Human-Centered Design to Tailor Telehealth Cardiac Rehabilitation to Diverse Populations: The MCNAIR Study

Abstract

Background: Although telehealth cardiac rehabilitation (CR) may improve access, there are concerns about its long-term effectiveness and impact on equity as compared with in-person CR. Our objective was to tailor a patient-centered telehealth CR program for diverse populations.

Methods: CR patients and caregivers were recruited between January and September 2023 from 4 US academic medical centers. Participants engaged in human-centered design sessions to iteratively refine a telehealth CR program. Sessions had planned topics, but there was variation across sites to account for site-specific needs and participant feedback. Sessions were qualitatively analyzed using rapid template analysis with preselected behavioral science constructs and other emergent codes.

Results: The study included 21 participants (71% aged ≥60 years, 48% women, 62% non-Hispanic White individuals; 90% CR patients, 10% CR caregivers). Participants thought that telehealth CR could be helpful for personalized support at home and convenience but recognized that technology is not always easy to use. Some expressed concerns about the safety of telehealth CR, especially at the beginning, and desired monitoring through a mobile device or video observation of exercise. Safety protocols and technology training were developed, which addressed concerns about telehealth CR. Opportunities for social support with telehealth CR were also desired. From these findings, an implementation toolkit was developed, including a graphic program description, safety plan, home exercise plan for during and after CR, and scripts for technology training and individual and group telehealth visits.

Conclusions: A patient-centered telehealth CR program and implementation toolkit were systematically tailored to address the needs of diverse populations.

Keywords: cardiac rehabilitation; equity; implementation science; telehealth.