Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Aug 8, 2020
Open Peer Review Period: Aug 7, 2020 - Oct 2, 2020
(currently open for review)
Development of Various Types and Forms of Messages for Smartphone-Based Cardiac Rehabilitation for Secondary Prevention in Patients with Coronary Artery Disease
Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, the previous applications have several limitations and there are scarce data regarding its usefulness and clinical benefit. The application for self-improvement (AnSim) trial is a multicenter, prospective randomized trial to explore the feasibility and efficacy of smartphone-based messaging application for patients who underwent percutaneous coronary intervention (PCI).
The current study will focus on the development of a smartphone-based, patient-specific messaging application and detailed design of the trial.
The AnSim application is developed by multidisciplinary team collaboration including cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctor and therapists. First, the focus group interview was conducted and narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 30 messages were developed according to three simplified steps of the transtheoretical model of behavioral change: (1) pre-contemplation, (2) contemplation and preparation, and (3) action and maintenance. After internal review and feedback from potential users, a bank of 450 messages and application were finally developed.
The focus interview was performed with 8 patients with recent PCI within 1 month and development of 450 messages were done. Positive feedback obtained from the potential users (n = 200) that Likert scale score was 3.95±SD and 3.91±SD for readability and usefulness, respectively. Based on the results, the several messages were refined. Furthermore, messages using various forms of multimedia such as exercise videos and dietary regimens, and connection for smoking cessation center were also developed as needed.
A final bank of 450 smartphone-based, patient-specific messages were developed to support behavior change and decrease cardiovascular risk factors through 5 step iterative process. The detailed process of multidisciplinary collaboration in the course of the study provides a scientific basis for various medical professionals who are planning smartphone based clinical research and AnSim trial will demonstrate the feasibility and efficacy of a patient-specific messaging smartphone application in secondary prevention of coronary heart disease.
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