Evaluation of a Web-Based Tailored Nursing Intervention (TAVIE en m@rche) Aimed at Increasing Walking After an Acute Coronary Syndrome: A Multicenter Randomized Controlled Trial Protocol

Abstract

BackgroundDespite the health benefits of increasing physical activity in the secondary prevention of acute coronary syndrome (ACS), up to 60% of ACS patients are insufficiently active. Evidence supporting the effect of Web-based interventions on increasing physical activity outcomes in ACS patients is growing. However, randomized controlled trials (RCTs) using Web-based technologies that measured objective physical activity outcomes are sparse.ObjectiveOur aim is to evaluate in insufficiently active ACS patients, the effect of a fully automated, Web-based tailored nursing intervention (TAVIE en m@rche) on increasing steps per day.MethodsA parallel two-group multicenter RCT (target N=148) is being conducted in four major teaching hospitals in Montréal, Canada. An experimental group receiving the 4-week TAVIE en m@rche intervention plus a brief “booster” at 8 weeks, is compared with the control group receiving hyperlinks to publicly available websites. TAVIE en m@rche is based on the Strengths-Based Nursing Care orientation to nursing practice and the Self-Determination Theory of human motivation. The intervention is centered on videos of a nurse who delivers the content tailored to baseline levels of self-reported autonomous motivation, perceived competence, and walking behavior. Participants are recruited in hospital and are eligible if they report access to a computer and report less than recommended physical activity levels 6 months before hospitalization. Most outcome data are collected online at baseline, and 5 and 12 weeks postrandomization. The primary outcome is change in accelerometer-measured steps per day between randomization and 12 weeks. The secondary outcomes include change in steps per day between randomization and 5 weeks, and change in self-reported energy expenditure for walking and moderate to vigorous physical activity between randomization, and 5 and 12 weeks. Theoretical outcomes are the mediating role of self-reported perceived autonomy support, autonomous and controlled motivations, perceived competence, and barrier self-efficacy on steps per day. Clinical outcomes are quality of life, smoking, medication adherence, secondary prevention program attendance, health care utilization, and angina frequency. The potential moderating role of sex will also be explored. Analysis of covariance models will be used with covariates such as sex, age, fatigue, and depression symptoms. Allocation sequence is concealed, and blinding will be implemented during data analysis.ResultsRecruitment started March 30, 2016. Data analysis is planned for November 2017.ConclusionsFinding alternative interventions aimed at increasing the adoption of health behavior changes such as physical activity in the secondary prevention of ACS is clearly needed. Our RCT is expected to help support the potential efficacy of a fully automated, Web-based tailored nursing intervention on the objective outcome of steps per day in an ACS population. If this RCT is successful, and after its implementation as part of usual care, TAVIE en...

An empirically sound telemedicine taxonomy – applying the CAFE methodology

“…As current research stresses the importance of tailoring telemedicine applications to the individual end user (Kayser et al 2017), we added further characteristics, namely demographics, to the dimension target population, as this dimension was underrepresented in existing taxonomies (see Fig. 2).…”

A web‐based tailored nursing intervention (TAVIE en m@rche) aimed at increasing walking after an acute coronary syndrome: Multicentre randomized trial

“…As the study protocol was previously published (Kayser et al, ), we provide a summary, with the changes that occurred after study commencement. Although this two‐group parallel multicentre RCT included four teaching hospital centres in Montréal, randomization occurred at three sites due to lack of recruitment at one site.…”

“…The experimental intervention was described previously (Kayser et al, ). Briefly, the intervention is based on a theoretical framework that integrates Strengths‐Based Nursing Care (SBNC) with Self‐Determination Theory (SDT).…”

Development and feasibility of a mobile phone application designed to support physically inactive employees to increase walking

“…Although commercial apps may rely on, and contain features that align with, behaviour and motivational theory [ 17 , 18 ], few studies have purposefully adopted a need-supportive communication style for delivery of content and BCTs within mobile applications [ 19 ]. There has been an increase in the number of studies investigating mechanisms and style of communication based on SDT used to deliver content via internet-based [ 20 , 21 ] and via mobile technology (text messages [ 22 ]) with the aim of promoting physical activity. Results from several studies provide indicative evidence that need support delivered via agency-based means (i.e., not just face-to-face) has potential to lead to sustained physical activity behavior change [ 21 , 22 ].…”