Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 15:7:1427539.
doi: 10.3389/fdgth.2025.1427539. eCollection 2025.

The HEALERS: a patient, community, and stakeholder advisory board focus group series to refine a novel virtual world-based cardiac rehabilitation intervention and clinical trial

Helayna Abraham  1 , Grace Patrice Anyetei-Anum  2 , Ashton Krogman  3 , Donald Clark 3rd  4 , Melvin Echols  5 , Michael E Hall  4 , Karen Hodgman  3 , Brian Kaihoi  6 , Stephen Kopecky  3 , Shawn Leth  3 , Shaista Malik  7 , Jill Marsteller  8 , Lena Mathews  9 , Robert Scales  10 , Phillip Schulte  11 , Adam Shultz  3 , Julie Becker  3 , Bryan Taylor  12 , Randal Thomas  3 , Nathan D Wong  7 , Thomas Olson  3 , LaPrincess C Brewer  3   13
Affiliations

The HEALERS: a patient, community, and stakeholder advisory board focus group series to refine a novel virtual world-based cardiac rehabilitation intervention and clinical trial

Helayna Abraham et al. Front Digit Health. .

Abstract

Background: Cardiac rehabilitation (CR) is a widely underutilized secondary cardiovascular disease prevention strategy, due to a variety of barriers to participation that disproportionately impact women, minoritized racial and ethnic groups, and patients with low socioeconomic status. Destination Cardiac Rehab, a virtual world-based CR (VWCR) program designed by our team in collaboration with patients and community members to mitigate the barriers to CR participation, has demonstrated feasibility and acceptability. In anticipation of a randomized controlled trial (RCT) to further validate the intervention, this qualitative descriptive analysis provides insights garnered from a patient/community/stakeholder-advisory board (PCS-AB, HEALERS) focus group series, convened to inform iterative refinements to a RCT protocol.

Methods and results: HEALERS participated in five 90-min virtual focus group sessions to provide feedback on various aspects of the VWCR intervention and the recruitment/retention strategies. Major themes were identified from participant feedback to inform revisions to the trial protocol. Illustrative quotes were selected to represent each theme. Twenty-two members were recruited with diverse sociodemographic and personal/professional backgrounds (mean age 59.3 ± 13 years, 50% female). Regarding trial recruitment, members recommended effective communication strategies, recruitment video suggestions, and expansion of recruitment settings. HEALERS emphasized the importance of feeling safe during exercise and social support in designing an effective VWCR intervention. Lastly, they identified reminder messages, tangible incentives, and fostering positive relationships with the CR staff as important retention tools.

Conclusions: A diverse PCS-AB was convened to better understand community needs to improve the patient-centric nature of Destination Cardiac Rehab in anticipation of an upcoming RCT. The HEALERS offered valuable insights that informed actionable changes to the RCT protocol.

Keywords: cardiac rehabilitation; caregiver; community engaged research; healthcare equity patient; stakeholder advisory board; telehealth; virtual world.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Theoretical framework for destination cardiac rehab. Created with BioRender.com. Bottom left image: Reproduced with permission from “Senior African American couple using laptop” by Monkey Business Images, licensed under Standard Image License. Right image: Reproduced with permission from “Motion blur shot of an African American mother and daughter jogging together in park” by sirtravelalot, licensed under Standard Image License.
Figure 2
Figure 2
Overview of trial protocol including overview of intervention and control arms. Created with BioRender.com.
Figure 3
Figure 3
Study overview with a brief description of the FG session topics. Created with BioRender.com.
Figure 4
Figure 4
Destination Cardiac Rehab logo selected by the HEALERS. Created with adobe illustrator.
See this image and copyright information in PMC

References

    1. Haynes N, Kaur A, Swain J, Joseph JJ, Brewer LC. Community-based participatory research to improve cardiovascular health among us racial and ethnic minority groups. Curr Epidemiol Rep. (2022) 9(3):212–21. 10.1007/s40471-022-00298-5 - DOI - PMC - PubMed
    1. Wieland ML, Njeru JW, Alahdab F, Doubeni CA, Sia IG. Community-engaged approaches for minority recruitment into clinical research: a scoping review of the literature. Mayo Clin Proc. (2021) 96(3):733–43. 10.1016/j.mayocp.2020.03.028 - DOI - PubMed
    1. Thomas VE, Metlock FE, Hines AL, Commodore-Mensah Y, Brewer LC. Community-based interventions to address disparities in cardiometabolic diseases among minoritized racial and ethnic groups. Curr Atheroscler Rep. (2023) 25(8):467–77. 10.1007/s11883-023-01119-w - DOI - PMC - PubMed
    1. Brewer LC, Cyriac J, Kumbamu A, Burke LE, Jenkins S, Hayes SN, et al. Sign of the times: community engagement to refine a cardiovascular mHealth intervention through a virtual focus group series during the COVID-19 pandemic. Digit Health. (2022) 8:20552076221110537. 10.1177/20552076221110537 - DOI - PMC - PubMed
    1. Adedinsewo D, Eberly L, Sokumbi O, Rodriguez JA, Patten CA, Brewer LC. Health disparities, clinical trials, and the digital divide. Mayo Clin Proc. (2023) 98(12):1875–87. 10.1016/j.mayocp.2023.05.003 - DOI - PMC - PubMed

LinkOut - more resources