Web-based Cardiac Rehabilitation: A Co-design Experience With Patients Living in Rural and Remote South Australia in the Country Heart Attack (CHAP) Prevention Project

Background: Cardiac rehabilitation (CR) significantly reduces death, reoccurring cardiac events, hospital admissions while improving quality of life. However, it is still poorly attended with participation rates worldwide between 20-50%, worsened for rural and remote patients by the tyranny of distance, work responsibilities and transportation. Web-based CR can provide an alternative, patient centred, flexible delivery option. Co-design with consumers and clinicians is recommended to tailor web-based CR to their needs and preferences as a means of increasing attendance.

Objective: The objective of this study is to describe how patient-generated data through workshops on desired content and features informs technology and implementation specifications for the patient portal of a CR website.
Methods
UX Design theoretical framework, using a co-design workshop, with thematic analysis, a survey, and the System Usability Scale to report outcomes.

Results: Based on the feedback from participants in rural and remote SA, desired content and features were updated for improving user experience. We recruited 27 participants across 4 regional Local health Networks in SA. The median age of participants was 71.0 (IQR 58-78), 14 (51.9%) were female, and 27 (100%) had completed a cardiac rehabilitation program. More than half used a smart phone (16; 59.3%) and Facebook (21; 77.8%). Overall usability remains low with a mean SUS score of 63.4 (SD 21.1).

Conclusions: The co-design process has contributed to the development of the CR website, improving desired content and features. Maximum useability can be achieved through further incorporating consumer feedback into the development of the CR website.