Health literacy interventions for secondary prevention of coronary artery disease : a scoping review

Deficits in health literacy are common in patients with coronary artery disease (CAD), and this is associated with increased morbidity and mortality. In this scoping review, we sought to identify health literacy interventions that aimed to improve outcomes in patients with CAD, using a contemporary conceptual model that captures multiple aspects of health literacy. We searched electronic databases for studies published since 2010. Eligible were studies of interventions supporting patients with CAD to find, understand and use health information via one of the following: building social support for health; empowering people with lower health literacy; improving interaction between patients and the health system; improving health literacy capacities of clinicians or facilitating access to health services. Studies were assessed for methodological quality, and findings were analysed through qualitative synthesis. In total, 21 studies were included. Of these, 10 studies aimed to build social support for health; 6 of these were effective, including those involving partners or peers. Five studies targeted interaction between patients and the health system; four of these reported improved outcomes, including through use of teach-back. One study addressed health literacy capacities of clinicians through communication training, and two facilitated access to health services via structured follow-up-all reporting positive outcomes. Health literacy is a prerequisite for CAD patients to self-manage their health. Through use of a conceptual framework to describe health literacy interventions, we identified mechanisms by which patients can be supported to improve health outcomes. Our findings warrant integration of these interventions into routine clinical practice. [Abstract copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

E-services or Re-serveices : A user-focused evaluation of the usability of municipal e-services

Introducerandet av e-samhället har medfört både stora samhällsmöjligheter och samhällsutmaningar på individ-, organisations- och samhällsnivå. Det är i dagsläget invävt i vår vardagliga tillvaro och har med tiden transformerat hela samhället. Medborgare ges internetbaserad tillgång till samhällsservice från myndigheter dygnet runt, samtidigt snabbas processerna upp, stora skattebesparingar skapas och miljövinster görs. Informationsteknik är en resurs som rätt utnyttjad underlättar för privatpersoner och företag, stödjer effektivitet, kvalitet och interaktion. Sverige ligger i framkant när det gäller att ta tillvara på digitaliseringens möjligheter, men omställningen ställer höga krav på samhället där ständig innovation är nödvändig för att ligga i framkant. Den accelererande digitala strukturomvandlingen ställer även ökade krav på den offentliga sektorn som måste rustas för att följa med i utvecklingen när traditionella sätt att arbeta utmanas och behov av att kunna använda befintliga resurser effektivare skapas.Studien syftar till att utforska hur ökat samarbete mellan kommun och medborgare kan vara en värdefull grund för vidare e-tjänstutveckling, där samverkan är grunden för ett fungerande e-samhälle. Genom att inkludera medborgarnas behov och synpunkter kring kommunens elektroniska tjänster kan detta tillvaratas och leda till adderade egenskaper inom e-tjänsten. Målet är att bidra till en ökad förståelse för medborgarinvolvering vid utveckling av elektroniska tjänster hos kommuner för att bättre motsvara medborgarnas behov.Genom enkätundersökning och intervjuer har Borgholms kommuns elektroniska tjänster genomgått en utvärdering som genererat underlag för betydelsen av att involvera användare i utvecklingsprocessen. Dagens upplevelse av de elektroniska tjänsterna är att de är simpla samt begränsande och skulle kunna gynnas av att utvecklas utifrån användarnas perspektiv för ökad användbarhet och användarnytta. Informanter uttrycker även upplevelsen av missnöje relaterat till återkoppling med hänvisning till handläggningstid och att alternativa tillvägagångssätt behövt användas för att slutföra uppgifter.Baserat på Borgholms kommuns problematik kring utveckling av elektroniska tjänster har därav en användarcentrerad vägledning framställts som grundas i att involvera medborgaren genom utvecklingen. Den användarcentrerade arbetsprocessen är tilltänkt att bidra med större förståelse för medborgaren och dess behov med en förhoppning om att kunna utveckla elektroniska tjänster som är mer användbara och bidrar till ökad användarnytta.The introduction of the e-society has led to both great societal opportunities and societal challenges at the individual, organizational and societal level. It is currently woven into our everyday lives and has over time transformed the whole of society. Citizens are given internet-based access to community services from authorities around the clock, at the same time speeding up processes, creating large tax savings and making environmental gains. Information technology is a resource that, when used properly, facilitates for individuals and companies, supports efficiency, quality and interaction. Sweden is at the forefront when it comes to taking advantage of the opportunities of digitalization, but the transition places high demands on society, where constant innovation is necessary to be at the forefront. The accelerating digital structural transformation also places increased demands on the public sector, which must prepare itself to keep up with developments when traditional ways of working are challenged and the need to be able to use existing resources more efficiently is created.The study aims to explore how increased collaboration between municipalities and citizens can be a valuable basis for further e-service development, where collaboration is the basis for a functioning e-society. By including the citizens' needs and views on the municipality's electronic services, this can in turn be utilized and lead to added properties within the e-service. The goal is to contribute to an increased understanding of citizen involvement in the development of electronic services in municipalities in order to better meet the needs of citizens.Through surveys and interviews, Borgholm Municipality's electronic services have undergone an evaluation that has generated a basis for the importance of involving users in the development process. Today's experience of the electronic services is that they are simple and limited and could benefit from being developed from the users' perspective for increased usability and usefulness. Informants also express the experience of dissatisfaction related to feedback with reference to processing time and that alternative approaches needed to be used to complete tasks.Based on Borgholm's municipality's problems regarding the development of electronic services, a user-centered guide has been produced which is based on involving the citizens through the development. The user-centered work process is intended to contribute to a greater understanding of the citizen and its needs with a hope of being able to develop electronic services that are more useful and contribute to increased user benefit

E-services or Re-serveices : A user-focused evaluation of the usability of municipal e-services

Introducerandet av e-samhället har medfört både stora samhällsmöjligheter och samhällsutmaningar på individ-, organisations- och samhällsnivå. Det är i dagsläget invävt i vår vardagliga tillvaro och har med tiden transformerat hela samhället. Medborgare ges internetbaserad tillgång till samhällsservice från myndigheter dygnet runt, samtidigt snabbas processerna upp, stora skattebesparingar skapas och miljövinster görs. Informationsteknik är en resurs som rätt utnyttjad underlättar för privatpersoner och företag, stödjer effektivitet, kvalitet och interaktion. Sverige ligger i framkant när det gäller att ta tillvara på digitaliseringens möjligheter, men omställningen ställer höga krav på samhället där ständig innovation är nödvändig för att ligga i framkant. Den accelererande digitala strukturomvandlingen ställer även ökade krav på den offentliga sektorn som måste rustas för att följa med i utvecklingen när traditionella sätt att arbeta utmanas och behov av att kunna använda befintliga resurser effektivare skapas.Studien syftar till att utforska hur ökat samarbete mellan kommun och medborgare kan vara en värdefull grund för vidare e-tjänstutveckling, där samverkan är grunden för ett fungerande e-samhälle. Genom att inkludera medborgarnas behov och synpunkter kring kommunens elektroniska tjänster kan detta tillvaratas och leda till adderade egenskaper inom e-tjänsten. Målet är att bidra till en ökad förståelse för medborgarinvolvering vid utveckling av elektroniska tjänster hos kommuner för att bättre motsvara medborgarnas behov.Genom enkätundersökning och intervjuer har Borgholms kommuns elektroniska tjänster genomgått en utvärdering som genererat underlag för betydelsen av att involvera användare i utvecklingsprocessen. Dagens upplevelse av de elektroniska tjänsterna är att de är simpla samt begränsande och skulle kunna gynnas av att utvecklas utifrån användarnas perspektiv för ökad användbarhet och användarnytta. Informanter uttrycker även upplevelsen av missnöje relaterat till återkoppling med hänvisning till handläggningstid och att alternativa tillvägagångssätt behövt användas för att slutföra uppgifter.Baserat på Borgholms kommuns problematik kring utveckling av elektroniska tjänster har därav en användarcentrerad vägledning framställts som grundas i att involvera medborgaren genom utvecklingen. Den användarcentrerade arbetsprocessen är tilltänkt att bidra med större förståelse för medborgaren och dess behov med en förhoppning om att kunna utveckla elektroniska tjänster som är mer användbara och bidrar till ökad användarnytta.The introduction of the e-society has led to both great societal opportunities and societal challenges at the individual, organizational and societal level. It is currently woven into our everyday lives and has over time transformed the whole of society. Citizens are given internet-based access to community services from authorities around the clock, at the same time speeding up processes, creating large tax savings and making environmental gains. Information technology is a resource that, when used properly, facilitates for individuals and companies, supports efficiency, quality and interaction. Sweden is at the forefront when it comes to taking advantage of the opportunities of digitalization, but the transition places high demands on society, where constant innovation is necessary to be at the forefront. The accelerating digital structural transformation also places increased demands on the public sector, which must prepare itself to keep up with developments when traditional ways of working are challenged and the need to be able to use existing resources more efficiently is created.The study aims to explore how increased collaboration between municipalities and citizens can be a valuable basis for further e-service development, where collaboration is the basis for a functioning e-society. By including the citizens' needs and views on the municipality's electronic services, this can in turn be utilized and lead to added properties within the e-service. The goal is to contribute to an increased understanding of citizen involvement in the development of electronic services in municipalities in order to better meet the needs of citizens.Through surveys and interviews, Borgholm Municipality's electronic services have undergone an evaluation that has generated a basis for the importance of involving users in the development process. Today's experience of the electronic services is that they are simple and limited and could benefit from being developed from the users' perspective for increased usability and usefulness. Informants also express the experience of dissatisfaction related to feedback with reference to processing time and that alternative approaches needed to be used to complete tasks.Based on Borgholm's municipality's problems regarding the development of electronic services, a user-centered guide has been produced which is based on involving the citizens through the development. The user-centered work process is intended to contribute to a greater understanding of the citizen and its needs with a hope of being able to develop electronic services that are more useful and contribute to increased user benefit

Determinants of Physical Activity in the Cardiac Population:Protocol for a Systematic Review

BACKGROUND: Lack of physical activity is a critical contributing risk factor to cardiovascular disease. Hence, regular physical activity is a mainstay in the primary and secondary prevention of cardiovascular disease. Despite the extensive promotion of physical activity in both primary and secondary prevention programs, including cardiac rehabilitation, physical activity levels in the cardiac population remain low. Therefore, it is crucial to understand critical determinants that influence physical activity behavior. OBJECTIVE: This study aims to deliver a systematic review of studies with collated observational data exploring the association between determinants and physical activity behavior in the target population. These new insights inform the design of future interventions targeted at lasting heart-healthy physical activity behavior in the cardiac population. METHODS: Primary studies with observational quantitative data on determinants and their association with physical activity behavior in the cardiac population will be included. Information on relevant primary studies will be retrieved from various databases, including Embase, CINAHL, MEDLINE, PsycInfo, and Web of Science Core Collection. Six reviewers will independently double-screen articles. Studies will be selected according to the prespecified inclusion and exclusion criteria. Data will be extracted and entered into suitable worksheets. The US-based National Heart, Lung, and Blood Institute's Study Quality Assessment Tool for Observational Studies will be used to assess the quality of all eligible primary studies. The results will be presented in a descriptive and narrative synthesis. If the type and quality of data are suitable, meta-analyses will be conducted. Study reporting will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS: Data collection started in September 2020, and the literature search was updated in July 2021. Data synthesis is ongoing, and the literature search will be updated in October 2022. CONCLUSIONS: This review will be valuable to relevant stakeholders, including clinicians and health care professionals, intervention developers, and decision makers in health care. It lays a comprehensive foundation for understanding the determinants of physical activity to inform the design of secondary prevention interventions relevant to the cardiac population. TRIAL REGISTRATION: PROSPERO CRD42020206637; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206637. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/39188

Translation to German and linguistic validation of the Rapid Assessment of Physical Activity (RAPA) questionnaire

Abstract Purpose To produce a culturally adapted translation of the Rapid Assessment of Physical Activity (RAPA) questionnaire for German speaking Austrians and to conduct a linguistic validation of the new language version. Methods The original English RAPA questionnaire was translated into German for Austria and underwent an independent forward and back translation, followed by cognitive debriefing interviews with older adults aged 55 to 78 years with and without health conditions (n = 13), for linguistic validation. Results Several distinct choices were made in the translation of the RAPA questionnaire to German, including the use of colloquial terms for ‘physical activity’ and ‘intensity’; and the decision to keep to the original examples and images of different physical activities for illustrating the intensity levels (light, moderate, vigorous) of physical activity. In cognitive debriefing, interviewees commented that some example activities for the respective intensity levels could – depending on the individual – also represent a higher or lower intensity level; and that the wording of RAPA items 4 and 5, which describe the category ‘under-active regular’ aerobic activity, was difficult to understand. Both issues were addressed and resolved through minor iterative modifications made during the cognitive debriefing process. Conclusions A new version of the RAPA questionnaire in German for Austria has been produced by forward and back translation and linguistic validation. The questionnaire may now undergo psychometric evaluation

Patient-Generated Health Data (PGHD) Interoperability:An Integrative Perspective

With advances in Digital Health (DH) tools, it has become much easier to collect, use, and share patient-generated health data (PGHD). This wealth of data could be efficiently used in monitoring and controlling chronic illnesses as well as predicting health outcome. Although integrating PGHD into clinical practice is currently in a promising stage, there are several technical challenges and usage barriers that hinder the full utilization of the PGHD potential in clinical care and research. This paper aims to address PGHD opportunities and challenges while developing the DH-Convener project to integrate PGHD into the Electronic Health Record in Austria (ELGA). Accordingly, it provides an integrative technical-clinical-user approach for developing a fully functional health ecosystem for exchanging integrated data among patients, healthcare providers, and researchers

Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria:A Mixed-Methods Study

OBJECTIVE: To assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown. DESIGN: Mixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown. SETTING: Outpatient CR centre in Salzburg, Austria. PARTICIPANTS: Twenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020. OUTCOME MEASURE(S): Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews. RESULTS: Exercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), p < 0.001; submaximal ergometer training 99 (40) vs. 97 (40), p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity. CONCLUSION: This study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward

Physical Activity in Cardiac Rehabilitation: Towards Citizen-Centered Digital Evidence-Based Interventions

Physical activity is a vital part of cardiac rehabilitation (CR). However, heart-healthy physical activity levels in people with cardiovascular disease drop significantly after CR. This exploratory study employs qualitative and survey methods within a co-creation approach. The aim is to understand the mechanisms of healthy behavior and habit formation in order to create a novel evidence-based (post-)rehabilitation approach that employs digital means to sustain long-term physical activity levels in people with cardiovascular disease

Research on Digital Technology Use in Cardiology:Bibliometric Analysis

BACKGROUND: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. OBJECTIVE: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. METHODS: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. RESULTS: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. CONCLUSIONS: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth