A B C digital heart manual: lessons learned

Abstract

The Heart Manual (HM) NHS Lothian, is the UK’s leading home-based cardiac rehabilitation programme evidenced by three RCTs. The HM clinical specialists provide training for health professionals (HPs) and support for sustained programme implementation across NHS and internationally. The team’s collaboration extends to other conditions, cancer, stroke and heart failure. The latest challenge was to steer the transition of the entire HM to a digital platform. This resource had to be fit for purpose within considerable constraints facing NHS ehealth. Challenges: There is disconnect between scope for digital developers, researchers and what can be implemented across the NHS. Ehealth strategies for NHS have not been fully achieved. WiFi in wards is not the norm, or if available may only be via NHS owned devices. Restrictions exist for social media (Facebook, Skype) and video streaming (Youtube). A health ‘digital divide’ exists perceivably between older and younger users. Regarding choice of format (digital or paper) there is discrepancy between HPs’ perceived preferences of patients and those articulated by the patients. Methods: Adopting an agile development approach the team worked closely with ehealth experts, patients and HPs to finalise a version taking account of known constraints and those identified via thematic analysis. Solutions The award winning resource can be used across the NHS. Its introduction does not rely on the presence of WiFi on wards. HPs are encouraged to offer choice and avoid ageist assumptions on patient preference. Conclusion A pragmatic approach led to users generating and implementing solutions to digital engagement barriers.