title: Implementation of a consumer-focused eHealth intervention for people with moderate-to-high cardiovascular disease risk: protocol for a mixed-methods process evaluation.
abstract: Technology-mediated strategies have potential to engage patients in modifying unhealthy behaviour and improving medication adherence to reduce morbidity and mortality from cardiovascular disease (CVD). Furthermore, electronic tools offer a medium by which consumers can more actively navigate personal healthcare information. Understanding how, why and among whom such strategies have an effect can help determine the requirements for implementing them at a scale. This paper aims to detail a process evaluation that will (1) assess implementation fidelity of a multicomponent eHealth intervention; (2) determine its effective features; (3) explore contextual factors influencing and maintaining user engagement; and (4) describe barriers, facilitators, preferences and acceptability of such interventions.
  
  
  
  Mixed-methods sequential design to derive, examine, triangulate and report data from multiple sources. Quantitative data from 3 sources will help to inform both sampling and content framework for the qualitative data collection: (1) surveys of patients and general practitioners (GPs); (2) software analytics; (3) programme delivery records. Qualitative data from interviews with patients and GPs, focus groups with patients and field notes taken by intervention delivery staff will be thematically analysed. Concurrent interview data collection and analysis will enable a thematic framework to evolve inductively and inform theory building, consistent with a realistic evaluation perspective. Eligible patients are those at moderate-to-high CVD risk who were randomised to the intervention arm of a randomised controlled trial of an eHealth intervention and are contactable at completion of the follow-up period; eligible GPs are the primary healthcare providers of these patients.
  
  
  
  Ethics approval has been received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council (AH&MRC) of New South Wales. Results will be disseminated via scientific forums including peer-reviewed publications and national and international conferences.
  
  
  
  ANZCTR 12613000715774.
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Genevieve M
authors.initials: GM
authors.lastname: Coorey
authors.affiliation: School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.|Sydney Nursing School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.|Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Flinders University, Adelaide, Australia.
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Peiris
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Parker
authors.affiliation: Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Annie Y S
authors.initials: AY
authors.lastname: Lau
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Clara
authors.initials: C
authors.lastname: Chow
authors.affiliation: Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Panaretto
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Mark
authors.identifier: 0000-0002-0705-8913
authors.initials: M
authors.lastname: Harris
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zwar
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D054626:Consumer Health Information; D057286:Electronic Health Records; D006266:Health Education; D006293:Health Promotion; D006801:Humans; D009517:New South Wales / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012107:Research Design; D040242:Risk Reduction Behavior; D017216:Telemedicine
keywords: PRIMARY CARE; PUBLIC HEALTH