1 Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a remote area

<h3>Background</h3> Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. CR programs are offered inequitably and are available in less than 15% of the world’s remote areas. <h3>Aim</h3> This study was to design a CR program adapted to the contexts of remote areas, in order to improve the service offer for patients. <h3>Methods</h3> We used an iterative user-centered design approach to understand the user context and services offered in CR in remote areas. We conducted two co-design processes with two advisory committees created in two remote regions, composed of managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We used the guidelines of CR available at the time of the study (BACPR, 2017) to conceptualise data collection for the development of the CR program. We conducted four cycles of co-design with each of the committees. Qualitative data were analysed iteratively after each cycle. <h3>Results</h3> The co-design process led to the development of a prototype CR program that is similar in both regions, based on a six-phase care and service trajectory contextualized to remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes made it possible to decentralise CR expertise away from specialised centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients‘ needs. All the participants suggested that three follow-up offers could come from nursing services in order to increase access to the CR programme (primary care, home care, special programmes for chronic illnesses) in patients‘ home communities. <h3>Conclusion</h3> The co-design process enables us to meet the needs of remote areas in program development. This final program can be the subject of future implementation research.