JMIR Publications

ABSTRACT

Background:

Dealing with cardiovascular diseases is challenging and people often struggle to follow rehabilitation and self-management programmes. A number of systematic reviews have explored quantitative evidence on the potential of digital health interventions to support cardiac rehabilitation and self-management. However, while promising, evidence regarding the effectiveness and uptake of existing systems is mixed. In this paper we take a different, but complementary approach, focusing on qualitative data related to people’s experiences of technology in this space.

Objective:

This systematic review aims to identify evidence based barriers, facilitators, and trends of digital interventions in cardiac rehabilitation and self-management. By focusing on qualitative data we aim to provide a subjective perspective of patients’ needs and experiences. Qualitative data is systematically identified and findings are analysed via a Human Computer Interaction lens considering the role of user-centered design processes in the development and evaluation of previous systems.

Methods:

A grounded theory literature review of peer-reviewed research articles from the following major electronic databases was conducted: ACM Digital Library, PsychInfo, Scopus and PubMed. Papers published in the last 10 years, 2009-2019 were considered and a systematic search with pre-defined keywords was conducted. Papers were screened against pre-defined inclusion and exclusion criteria. Comparative and in-depth analysis of the screened qualitative data was carried out through three levels of iterative coding and concept development.

Results:

16 papers were included in the final analysis. The most common digital intervention presented were web-based, followed by mobile, tablet, and a combination of web and mobile based systems. Most studies presented systems that focused on increasing physical activity, followed by systems to facilitate greater connection and communication between patients and care-providers. Some focused on providing remote cardiac rehabilitation. The key barriers and facilitators of cardiac self-management were found to be knowledge and awareness, personal responsibility and social connectedness. While some studies applied user-centered design process, users were only involved in some, not all stages, of the process and there was limited evidence of studies applying iterative approaches.

Conclusions:

This review identifies key barriers, facilitators and opportunities for technology in cardiac self-management and rehabilitation. It highlights the importance of multiple forms of knowledge, including general knowledge about health conditions, but also self-awareness and in the moment knowledge. Technology can support motivation in several distinct ways, e.g. the use personalization to improve adherence. Relationships and connectedness represent a significant facilitator for many people, but this contrasts with a preference of others for self-reliance. Challenges include the potential to be overburden by devices and lack of trust in technology. Our findings also highlight the limited use of iterative, user-centered approaches and theoretical models to guide design in this space.