Acceptability and appropriateness of app-based follow-up post-cardiac rehabilitation: a qualitative study

Abstract Background The beneficial effects of cardiac rehabilitation (CR) are well demonstrated, and it is a crucial part of the treatment of patients with cardiac diseases. Unfortunately, adherence to healthy behaviour initiated or adapted in CR is challenging for most of the patients. The use of mHealth interventions has proven to be effective to improve adherence to healthy behaviour post-CR. Desipte increasing evidence supporting mHealth interventions for post-CR adherence and health authorities´ requirement for digital follow-up, no studies have evaluated healthcare providers and managers´ perceived acceptability and suitability of implementing mHealth in clinical practice. Therefore, the purpose of this study was to explore the acceptability and appropriateness as perceived by healthcare providers and managers working in CR. Methods A qualitative study with focus group interviews was conducted from March 2023 to September 2023. Participants were recruited from different CR institutions across Norway and included healthcare professions working in CR and managers. Two thematic interview guides were used when conducting the interviews. The interviews were held digitally and were recorded and transcribed successively during the period in which the interviews were conducted. Transcripts were managed and systematized by hyperRESEARCH. We used a thematic analysis approach. Results In total, eight focus group interviews were conducted of which seven included healthcare providers from different CR institutions across Norway, and one included midlevel managers. The analysis resulted in four themes describing healthcare providers and midlevel managers perceived acceptability and appropriateness of an app-based interventions post-CR: (1) Expectations based on experience and attitudes; (2) Goalsetting; (3) Necessities for goal achievement; (4) App components to motivate and support. Healthcare providers and managers deemed an app-based intervention post-CR acceptable. Several appropriateness-related barriers were found, including a lack of aligned goals across and within healthcare service levels and a financial framework for CR that doesn't account for the continuously evolving society and evidence. Conclusions App-based post-CR follow-up is acceptable to healthcare providers and midlevel managers in Norwegian CR institutions. However, misaligned goals across healthcare service levels and inflexible financial frameworks present significant barriers. Further exploration of these barriers is necessary before implementing such an intervention.