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.

项目摘要/摘要 心血管疾病（CVD）是死亡的主要原因，也是大量的发病率来源 成人≥65岁。心脏康复（CR）是一种被证明减少死亡的次要预防策略 以及复发性的CVD事件，以及改善的身体和心理功能。退伍军人组成 一个独特的患者人群具有复杂，CVD升高的风险特征，可能会从CR中受益匪浅。 经常引用退伍军人参与传统的中心CR计划的障碍植根于社会 以及健康分布的经济驱动因素，例如到CR中心的地理距离，运输 局限性和患者优先。技术增强CR（TECR），一个改编的家庭CR计划 具有技术补充剂（例如，启用视频访问，远程心脏监控，健身追踪器）已有 作为潜在解决方案促进。 TECR在吸引VA患者方面已经获得了早期的成功，但展示了新的 老年人面临的挑战。但是，必须考虑的与衰老有关的挑战包括身体和 认知局限性，减少对行为改变的社会支持以及动画和挫败感 通过学习和运营新技术。老年退伍军人中TECR干预措施的评估是 限量，COVID-19的运营限制和安全保护强调了紧迫的紧迫性 了解弱势群体的替代策略。这个项目将建立在现有的 务实的试验评估退伍军人人口中的CR和员工的混合方法序列设计 检查TECR参与的交叉决定者。使用多生态，理论驱动的框架， 该项目旨在实现三个目标。第一个目标将确定上下文，人际关系和个人级别 使用父母研究的二级数据，在TECR计划中，老年退伍军人入学的预测因素。 同样，第二个目的涉及二级分析以识别主动参与的多级相关性 在参加TECR的退伍军人中。基于前两个目标的结果，这是一项两阶段的定性研究 将进行a）检查TECR可感知的易用性，感知的有用性并参加 选择或拒绝TECR入学的合格退伍军人中的TECR； b）考试障碍和促进者 参加TECR的老年人的参与度。拟议的研究是及时的，直接与 国家老化研究所的战略方向。通过使用基于理论的框架评估TECR 参与，这项研究将确定增加入学率和遵守的优势和机会 有效的CVD行为改变干预。了解这些因素如何机械起作用至关重要 为了增加CR的吸收并减少了老年退伍军人的健康差异。