Less Supervising, More Caring: Design Recommendations for Informal Caregivers’ Co-Participation in Cardiac Telerehabilitation

Cardiac rehabilitation (CR) is a critical intervention designed to restore physical, emotional, and social well-being in individuals recovering from cardiovascular disease (CVD). Technological advancements have made it possible for CR services to be delivered in the home of the patient, resulting in cardiac telerehabilitation (CTR). CTR holds transformative potential for cardiac patients' health management, yet the voices of informal caregivers (ICs) -- the silent pillars of support -- remain largely unheard by the designers of CTR systems. This study focuses on an underexplored yet significant subgroup: recreational athletes with CVD, whose identities are deeply tied to physical activity and who face unique challenges in balancing recovery with their active lifestyles. Understanding the potential role of athletes' ICs in CTR can be vital to their return to normality. Through interviews with 10 ICs of athletes with CVD and six evocative visual scenarios, this study reveals how co-participation in CTR systems can enhance dyadic coping and management by fostering mutual support and shared responsibility. However, this delicate balance is fraught with trade-offs, such as privacy intrusions, role misalignments, and the risk of transforming caregivers into supervisors. By addressing the complex dynamics between autonomy, collaboration, and emotional well-being, this research provides actionable design recommendations for user-centric CTR solutions. These recommendations advocate for transparent, context-aware systems that respect individuality while enabling co-participation, ultimately redefining caregiver involvement. This work advances social computing in healthcare, reshaping CTR into a platform for shared recovery, emotional resilience, and personalised care for patients and caregivers alike.