Trust-building and personalized life changes among digital cardiac rehabilitation process

Abstract

The purpose of the present dissertation project was to create a conceptual model for the process of digital cardiac rehabilitation (CR) by using the Glaserian grounded theory approach (GT). The project explored technology experience, attitudes, and behavior by creating different groups (Study I) and deepening the understanding of the groups’ profiles by comparing them to aspects of biomedical, psychosocial, and environmental lifestyle risk, and health behavior (Study II) as well as the different meanings attached to the rehabilitation process of patients with coronary heart disease (CHD) (Study III). The analyses were based on 39 patients with CHD who attended CR in 2015–2017. The intervention lasted for 12 months and included three 5-day periods of traditional rehabilitation. Between the rehabilitation periods, the intervention provided patients with web-based coaching via a remote connection and daily physical activity monitoring. The data consisted of focus group interviews, and questionnaires, physical tests and measurements. The data were analyzed using GT, which included open, selective, and theoretical coding. Analysis of variance, Tukey’s honestly significant differences test, Student’s t-test, the Mann-Whitney U-test, and the Kruskal-Wallis test were used to analyze the data. The study showed the diverse behaviors of patients as technology users and how cardiac patients reflected various lifestyle risk behaviors during the rehabilitation process. Trust-building was part of the life change process and involved interactions between emotion, cognition, acceptance, and support processes. The processes go on forward to the identification of new meaning of life towards trust and hope in life. During rehabilitation process personalized encounters will enhance the patient’s trust and promote life change. The result of the project was creating a model for the trust-building process enabling personalized life changes. These results provide a new kind of theoretical perspective to tailor actions that promote and support behavioral and life changes. The CR program featured various personalized trust-building methods that are valuable tools for life change management, which seeks self-awareness of thoughts and emotions. This study’s findings can help clinicians develop tailored digital health solutions for patients in CR.