The development and evaluation of an mHealth-delivered comprehensive cardiac rehabilitation programme

Abstract

Background Cardiovascular disease (CVD) secondary prevention programmes, such as cardiac rehabilitation (CR), have been shown to reduce mortality through education, psychosocial support, and lifestyle behaviour change. The benefits of CR are clear yet participation rates are less than 50% worldwide. The reach of CR may be increased if people can choose to receive programmes delivered by mobile technologies (mHealth), as programmes could be accessed anywhere and anytime. The objective of this thesis was to develop and evaluate an mHealth delivered comprehensive CR intervention (Text4Heart) in adults with CVD. Methods A systematic review was undertaken to investigate the effectiveness of mHealth delivered behaviour change interventions in adults with CVD. Four development studies were then conducted with the target audience, adults with CVD, to inform the Text4Heart intervention content and delivery mode. The first study examined participant perceptions of an exercise-based mHealth intervention. The second study evaluated mobile phone usage rates. A third study pre-tested mHealth healthy eating content. The fourth study examined the convergent validity of a smartphone delivered physical activity questionnaire. After Text4Heart was finalised, a randomised controlled trial was conducted to evaluate the effectiveness of the intervention on adherence to lifestyle change. Results The systematic review showed five of seven mHealth trials had positive effects on physical activity or medication adherence. The development studies found adults with CVD were receptive to using mobile technologies to receive CR and they found the text messages motivating. The smartphone physical activity questionnaire had good agreement with accelerometry and the International Physical Activity Questionnaire, but was not included in the Text4Heart trial due to the small numbers of participants using smartphones. The Text4Heart trial randomised 123 adults with coronary heart disease (n=61intervention; n=62 usual care control). The intervention group had significantly higher adherence to multiple lifestyle behaviours at 3 months (adjusted OR=2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (adjusted OR=1.93, 95% CI 0.83-4.53; P=.13). The intervention group also reported greater medication adherence (mean difference: 0.58, 95% CI 0.19 to 0.97; P =.004) than the control. Conclusions The findings from this thesis showed that adults with CVD are willing and able to using mobile technologies to receive CR, and that mHealth interventions are effective at changing multiple lifestyle behaviours. Larger, multi-centre studies with longer follow-up are needed to determine if mHealth interventions can improve clinical outcomes as a result of positive behaviour change.