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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Sep 6, 2019
Open Peer Review Period: Sep 6, 2019 - Nov 1, 2019
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Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development

  • Roberto Rafael Cruz-Martínez; 
  • Jobke Wentzel; 
  • Rikke Aune Asbjørnsen; 
  • Peter Daniel Noort; 
  • Johan Magnus van Niekerk; 
  • Robbert Sanderman; 
  • Lisette van Gemert-Pijnen; 



Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the usage of different terms and concepts to explain the same phenomena and the lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A holistic view of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts.


This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to create a holistic understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods.


The metaethnography approach was used to review and synthesize researchers’ reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, ACM Digital Library, and the Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters.


Out of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) were identified to have informed these projects. Key ingredients (n=293) were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) key ingredients for behavior change; (7) key ingredients for technology adoption; (8) key health-related outcomes of an intervention.


The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modelling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and to supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches.


Please cite as:

Cruz-Martínez RR, Wentzel J, Asbjørnsen RA, Noort PD, van Niekerk JM, Sanderman R, van Gemert-Pijnen L

Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development

JMIR Preprints. 06/09/2019:16157

DOI: 10.2196/preprints.16157


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