Evaluation of a mHealth Cardiac Rehabilitation Intervention in Older Veterans

老年退伍军人 mHealth 心脏康复干预的评估

• 批准号: 10354835
• 负责人: Phenesse Dunlap
• 金额: $ 5.01万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10354835
• 关键词: Activities of Daily Living; Adherence; Adoption; Adult; Aging; Ancillary Study; Anxiety; Attitude; Award; Blood Pressure; COVID-19; COVID-19 pandemic; Cardiac; Cardiac rehabilitation; Cardiovascular Diseases; Cause of Death; Cessation of life; Characteristics; Cognitive; Complex; Data; Decision Making; Economics; Elderly; Electronics; Enhancement Technology; Enrollment; Evaluation; Event; Failure; Frustration; General Population; Geography; Goals; Habits; Health; Healthcare Systems; Heart; Heart Diseases; Home; Hospitals; Individual; Internet; Intervention; Lead; Learning; Light; Methods; Modeling; Modification; Monitor; Morbidity - disease rate; National Institute on Aging; Outcome; Parents; Pathway interactions; Patients; Physiological; Pilot Projects; Plant Roots; Policies; Prevention program; Prevention strategy; Process; Provider; Recurrence; Reduce health disparities; Rehabilitation Centers; Research; Research Methodology; Research Personnel; Risk; Safety; Secondary Prevention; Shapes; Social support; Source; Supplementation; Technology; Time; Transportation; Veterans; Veterans Health Administration; Visit; Vulnerable Populations; Work; base; behavior change; cardiovascular disorder prevention; cardiovascular disorder risk; catalyst; design; digital; fitness; health disparity; human old age (65+); improved; improved outcome; interest; mHealth; military veteran; mobile computing; new technology; pandemic coronavirus; patient population; pragmatic trial; preventive intervention; programs; psychologic; rehabilitation strategy; rural setting; secondary analysis; social; success; theories; uptake; usability

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of death and a substantial source of morbidity for adults ≥ 65 years old. Cardiac rehabilitation (CR) is a secondary prevention strategy proven to reduce death and recurrent CVD events, as well as improve physiological and psychological functioning. Veterans constitute a unique patient population with complex, elevated CVD risk profiles that could significantly benefit from CR. Frequently cited barriers for veteran participation in traditional, center-based CR programs are rooted in social and economic drivers of health disparities, such as geographic distance to CR centers, transportation limitations, and patient priorization. Technology-enhanced CR (TECR), an adapted home-based CR program with technological supplements (e.g., video-enabled visits, remote heart monitoring, fitness trackers) has been promoted as a potential solution. TECR has seen early success with engaging VA patients but presents new challenges for older adults. However, aging-related challenges that must be considered include physical and cognitive limitations, reduced programmatic social support for behavior change, and anxiety and frustration with learning and operating new technologies. Evaluations of TECR interventions among older veterans is limited, and COVID-19 operational restrictions and safety protections underscore the urgency for understanding alternative CR strategies for vulnerable populations. This project will build on an existing pragmatic trial evaluating CR in a veteran population and employ a mixed-methods sequential design to examine intersectional determinants of TECR participation. Using a multi-ecological, theory-driven framework, the project seeks to achieve three aims. The first aim will identify contextual, interpersonal, and individual-level predictors of enrollment for older veterans in a TECR program using secondary data from the parent study. Similarly, the second aim involves a secondary analysis to identify multilevel correlates of active engagement among veterans who enroll in TECR. Building on the results of the first two aims, a two-stage qualitative study will be conducted to a) examine TECR perceived ease of use, perceived usefulness, and attitudes towards TECR among eligible veterans who select or decline TECR enrollment; and b) examine barriers and facilitators of engagement for older adults enrolled in TECR. The proposed research is timely and directly aligns with the strategic directions for the National Institute on Aging. By using a theory-based framework to evaluate TECR participation, this study will identify strengths and opportunities for increasing enrollment and adherence to an effective CVD behavior change intervention. Understanding how these factors work mechanistically is crucial for increasing CR uptake and reducing health disparities for older veterans.

项目概要/摘要 心血管疾病（CVD）是导致死亡的主要原因，也是导致患者发病的重要原因 ≥ 65 岁的成年人 心脏康复 (CR) 是一种被证明可以减少死亡的二级预防策略。 和复发性心血管疾病事件，以及改善退伍军人的生理和心理功能。 具有复杂且升高的 CVD 风险状况的独特患者群体可以从 CR 中显着受益。 退伍军人参与传统的、以中心为基础的 CR 计划经常被提及的障碍根源于社会因素 以及健康差异的经济驱动因素，例如距 CR 中心的地理距离、交通 限制和患者优先顺序（TECR），一种适应的基于家庭的 CR 计划。 通过技术补充（例如，视频访问、远程心脏监测、健身追踪器） 作为一种潜在的解决方案，TECR 在吸引 VA 患者方面取得了早期成功，但也带来了新的成果。 然而，必须考虑的与衰老相关的挑战包括身体和健康方面的挑战。 认知限制、对行为改变的程序性社会支持减少以及焦虑和沮丧 对老年退伍军人学习和操作新技术进行评估。 有限，并且 COVID-19 的运营限制和安全保护措施凸显了采取紧急行动的紧迫性 了解针对弱势群体的替代 CR 策略 该项目将建立在现有的基础上。 评估退伍军人群体 CR 的实用试验，并采用混合方法序贯设计 使用多生态、理论驱动的框架检查 TECR 参与的交叉决定因素， 该项目力求实现三个目标，第一个目标是确定背景、人际和个人层面。 使用母研究的二手数据预测老年退伍军人参加 TECR 计划的情况。 同样，第二个目标涉及二次分析，以确定积极参与的多层次关联 在前两个目标的基础上，对参加 TECR 的退伍军人进行了一项两阶段的定性研究。 将进行 a) 检查 TECR 感知的易用性、感知的有用性以及对 TECR 的态度 对选择或拒绝参加 TECR 的合格退伍军人进行 TECR；b) 检查障碍和促进因素； 拟议的研究是及时的，并且与 TECR 直接相关。 国家老龄化研究所的战略方向 通过使用基于理论的框架来评估 TECR。 参与，这项研究将确定增加入学率和遵守 有效的 CVD 行为改变干预至关重要。 提高老年退伍军人的 CR 吸收率并减少健康差距。