Genevieve Coorey|David Peiris|Anish Scaria|John C. Mulley|Lis Neubeck|Nashid Hafiz|Julie Redfern
An Internet-Based Intervention for Cardiovascular Disease Management Integrated With Primary Care Electronic Health Records: Mixed Methods Evaluation of Implementation Fidelity and User Engagement
University of Sydney|The George Institute for Global Health|UNSW Sydney|The George Institute for Global Health|The George Institute for Global Health|The George Institute for Global Health|Edinburgh Napier University|University of Sydney|University of Sydney|University of Sydney
background growing evidence supports benefits ehealth interventions increase patient engagement improve outcomes range conditions however ineffective program delivery usage attrition limit exposure interventions may reduce effectiveness objective study aims evaluate delivery fidelity ehealth intervention describe use patterns compare outcomes low high users identify mediating factors intervention delivery receipt methods mixed methods study internetbased intervention evaluated effectiveness randomized controlled trial rct intervention comprised medication cardiovascular disease cvd risk data uploaded primary care electronic health record ehr interactive personalized cvd risk score estimation goal setting selfmonitoring interactive social forum optional receipt heart health messages fidelity assessed 12 months trial outcomes compared low high users data sources included program delivery records web log data trial data thematic analysis communication records results participants intervention group 451486 93 initial training session conducted telephone 413447 924 participants trained mean duration 44 minutes range 1090 minutes staff conducted 9845 17761804 expected followups mostly telephone email 451 participants commenced logins 468 211 categorized low users defined least one login 3 fewer months followup 404 182 categorized high users least one login 3 months followup 128 58 nonadopters logins training session mean login frequency 34 per month ongoing users significant difference groups primary trial outcome adherence guidelinerecommended medications p44 unadjusted analyses high users significantly greater ehealth literacy scores p003 likely meet recommended weekly targets fruit p03 fish p004 servings however adjusted findings significant interactive screen use highest goal tracking lowest chat forum screens ehrderived data held early interest users fidelity measures reach content dose delivered dose received influenced facilitation strategies used staff invisible qualities staffparticipant communication participants responsiveness intervention attributes conclusions multifeature internetbased intervention delivered high fidelity rct protocol regularly used 404 182451 users 12 months higher login frequency indicator greater intervention exposure associated statistically significant improvements ehealth literacy scores lifestyle changes clinical outcomes attributes intervention individualized support influenced initial ongoing use