A RE-AIM analysis of a co-designed interactive web-based cardiac rehabilitation programme for rural and remote populations: a descriptive observational prospective implementation study

Introduction Involvement in cardiac rehabilitation programmes reduces death and reoccurring cardiac events, but cardiac rehabilitation attendance is suboptimal globally. The aim of the present project was to evaluate the effectiveness of a co-designed, interactive, web-based cardiac rehabilitation programme as an alternative mode of delivery, as a means of improving access and attendance. Methods This study reports on the outcomes from the implementation process evaluation using a descriptive observational prospective study design, guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Results A total of 828 rural patients were enrolled in cardiac rehabilitation, with 50 choosing the web-based cardiac rehabilitation programme. The web-based cohort's mean age was 60 years (SD ± 11.9) and included 17 (34%) men and 33 (66%) women. The rate of programme completion was higher for usual care than for the web-based cohort (17, 34% vs 553, 71.4%, p=<0.001). The web-based cohort reported a positive overall experience (77.8%). Clinicians reported the web-based programme to be high-quality (71.4%). The fidelity of entry of self-reported data for the web-based cohort was high, with all patients completing a pre-assessment. Web-based programme enrolment was associated with a lower chance of cardiac rehabilitation completion (odds ratio 0.19; 95% confidence interval: 0.10, 0.37; P<0.001) after adjusting for age and gender. Conclusions The web-based programme provides an alternative and more flexible mode of cardiac rehabilitation. It has been integrated and successfully used by patients and clinicians, capturing a cohort that may be unable to attend an in-person cardiac rehabilitation programme. Strategies for improving the rate of completion of web-based programmes need further investigation.