Feasibility and acceptability of a person-centred co-designed women-focused web-based cardiac rehabilitation program

Women remain underrepresented in cardiac rehabilitation (CR), particularly those residing in rural and remote areas. Geographic isolation and the lack of gender-tailored programs are key barriers to participation. Home-based CR models incorporating telehealth and a gender-tailored approach have shown promise in overcoming these challenges.

To evaluate the feasibility and acceptability of a co-designed, women-focused, web-based CR (CR Web) program tailored for women in rural and remote communities.

This study was a mixed-methods, non-randomised feasibility study that employed a convergent design. The CR Web program was co-designed with 19 women who had completed CR, using a person-centred care and user experience (UX) design framework (Figure 1). The program included four modules: (1) Getting started - overview and user guide; (2) Tell Us about Your Health - self-reported health assessments; (3) My Cardiac Rehab - core CR education; and (4) Cardiac Rehab for Women - content addressing gender-specific needs. The program was mobile-responsive, secure, and integrated multimedia content to support self-management.

Women residing in rural and remote areas eligible for CR (November 2023-November 2024) were invited to enrol on CR Web via SMS and postcards. CR Web was offered either as a standalone resource or alongside traditional face-to-face or telephone-based CR (Figure 2). Program attendance, completion, and satisfaction were assessed through an online survey. Semi-structured interviews were conducted with enrolled women and clinicians to evaluate program acceptability and perceived value.

Forty women enrolled in CR Web (mean age 61.2 years, ±9.3). At three-month follow-up, six participants completed the evaluation survey; four reported program completion. Three used CR Web as a standalone, while others used it in combination with traditional CR. Five of six respondents (83%) indicated that the program supported CR initiation. Ten interviews were conducted (n=5 enrolled women, n=5 CR clinicians in rural areas). Among women, 66.7% (n=4) expressed satisfaction with the program. Among clinicians, four were nurses and one was an exercise physiologist; 80% (n=4) rated it as high quality. Both groups highlighted the potential of CR Web to enhance access to CR, particularly for women balancing work and caregiving responsibilities. Suggestions for improvement included integrating automated reminders and adding a shortcut icon on device screens for ease of access and engagement.

The CR Web program demonstrated good feasibility and acceptability among women and clinicians. This gender-tailored, digitally delivered model shows promise for reducing persistent disparities in access to centre-based CR. Next steps will be to assess clinical effectiveness, user engagement, and scalability in broader populations.