Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review

Background An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients’ perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians.

External Variables Participants were satisfied with the virtual format as it was accessible, convenient negated the need for travel and provided easy access to key healthcare professionals. Lack of time, infrequent access to the Internet or computer, lack of motivation, and poor computer literacy influenced levels of engagement. Challenges related to the use of the computer were largely isolated to the initial set up and were resolved with greater familiarity or direct support. Ongoing surveillance from healthcare providers, as well as support for selfmanagement activities, helped participants to adhere to their recommended program.

Usability
Feedback from interviews reported that the uploading of HR data onto the VCRP website was easy to perform Utility Participants reported greater awareness and motivation to manage their health condition and maintain a healthy diet, undertake regular exercise with suitable intensity, and to monitor their health condition appropriately. Participants reported that they felt more accountable for their progress and confident in their recovery.

Devi et al. (2015)
External Variable Participants valued convenience of the programme as there was no time or location restrictions; tailored information; communication with a healthcare professional during the program; and goal setting with an online exercise diary increased motivation. Participants reported barriers were perceived lack of time due their family responsibilities and employment; timing of programme introduction too late after diagnosis and in the winter made it difficult to exercise outdoors; preconceptions about the programme being designed and more suitable for a younger age group. Participants reported that self-motivation, seriousness and honesty were required as the programme was carried out independently Usability NR Utility Participants reported feeling more confident and encouraged to try different ways to engage in physical activity and reported decreased anxiety and improved psychological well-being. Participants felt empowered and more in control and better able to manage their stress and symptoms.

Ding et al. (2021) External Variables NR
This is a Multimedia Appendix to a full manuscript published in the J Med Internet Res. For full copyright and citation information see https://www.jmir.org/2022/1/e34657 Usability System Usability Scale (SUS) median score was 82.5 (IQR 65.0, 90.0); 82% of participants agreed that the system was easy to use and that people can learn to use quickly, 71% agreed that the functions were well integrated; 71% disagreed that the system use required technical support and 81% disagreed that a lot of learning was required prior to use; 13% found the system unnecessarily complexed.
Utility 82% of participants (n = 14) reported that the system motivated them to be physically active and helped them to achieve physical activity recommendations; 35% (n = 6) agreed that they walked and exercised more than they previously had Participants who agreed/strongly agreed that: SMART-CR/SP was helpful to me 100% (n = 125); Eat more healthily after receiving SMART-CR/SP 98% (n = 122); Increased physical activity frequency and intensity 96% (n = 100); Increased medication adherence 98% (n = 123); Reduced outpatient clinic visits 78% (n = 98) Acceptability NR

Usability NR
Utility NR Acceptability 59.3% (n = 89) reported willingness to participate in HBCTR

Harzand et al. (2018)
External Variables NR Usability Participants reported that the platform was "not hard to use" and "at times fun"