Feasibility and Acceptability of a Values-Based Telehealth Intervention to Promote Adherence in Cardiopulmonary Rehabilitation Patients
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Date
2023-12-07
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Authors
Midgette, Emily P
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Publisher
East Carolina University
Abstract
Background: Current research indicates an ongoing need to identify interventions to promote Cardiopulmonary Rehabilitation (CVPR) participation, as participation in CVPR remains low despite positive effects on health outcomes. Values-based interventions, such as Behavioral Activation and Acceptance & Commitment Therapy (ACT), have been shown to be effective for improving the quality of life of patients with a variety of chronic illnesses including cardiovascular disease. We hypothesized that a values-based intervention may be helpful to promote CVPR participation through reduced avoidance and exploration of intrinsically motivating factors that improve patients’ willingness to engage in potentially unpleasant activities (e.g., physical activity) that are important for managing their diagnoses. The COVID-19 pandemic also provided the opportunity for more widespread implementation of telehealth interventions to increase access to psychosocial support, especially for marginalized patient populations who experience a high number of attendance barriers.
Purpose: The purpose of this study was to assess the feasibility and acceptability of a novel telehealth intervention that is informed by ACT principles and focused on improving adherence to CVPR.
Methods: Participants in this single-armed study could choose to participate in a 5-session ACT-informed telehealth intervention via live virtual meetings (at home) or self-guided pre-recorded videos (at home or onsite) featuring the same content. Feasibility was assessed by the number of participants enrolled (goal of 50), sessions attended, Ecological Momentary Assessment (EMA) response rates (measuring mood, experiential avoidance, values congruence), and rates of post-completion assessment. Acceptability was assessed through a qualitative interview following the five-week intervention period.
Results: Feasibility of the study was hindered by low participation. Forty-four participants were consented and 21 did post-completion questionnaires. Only 8 participants attended > of the 5 live sessions. Twenty participants requested pre-recorded videos, and though exact numbers of views could not be determined due to our distribution method, only 6 reported watching > 1 videos. Participants often reported difficulty with the virtual meetings and EMA technology, despite staff demonstrating its use and a prior study’s success with the same EMA program. Also, participants anecdotally reported exhaustion with virtual meetings across multiple settings. Fourteen participants dropped out of the study due to illness/hospitalization or time conflicts. Five participants completed the qualitative follow-up interview. Qualitative responses generally indicated a high acceptability of the intervention, though this small group included mostly those with high engagement; those who dropped out may feel differently.
Discussion: Overall, our results indicate that major changes are needed to increase feasibility and better measure acceptability of this intervention. Participants provided helpful feedback regarding their preferences, challenges encountered, and suggestions for improvement that will be helpful for future repetitions of this research. The results especially highlight the potential benefits of developing a self-guided version that is modified to improve accessibility to the technology required to participate in the intervention.