Perspectives of people hospitalized with acute coronary syndrome who decline digital health interventions targeting secondary prevention

BACKGROUND: Secondary prevention education needs are not well understood following admission to hospital with acute coronary syndrome (ACS). OBJECTIVES: To explore reasons for non-engagement and low uptake of an education app from the patient perspective, and identify barriers and solutions to engaging in education on secondary prevention during the hospital admission for people with ACS. METHODS: Semi-structured interviews were conducted in adults admitted to hospital with ACS and who declined to take part in a clinical trial examining the effectiveness of a digital health intervention on coronary heart disease (CHD) knowledge. Deidentified transcripts were coded independently by two researchers using both an inductive and deductive approach according to the candidacy framework. Purposive sampling was conducted regarding barriers to engaging in education on secondary prevention to further develop emerging categories. RESULTS: Fifteen participants (age 73 (IQR 63-77), 67% male, 53% ST-elevated myocardial infarction, 60% born in a non-English speaking country) were included. Reasons for low engagement and uptake of digital secondary prevention education included a lack of trust in digital health interventions and poor English literacy. Barriers to engagement were pre-existing personal stressors, especially for people with "poor" knowledge of CHD, spiritual or fatalistic perspectives of ACS, and "low" self-efficacy. Such barriers reduced participants' perceived need for secondary prevention education and negatively impacted their ability to navigate and use health services. CONCLUSIONS: Assessment of people with CHD's knowledge, life stressors, patient activation and spiritual or fatalistic beliefs may help inform the timing, format, content and amount of education delivered prior to discharge. PRACTICE IMPLICATIONS: Tailoring education to the individual's learning style and cultural background, support targeting caregivers, and improving the perceived usefulness of digital health apps may be potential solutions for improving the impact of education on secondary prevention for those who decline or are ineligible to use digital health interventions.