Evaluating a Preventive Heart Health Program for Women at Midlife: Protocol for a Mixed Methods Pilot Study

Cardiovascular disease (CVD) is the leading cause of death in women. Risk factors can be compounded by hormonal changes, especially during the menopause transition. Positive health promotion through a behavioral change strategy may be the most effective approach to reducing CVD mortality and morbidity.

Health care providers are instrumental in identifying and managing CVD risk factors in women. This study aims to explore and assess the barriers and facilitators to implementing preventive heart health care in Singapore.

A prospective mixed methods pilot study using both quantitative and qualitative research methods for program implementation and evaluation through an interrupted time series study design will be conducted with a sample of 100 women aged 45 to 65 years. An A-B-A reversal design of 6-month intervals (baseline [A]-participants' healthy heart behaviors before the introduction of health coaching, intervention [B]-health coaching is introduced and participants' behaviors are measured to observe for changes from baseline, and return to baseline [A]-health coaching is removed and there is a return to baseline) will be used to assess the feasibility and acceptability of behavioral change strategies to increase heart-healthy habits. Data collection will occur over 3 phases: the preimplementation phase, the implementation phase, and the postimplementation phase. Quantitative data collection will include structured surveys. Qualitative interviews will be conducted among a subset of patients and health care providers for the exploratory evaluation of this study. Purposive sampling will be used for the recruitment of interview participants. Primary outcomes will be the reach, effectiveness, adoption, and feasibility of the preventive heart health program. Secondary outcomes will include laboratory blood test results and CVD risk assessment. A segmented regression analysis of interrupted time series will be used to evaluate the impact of the behavioral change strategy intervention. Qualitative data will be analyzed using an inductive approach, and thematic synthesis will be used to identify patterns. Integrating quantitative and qualitative data will facilitate a nuanced understanding of the barriers and facilitators of implementing a preventive heart health program among midlife women.

This study was funded in May 2022. Data collection started in April 2024 and is projected to end in April 2026. A total of 60 participants had been enrolled as of December 2025. Data analysis is expected to commence in June 2026 and expected results published in the autumn of 2026.

Experiential knowledge arising from the adoption of personalized health coaching for midlife women can help ascertain the contextual challenges and effectiveness of service implementation in Singapore. Study findings can contribute to refining the framework of sex-specific, tailored CVD prevention care; enable upscaling of such services to other hospitals; and improve future preventive care for midlife women.