Adaptive web-based stress management programs among adults with a cardiovascular disease: A pilot Sequential Multiple...

Area of Science:

• Digital health interventions
• Cardiovascular disease management
• Behavioral science

Background:

• Web-based stress management programs show promise for cardiovascular disease (CVD) patients.
• Optimizing intervention delivery is crucial for maximizing efficacy and patient engagement.
• Sequential Multiple Assignment Randomized Trials (SMART) offer a flexible approach to intervention optimization.

Purpose of the Study:

• To evaluate the feasibility and acceptability of a SMART design for a web-based stress management intervention in CVD patients.
• To explore different delivery strategies, including lay telephone coaching and motivational interviewing (MI).
• To assess the clinical significance of optimized intervention pathways.

Main Methods:

• A total of 59 CVD patients with moderate stress were enrolled.
• Participants were initially randomized to a web-based program alone or with lay coaching.
• Non-responders were re-randomized to their initial intervention or to motivational interviewing (MI).

Main Results:

• SMART procedures were found to be feasible.
• Attrition rates were higher in the web-only group compared to the lay coach group, potentially due to lower satisfaction (47%).
• Effect sizes for stress and quality of life generally exceeded the 0.2 clinical benchmark, with an exception for one subgroup.

Conclusions:

• The findings suggest that a larger-scale trial employing a SMART design is feasible.
• Strategies to mitigate attrition and improve satisfaction among non-responders require further attention.
• This study contributes to developing effective and cost-efficient e-Health interventions for chronic disease management.