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Updated: Jul 30, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
A hybrid type 2 effectiveness-implementation design to evaluate a community-based, heart-healthy intervention for
Heidi Luft1, Roger Brown2, Diane Lauver3
1School of Nursing, University of Texas Medical Branch, United States.
Background:
Women of low socioeconomic status continue to experience a disproportionate burden of cardiovascular disease. To respond to their unique needs, we adapted the intervention and implementation strategy of an effective theory-based psychoeducational intervention for improving heart-healthy behaviors. Study aims were to evaluate implementation (i.e., reach, fidelity, acceptability, appropriateness) and effectiveness (i.e., perceived stress, common physical symptoms in primary care, physical activity, diet) of the adapted program we called mySTEPS.
Method:
We used a hybrid type 2 effectiveness-implementation approach. To evaluate implementation, we conducted a process evaluation using data from research records, observation rubrics, and pre-/post-intervention surveys. To evaluate potential effectiveness, we used a one-group, pre-/post-test design with three, sequential offerings (16 weeks each) in unique settings, used standardized, quantitative measures at 8 weeks post-intervention, and calculated effect sizes.
Results:
Forty-two women were included in the evaluation. For reach, 66 % and 61 % of participants attended adequate numbers of educational and coaching sessions. Supporting fidelity of delivery, nurse implementers addressed 85-98 % of required criteria. Supporting fidelity of receipt, participants' pre- to post- knowledge scores increased and other scores revealed that nurse-implementers had interacted supportively throughout mySTEPS. Participants rated the acceptability and appropriateness of components positively. Effect-sizes revealed moderate decreases in stress, moderate increases in physical activity, and modest decreases in the number of physical symptoms. Dietary scores did not change.
Conclusions:
The effectiveness and implementation of mySTEPS were positive overall. After strengthening the dietary component, more extensive evaluation of mySTEPS can be conducted to explain mechanisms of action.
Mesh Headings:
Health behavior, prevention, self-determination theory, self-regulation theory, cardiovascular diseases, implementation strategies.
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