A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study

Abstract

Background Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings.

Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review

“…There was a range of 4–56 sessions/program overall (median = 24). Thirteen (46.4%) studies offered only women-focused sessions (with an average of 14.2 such sessions/program, where reported) [ 23 , 39 – 41 , 43 , 46 , 54 , 55 , 59 , 61 , 64 , 68 , 73 , 78 ], with the remainder of studies testing full women-focused programs (Table 1 ).…”

“…This was surprising, and suggests there may be challenges for programs in safely, affordably and/or equitably offering such programming; future research should investigate program-level barriers to offering modes of exercise preferred by women. Finally, given women often desire social interaction [ 20 ], it was appropriate most programming was delivered in a group; it may be desirable to do this virtually more commonly in future to augment accessibility for women [ 78 ]. It is hoped with this information the CR community can come to consensus on what is considered women-focused CR, with our suggestion that it refers to programs: (a) with at least some CR components with ≥ 50% women, and (b) comprising some form(s) of tailoring to meet women’s needs or preferences (e.g., fulsome psychosocial screening and programming, education content, and/or forms of exercise).…”

“…With the COVID-19 pandemic, our program delivers weekly women-focused CR sessions, based on our validated patient education program [ 92 – 94 ], which are freely available online ( https://www.healtheuniversity.ca/EN/CardiacCollege/Pages/Women-Learn-Online.aspx ). A recently-published paper presents development and evaluation of a theoretically-based mobile phone-based women-focused CR program using machine learning [ 78 ]; preliminary engagement and walking results are promising.…”

A precision medicine approach to sex-based differences in ideal cardiovascular health

“…It is, therefore, possible that participants that contributed data from these devices were more motivated to achieve ideal health metrics in each of the Life’s Simple 7 categories. This may especially be true in women with cardiovascular disease where a 12-week pilot study of a mobile health device-based intervention resulted in improvements in BMI, waist circumference, and depressive symptoms 40 . Furthermore, as there were no differences in average daily step counts between the phenogroups of women and men, it is unlikely that there were differences in device use between the groups.…”

Feasibility and validity of Ecological Momentary Assessment in patients with acute coronary syndrome

“…Ambulatory monitoring of these variables provides an important source of information for both research and clinical intervention. EMA has previously been used in community samples to monitor risk for cardiovascular disease [ 17 ], mobile health interventions following cardiac events [ 18 , 19 ], and non-computerized versions of EMA have been used to examine how mood patterns affect coronary artery calcification [ 20 ]. However, despite extensive research examining EMA methodology in other health domains, information is currently lacking concerning the basic metrics of feasibility and validity in cardiology.…”