Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants

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Abstract

Objectives

To study older peoples’ experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care.

Design

Qualitative semistructured interview study, with thematic analysis.

Setting

Primary care in the Netherlands.

Participants

People ≥65 years with an increased risk of cardiovascular disease who used the ‘Healthy Ageing Through Internet Counselling in the Elderly’ internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency.

Results

We performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting.

Conclusions

Human support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption.

Trial registration number

ISRCTN48151589; Pre-results.

Related collections

Most cited references 17

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In search of how people change. Applications to addictive behaviors.

J Prochaska, C C DiClemente, J Norcross (1992)

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

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Is Open Access

Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

Siobhan O’Connor, Peter Hanlon, Catherine A O'Donnell … (2016)

Background Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. Methods PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. Results Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. Conclusion This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. Systematic review registration International Prospective Register of Systematic Reviews CRD42015029846 Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0359-3) contains supplementary material, which is available to authorized users.

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Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes.

Salim Yusuf, Sanjit Jolly, Mary A. Fox … (2010)

Although preventive drug therapy is a priority after acute coronary syndrome, less is known about adherence to behavioral recommendations. The aim of this study was to examine the influence of adherence to behavioral recommendations in the short term on risk of cardiovascular events. The study population included 18 809 patients from 41 countries enrolled in the Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS) 5 randomized clinical trial. At the 30-day follow-up, patients reported adherence to diet, physical activity, and smoking cessation. Cardiovascular events (myocardial infarction, stroke, cardiovascular death) and all-cause mortality were documented to 6 months. About one third of smokers persisted in smoking. Adherence to neither diet nor exercise recommendations was reported by 28.5%, adherence to either diet or exercise by 41.6%, and adherence to both by 29.9%. In contrast, 96.1% of subjects reported antiplatelet use, 78.9% reported statin use, and 72.4% reported angiotensin-converting enzyme/angiotensin receptor blocker use. Quitting smoking was associated with a decreased risk of myocardial infarction compared with persistent smoking (odds ratio, 0.57; 95% confidence interval, 0.36 to 0.89). Diet and exercise adherence was associated with a decreased risk of myocardial infarction compared with nonadherence (odds ratio, 0.52; 95% confidence interval, 0.4 to 0.69). Patients who reported persistent smoking and nonadherence to diet and exercise had a 3.8-fold (95% confidence interval, 2.5 to 5.9) increased risk of myocardial infarction/stroke/death compared with never smokers who modified diet and exercise. Adherence to behavioral advice (diet, exercise, and smoking cessation) after acute coronary syndrome was associated with a substantially lower risk of recurrent cardiovascular events. These findings suggest that behavioral modification should be given priority similar to other preventive medications immediately after acute coronary syndrome. Clinical Trial Registration Information- URL: http://clinicaltrials.gov/ct2/show/NCT00139815. Unique identifier: NCT00139815.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2018

Publication date (Electronic): 21 January 2018

Volume: 8

Issue: 1

Electronic Location Identifier: e019683

Affiliations

[1 ] departmentDepartment of Neurology , Academic Medical Center , Amsterdam, The Netherlands

[2 ] departmentDepartment of Neurology , Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center , Nijmegen, The Netherlands

[3 ] departmentEpidemiology and Public Health , University of Toulouse , Toulouse, France

[4 ] departmentInstitute of Clinical Medicine/Neurology , University of Eastern Finland , Kuopio, Finland

[5 ] departmentDepartment of General Practice , Amsterdam Public Health Research Institute, Academic Medical Center , Amsterdam, The Netherlands

Author notes

[Correspondence to ] Tessa van Middelaar; t.vanmiddelaar@ 123456amc.uva.nl

Article

Publisher ID: bmjopen-2017-019683

DOI: 10.1136/bmjopen-2017-019683

PMC ID: 5781010

PubMed ID: 29358447

SO-VID: 8bbb72c2-768c-4953-86f3-cfaca9b342da

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 19 September 2017

Date revision received : 07 November 2017

Date accepted : 28 November 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001826, ZonMw;

Funded by: FundRef http://dx.doi.org/10.13039/501100002341, Suomen Akatemia;

Funded by: FundRef http://dx.doi.org/10.13039/501100001665, Agence Nationale de la Recherche;

Funded by: FundRef http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;

Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;

Funded by: FundRef http://dx.doi.org/10.13039/100011102, Seventh Framework Programme;

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ScienceOpen disciplines: Medicine

Keywords: ehealth,prevention and control,primary healthcare,cardiovascular diseases,qualitative research,implementation

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ScienceOpen disciplines: Medicine

Keywords: ehealth, prevention and control, primary healthcare, cardiovascular diseases, qualitative research, implementation

Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants

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Abstract

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Setting

Participants

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China Occupational Medicine

Most cited references 17

In search of how people change. Applications to addictive behaviors.

Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies

Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes.

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