A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial

Eva Rosalinde Broers, Willem Johan Kop, Johan Denollet, Jos Widdershoven, Mart Wetzels, Idowu Ayoola, Jordi Piera-Jimenez, Mirela Habibovic, Eva Rosalinde Broers, Willem Johan Kop, Johan Denollet, Jos Widdershoven, Mart Wetzels, Idowu Ayoola, Jordi Piera-Jimenez, Mirela Habibovic

Abstract

Background: Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes.

Objective: This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated.

Methods: Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies.

Results: The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean -1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07).

Conclusions: The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change.

Trial registration: ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281.

Keywords: cardiovascular diseases; eHealth; habits; lifestyle; mHealth.

Conflict of interest statement

Conflicts of Interest: None declared.

©Eva Rosalinde Broers, Willem Johan Kop, Johan Denollet, Jos Widdershoven, Mart Wetzels, Idowu Ayoola, Jordi Piera-Jimenez, Mirela Habibovic. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.05.2020.

Figures

Figure 1
Figure 1
Flow diagram of patient recruitment.
Figure 2
Figure 2
Mean scores of intervention and care as usual group on primary outcome measures.
Figure 3
Figure 3
Standalone Equation 1.

References

    1. Piepoli M, Hoes A, Agewall S, Albus C, Brotons C, Catapano A, Cooney M, Corrà U, Cosyns B, Deaton C, Graham I, Hall M, Hobbs F, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter D, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM, Binno S, ESC Scientific Document Group 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur Heart J. 2016 Aug 1;37(29):2315–81. doi: 10.1093/eurheartj/ehw106.
    1. Chow CK, Jolly S, Rao-Melacini P, Fox KA, Anand SS, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation. 2010 Feb 16;121(6):750–8. doi: 10.1161/CIRCULATIONAHA.109.891523.
    1. Kotseva K, Wood D, de Bacquer D, de Backer G, Rydén L, Jennings C, Gyberg V, Amouyel P, Bruthans J, Conde AC, Cífková R, Deckers JW, de Sutter J, Dilic M, Dolzhenko M, Erglis A, Fras Z, Gaita D, Gotcheva N, Goudevenos J, Heuschmann P, Laucevicius A, Lehto S, Lovic D, Miličić D, Moore D, Nicolaides E, Oganov R, Pajak A, Pogosova N, Reiner Z, Stagmo M, Störk S, Tokgözoğlu L, Vulic D, EUROASPIRE Investigators EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016 Apr;23(6):636–48. doi: 10.1177/2047487315569401.
    1. Charlson M, Wells M, Peterson J, Boutin-Foster C, Ogedegbe G, Mancuso C, Hollenberg J, Allegrante J, Jobe J, Isen A. Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation. Transl Behav Med. 2014 Mar;4(1):7–17. doi: 10.1007/s13142-013-0241-0.
    1. Habibović M, Burg M, Pedersen S. Behavioral interventions in patients with an implantable cardioverter defibrillator: lessons learned and where to go from here? Pacing Clin Electrophysiol. 2013 May;36(5):578–90. doi: 10.1111/pace.12108.
    1. Minich DM, Bland JS. Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. ScientificWorldJournal. 2013;2013:129841. doi: 10.1155/2013/129841. doi: 10.1155/2013/129841.
    1. Young L, Buse J, Weaver M, Vu M, Mitchell C, Blakeney T, Grimm K, Rees J, Niblock F, Donahue K, Monitor Trial Group Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Intern Med. 2017 Jul 1;177(7):920–9. doi: 10.1001/jamainternmed.2017.1233.
    1. Kraal JJ, van den Akker-van Marle M, Abu-Hanna A, Stut W, Peek N, Kemps HM. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study. Eur J Prev Cardiol. 2017 Aug;24(12):1260–73. doi: 10.1177/2047487317710803.
    1. Sankaran S, Dendale P, Coninx K. Evaluating the impact of the hearthab app on motivation, physical activity, quality of life, and risk factors of coronary artery disease patients: Multidisciplinary crossover study. JMIR Mhealth Uhealth. 2019 Apr 4;7(4):e10874. doi: 10.2196/10874.
    1. Kangovi S, Asch DA. Behavioral phenotyping in health promotion: embracing or avoiding failure. J Am Med Assoc. 2018 May 22;319(20):2075–6. doi: 10.1001/jama.2018.2921.
    1. Habibović M, Broers E, Piera-Jimenez J, Wetzels M, Ayoola I, Denollet J, Widdershoven J. Enhancing lifestyle change in cardiac patients through the do CHANGE system ('Do cardiac health: advanced new generation ecosystem'): randomized controlled trial protocol. JMIR Res Protoc. 2018 Feb 8;7(2):e40. doi: 10.2196/resprot.8406.
    1. Pine K, Fletcher B. Time to shift brain channels to bring about effective changes in health behaviour. Perspect Public Health. 2014 Jan;134(1):16–7. doi: 10.1177/1757913913514705.
    1. Fletcher B, Hanson J, Page N, Pine K. FIT – Do something different. A new behavioral program for sustained weight loss. Swiss J Psychol. 2011;70(1):25–34. doi: 10.1024/1421-0185/a000035.
    1. Walker SN, Sechrist KR, Pender NJ. Deep Blue. 1995. [2018-06-30]. Health Promotion Model - Instruments to Measure Health Promoting Lifestyle : Health-Promoting Lifestyle Profile [HPLP II] .
    1. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998 May;28(3):551–8. doi: 10.1017/s0033291798006667.
    1. Venkatesh V, Thong JY, Xu X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. Manag Inf Syst Q. 2012;36(1):157–78. doi: 10.2307/41410412.
    1. Larsen DL, Attkisson C, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. 1979;2(3):197–207. doi: 10.1016/0149-7189(79)90094-6.
    1. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med. 2005;67(1):89–97. doi: 10.1097/01.psy.0000149256.81953.49.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7. doi: 10.1001/archinte.166.10.1092.
    1. Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry. 2007;29(5):417–24. doi: 10.1016/j.genhosppsych.2007.06.005.
    1. Kelders SM, Kok RN, Ossebaard HC, van Gemert-Pijnen JE. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012 Nov 14;14(6):e152. doi: 10.2196/jmir.2104.
    1. Alm-Roijer C, Fridlund B, Stagmo M, Erhardt L. Knowing your risk factors for coronary heart disease improves adherence to advice on lifestyle changes and medication. J Cardiovasc Nurs. 2006;21(5):E24–31. doi: 10.1097/00005082-200609000-00015.
    1. Riegel B, Moser D, Buck H, Dickson V, Dunbar S, Lee C, Lennie T, Lindenfeld J, Mitchell J, Treat-Jacobson DJ, Webber D, American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease;Council on Quality of Care and Outcomes Research Self-care for the prevention and management of cardiovascular disease and stroke: a scientific statement for healthcare professionals from the American Heart Association. J Am Heart Assoc. 2017 Aug 31;6(9):pii: e006997. doi: 10.1161/JAHA.117.006997.
    1. Habibović M, Denollet J, Cuijpers P, van der Voort PH, Herrman J, Bouwels L, Valk SD, Alings M, Theuns DA, Pedersen SS. Web-based distress management for implantable cardioverter defibrillator patients: a randomized controlled trial. Health Psychol. 2017 Apr;36(4):392–401. doi: 10.1037/hea0000451.
    1. Kashdan TB, Rottenberg J. Psychological flexibility as a fundamental aspect of health. Clin Psychol Rev. 2010 Nov;30(7):865–78. doi: 10.1016/j.cpr.2010.03.001.
    1. Huffman JC, Celano CM, Beach SR, Motiwala SR, Januzzi JL. Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol. 2013;2013:695925. doi: 10.1155/2013/695925. doi: 10.1155/2013/695925.
    1. Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, Freedland K, Jaffe A, Leifheit-Limson E, Sheps D, Vaccarino V, Wulsin L, American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014 Mar 25;129(12):1350–69. doi: 10.1161/CIR.0000000000000019.
    1. Freedland KE, Rich MW, Skala JA, Carney RM, Dávila-Román VG, Jaffe AS. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom Med. 2003;65(1):119–28. doi: 10.1097/01.psy.0000038938.67401.85.
    1. Sin NL, Kumar AD, Gehi AK, Whooley MA. Direction of association between depressive symptoms and lifestyle behaviors in patients with coronary heart disease: the heart and soul study. Ann Behav Med. 2016 Aug;50(4):523–32. doi: 10.1007/s12160-016-9777-9.
    1. Penninx BW. Depression and cardiovascular disease: Epidemiological evidence on their linking mechanisms. Neurosci Biobehav Rev. 2017 Mar;74(Pt B):277–86. doi: 10.1016/j.neubiorev.2016.07.003.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться