The development of an internet-based outpatient cardiac rehabilitation intervention: a Delphi study

Background: Face-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. However, these programs have low participation rates, especially among patients who live rural or remote. Hence, there is a need to develop OCR programs that provide an alternative to face-to-face contact such as by using the Internet. Only a very limited number of Internet-based OCR programs have been developed and evaluated. Therefore, the purpose of this study was to identify issues that are relevant to the development of an Internet-based OCR intervention. Methods: A three-round Delphi study among cardiac rehabilitation experts was conducted. In the first round, 43 experts outlined opinions they had on the development of an online ORC platform into an open-ended electronic questionnaire. In the second round, 42 experts completed a structured (five-point scale) electronic questionnaire based on first round results, in which they scored items on their relevance. In the third round, the same experts were asked to re-rate the same items after feedback was given about the group median relevance score to establish a level of consensus. Results: After the third round, high consensus was reached in 120 of 162 (74%) questionnaire items, of which 93 (57% of 162 items) also had high relevance according to the experts. The results indicate that experts strongly agreed on desired website content, data obtained from the patient, and level of interaction with patients that should be part of an Internet-based OCR intervention. Conclusion: The high rates of consensus and relevance observed among cardiac rehabilitation experts are an indication that they perceived the development and implementation of an Internet-based ORC intervention as feasible, and as a valuable alternative to face-to-face programs. In many ways the experts indicated that an Internet based ORC program should mimic a traditional face-to-face program, and emphasize the crucial role of the cardiac rehabilitation manager who interacts with patients from a distance. The present study revealed practical insights into how Internet OCR interventions should be designed and opens the door for the development of such an intervention to be subsequently examined in a longitudinal and experimental study

Applying usability testing techniques to improve a health promotion website

Issue addressed: Use of the Internet for health promotion is increasing; however the lack of published research regarding website usability suggests that health promotion websites are being developed without formal evaluation and consultation of their users. The purpose of this study was to conduct usability testing of an existing health promotion website to inform modifications to improve the website, and to identify common usability themes that should be addressed by organisations developing or maintaining a health promotion website. Methods: A combination of qualitative and quantitative techniques were implemented during the usability testing sessions to gather data from users while completing tasks on the website. Techniques included performance measures (time taken), direct observation (participant observation) and subjective user preferences (questionnaire and interview). Results: Improvements to the website were measured in terms of reduced problems reported, reduced time taken to complete tasks and increased subjective reports. In addition, seven usability themes emerged from the data. These were identified as design, feedback, format, instructions, navigation, terminology and learnability. Conclusions: This study demonstrates the application of usability testing to the design and modification of a health promotion website and illustrates the areas, or themes that can be used as a framework for testing and modification

Every step counts: understanding the success of implementing the 10,000 Steps Project

The 10,000 Steps program originated from a landmark whole-of-community multi-strategy intervention to increase physical activity (PA) in Rockhampton, Australia in 2001-2003. It used a social ecological framework to promote physical activity at the individual, population, environmental and policy level. Two of the fundamental aspects of the original program were goal setting (10,000 steps per day) and self-monitoring (use of a pedometer for daily step counts). A project website (www.10000steps.org.au) allowed registered participants to record their physical activity. Over time the program morphed into an e- & mHealth intervention without face-to-face elements. The program is now delivered via website and smartphone apps and employs activity trackers (pedometers, Fitbit, Garmin). To date the project has signed-up over 425,000 members who have logged 221 billion steps (?43 million a day) on the website or app. More than 14,000 workplaces and community organisations have been involved with the program. A central element of the program, the 'Workplace Challenge' has been used by ?65% of 10,000 Steps members, which on average increases physical activity by 159 min/week for those who participate in it. In 2011, the Queensland Government designated the 10,000 Steps program as their key physical activity workplace health promotion strategy. Multiple factors underpin the success of the program. The message is simple and clear: the project name, with its distinctive logo and tagline ('Every Step Counts') provides a clear and prescriptive target for the physical activity 'dose'. Using effective behaviour change techniques: goal setting (the 10,000 Steps concept), self-monitoring (steps are tracked), social support (participants organise as 'teams' to reach certain step goals) and gamification (teams competing against each other creating 'friendly competition'). Ongoing redevelopment: since inception, there have been three complete redesigns of the website (including a branding redesign), and new smartphone apps. More recently, the website was modified to allow syncing of steps using popular activity trackers. Resources to support implementation: the program provides resources (e.g. 'Active Workplace Guide') and has dedicated staff to respond to queries from workplaces and individuals to help overcome implementation barriers. Project staff continuously promote the program via media interviews, attendance at events, social media and marketing, advertising, and networking and collaboration. Ongoing evaluation has contributed to continuous funding: to ensure the program remains successful in a fast-changing technology environment, continuous evaluation has been necessary. These evaluation strategies, the success of the original project and the strong partnership with the program funder (Queensland Health) have all contributed to the long-term (19 years) support for the project

Impact of COVID-19 on physical activity of 10,000 Steps members and engagement with the program in Australia: Prospective study

BACKGROUND: Background: Physical activity is an important health behavior due to its association with many physical and mental health conditions. During distressing events such as the COVID-19 pandemic, there is a concern that physical activity levels may be negatively impacted. However, recent studies have shown inconsistent results. Additionally, there is a lack of studies in Australia on this topic. OBJECTIVE: Objective: To investigate changes in physical activity reported through the 10,000 Steps program and changes in engagement with the program during the COVID-19 pandemic. METHODS: Methods: Data between 01/01/2018 and 30/06/2020 from registered members of the 10,000 Steps program, which included 3,548,825 days with steps data, were used. The number of daily steps was logged manually by the members or synced automatically from the activity trackers connected to the program. Measures on the program usage were the number of new registered members per day, the number of newly registered organisations per day, the number of steps logged per day, and the number of step entries per day. Key dates used for comparison were: first case with symptoms in Wuhan; first case in Australia reported; a 14-day ban for non-citizens arriving to Australia from China implemented; lockdown starts in Australia; and Australian Government starts relaxing restrictions. Wilcoxon signed-rank tests were used to test for significant differences in steps between subgroups, engagement measures in 2019 vs. 2020, and before and after an event. RESULTS: Results: A decrease in steps was observed after the first case in Australia (1.5%, p9,000 step entries/day with nearly 100 million steps/day logged; and >450 new users and >15 new organizations registering per day although the numbers decreased quickly when restrictions were relaxed. On average per day, there were about 55 new registered users (p<0.001) and two new organisations (p<0.001), 25.6 million steps (p<0.001), and 2672 log entries (p<0.001) more in 2020 compared to the same period in 2019. CONCLUSIONS: Conclusion: The pandemic has had negative effects on steps among Australians across age groups and gender. However, the effect was relatively small with steps recovering quickly after the lockdown. There was a large increase in the program usage during the pandemic that might help minimize the health impact of the lockdown and confirms the important role of physical activity programs during times of distress and lockdowns. CLINICALTRIAL

10,000 Steps Workplaces Evaluation

This report details the results of an evaluation of the 10,000 Steps programs and resources within workplaces. It examines the type of workplaces that utilise the program, how it has been used and the usefulness of the 10,000 Steps resources for promoting physical activity in the workplace. A web-based survey was conducted between April 7 and May 20, 2011 to determine the use and usefulness of the 10,000 Steps program and its resources in workplaces. A sample of 1,698 current 10,000 Steps Providers were invited to participate in the web-based survey. In total, 282 Providers responded with a partial or complete survey that was able to be analysed, resulting in a response rate of 16.6%

The development of an internet-based outpatient cardiac rehabilitation intervention : a Delphi study

Background: Face-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. However, these programs have low participation rates, especially among patients who live rural or remote. Hence, there is a need to develop OCR programs that provide an alternative to face-to-face contact such as by using the Internet. Only a very limited number of Internet-based OCR programs have been developed and evaluated. Therefore, the purpose of this study was to identify issues that are relevant to the development of an Internet-based OCR intervention. Methods: A three-round Delphi study among cardiac rehabilitation experts was conducted. In the first round, 43 experts outlined opinions they had on the development of an online ORC platform into an open-ended electronic questionnaire. In the second round, 42 experts completed a structured (five-point scale) electronic questionnaire based on first round results, in which they scored items on their relevance. In the third round, the same experts were asked to re-rate the same items after feedback was given about the group median relevance score to establish a level of consensus. Results: After the third round, high consensus was reached in 120 of 162 (74%) questionnaire items, of which 93 (57% of 162 items) also had high relevance according to the experts. The results indicate that experts strongly agreed on desired website content, data obtained from the patient, and level of interaction with patients that should be part of an Internet-based OCR intervention. Conclusion: The high rates of consensus and relevance observed among cardiac rehabilitation experts are an indication that they perceived the development and implementation of an Internet-based ORC intervention as feasible, and as a valuable alternative to face-to-face programs. In many ways the experts indicated that an Internet based ORC program should mimic a traditional face-to-face program, and emphasize the crucial role of the cardiac rehabilitation manager who interacts with patients from a distance. The present study revealed practical insights into how Internet OCR interventions should be designed and opens the door for the development of such an intervention to be subsequently examined in a longitudinal and experimental study

Dissemination of a community-based physical activity project : the case of 10,000 steps

This paper describes the use of a web-site for the dissemination of the community-based ‘10,000 steps’ program which was originally developed and evaluated in Rockhampton, Queensland in 2001–2003. The website provides information and interactive activities for individuals, and promotes resources and programs for health promotion professionals. The dissemination activity was assessed in terms of program adoption and implementation. In a 2-year period (May 2004–March 2006) more than 18,000 people registered as users of the web-site (logging more than 8.5 billion steps) and almost 100 workplaces and 13 communities implemented aspects of the 10,000 steps program. These data support the use of the internet as an effective means of disseminating ideas and resources beyond the geographical borders of the original project. Following this preliminary dissemination, there remains a need for the systematic study of different dissemination strategies, so that evidence-based physical activity programs can be translated into more widespread public health practice