JMIR Publications

ABSTRACT

Background:

Exercise-based cardiac rehabilitation (CR) is a crucial part of the treatment of patients with cardiac diseases and adherence of healthy behavior is a prerequisite to improve long-term prognosis. Unfortunately, adherence to healthy behavior adapted in CR is challenging for many cardiac patients in the long-term. Recently, we demonstrated that follow-up conducted via an application (app) for one year significantly improved adherence to healthy behavior post-CR. In order to increase the knowledge and understanding of mobile Health (mHealth) interventions that can promote acceptance and adherence, qualitative research investigating patients’ experiences with these interventions are warranted.

Objective:

The aim of this study was to investigate patient experiences with individualized long-term follow-up conducted via an app for one year and their thoughts about what features promoted adherence to healthy behavior post-CR. This to increase the understanding of significant findings previously reported as well as to guide future development of similar interventions in the field of adherence.

Methods:

Ten patients who had participated in a randomized controlled trial evaluating the effect of follow-up conducted via an app on adherence to healthy behavior post-CR were included in this qualitative study with individual semi-structured, in-depth interviews. Median age was 65, ranging from 46 to 72 years old, and both genders were represented. Interviews were analyzed by qualitative content analysis. Primarily, codes and themes were inductively developed.

Results:

The analysis resulted in four themes describing the patients’ experiences with follow-up conducted via an app for one-year post-CR: 1) The person behind the app is crucial for motivation and adherence, 2) The app as a commitment, 3) The app as a path to independence, and 4) Suggestions for improvements. Additionally features experienced as beneficial to promote adherence were individualized feedback as well as the use of goalsetting. The significance of the person behind the app that provided individualized feedback turned out to be a consistent finding. This person seemed to promote motivation in general and to enable other known behavioral change techniques to be motivating as well.

Conclusions:

The person behind the app (the supervisor) seems to be one of the main features which promoted adherence to healthy behavior post-CR. This indicates that healthcare providers must actively participate in the patients´ process of adherence to healthy behavior, also when using interventions including an app. Future development of interventions in the field of adherence should strive to develop tools that enable an ongoing collaborative relationship between the patient and the healthcare provider. The follow-up should be based on the patient’s own goals and individualized feedback should be provided.