Technology-bAsed cardiac rehabilitation therapy (TaCT) for women: Intervention implementability, usability,...

Despite the benefits of cardiac rehabilitation (CR), women are under-represented, especially in lower-income settings. Technology may be leveraged to tailor CR to better engage women, but this has never been tested in a middle-income country. This study assessed the implementability, usability, engagement, and acceptability of Technology-bAsed Cardiac rehabilitation Therapy (TaCT) in women with cardiovascular disease (CVD) in a middle-income country.

Data from intervention arm participants in a randomized trial was analyzed. The trial was undertaken in the outpatient cardiology department of a private tertiary care center in India. The 6-month CR intervention was delivered via an app (individualized secondary prevention recommendations), website (patient education), WhatsApp (standardized behavior change promotion messages, yoga/relaxation video, support chat), and bi-weekly one-on-one phone calls with a nurse trainee (risk factor management). At the end of the intervention, participants' engagement, usability (System Usability Scale), and, acceptability (/5) of the program were evaluated using descriptive statistics.

50 women were randomized to intervention; one died and 49 (100%) were retained. Some participants faced challenges such as internet availability issues and technical glitches. There were no adverse events. Engagement was high for calls (mean = 11.6 ± 1.4/12), WhatsApp messages (mean = 34.2 ± 4.6/36 read) the website (74-151 hits/education page), and the mobile app (7.2 ± 4.2 times/patient); there were no group chat messages. Usability was rated as "excellent" (94.7 ± 5.2/100). Acceptability with the overall intervention was high (means ≥4.5/5), but was lower for information understandability, including diet and exercise recommendations.

Favorable implementability and acceptability, as well as excellent usability and engagement with TaCT were established. Along with favorable outcome results, this suggests that TaCT may serve as a valuable intervention to improve women's access and adherence to CR in resource-constrained environments.