A web-based tailored nursing intervention to support illness management in patients hospitalized for an acute coronary syndrome : a pilot study
Article [Version of Record]
Abstract(s)
Background: Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, to foster
participation in a cardiac rehabilitation (CR) program, and to optimize recovery. Web-based tailored interventions have the
potential to provide individualized information and counseling to optimize patient’s illness management after hospital discharge.
Objective: We aimed to assess the feasibility and acceptability of a Web-based tailored intervention (TAVIE@COEUR) designed
to improve illness management in patients hospitalized for an ACS. Illness management outcomes were operationalized by
self-care, medication adherence, anxiety management, cardiac risk factors reduction, and enrollment in a CR program.
Methods: This posttest pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary
care unit of a tertiary cardiology center. TAVIE@COEUR comprises three Web-based sessions, with a duration ranging from 10
to 45 min and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to
patients’ responses to questions. TAVIE@COEUR includes 90 pages, 85 videos, and 47 PDF documents divided across session
1 (S1), session 2 (S2), and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking
(S1), emotional control and problem-solving skills (S2), and social skills and interacting with health professionals (S3). Throughout
the videos, a virtual nurse (providing the intervention virtually) guides the participants in the acquisition of self-care skills. Patients
completed S1 of TAVIE@COEUR before hospital discharge and were asked to complete S2 and S3 within 2 weeks after discharge.
Feasibility indicators were extracted from the TAVIE@COEUR system. Data regarding acceptability (satisfaction and appreciation
of the platform) and preliminary effect (self-care, medication adherence, anxiety management, risk factor reduction, and CR
enrollment) were assessed through questionnaires at 1 month following discharge. Preliminary effect was assessed by comparing
baseline and 1-month illness management variables.
Results: Of the 30 participants, 20 completed S1, 10 completed S2, and 5 completed S3. Good acceptability scores were observed
for ease of navigation (mean=3.58, standard deviation [SD]=0.70; scale=0-4), ease of understanding (mean=3.46, SD=0.63;
scale=0-4), and applicability (mean=3.55, SD=0.74; scale=0-4). The lowest acceptability scores were observed for information tailoring (mean=2.93, SD=0.68; scale=0-4) and individual relevance (mean=2.56, SD=0.96; scale=0-4). With regard to preliminary
effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at 1 month=54.07,
SD=3.99 vs mean at baseline=49.09, SD=6.92; scale-0-60).
Conclusions: Although participants reported general satisfaction and appreciation of TAVIE@COEUR, acceptability and
feasibility results show the need for further development of the Web-based intervention to enhance its tailoring before undertaking
a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to
patients’ knowledge, needs, interests, individual capabilities, and emotional and cognitive responses during session completion.