Development, implementation and evaluation of a co-designed web-based cardiac rehabilitation program for patients living in rural and remote areas

Author: Katie Nesbitt

Nesbitt, Katie, 2024 Development, implementation and evaluation of a co-designed web-based cardiac rehabilitation program for patients living in rural and remote areas, Flinders University, College of Nursing and Health Sciences

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Aim: This doctoral thesis aimed to develop, implement and evaluate a web-based cardiovascular rehabilitation program to improve cardiovascular rehabilitation access for populations living in rural and remote areas through a web-based delivery model, thus increasing attendance at and completion of cardiovascular rehabilitation.

Methods: First, a systematic review was conducted to examine the effectiveness of web-based cardiac rehabilitation (CR) programs on attendance and completion compared to usual care. Second, a co-design study was conducted to develop the essential elements used to build the web-based program and guide its implementation into clinical use. Finally, an evaluation of the web-based CR program’s implementation was conducted. Using the RE-AIM framework it reported on its reach, effectiveness, adoption, implementation and maintenance.

Results: Web-based programs were 43% more likely to be completed than usual care [RR: 1.43; 95% CI: 0.96, 2.13] based on the systematic review of the literature, while there was no difference between groups for clinical outcomes. The evolution of the web-based CR program development was completed with an improvement in usability and launched for clinical use on July 1, 2021. Despite low enrolment and completion, our web-based cardiovascular rehabilitation program has successfully been implemented through adoption and utilisation at health service, clinician and patient levels.

Conclusions: This research resulted in a newly developed and implemented web-based CR program, providing a third option, along with face to face and telephone, to complete CR in rural and remote areas. This program was successfully implemented and although attendance at and completion of the web-based CR mode were less than usual care, it provided a mainstream option during COVID-19 pandemic restrictions. Future research and policy efforts should address barriers to engaging patients and clinicians and the routine integration of web-based cardiovascular rehabilitation programs into mainstream clinical use and already established programs in particular.

Keywords: Co-design, cardiac rehabilitation, remote health, program completion

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Dr Alline Beleigoli