Self-Management Support Program for Patients With Cardiovascular Diseases: User-Centered Development of the Tailored, Web-Based Program Vascular View.
BACKGROUND
In addition to medical intervention and counseling, patients with cardiovascular disease (CVD) need to manage their disease and its consequences by themselves in daily life.


OBJECTIVE
The aim of this paper is to describe the development of "Vascular View," a comprehensive, multi-component, tailored, Web-based, self-management support program for patients with CVD, and how this program will be tested in an early randomized controlled trial (RCT).


METHODS
The Vascular View program was systematically developed in collaboration with an expert group of 6 patients, and separately with a group of 6 health professionals (medical, nursing, and allied health care professionals), according to the following steps of the intervention mapping (IM) framework: (1) conducting a needs assessment; (2) creating matrices of change objectives; (3) selecting theory-based intervention methods and practical applications; (4) organizing methods and applications into an intervention program; (5) planning the adaption, implementation, and sustainability of the program, and (6) generating an evaluation plan.


RESULTS
The needs assessment (Step 1) identified 9 general health problems and 8 determinants (knowledge, awareness, attitude, self-efficacy, subjective norm, intention, risk perception, and habits) of self-managing CVD. By defining performance and change objectives (Step 2), 6 topics were distinguished and incorporated into the courses included in Vascular View (Steps 3 and 4): (1) Coping With CVD and its Consequences; (2) Setting Boundaries in Daily Life; (3) Lifestyle (general and tobacco and harmful alcohol use); (4) Healthy Nutrition; (5) Being Physically Active in a Healthy Way; and (6) Interaction With Health Professionals. These courses were based on behavioral change techniques (BCTs) (eg, self-monitoring of behavior, modeling, re-evaluation of outcomes), which were incorporated in the courses through general written information: quotes from and videos of patients with CVD as role models and personalized feedback, diaries, and exercises. The adoption and implementation plan (Step 5) was set up in collaboration with the members of the two expert groups and consisted of a written and digital instruction manual, a flyer, bimonthly newsletters, and reminders by email and telephone to (re-)visit the program. The potential effectiveness of Vascular View will be evaluated (Step 6) in an early RCT to gain insight into relevant outcome variables and related effect sizes, and a process evaluation to identify intervention fidelity, potential working mechanisms, user statistics, and/or satisfaction.


CONCLUSIONS
A comprehensive, multi-component, tailored, Web-based, self-management support program and an early RCT were developed in order to empower patients to self-manage their CVD.


BACKGROUND
Nederlands Trial Register NTR5412; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5412 (Archived by WebCite at http://www.webcitation.org/6jeUFVj40).
Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, Netherlands.
Saskia
http://orcid.org/0000-0001-6268-0986
S
Puijk-Hekman
Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, Netherlands.|Institute of Nursing, HAN University of Applied Sciences, Nijmegen, Netherlands.
Betsie Gi
http://orcid.org/0000-0001-8884-6235
BG
van Gaal
Radboud university medical center, Department of General Internal Medicine, Nijmegen, Netherlands.
Sebastian Jh
http://orcid.org/0000-0002-6973-7540
SJ
Bredie
Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, Netherlands.
Maria Wg
http://orcid.org/0000-0003-2637-6877
MW
Nijhuis-van der Sanden
Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.|NIVEL (Netherlands institute for health services research), Utrecht, Netherlands.|Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway.
Sandra
http://orcid.org/0000-0002-1651-7544
S
van Dulmen
cardiovascular diseases; chronic secondary care; eHealth; early RCT; intervention mapping; nursing care; outpatients; self-management; tailoring