title: Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management-Related Outcomes: A Systematic Review.
abstract: BACKGROUND
  Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access.
  
  
  OBJECTIVE
  The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness.
  
  
  METHODS
  Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase).
  
  
  RESULTS
  Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used.
  
  
  CONCLUSIONS
  More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.
authors.affiliation: Jorge Palacios, MD, MSc PhD Student, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Geraldine A. Lee, PhD Senior Lecturer, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Maria Duaso, PhD Lecturer, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Abigail Clifton, BSc Research Assistant, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Ian J. Norman, PhD Executive Dean, Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK. Derek Richards, PhD Director of Clinical Research and Innovation, Silvercloud Health, and School of Psychology, Trinity College Dublin, Ireland. Elizabeth Alexandra Barley, PhD, CPsychol Professor in Health and Wellbeing, College of Nursing, Midwifery and Healthcare, University of West London, UK.
authors.forename: Jorge
authors.initials: J
authors.lastname: Palacios
authors.forename: Geraldine A
authors.initials: GA
authors.lastname: Lee
authors.forename: Maria
authors.initials: M
authors.lastname: Duaso
authors.forename: Abigail
authors.initials: A
authors.lastname: Clifton
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Norman
authors.forename: Derek
authors.initials: D
authors.lastname: Richards
authors.forename: Elizabeth Alexandra
authors.initials: EA
authors.lastname: Barley
mesh_terms: D003327:Coronary Disease / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology; D000073278:Self-Management / Q000706:statistics & numerical data*