The Effectiveness of a Personalized Digital Health Intervention Plan (Naluri App) on Clinical and Psychological Outcomes Among Cardiac Patients at The National Heart Institute (IJN): A Randomized Controlled Trial
Background: Coronary Artery Disease (CAD) continues to be a significant burden in Malaysia that can lead to severe cardiac events and even death. Early interventions like cardiac rehabilitation programs can provide patients the necessary skills to recover from and prevent more cardiac events. EHealth interventions have great potential in complementing hospital based rehabilitation programs to improve the health of cardiac patients. Any behavior change interventions need to be guided by theories in order to obtain meaningful findings. This study aims to investigate the effectiveness of the Naluri app in improving clinical and psychological outcomes in a sample of cardiac patients in Malaysia.
Methods: A randomised controlled trial was conducted whereby patients in the treatment group (n=84) downloaded and used the Naluri app for four months after recruitment. The control group (n=91) received usual care that included lifestyle counselling. The Health Action Process Approach (HAPA) theory was used as the theoretical framework for the Naluri app and to investigate patients’ intention, planning and action in improving diet and physical activity. The clinical and psychological outcomes included BMI, HbA1c, lipid levels, anxiety, depression and health-related quality of life.
Results: The mixed methods analysis found that the Naluri app intervention was effective in increasing physical activity, specifically vigorous physical activity compared to the control group, F(1,173) = 8.47, p = .004, ηp2 = .047. The app was not effective in improving diet, clinical and psychological outcomes. The HAPA theory was a useful theoretical framework to explain patients' health behaviour change. Perceived facilitators and barriers to behaviour change include intra- and interpersonal factors. There was high acceptability of the app although attrition rate was high due to issues with instability and complexity of the app.
Conclusion: The Naluri app can be a useful tool in improving physical activity among CAD patients. However, further improvements on the app are required to maximize patient engagement.
First SupervisorDr. Karen Morgan
Second SupervisorProf. Anne Hickey
CommentsSubmitted for the Award of Doctor of Philosophy to RCSI University of Medicine and Health Sciences, 2022
Published CitationFadil Azim, DH,. The Effectiveness of a Personalized Digital Health Intervention Plan (Naluri App) on Clinical and Psychological Outcomes Among Cardiac Patients at The National Heart Institute (IJN): A Randomized Controlled Trial. [PhD Thesis] Dublin: RCSI University of Medicine and Health Sciences; 2022
Degree NameDoctor of Philosophy (PhD)
Date of award2022-11-30
- Doctor of Philosophy (PhD)
- Population Health and Health Services