4 Technology-enabled hybrid cardiac rehabilitation: qualitative study of healthcare professional and patient perspectives at three cardiac rehabilitation centres in England

<h3>Background</h3> Despite national guidance, current uptake of in-person, group-based cardiac rehabilitation (CR) is only 50% of those eligible, with variation by gender, locality, ethnicity and socioeconomic status. Hybrid CR, which combines in-person and remote service delivery, has potential to improve uptake and reduce inequalities in access. <h3>Aim</h3> To explore healthcare staff and patient experiences of using the Active⁺me REMOTE hybrid CR app across three NHS sites in the East of England. <h3>Methods</h3> Eight semi-structured interviews and two focus groups (n=10) were undertaken with twelve CR staff and six patients who had been offered hybrid CR. Topic guides explored participants’ barriers/facilitators and experiences of delivering/receiving hybrid CR, and implications for the future implementation of the Active⁺me REMOTE app. Interviews/focus groups were conducted remotely, audio-recorded and independently transcribed. Staff data were analysed deductively, using the Consolidated Framework for Implementation Research. Patient data were analysed inductively using Braun and Clarke’s thematic analysis approach. <h3>Results</h3> Despite some technical issues and governance delays, staff reported Active⁺me REMOTE allowed tailoring of support to meet patients’ needs and individual circumstances. Data upload from connected devices allowed staff to monitor patient progress and empowered patients to direct their own recovery. Staff initially screened patients to ensure hybrid CR was offered to digitally-literate, physically active individuals, although screening became less common as staff familiarity with the app increased. Staff expressed some concerns about workloads associated with offering both centre-based and app-based CR. Patients reported Active+me to be acceptable, convenient, and they valued the remote monitoring and ability to undertake CR around commitments; some identified need for more psychological support. <h3>Conclusion</h3> Effective implementation of hybrid CR requires system-level resources to facilitate governance approaches and embed hybrid CR as the standard care offer. Sufficient time must be allowed for staff training and to support staff to enrol patients to hybrid services.