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Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management-Related Outcomes:
Jorge Palacios1, Geraldine A Lee, Maria Duaso
1Jorge Palacios, MD, MSc PhD Student, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Geraldine A. Lee, PhD Senior Lecturer, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Maria Duaso, PhD Lecturer, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Abigail Clifton, BSc Research Assistant, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Ian J. Norman, PhD Executive Dean, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Derek Richards, PhD Director of Clinical Research and Innovation, Silvercloud Health, and School of Psychology, Trinity College Dublin, Ireland. Elizabeth Alexandra Barley, PhD, CPsychol Professor in Health and Wellbeing, College of Nursing, Midwifery and Healthcare, University of West London, UK.
Insights
Internet-delivered interventions show promise for improving self-management in coronary heart disease (CHD) patients, particularly for lifestyle outcomes. Further research is needed to optimize engagement and personalization for better results.
Area of Science:
- Cardiovascular Health
- Digital Health Interventions
- Behavioral Science
Background:
- Coronary heart disease (CHD) presents significant mortality and morbidity risks, often compounded by mental health comorbidities.
- Effective self-management is crucial for CHD patients, yet access to support remains a challenge.
- Internet-delivered interventions offer a potential solution to increase access to self-management support.
Purpose of the Study:
- To systematically review the effectiveness of Internet-delivered self-management support for coronary heart disease.
- To identify key components contributing to the effectiveness of these digital interventions.
- To assess impacts on CHD, mood, and self-management outcomes.
Main Methods:
- A systematic literature search was conducted across Medline, PsychINFO, and Embase.
- Eligibility criteria were applied to identify relevant randomized controlled trials (RCTs).
- Seven RCTs involving 1321 CHD patients met the inclusion criteria.
Main Results:
- All seven included studies reported significant positive between-group effects, especially for lifestyle-related outcomes.
- Intervention personalization and engagement support may enhance outcomes, though further data are needed.
- While evidence-based behavior change techniques were used, the theoretical underpinnings of interventions were often underdeveloped.
Conclusions:
- Well-designed RCTs are necessary to further evaluate Internet-delivered CHD self-management support.
- Future research should investigate mechanisms of action, participant retention, and satisfaction.
- The role of personalization and support within digital interventions requires further examination.
Introduction:
Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access.
Objective:
The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness.
Method:
Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase).
Results:
Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used.
Conclusion:
More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.
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