Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study

Background Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers. Objective The primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses’ perceived brief MI skills and self-reported clinical use of brief MI. Methods We conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@CŒUR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@CŒUR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients’ motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session. Results We enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%–91%) completed both sessions in ≤20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0–7), perceived ease of use (mean 6.16, SD 0.78; scale 0–7), and system quality (mean 6.15, SD 0.58; scale 0–7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10–50). Other results were nonsignificant. Conclusions Brief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx)


1a-i) Identify the mode of delivery in the title
Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if ofoine products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms. 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1a-i? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Yes, "Nurses in Cardiovascular Care".
1b) ABSTRACT: Structured summary of trial design, methods, results, and conclusions NPT extension: Description of experimental treatment, comparator, care providers, centers, and blinding status.

1b-i) Key features/functionalities/components of the intervention and comparator in the METHODS section of the ABSTRACT
Mention key features/functionalities/components of the intervention and comparator in the abstract. If possible, also mention theories and principles used for designing the site. Keep in mind the needs of systematic reviewers and indexers by including important synonyms. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1b-i? * Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "MOTIV@COEUR is a web-based e-learning platform in brief MI consisting of two 30 minutes sessions covering 4 clinical situations based on role modeling videos of nurse-patient interactions. An introduction to brief MI is followed by role playing based on real life clinical situations during which a nurse practitioner evaluates patients' motivation to change, and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity and diet".

1b-ii) Level of human involvement in the METHODS section of the ABSTRACT
Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential

Does your paper address subitem 1b-ii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Nurses were asked to complete both training sessions online asynchronously within ≤ 20 days to assess the feasibility of the intervention".

1b-iii) Open vs. closed, web-based (self-assessment) vs. face-to-face assessments in the METHODS section of the ABSTRACT
Mention how participants were recruited (online vs. ofoine), e.g., from an open access website or from a clinic or a closed online user group (closed usergroup trial), and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment). Clearly say if outcomes were self-assessed through questionnaires (as common in web-based trials). Note: In traditional ofoine trials, an open trial (open-label trial) is a type of clinical trial in which both the researchers and participants know which treatment is being administered. To avoid confusion, use "blinded" or "unblinded" to indicated the level of blinding instead of "open", as "open" in web-based trials usually refers to "open access" (i.e. participants can self-enrol). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential

Does your paper address subitem 1b-iii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Participants were recruited during individual face-to-face encounters at the research setting". And, "Data on acceptability and preliminary effects (perceived skills in brief MI and self-reported clinical use of conviction and confidence interventions) were self-assessed through online questionnaires at 30 days (± 5 days) following the first session".

1b-iv) RESULTS section in abstract must contain use data
Report number of participants enrolled/assessed in each group, the use/uptake of the intervention (e.g., attrition/adherence metrics, use over time, number of logins etc.), in addition to primary/secondary outcomes.

2a-i) Problem and the type of system/solution
Describe the problem and the type of system/solution that is object of the study: intended as stand-alone intervention vs. incorporated in broader health care program? Intended for a particular patient population? Goals of the intervention, e.g., being more cost-effective to other interventions, replace or complement other solutions? (Note: Details about the intervention are provided in "Methods" under 5) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 2a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "According to clinical practice guidelines, the reduction of cardiovascular risk factors through health behavior change plays a critical role in treatment for coronary artery disease [2]." "Brief motivational interviewing (MI) is a patient-centered clinical approach designed to guide individuals through collaborative conversational style and solidify their motivation and commitment to health behavior change [7,11]." "While brief MI is promising, healthcare practitioners often lack time, basic training, or continuous education opportunities to update their knowledge and skills regarding increasing patients' motivation for change [18]." "Therefore, in this study, we developed and pilot tested a web-based elearning platform for brief MI that included videos in which nurses could observe brief MI in a real-life clinical context". Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes: "The primary objective of this pilot study was to develop and assess the feasibility and acceptability of a web-based e-learning platform for brief MI (MOTIV@COEUR) for cardiovascular nurses. The primary endpoint of the pilot study was the proportion of nurses who had completed both training sessions 20 days after the initiation of the training session.

2a-ii) Scienti/c background, rationale: What is known about the (type of) system
The secondary objective was to assess the preliminary effect of MOTIV@COEUR on nurses' perceived skill in, and self-reported clinical use of, brief MI".

METHODS
3a) Description of trial design (such as parallel, factorial) including allocation ratio Does your paper address CONSORT subitem 3a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "A single-group, pre-post pilot study involving cardiovascular nurses was conducted to assess MOTIV@COEUR".
3b) Important changes to methods after trial commencement (such as eligibility criteria), with reasons Does your paper address CONSORT subitem 3b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "No content or methodological modifications were made after study commencement".

3b-i) Bug /xes, Downtimes, Content Changes
Bug Uxes, Downtimes, Content Changes: ehealth systems are often dynamic systems. A description of changes to methods therefore also includes important changes made on the intervention or comparator during the trial (e.g., major bug Uxes or changes in the functionality or content) (5-iii) and other "unexpected events" that may have inouenced study design such as staff changes, system failures/downtimes, etc. [2].

Does your paper address subitem 3b-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "A pre-test of the intervention was conducted with 5 nurses who were not part of the sample of nurses included in the present study. Adjustments were made to MOTIV@COEUR content according to the nurses' comments prior to recruitment of the present study sample".

4a) Eligibility criteria for participants
Does your paper address CONSORT subitem 4a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "To be included in the study, nurses had to hold a temporary replacement or permanent position at the CCU and be at ease with basic computer use. The exclusion criteria was to have completed MI training in the preceding year". https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full

4a-i) Computer / Internet literacy
Computer / Internet literacy is often an implicit "de facto" eligibility criterion -this should be explicitly clariUed.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "To be included in the study, nurses had to hold a temporary replacement or permanent position at the CCU and be at ease with basic computer use".

4a-ii) Open vs. closed, web-based vs. face-to-face assessments:
Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. ofoine), e.g., from an open access website or from a clinic, and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasianonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email conUrmation, phone calls) were used to detect/prevent these.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Enrollment and follow up occurred between March and May 2016 (see Table 1). Nurses were recruited via individual face-to-face encounters at the CCU. After receiving an explanation regarding the study and providing written consent, participants completed a paper-based sociodemographic questionnaire".

4a-iii) Information giving during recruitment
Information given during recruitment. Specify how participants were briefed for recruitment and in the https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4a-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "An individual identification number, username, and password were then provided to participants, to allow them to log into the e-learning platform throughout the study. They also received a training information sheet that explained MOTIV@COEUR using screen captures and colorful textual content (see Multimedia Appendix 1)".
4b) Settings and locations where the data were collected Does your paper address CONSORT subitem 4b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Nurses were recruited via individual face-to-face encounters at the CCU. After receiving an explanation regarding the study and providing written consent, participants completed a paper-based sociodemographic questionnaire".
"Feasibility indicators collected by the research team included the proportion of nurses enrolled in the eligible population, recruitment duration, and completion of outcome measures. Feasibility indicators were also extracted from the Moodle platform".
"Secondary outcomes included the acceptability of MOTIV@COEUR according to cardiovascular nurses, the skills perceived in brief MI, and the self-reported clinical use of brief MI with coronary patients. These outcomes were self-assessed via online questionnaires".

4b-i) Report if outcomes were (self-)assessed through online questionnaires
Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4b-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Secondary outcomes included the acceptability of MOTIV@COEUR according to cardiovascular nurses, the skills perceived in brief MI, and the self-reported clinical use of brief MI with coronary patients. These outcomes were self-assessed via online questionnaires".

4b-ii) Report how institutional af/liations are displayed
Report how institutional afUliations are displayed to potential participants [on ehealth media], as afUliations with prestigious hospitals or universities may affect volunteer rates, use, and reactions with regards to an intervention.(Not a required item -describe only if this may bias results) 1 2 3 4 5 subitem not at all important essential

Does your paper address subitem 4b-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "The MOTIV@COEUR homepage (see Figure 1) was designed to create an appealing first impression using visual material and dynamic components. The homepage also highlighted institutional affiliations".

5)
The interventions for each group with sufUcient details to allow replication, including how and when they were actually administered

5-i) Mention names, credential, af/liations of the developers, sponsors, and owners
Mention names, credential, afUliations of the developers, sponsors, and owners [6] (if authors/evaluators are owners or developer of the software, this needs to be declared in a "Conoict of interest" section or mentioned elsewhere in the manuscript).
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, the names and logos of the consulting firm for the development of the web-based platform and affiliated research institutes were visible on the homepage. "The MOTIV@COEUR web-based platform was developed by an independent consulting firm in Montreal, Canada". "Conflicts of Interest MOTIV@COEUR is owned by the authors of this study".

5-ii) Describe the history/development process
Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results.

Does your paper address subitem 5-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "The MOTIV@COEUR web-based platform was developed by an independent consulting firm in Montreal, Canada. The firm was chosen because it designs interactive websites whose format is adaptive to computers, tablets, and smartphones. MOTIV@COEUR is based on the open-source learning platform, MoodleTM 3.0 (Modular Object-oriented Dynamic Learning Environment). The MOTIV@COEUR homepage (see Figure 1) was designed to create an appealing first impression using visual material and dynamic components". "A pre-test of the intervention was conducted with 5 nurses who were not part of the sample of nurses included in the present study. Adjustments were made to MOTIV@COEUR content according to the nurses' comments prior to recruitment of the present study sample".

5-iii) Revisions and updating
Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial. Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b).

Does your paper address subitem 5-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, there were no modifications during the study.

5-iv) Quality assurance methods
Provide information on quality assurance methods to ensure accuracy and quality of information provided [1], if applicable.

Does your paper address subitem 5-iv?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "The content of the brief MI on the web-based e-learning platform was developed by the project team, which included 3 MI experts and an experienced cardiology researcher who supervised the development of the intervention led by GF".

5-v) Ensure replicability by publishing the source code, and/or providing screenshots/screencapture video, and/or providing ]owcharts of the algorithms used
Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing oowcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scientiUc reporting.

Does your paper address subitem 5-v?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Selected screenshots are included in the manuscript as a Multimedia appendix.

5-vi) Digital preservation
Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login.

Does your paper address subitem 5-vi?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "MOTIV@COEUR could be accessed at a fixed URL. The availability of the website was restricted to the study period".
A complete set of screenshots can be obtained from the first author (GF).

5-vii) Access
Access: Describe how participants accessed the application, in what setting/context, if they had to pay (or were paid) or not, whether they had to be a member of speciUc group. If known, describe how participants obtained "access to the platform and Internet" [1]. To ensure access for editors/reviewers/readers, consider to provide a "backdoor" login account or demo mode for reviewers/readers to explore the application (also important for archiving purposes, see vi).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-vii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Yes, "Participants could log into the e-learning platform from home or work via the device of their choice using their personal login credentials provided during the face-to-face encounter at the CCU. We suggested that participants change their passwords after the initial login. Passwords could also be reset via their personal email accounts if forgotten". subitem not at all important essential Does your paper address subitem 5-viii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study retained in response to the patient's motivation profile.

5-viii) Mode of delivery, features/functionalities/components of the intervention and comparator, and the theoretical framework
The content of brief MI for the 4 scenarios was based on the model developed by Bédard [40], who adapted the work of Miller and Rollnick [11]. In this model, conviction represents the extent to which each individual perceives practical and emotional benefits as likely to change. Confidence represents the extent to which the individual is confident of being able to achieve change [40]. After assessing the patient's motivation, the practitioner provides tailored brief MI to increase conviction and confidence regarding health behavior change. Through videotaped role modeling, nurses could observe the CNP involving brief MI in a real-life clinical context. Videos were recorded at the research setting in a real patient room, to represent the real-life context (see Multimedia Appendix 2 for screenshots). Four volunteers (2 men and 2 women) represented different ages; 3 were Caucasian and 1 was Italian, as this reflects the prevalent community in the area in which the study hospital is located.
MOTIV@COEUR was conceptualized to ensure that participants would see real-life examples enabling them to: 1) familiarize themselves with the spirit of brief MI; 2) acquire basic skills in brief MI (e.g., open-ended questions, validation, and reformulation); 3) recognize and reinforce the change discourse, specifically conviction and confidence; 4) learn to create and strengthen the change discourse; 5) learn to accept resistance to avoid confrontation; 6) understand how to develop a plan; and 7) understand how to help patients to initiate change [11,42].

MOTIV@COEUR Structure
MOTIV@COEUR consists of 2 training sessions including 13 video modules (see Figure 3). The planned durations of the first session (S1) and second session (S2) were 30 and 20 min, respectively. Following an introduction and statement of objectives, each session was initiated with a video containing a theoretical introduction to brief MI. Each clinical case was then separated into 3 sections: 1) a textual presentation of the clinical case on the screen; 2) a video of brief MI, in which the CNP interacted with each patient; and 3) a video in which the CNP explained why each intervention was retained in response to the patient's motivation profile. Both sessions ended with a conclusion that reminded participants of the key concepts and provided them with tips for realworld use of brief MI".

5-ix) Describe use parameters
Describe use parameters (e.g., intended "doses" and optimal timing for use). Clarify what instructions or recommendations were given to the user, e.g., regarding timing, frequency, heaviness of use, if any, or was the intervention used ad libitum. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study computers at the study hospital, during a scheduled session in which a facilitator would explain the project and procedure for accessing MOTIV@COEUR to the group. Participants could also complete the training at home with remote support (e.g., email or telephone). They were also encouraged to practice brief MI techniques observed in the video in their regular clinical practice, if appropriate.
Nurses were asked to complete the second MOTIV@COEUR session either at home or at the hospital, 2 weeks subsequent to S1. There was no computer constraint limiting completion of S2 earlier or later than this. However, in the context of this study, participants had to complete both sessions within 1 month".

5-x) Clarify the level of human involvement
Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability).

Does your paper address subitem 5-x?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "The intervention was completely asynchronous and web-based. The research team was available at all times, to provide technical support in person or via mail or telephone. Apart from the technical support provided when necessary (access to the website, login, and password), no other intervention, such as that involving information and content explanation regarding the brief MI, was offered".

5-xi) Report any prompts/reminders used
Report any prompts/reminders used: Clarify if there were prompts (letters, emails, phone calls, SMS) to use the application, what triggered them, frequency etc. It may be necessary to distinguish between the level of prompts/reminders required for the trial, and the level of prompts/reminders for a routine application outside of a RCT setting (discuss under item 21 -generalizability). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "A maximum of 3 email or telephone reminders were planned at 3-day intervals for each of the 3 time points in the study (S1, S2, and outcome measures). A maximum of 9 emails or telephone reminders could be sent throughout the study period".

5-xii) Describe any co-interventions (incl. training/support)
Describe any co-interventions (incl. training/support): Clearly state any interventions that are provided in addition to the targeted eHealth intervention, as ehealth intervention may not be designed as stand-alone intervention. This includes training sessions and support [1]. It may be necessary to distinguish between the level of training required for the trial, and the level of training for a routine application outside of a RCT setting (discuss under item 21 -generalizability.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-xii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Apart from the technical support provided when necessary (access to the website, login, and password), no other intervention, such as that involving information and content explanation regarding the brief MI, was offered".
6a) Completely deUned pre-speciUed primary and secondary outcome measures, including how and when they were assessed Does your paper address CONSORT subitem 6a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study subitem not at all important essential

Copy and paste relevant sections from manuscript text
Limited, to our knowledge study measures were not specifically validated for online use.

6a-ii) Describe whether and how "use" (including intensity of use/dosage) was de/ned/measured/monitored
Describe whether and how "use" (including intensity of use/dosage) was deUned/measured/monitored (logins, logUle analysis, etc.). Use/adoption metrics are important process outcomes that should be reported in any ehealth trial.

Does your paper address subitem 6a-ii?
Copy and paste relevant sections from manuscript text engagement via the site or absence from the site. Since an inappropriately long latency period between the user's actions would overestimate the time spent on each session, we defined a maximum latency period. This period of latency was fixed at 15 minutes. When a latency period exceeded this threshold, it was deducted from the time spent on MOTIV@COEUR. Feasibility indicators extracted from the Moodle platform for each user included the duration of each session, the number of sessions completed, and the time elapsed between the completion of S1 and S2".

6a-iii) Describe whether, how, and when qualitative feedback from participants was obtained
Describe whether, how, and when qualitative feedback from participants was obtained (e.g., through emails, feedback forms, interviews, focus groups).

Does your paper address subitem 6a-iii?
Copy and paste relevant sections from manuscript text Yes, "Nurses could also provide suggestions and comments regarding MOTIV@COEUR at the end of the acceptability questionnaire". 6b) Any changes to trial outcomes after the trial commenced, with reasons Does your paper address CONSORT subitem 6b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study NPT: When applicable, details of whether and how the clustering by care provides or centers was addressed

7a-i) Describe whether and how expected attrition was taken into account when calculating the sample size
Describe whether and how expected attrition was taken into account when calculating the sample size.

Does your paper address subitem 7a-i?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "For the primary feasibility outcome, the success level was determined as the completion of both training sessions by 80% of participants within a 20-day period. Expecting this rate to be 80%, a sample of 30 participants was targeted to allow estimation with an accuracy of ± 14.3% and a confidence level of 95%".

7b) When applicable, explanation of any interim analyses and stopping guidelines
Does your paper address CONSORT subitem 7b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.
8a) Method used to generate the random allocation sequence NPT: When applicable, how care providers were allocated to each trial group https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Does your paper address CONSORT subitem 8a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.
8b) Type of randomisation; details of any restriction (such as blocking and block size) Does your paper address CONSORT subitem 8b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable. 9) Mechanism used to implement the random allocation sequence (such as sequentially numbered containers), describing any steps taken to conceal the sequence until interventions were assigned Does your paper address CONSORT subitem 9? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Not applicable.
10) Who generated the random allocation sequence, who enrolled participants, and who assigned participants to interventions Does your paper address CONSORT subitem 10? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "A convenience sample of nurses employed at the CCU was recruited by the first author of this study".
11a) If done, who was blinded after assignment to interventions (for example, participants, care providers, those assessing outcomes) and how NPT: Whether or not administering co-interventions were blinded to group assignment

11a-i) Specify who was blinded, and who wasn't
Specify who was blinded, and who wasn't. Usually, in web-based trials it is not possible to blind the participants [1, 3] (this should be clearly acknowledged), but it may be possible to blind outcome assessors, those doing data analysis or those administering co-interventions (if any).

2 3 4 5 subitem not at all important essential
Does your paper address subitem 11a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.
11a-ii) Discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator" Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator".

Does your paper address subitem 11a-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.

11b) If relevant, description of the similarity of interventions
(this item is usually not relevant for ehealth trials as it refers to similarity of a placebo or sham intervention to a active medication/intervention) Does your paper address CONSORT subitem 11b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Not applicable.
12a) Statistical methods used to compare groups for primary and secondary outcomes NPT: When applicable, details of whether and how the clustering by care providers or centers was addressed Does your paper address CONSORT subitem 12a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Changes in pre-and posttraining measures for perceived skill in brief MI and self-reported clinical use of brief MI were compared using Student's t test for paired samples, with a 2-sided significance level of 0.05. We also performed a Student's t test for paired samples with the same parameters for the 4 subdimension scores for pre-and posttraining conviction and confidence. All statistical tests were twosided and performed at a significance level of 0.05 using SPSS version 23.0. Basic assumptions, such as normal distribution, were verified prior to analyses".

12a-i) Imputation techniques to deal with attrition / missing values
Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4]).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 12a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Not applicable.

12b) Methods for additional analyses, such as subgroup analyses and adjusted analyses
Does your paper address CONSORT subitem 12b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.

X26-i) Comment on ethics committee approval
1 2 3 4 5 subitem not at all important essential

Does your paper address subitem X26-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "The pilot study was registered at Controlled Trials (#ISRCTN16510888) and approved by the Scientific and Ethics Committee of the Montreal Heart Institute Research Center (Reference number: 2015-1948)".

x26-ii) Outline informed consent procedures
Outline informed consent procedures e.g., if consent was obtained ofoine or online (how? Checkbox, etc.?), and what information was provided (see 4a-ii). See [6] for some items to be included in informed consent documents.

Does your paper address subitem X26-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Nurses were recruited via individual face-to-face encounters at the CCU. After receiving an explanation regarding the study and providing written consent, participants completed a paper-based sociodemographic questionnaire".

X26-iii) Safety and security procedures
Safety and security procedures, incl. privacy considerations, and any steps taken to reduce the likelihood or detection of harm (e.g., education and training, availability of a hotline) 1 2 3 4 5 subitem not at all important essential

Does your paper address subitem X26-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "An individual identification number, username, and password were then provided to participants, to allow them to log into the e-learning platform throughout the study". "We suggested that participants change their passwords after the initial login. Passwords could also be reset via their personal email accounts if forgotten".

RESULTS
13a) For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome NPT: The number of care providers or centers performing the intervention in each group and the number of patients treated by each care provider in each center Does your paper address CONSORT subitem 13a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.
13b) For each group, losses and exclusions after randomisation, together with reasons

Does your paper address CONSORT subitem 13b? (NOTE: Preferably, this is shown in a CONSORT ]ow diagram) *
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Not applicable.

13b-i) Attrition diagram
Strongly recommended: An attrition diagram (e.g., proportion of participants still logging in or using the intervention/comparator in each group plotted over time, similar to a survival curve) or other Ugures or tables demonstrating usage/dose/engagement. 1 2 3 4 5 subitem not at all important essential

Does your paper address subitem 13b-i?
Copy and paste relevant sections from the manuscript or cite the Ugure number if applicable (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, see study flowchart ( Figure 4).

14a) Dates deUning the periods of recruitment and followup
Does your paper address CONSORT subitem 14a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Enrollment and follow up occurred between March and May 2016 (see Table 1)". https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4lE…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full

14a-i) Indicate if critical "secular events" fell into the study period
Indicate if critical "secular events" fell into the study period, e.g., signiUcant changes in Internet resources available or "changes in computer hardware or Internet delivery resources" 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 14a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.
14b) Why the trial ended or was stopped (early) Does your paper address CONSORT subitem 14b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.

15) A table showing baseline demographic and clinical characteristics for each group
NPT: When applicable, a description of care providers (case volume, qualiUcation, expertise, etc.) and centers (volume) in each group Does your paper address CONSORT subitem 15? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Yes, see table 2.

15-i) Report demographics associated with digital divide issues
In ehealth trials it is particularly important to report demographics associated with digital divide issues, such as age, education, gender, social-economic status, computer/Internet/ehealth literacy of the participants, if known.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 15-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Most participants were women, and their mean age was 37 ± 9 years (see Table 2). The majority had completed university-level education and worked full-time as bedside nurses. The duration of participants' experience as a critical cardiovascular care nurses ranged from 1 month to 37 years, with a mean of 11 ± 10 years. Nurses were almost evenly distributed across all work shifts, with 5 working rotating shifts. More than three-quarters of participants had previously completed online training, but none had undertaken MI in the preceding year".
16) For each group, number of participants (denominator) included in each analysis and whether the analysis was by original assigned groups

16-i) Report multiple "denominators" and provide de/nitions
Report multiple "denominators" and provide deUnitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at speciUc pre-deUned time points of interest (in absolute and relative numbers per group). Always clearly deUne "use" of the intervention.
However, since this was a pilot study, there was not enough power for most results to be statistically significant in regard to skills and clinical use of brief MI.

17a-i) Presentation of process outcomes such as metrics of use and intensity of use
In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational deUnitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is deUned (e.g., timeout after idle time) [1] (report under item 6a).

Does your paper address subitem 17a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "The results showed that 25 and 22 participants completed S1 and S2, respectively, during a single connection. The mean durations of S1 and S2 were 31 ± 6 and 19 ± 6 min, respectively. The mean total training duration was 50 ± 11 min, which was consistent with the expected duration for MOTIV@COEUR. The mean period between the completion of S1 and S2 was 13.12 ± 6.67 days, which was close to the recommended time of 2 weeks.
Ten participants out of 31 (32%) completed the baseline measures and S1 without any reminder after the initial email providing instructions to access the web-based e-learning platform. This proportion was higher for the rest of the study; 14 out of 28 participants (50%) completed S2 without any reminder and 13 out of 28 participants (46%) did the same for the completion of outcome measures. Across the 3 timepoints, the first email reminder made to participants was the most effective, doubling the number of participants completing the requirements. The second and third reminders were less effective.
A total of 80 emails and phone reminders were sent throughout the study. More specifically, 44 email reminders, 16 telephone reminders and 20 voicemail reminders were made. Of these 3 types participant reminders, email reminders proved more effective. Twenty-seven out of 44 email reminders (61%) resulted in the completion of requirements at each timepoint (S1, S2, outcome measures). As for telephone and voicemail reminders; 9 out of 16 reminders (56%) and 9 out of 20 reminders (45%), respectively, were effective throughout the study".
17b) For binary outcomes, presentation of both absolute and relative effect sizes is recommended Does your paper address CONSORT subitem 17b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Not applicable.

19-ii) Include qualitative feedback from participants or observations from staff/researchers
Include qualitative feedback from participants or observations from staff/researchers, if available, on strengths and shortcomings of the application, especially if they point to unintended/unexpected effects or uses. This includes (if available) reasons for why people did or did not use the application as intended by the developers.

Does your paper address subitem 19-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.

22) Interpretation consistent with results, balancing beneUts and harms, and considering other relevant evidence
NPT: In addition, take into account the choice of the comparator, lack of or partial blinding, and unequal expertise of care providers or centers in each group

22-i) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use)
Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use). https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 22-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "This study involved the design, implementation, and evaluation of a web-based e-learning platform for brief MI including role-modeling videos for nurses in cardiovascular care. We demonstrated the feasibility, acceptability, and preliminary efficacy of the intervention. In addition, the posttraining preliminary results regarding perceived skill and clinical use of brief MI were all more favorable than at the pretraining assessment. Overall, the feedback received from participants was positive While some previous studies examined web-based MI training with healthcare practitioners [48][49][50][51], to our knowledge, this study was the first to assess an asynchronous web-based e-learning platform for brief MI by nurses in cardiovascular care. We were successful in recruiting 31 participants within 11 days among which 28 completed the study. This demonstrates cardiovascular care nurses' significant interest in webbased e-learning and interventions targeting health behavior change.
The large participation in the study may reflect the applicability and credibility of brief MI use in an acute care setting. Brief MI demonstrated in the videos of MOTIV@COEUR lasted 3 to 4 minutes. This amount of time is more likely to be feasible in clinical settings than longer motivational interventions [12][13][14].
The high acceptability scores in the present study suggested that the web-based e-learning platform for brief MI, based on MoodleTM, could be ready for a larger study. However, some participants asked for more details and interactivity measures, which could be included in a future iteration of the platform. The positive aspects of e-learning observed in this study, such as flexibility and control regarding the learning time and location, are consistent with the literature [22,25,26]. This may be possibly explained by the adaptive format of MOTIV@COEUR, which can be used anywhere via smartphones, tablets, and compute, although we did not collect this information in the present study. Moreover, participants appreciated the presentation of MOTIV@COEUR course materials in a multimedia format since all participants reported an acceptability score over 6 for this item at the posttraining assessment. This builds on existing literature concerning the feasibility and acceptability of illustrating complex clinical processes, such as brief MI, in video modules [18, 31, 51]".

22-ii) Highlight unanswered new questions, suggest future research
Highlight unanswered new questions, suggest future research.

Does your paper address subitem 22-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "Future research should focus on assessing a more tailored and interactive web-based e-learning platforms for brief MI, since it was not the case in the present study and scientific literature supports efficacy of such features [29]. Relative to the tailoring of the platform, researchers should develop an algorithm taking into account each participant's knowledge and specific needs. For instance, some participants asked for more content, as others were satisfied by what was provided in MOTIV@COEUR. By doing so, researchers could ensure every participant follows an individualized path that may further increase knowledge and clinical skills [25,29]. As for the interactivity measures in e-learning, their efficacy is supported by scientific literature [25,29]. A web-based e-learning platform for brief MI could benefit from the inclusion of self-assessment questions, interactive models and figures, and thought-stimulating activities [29]. These elements, when conjugated to videos, hold promising value for scientific, pedagogical and clinical purposes.
Future research should also focus on assessing the effects of webbased e-learning for brief MI on more objective results in clinical settings. Indeed, despite progress in recent years, evaluation of the effects of e-learning on real life clinical behavior and patient outcomes remains a challenge [55,60]. In regard to clinical behavior, researchers 20) Trial limitations, addressing sources of potential bias, imprecision, and, if relevant, multiplicity of analyses

20-i) Typical limitations in ehealth trials
Typical limitations in ehealth trials: Participants in ehealth trials are rarely blinded. Ehealth trials often look at a multiplicity of outcomes, increasing risk for a Type I error. Discuss biases due to non-use of the intervention/usability issues, biases through informed consent procedures, unexpected events. https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 20-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study measures of real clinical use of brief MI.
In addition, the single-group pre-post study design did not allow for comparison of results obtained using an alternative training method to evaluate a control group.
Most participants had experimented with online training prior to entering the study. This could provide a partial explanation as to why the webbased e-learning platform showed such high levels of acceptability. Conducting a study with a more diverse population of nurses and other healthcare practitioners could be interesting and allow researchers to determine whether sociodemographic variables increase acceptability scores and affect knowledge acquisition and clinical outcomes.
Not all participants enrolled in the study ultimately used MOTIV@COEUR for training in brief MI, as 3 individuals dropped out before beginning the training. However, the global participation rate in the study was superior to those was observed in similar studies. Indeed, 28 of the 31 participants (90%) used MOTIV@COEUR, and this proportion ranged from 82% to 89% in other studies [61-64]".

21) Generalisability (external validity, applicability) of the trial Undings
NPT: External validity of the trial Undings according to the intervention, comparators, patients, and care providers or centers involved in the trial

21-i) Generalizability to other populations
Generalizability to other populations: In particular, discuss generalizability to a general Internet population, outside of a RCT setting, and general patient population, including applicability of the study results for other organizations 1 2 3 4 5 subitem not at all important essential

Does your paper address subitem 21-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Yes, "While our study included cardiovascular nurses, it is possible that other healthcare practitioners could benefit from the training".

21-ii)
Discuss if there were elements in the RCT that would be different in a routine application https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full setting Discuss if there were elements in the RCT that would be different in a routine application setting (e.g., prompts/reminders, more human involvement, training sessions or other co-interventions) and what impact the omission of these elements could have on use, adoption, or outcomes if the intervention is applied outside of a RCT setting.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 21-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study Not applicable.

23) Registration number and name of trial registry
Does your paper address CONSORT subitem 23? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study

X27-i) State the relation of the study team towards the system being evaluated
In addition to the usual declaration of interests (Unancial or otherwise), also state the relation of the study team towards the system being evaluated, i.e., state if the authors/evaluators are distinct from or identical with the developers/sponsors of the intervention.

Does your paper address subitem X27-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brieoy explain why the item is not applicable/relevant for your study https://docs.google.com/forms/d/1KlxFl4iTrxRIWADX-jCukJwHv4l…?hl=en_US&formkey=dGlKd2Z2Q1lNSGQ0THl1azM5MS1aWWc6MA&rm=full Yes, "Conflicts of Interest MOTIV@COEUR is owned by the authors of this study".

About the CONSORT EHEALTH checklist
As a result of using this checklist, did you make changes in your manuscript? * yes, major changes yes, minor changes no What were the most important changes you made as a result of using this checklist?
Changes to the abstract to include more details on participant recruitment and intervention content.
How much time did you spend on going through the checklist INCLUDING making changes in your manuscript *

Approximately 2 hours.
As a result of using this checklist, do you think your manuscript has improved? * yes no Other:

Would you like to become involved in the CONSORT EHEALTH group?
This would involve for example becoming involved in participating in a workshop and writing an "Explanation and Elaboration" document yes no Other: