consultation and for introducing direct peer interaction to reassure patients.

      Keywords

      Abbreviation:

      CHD (coronary heart disease), CR (cardiac rehabilitation), NeCR (nurse-led eHealth cardiac rehabilitation), RCT (randomized controlled trial), PCI (percutaneous coronary intervention)
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