title: The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial.
abstract: BACKGROUND
  Coronary heart disease (CHD) is the most prevalent type of cardiac disease among adults worldwide, including those in Singapore. Most of its risk factors, such as smoking, physical inactivity and high blood pressure, are preventable. mHealth has improved in the last decade, showing promising results in chronic disease prevention and health promotion worldwide. Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention (SBCHDP) programme in improving awareness and knowledge of CHD, perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore.
  
  
  METHODS
  The smartphone app "Care4Heart" was developed as the main component of the programme. App content was reviewed and validated by a panel of experts, including two cardiologists and two experienced cardiology-trained nurses. A pilot randomised controlled trial was conducted. Eighty working people were recruited and randomised to either the intervention group (n = 40) or the control group (n = 40). The intervention group underwent a 4-week SBCHDP programme, whereas the control group were offered health promotion websites only. The participants' CHD knowledge, perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Questionnaire-2, Perceived Stress Scale, and Behavioural Risk Factor Surveillance System.
  
  
  RESULTS
  After the SBCHDP programme, participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore (X2= 6.486, p = 0.039), a better overall CHD knowledge level (t = 3.171, p = 0.002), and better behaviour concerning blood cholesterol control (X2= 4.54, p = 0.033) than participants in the control group.
  
  
  CONCLUSIONS
  This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population. Due to the small sample size and short follow-up period, this study was underpowered to detect significant differences between groups. A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Information Systems, Computing School, National University of Singapore, Singapore, Singapore.
authors.forename: Hoang D
authors.initials: HD
authors.lastname: Nguyen
authors.affiliation: Department of Information Systems, Computing School, National University of Singapore, Singapore, Singapore.
authors.forename: Danny Chiang Choon
authors.initials: DC
authors.lastname: Poo
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD 11, Level 2, 10 Medical Drive, Singapore, 117597, Singapore. nurww@nus.edu.sg.
authors.forename: Wenru
authors.identifier: http://orcid.org/0000-0002-0265-8215
authors.initials: W
authors.lastname: Wang
mesh_terms: D000328:Adult; D001364:Awareness; D003324:Coronary Artery Disease / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012846:Singapore; D000068997:Smartphone; D011795:Surveys and Questionnaires
keywords: Coronary heart disease; Health promotion; Primary prevention; Working population; mHealth