Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants

Abstract

ObjectivesTo study older peoples’ experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care.DesignQualitative semistructured interview study, with thematic analysis.SettingPrimary care in the Netherlands.ParticipantsPeople ≥65 years with an increased risk of cardiovascular disease who used the ‘Healthy Ageing Through Internet Counselling in the Elderly’ internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency.ResultsWe performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting.ConclusionsHuman support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption.Trial registration numberISRCTN48151589; Pre-results.

Healthy ageing through internet counselling in the elderly (HATICE): a multinational, randomised controlled trial

“…The intervention platform was carefully designed using an iterative process involving the end users throughout development, leading to good usability, as confirmed in a Intervention Control qualitative substudy. 17,18,25 Our pragmatic multicomponent approach makes it difficult to disentangle effects of different components of the intervention, particularly to differentiate between the effects of the application itself and of the coach. A limitation of our primary outcome is the difficulty to establish its clinical relevance.…”

“…During the screening visit, blood pressure and anthropometrics were assessed. Full study logistics and procedures are provided in the appendix (pp [25][26]. Medical history and medication use were registered.…”

“…The increasing effect size with every additional goal set during the study supports the notion of a dosage-effect relationship and the additional potential for a larger effect if the participant had interacted more frequently with the application and the coach. An embedded qualitative study 25 indicated that interaction with the coach in person at baseline and during the study was pivotal. This is in line with previous reports suggesting intensive counselling interventions can be effective in reducing cardiovascular risk and disease, 26,27 whereas less intensive interventions are not.…”

Adherence to multidomain interventions for dementia prevention: Data from the FINGER and MAPT trials

“…Insight into the acceptability of a preventive Internet intervention in older European adults will be provided by the recently completed Healthy Ageing Through Internet Counselling in the Elderly trial [26]. Initial qualitative results suggest that human support may be crucial for the success of this kind of intervention in older age groups [27].…”

Functional ability is associated with higher adherence to behavioral interventions in mild cognitive impairment

“…participated in classes, not engagement outside of classes), (Coley et al, 2019;Ngandu et al, 2015) individually and combined, and these findings are based mainly on active supervision of study staff. Research staff supervision and involvement in behavioral interventions is known to increase intervention participation (adherence) (Ligthart et al, 2015;Van Middelaar et al, 2018). Our reported adherence may differ from that of the FINGER trial because 1) we reported on-going adherence (post-intervention engagement) in intervention components outside of structured in-person sessions and 2), we used a mixture of direct observation (BrainHQ TM portal report and calendar completion) and partner report to determine post-intervention adherence.…”