JMIR Publications

ABSTRACT

Background:

Cardiac rehabilitation (CR) is a Class IA recommended treatment and secondary preventive strategy for patients with coronary artery disease. Electronic health (eHealth) solutions show promise in providing accessible CR. However, few offer a comprehensive and multimodal CR programme, and most programmes are developed without input from end users.

Objective:

The aim of this study was to provide a detailed description of the multidisciplinary co-creation process developing a person-centred, multimodal digital CR programme integrating stakeholders and end users’ perspectives throughout, with the rationale to optimize the acceptance and feasibility of the CR programme.

Methods:

We incorporated a user-centred design with a three-phased iterative multidisciplinary stakeholder co-creation process. This included defining needs (Phase 1), development and refinement (Phase 2), and testing and optimalisation (Phase 3). Overall, 26 internal stakeholders from the project team participated, including clinicians, researchers, software developers, and user representatives. In addition, 35 external stakeholders (20 clinicians and 15 cardiac patients) participated in a user-centered development process that included workshops, intervention content development, and usability testing. Data was collected through contextual inquiry, four workshops with stakeholders, 12 co-creation sessions with user representatives, two usability testing sessions using think aloud methodology, standardised usability surveys and individual and focus group interviews. Intervention content was developed and finalized based on existing evidence, stakeholder input, and user testing. A smoke test and a minimum viable product test was conducted. Data was analysed using rapid- and qualitative content analysis, and descriptive statistics.

Results:

Analyses from data gathered in the three phases identified five themes important to stakeholders and end-users: a programme with (1) personalized and tailored solutions with reliable, trustworthy, and evidence-based content (i.e. face-to-face introduction session at the programme start, a tailored registration page to individually register personal risk factors, goals, and medications), (2) options for feedback (i.e. an asynchronous messaging service and tailored face-to-face video consultations with clinicians), (3) peer support (i.e. exercise sessions in groups), (4) digital reminders (i.e. notifications on smartphone or tablet), and (5) motivational features (i.e. interactive cardiac-specific learning modules on coronary artery disease and secondary prevention). Evidence-based content development resulted in nine cardiac-specific interactive learning modules, a module for personal health data entry, live exercise sessions, tailored digital follow up, and asynchronous message service. Readability was assessed using the Gunning Fog Index with levels ranging from 4 - 13. The overall System Usability Scale score was 86.2 (± 12.2), indicating excellent usability.

Conclusions:

A multidisciplinary stakeholder co-creation process combining well-known evidence-based concepts with stakeholder input identified several areas of improvement and facilitated the development of the digital CR programme. Contextually tailored, co-designed interventions improve relevance and responsiveness to user needs. The feasibility and effect of the programme will be further evaluated in the eCardiacRehab trial. Clinical Trial: Nct06759805